Rashtriya Bal Swasthya Karyakram Research Articles

IJCM_26A: Validation of Rashtriya Bal Swasthya Karyakram (RBSK) screening tool in Screening of Developmental Delay (DD) among under 3-year children in Bengaluru.

Background: Most DD tools available are designed in western countries which are lengthy, time consuming and need expertise to administer. RBSK has a simple tool to screen children aged 0-6 for developmental delays and disabilities. However, the psychometric properties are not published in public domain to understand its validity Objective: To study psychometric properties of RBSK screening tool for Screening of Developmental Delay among under 3 year children in Bengaluru. Methodology: A cross-sectional study was conducted among 262 children were screened in area covering five PHCs in Bengaluru. The children, categorized into eight strata based on age and underwent evaluation for developmental delay using both by the RBSK screening tool and the Ages and Stages questionnaire (ASQ) which is considered as gold standard. sensitivity, specificity, positive and negative predictive value along with kappa statistics was calculated readings of both the study tools. Results: The study encompassed a near-equal proportion of male (145,55.3%) and female (117,44.7%) children. Notably, the RBSK screening tool detected developmental delays in 13% of cases, slightly higher than the 10.7% identified by the ASQ tool. The RBSK tool exhibited a sensitivity of 97.01%, specificity of 96.43%, positive predictive value of 99.56% and negative predictive value of 79.41%. The calculated Kappa value of 0.854 signifies substantial agreement with the gold standard ASQ tool, reaffirming the RBSK tool’s validity in identifying developmental delays. Good psychometric properties was observed across gross motor, fine motor, communication, psychosocial and problem solving domains. Conclusion: This study demonstrates good psychometric properties of the RBSK screening tool in terms of sensitivity, specificity, and positive predictive value. Its user-friendly administration enables screening a larger population, effectively identifying more children with developmental delays, thereby facilitating early interventions crucial for their well-being

Role of Mobile Health Team in Implementation of Rashtriya Bal Swasthya Karyakram: A Study of Shimla District of Himachal Pradesh

The Rashtriya Bal Swasthya Karyakram, launched by the Government of India, endeavors to ensure holistic healthcare for children up to the age of 18 years. Given the diverse and often challenging geographical terrain of Shimla District, the deployment of mobile health teams becomes imperative in reaching remote and underserved areas. This research paper investigates the pivotal role played by mobile health teams in the successful implementation of the Rashtriya Bal Swasthya Karyakram (a National Child Health Program) in the context of Shimla District of Himachal Pradesh. The overarching objective of this study is to provide a nuanced understanding of how mobile health teams contribute to the success of this vital public health initiative, specifically tailored to address the health needs of children and adolescents. The research employs a qualitative approach, utilizing interviews, surveys, and observational data to assess the role of these teams on the children health outcomes in the region. The study places particular emphasis on preventive and promotive healthcare measures implemented by these mobile health teams. By focusing on early detection of health issues and timely interventions, the research aims to assess the overall improvement in health outcomes among the targeted demographic. The findings of this research are expected to contribute significantly to the existing body of knowledge on public health interventions, specifically within the realm of child health. The nuanced understanding of the operational dynamics of mobile health teams in Shimla District can serve as a blueprint for refining similar initiatives in diverse geographic and demographic settings. Moreover, the insights garnered from this study may inform policy decisions aimed at enhancing the efficiency and impact of mobile health teams in the broader landscape of public health programs.

Public-Private Partnership for Treatment of Congenital Heart Diseases: Experiences From an Indian State.

Background: Treatment of congenital heart disease (CHD), being the most common congenital anomaly, puts immense financial burden in low- and middle-income countries (LMICs) and contributes significantly to infant mortality. We report experiences of treatment of CHD in the Indian state of West Bengal by a public-private partnership (PPP) model. Methods: Under the Rashtriya Bal Swasthya Karyakram, the government of the state of West Bengal in India launched a program called the "Sishu Sathi Scheme" to provide free treatment to children who need heart surgeries, irrespective of economic status. Treatment was provided in selected private hospitals and some public hospitals in a reimbursement model where government compensated the hospitals. Data were collected on such procedures from 2013 to 2022 and analyzed. Results: A total of 27,844 patients with CHD received treatment under the Sishu Sathi Scheme from August 2013 to December 2022. The average number of patients per year was 3,093. Detailed data of procedures from January 2016 to December 2022 showed a total of 22,572 procedures (6,249 device interventions, 4,840 cardiac catheterizations, and 11,483 surgical interventions). The in-hospital mortality of surgical procedures and catheterization lab procedures were 5.2% and 0.9%, respectively. Conclusions: A large number of patients with CHD were successfully treated under a PPP in the state of West Bengal in India. In spite of its inherent challenges, this model is of special relevance in LMICs where access and affordability for treatment of CHD always remain a challenge.

