Screen-detected health conditions among students in grade 1–9: findings from Timor-Leste’s first nationwide school-based screening program

Abstract

Systematic health data on school-aged children in Timor-Leste have been lacking. The School-Based Primary Health Care Package screened students in Grade 1–9 nationwide in 2025. We describe the conditions detected and assess how far the estimates reflect variation between screeners. Programmatic cross-sectional screening analysis of school-level records for 1,387 basic-education schools. Each community health center fielded at least one team consisting of one doctor and two nurses; the doctor performed physical examinations and substance-use assessments and nurses conducted anthropometry, vision and hearing assessments. Findings came from clinical examination or threshold-based tests, none confirmed by a reference standard, and are reported as screen-detected prevalence using assessment-specific denominator. Intracluster correlations and design effects were estimated directly and used for design-based confidence intervals. Inter-screener reliability was assessed by variance-components analysis across the 72 teams, benchmarked against nutritional status, the least judgement-dependent domain. Two hundred sixty-two thousand, four hundred thirty-four students were screened across 1,371 of 1,387 schools. Screen-detected dental caries affected 78,643 students (30.0%; design-based 95% CI 29.0–31.0), low BMI-for-age 53,565 (20.5%) and poor oral hygiene 44,508 (17.0%). Within-school clustering was strong, and municipal effect sizes were negligible after design correction (Cramér’s V 0.012–0.028). Between-team variation was concentrated in the dental assessments, performed by the doctors: these showed a mean team effect 3.51 times the instrument-measured benchmark, versus 0.67 for the doctor’s seven non-dental assessments (Mann-Whitney p = 0.012). Screen-detected caries ranged from 3.7% to 67.9% across 72 teams, and the screening team explained 43% of referral variance versus 13% for municipality. Dental caries and low BMI-for-age were the most frequently screen-detected problems. For the dental assessments the screening team accounted for more of the variation than the municipality, and this variation was specific to the dental tasks rather than to the examiners, who were consistent on assessments within their training. Screen-detected caries should be regarded as a lower bound and its municipal pattern not interpreted. Priorities are to calibrate the screening instrument, estimate caries prevalence through a pathfinder survey, and strengthen both preventive and restorative services.