A Cross-sectional Study on Awareness and Utilisation of Government Health Insurance Schemes among Patients at a Tertiary Level Hospital in Kolkata, India

Introduction: Despite the presence of multiple Government Health Insurance (GHI) schemes in West Bengal, the National Family Health Survey report (NFHS-5) has indicated that only 29.3% of households are covered by a health scheme. Awareness of health insurance schemes increases their utilisation. The absence of health insurance coverage results in increased out-of-pocket health expenditures, pushing families into debt. Therefore, there is a need to determine whether this lack of awareness among patients contributes to the issue. Aim: To estimate the awareness level, enrollment in GHI schemes, experiences of their utilisation, and to determine the contributory factors of awareness and enrollment among patients attending the Outdoor Patient Departments (OPDs) at a tertiary care hospital in Kolkata. Materials and Methods: An observational cross-sectional study was conducted from April 2023 to June 2023 at Medical College, Kolkata, West Bengal, India. A total of 390 respondents were chosen using a systematic random sampling technique and were interviewed using a predesigned, pretested, and semistructured questionnaire. Data were analysed using R Studio version 4.3.0. A p-value <0.05 was considered statistically significant. Results: Awareness about Swasthya Sathi was found to be present in 318 (81.54%) patients, but only 109 (34.28%) of them were enrolled. Awareness of Sishu Saathi and Rashtriya Bal Swasthya Karyakram (RBSK) was 12 (3.08%) and 10 (2.57%), respectively, and none were enrolled. The major source of information (11.03%) regarding health insurance among respondents was informal sources such as friends, relatives, and neighbours. The age of the respondents, type of family, occupation, and economic status were found to have a significant association with the right awareness (p=0.008, 0.012, 0.0005, and 0.029, respectively). The patient satisfaction level after utilising Swasthya Sathi was found to have a significant positive correlation with the right awareness (Spearman’s ρ=0.322, p-value <0.01). The determinants of enrollment in Swasthya Sathi were female gender, rural residence, and right awareness (p<0.001). The commonest reason for not enrolling in any GHI among the non subscribers was a lack of awareness (82.56%). Conclusion: Correct awareness was found to be a determinant of enrollment in GHI. In order to bridge the gap between awareness and utilisation of GHI, there is a need to focus on Information, Education, and Communication (IEC) activities involving mass media and frontline health workers.

Validation of a developmental screening tool from a national health program in India for screening speech-language disorders among children

Background Rashtriya Bal Swasthya Karyakram (RBSK) is a Government of India initiative that aims to develop a structured approach toward child health screening and early intervention. Objectives The current study aimed to validate the RBSK developmental screening tool incorporated within a mobile-based application for screening of speech and language delays/disorders among children below 6 years of age Methods A total of 235 caregiver-child dyads including 96 children aged below 2;6 years; months and 139 children between 2;6 and 6;0 years participated in the study. Children underwent developmental screening by a Speech Language Pathologist (SLP) using the RBSK screening tool and specific speech-language screening using the Language Evaluation Scale Trivandrum (LEST) followed by detailed evaluation by another SLP, blinded to the results of the screening. Each item in the RBSK and LEST screening tools was rated as ‘yes’ or ‘no’ by observing the child’s performance. Results and conclusion Detailed assessment by the SLP identified 133 children with typical speech and language development and 102 children with speech and language disorders. The sensitivity and specificity (95% CI) of the RBSK screening tool against both detailed assessment by SLP and LEST screening with one-item criteria were similar at 100% (87.23-100) and 97.1% (89.82-99.65) respectively in the younger group and 97.33% (90.70-99.68) and 92.19% (82.70-97.41) respectively in the older age group. The RBSK screening tool implemented via an mhealth application by SLPs demonstrated adequate psychometric properties for screening speech-language disorders among children less than six years of age.

Impact of training on awareness and Knowledge of Birth Defects among Community Health Workers in tribal district of Maharashtra, India

AbstractObjectiveEarly identification, referrals and timely treatment is crucial to improve the outcome of Birth Defects (BDs). The role of Community Health Workers (CHWs) in India is largely fulfilled by Accredited Social Health Activists (ASHAs) who can play an important role in community‐based reporting and referrals of BDs in newborn. In the study area, ASHAs have been previously trained for identification of BDs under Rashtriya Bal Swasthya Karyakram (RBSK); however, reporting through them was found to be sub‐optimal.MethodsTo strengthen the community based reporting of BDs through ASHAs, audio visual based training was provided to 1225 ASHAs in 6 tribal blocks of Palghar district in Maharashtra, India. The change in knowledge about BDs before and after training among 1023 participants was analyzed using paired sample t test & McNemar test.ResultsFindings reveal a significant increase in the knowledge of participants with regards to prevention, risk factors and identification of BDs after intervention as compared to before intervention.DiscussionThe study suggests that audio‐visual based refresher training increased knowledge of ASHAs with respect to identification, prevention and risk factors of BDs which may eventually improve reporting and referrals of BDs at community level.

Newborn Screening for Developmental Dysplasia of Hip—A Survey for Knowledge and Skills Among Physicians in Delhi-NCR Region, India

Introduction Developmental dysplasia of hip (DDH) is a developmental disorder leading to life-long disability in child unless diagnosed early and treated well in time. This condition is also included under the screening and early intervention services provided by “Rashtriya Bal Swasthya Karyakram” of National Health Mission in India. The present study was done to assess knowledge, perceptions, and self-confidence of pediatricians/neonatologists, obstetricians, primary care physicians (PCPs), and the orthopedic surgeons regarding the newborn screening for DDH. Materials and Methods This cross-sectional study used a prestructured validated online questionnaire in English language. Total 158 physicians, practicing in various private and government, teaching, and nonteaching institutions from Delhi-NCR region (54 pediatrician/neonatologists, 60 PCPs, 30 orthopedic surgeons, and 14 obstetricians), responded to the survey. Questions related to biodemographic details, specialty, professional experience, knowledge about the risk factors of DDH, appropriate timing(s) for screening DDH and the modalities used, and natural course of untreated severe and mild DDH were asked. Participants were required to self-assign a grade (score 0-10) for both knowledge and clinical examination skills with reference to screening of DDH. Data was analyzed using SPSS (version 23.0) software. P value <0.05 was considered significant. Results Only 18% pediatricians, 27% PCPs, 20% orthopedic surgeons, and none of the obstetrician could identify all risk factors for DDH ( P = 0.159). Only 24% physicians knew that the natural evolution of untreated severe DDH is bad with need for multiple surgeries throughout life and only 17% knew that the most common natural evolution of untreated mild hip dysplasia at birth is good with minimal functional sequelae without the need for surgery. Only 56% pediatricians mentioned correctly that the first screening for DDH needs to be done at birth before discharge from the hospital. Orthopedic surgeons, obstetricians, and PCPs were comparable to pediatricians in this knowledge ( P ≥ 0.05). Only 52% pediatricians were aware of both Barlow and Ortolani clinical maneuvers and 18% did not know about any of these tests. Among orthopedic surgeons, 60% knew about both these tests and among obstetricians, only 14% knew about both these tests. Self-assigned score for both knowledge and clinical examination skills were unsatisfactory in all groups, the range of median score being 5 to 7 and 2 to 6, respectively. Clinical examination skills scores were significantly lower among obstetricians than the other groups ( P = 0.001; Kruskal-Wallis test). Clinical examination skills scores were significantly lower than the knowledge scores among PCPs, orthopedic surgeons, and obstetricians ( P = 0.001, 0.026, and 0.005, respectively; Wilcoxon Signed-Rank test). Conclusion Knowledge was unsatisfactory among all physicians, regardless of their specialty. Self-assigned scores for clinical examination skills, which is a surrogate of self-confidence and likely to affect the practices, were also unsatisfactory among all physicians, regardless of their specialty. The findings of this study indicate an immediate need of attention for continuing education and handholding of all stakeholders who are directly responsible for screening and early diagnosis of DDH at birth and early infancy. Such a pertinent issue should be incorporated as a core knowledge as well as skill competencies in both undergraduate and postgraduate medical education curriculum.

Expansion of India’s national child healthcare programme, Rashtriya Bal Swasthya Karyakram (RBSK), for rare disease management : a health policy perspective

Rare diseases (RD) are severe and debilitating conditions. They are one of the leading causes of childhood mortality globally. In India, RDs have not been considered in most healthcare programs which usually cater to more common diseases. We believe, that for efficient utilization of resources in a resource-constrained healthcare system, existing programs must integrate RD management strategies. In this study, we explore the utility, expandability, and limitation of one of the important national child healthcare programs, Rashtriya Bal Swasthya Karyakram (RBSK) which translates to National Child Healthcare Program. We found that RBSK has immense potential to cater to RDs through some of its unique features, such as comprehensive screening, wide target age group, and efficient utilization of resources. We provide recommendations that can help to strengthen the present program. This study will inspire other low-resource countries to identify and expand existing public healthcare programs for RD management. Moreover, RBSK can serve as a model program to integrate RD management globally.

A qualitative study regarding perception and challenges faced by providers and beneficiaries of Rashtriya Bal Swasthya Karyakram in general and also amid the COVID-19 pandemic at an urban health center from Ahmedabad City

Background: During COVID-19 pandemic, service providers and beneficiaries of Rashtriya Bal Swasthya Karyakram (RBSK) faced certain challenges. Objectives: The objective was to assess the perception and challenges faced by service providers and beneficiaries in general and amid the pandemic for availing the services at an urban health center in Ahmedabad. Methodology: Data of registered cases under RBSK at Urban Health Center (UHC) Ognaj in 2018–2019 and 2019–2020 were compared. In depth interviews (IDIs) of Medical Officer RBSK were done. Home visits were done to document the perception and challenges of beneficiaries through semi/unstructured questionnaire. Results: Considering the cases of 2018–2019 as base, registered cases decreased by 22.8% in 2019–2020 and 92.4% in 2020–2021. The pandemic affected 15.6% of beneficiaries in availing the services. Program was affected due to: (1) less workforce (vacant pharmacist post), (2) target-based approach, and (3) birth defects, deficiency disorders, chronic diseases, and development delays, especially deficiency not perceived a serious health issue by beneficiaries. Corona-specific reasons included: (1) staff deployment in COVID-19 activities, (2) reluctance/fear in visiting District Early Intervention Center (DEIC)/health facility, (3) reduced screening due to the closure of schools/Anganwadi Kendras, and (4) enforced lockdown. Conclusions: RBSK mobile health teams found it difficult to reach all 4Ds, more so for follow-up. RBSK was badly affected due to the engagement of providers in COVID-19 work, the closure of facilities, perception of beneficiaries that 4Ds are not of urgent medical concern, prevailing myths. A clear strategy is required to address such problems when the same or a similar type of pandemic strikes us in future.

MORBIDITY PATTERN AMONG SCHOOL CHILDREN IN A TRIBAL DISTRICT OF MAHARASHTRA: A DESCRIPTIVE STUDY BASED ON SECONDARY DATA.

Background: India harbours one of the largest tribal populations in the world. Ashram schools are established in tribal districts, which are meant to uplift the education of tribal children. Rashtriya Bal Swasthya Karyakram (RBSK) was launched in 2013 to provide targeted and comprehensive health care to children aged 0 –18 years. This study targets to nd morbidity patterns among them with the help of data collected by RBSK and to give suitable recommendations based on the ndings This secondary Methodology: data-based observational descriptive study was carried out in two blocks of the Palghar district of Maharashtra State. After obtaining ethical approval and necessary permissions, health-related data of all Ashram School children collected by the RBSK team from November 2021 to October 2022 was retrieved and stored in electronic format. The proportion of different health problems was calculated. Rashtriya Bal Results: Swasthya Karyakram (RBSK) team screened 21,818 school children (49.4% boys and 50.6% girls) of the age group of 10-18 years from different Ashram schools for one year (November 2021 to October 2022). The team referred a total of 2016 students to higher medical facilities. Amongst the total screened 26.56% with 24 diseases as per the RBSK report. Additionally, 87% of students had 'Disease or Disorder', 5.8% had 'Deciencies', 4.5% had any kind of 'Defect' and 2.7% had any kind of 'Developmental delay'. The majority of the students were affected by respiratory airway diseases (44.5%), menstrual problems (16.1%) and skin conditions (11.1%). Study Conclusion: ing morbidity patterns under 4Ds approach enables intervention at an early stage of diseases. Capacity building of RBSK program and digitalised standard reporting system and integration of school health with other National Health Programmes may contribute to improving children's health.

Knowledge and Attitude Regarding Rastriya Bal Swasthya Karykarm among Aganwadi Workers

Rashtriya Bal Swasthya Karyakram (RBSK) is a new initiative aiming at early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases, Development delays including disability. It is important to note that the 0 - 6 years age group will be specifically managed at District Early Intervention Center ( DEIC ) level while for 6 -18 years age group, management of conditions will be done through existing public health facilities. DEIC will act as referral linkages for both the age groups. The finding shows the pre-test knowledge score of Anganwadi workers regarding on Rastriya Bal Swathya Karykarm. The level of knowledge on Rastriya Bal Swathya Karykarm is divided under the following heading inadequate, moderate adequate and adequate. Maximum samples is 66 %( 20) had inadequate score and 4% (1) had adequate score and 30 %( 09) was moderate adequate. Overall mean score of the data was 16.14, and SD 2.07, shows that the data is scattered around the mean value.

Maternal determinants for 4 Ds in children registered under Rashtriya Bal Swasthya Karyakram program at an urban health centre of Ahmedabad

Background: Maternal determinants influence the outcome of pregnancy and child’s health in early years. Rashtriya Bal Swasthya Karyakram (RBSK) deals with the 4 D (birth defects, chronic diseases, deficiency disorders and developmental delays) among children (from birth till 18th years). Objectives were to determine and document the association between maternal determinants especially antenatal care (ANC) and 4 Ds and suggest preventive measures. Methods: Out of 302 children with 4 D’s registered during April 2018-March 2020, 102 children were selected using probability proportionate to sample size (PPS) sampling for each category of 4D. Information of socio demographic details and maternal determinants was gathered on a semi structured questionnaire by interviewing mothers/caretaker. Results: Relevant information could be gathered from 96 mothers. Mean maternal age was 26.4±4.1 years. Congenital defects were significantly associated with higher maternal age (p<0.0001). Out of 102 cases under study, minimum recommended 4 ANC visits were not taken by 17 (17.7%) mothers. Also, 13 (13.5%) did not take IFA supplementation. Poor health status during pregnancy, was significantly associated for deficiency disorders of child in later life (p<0.04). Conclusions: Maternal age at pregnancy, health status of mother, ANC care (number of ANC visits, IFA supplementation), health seeking behaviour, birth weight and birth order of child were major determinants of 4Ds.

Methodology for the early identification of neurodevelopmental disorders in the primary and preschool children in rural India by applying intervention module developed for teachers.

Neurodevelopmental disorders NDD are neurologic processing problems that interfere with learning in children. Primary and preschool teachers who are essential links in public health reach out to such children do not receive any formal training to identify these disorders. Hence, a primary and preschool level intervention addressing the issue is proposed. Primary and preschool teachers of government and government-aided schools and Anganwadi/preschools in the Model Rural Health Research Unit Tirunelveli field practice area will be assigned into two groups. The training module will be developed and validated using neurodevelopmental screening tool (NDST). Before identifying the students using the NDST, the teachers in Group A will get training using the module. Group B is the control group, in which untrained teachers administer the NDST to the children and then will be trained. Neurologists will assess the same children over 1 year. The effectiveness of teacher training for the early detection of children with NDD will be assessed. Thus, the validity of the screening for NDD by the teachers will be estimated. If successful, the module can be incorporated into the Rashtriya Bal Swasthya Karyakram program of India for the early identification of children with NDD.

ASSESSMENT OF AVAILABLE RESOURCES, CHALLENGES OF DISTRICT EARLY INTERVENTION CENTRE UNDER RASHTRIYA BAL SWASTHYA KARYAKRAM AT DISTRICT JODHPUR: A CROSS SECTIONAL STUDY

Background: The Government of India launched the child health screening and early Intervention programme called Rashtriya Bal Swasthya Karyakram in 2014 to screen children from 0 to 18 years for the early detection of 4 Ds (Defects, Diseases, Deficiency, and Developmental Delays including disabilities). Under this program, district early intervention centres (DEICs) are set up as nodal centres at the district level to manage the cases of 4Ds. Objectives: To assess the available resources, challenges of District Early Intervention Centre under Rashtriya Bal Swasthya Karyakram at District Jodhpur. Methodology:A cross sectional study was conducted in the month of April. Jodhpur district was selected by purposive sampling.Data regarding the available resources was collected by using observational checklist and the information regarding the challenges was collected by semi structured questionnaire through face-to-face interview with the DEIC manager. Results: The resultsreveal that DEIC of district Jodhpur is deficient in terms of staff, equipment and physical space. The challenges identified were resistance in caretakers regarding treatment and less staff and physical space available for DEIC. Conclusion: Overallthe researcher identified that there was a deficiency of staff, furniture and medical equipment and tools at DEIC and the main challenges were community resistance, less staff and physical space. There is a need to be filled up vacant post and provide needed infrastructural facilities. separately so that RBSK program in DEIC can run smoothly and effectively.Education and sensitization of community with reinforcement could help to overcome the resistance in community.

Insights of Rashtriya Bal Swasthya Karyakram: a strength, weaknesses, opportunities, and threats analysis

Over 400 million children between 0 and 18 live in India, making it the world's largest country for children. Out of every 100 newborns, 6 to 7 are estimated to have birth abnormalities and a significant fraction of children experience nutritional inadequacies and developmental impairments. Rashtriya Bal Swasthya Karyakram (RBSK), a programme created to enhance the health of children from birth to 18 years of age through early identification, prevention, and management of 30 health conditions under the 4Ds, was introduced in 2013 by the ministry of health and family welfare to mitigate these downsides. This review study aims to gain insight into the RBSK program using the strength, weaknesses, opportunities, and threats (SWOT) analysis. All articles regarding the programme had been systematically searched using published scholarly databases, PubMed, and search engines like google as well as within the grey literature. All considerations were then organized thematically into risks and potential chances to improve its effectiveness, as well as strengths and weaknesses that address the survival outcome of the RBSK scheme. As a result, the dearth of service providers, a certain lack of diagnostic resources, and technological development are the downsides, while probable threats include ignorance and abandoning treatment. To enhance the quality of life for children, it is also crucial to encourage early identification and care, which reduces the risk of delayed diagnosis. To fix the weaknesses, avoid threats, and take advantage of all future opportunities to overcome the addressed issues, RBSK needs to be upgraded.

A Retrospective cohort study on Utilization of RashtriyaBalSwasthyaKaryakram (RBSK) Services among children screened at an Urban Health Centre (UHC) of Ahmedabad Municipal Corporation (AMC)

Introduction: Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. Objectives: (1) Document utilization of RBSK services within a year of referral, (2) Assess reasons for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Method: Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) taking two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Results: Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; major reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. Conclusion: After referral by RBSK team, only half utilized the services. Among users, OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.

Integration of national tuberculosis elimination programme with child and adolescent health: India on track of end tuberculosis strategy

As per the global tuberculosis (TB) report 2020, 56% adult males, 32% adult females and 12% children worldwide, have TB. In India, an estimated 3.33 lakh children in the 0-14 years age group become ill with TB each year (28% of global childhood TB burden), with a slightly higher burden among males. In 2019, the national tuberculosis elimination programme (NTEP) reported 1.5 lakh TB cases of children aged 0-14 years, indicating a gap of 55% in TB notifications in this age group.1 In order to address the gaps in pediatric TB coverage, the NTEP collaborated with child health and adolescent health programmes of the ministry of health and family welfare (MoHFW). The two primary health programmes that serve children and adolescents across the country are Rashtriya Bal Swasthya Karyakram (RBSK) and Rashtriya Kishor Swasthya Karyakram (RKSK), respectively. This integration will bring the country forward towards the efforts of its goal to achieve the target of end TB strategy.

Accelerating Actions Against Malnutrition: A Call for Strengthening the Capacity of Health and Nutrition Program Staff in Devbhumi Dwarka, Gujarat.

BackgroundThe Integrated Child Development Services (ICDS), a flagship program of the Government of India, is addressing the malnutrition, health, and development needs of young children, pregnant and lactating women, and adolescent girls for more than four decades. Although the program has been implemented for the past four decades, it could not bring the expected outcomes in terms of reducing malnutrition. The program's limited success can be attributed, among others, to insufficient skills of the program staff and inadequate convergence with the existing nutrition programs implemented through the health department. For the success of any program, advanced knowledge, improved skills, motivation, and the right attitude of the program staff are essential and can be instilled through the need-based training of the staff. The present study aimed at identifying gaps in existing training for health and ICDS program staff in the district and developing a capacity-building strategy to strengthen the implementation of the nutrition program in the district, including "Project Tushti," which aimed at combating malnutrition in Devbhumi Dwarka district of the Gujarat state.MethodsThe training needs assessment (TNA) was conducted using a descriptive cross-sectional study design. TNA is a method to determine program gaps and training required to fill in programmatic gaps. Appropriate use of TNA can promote designing effective training and nurture program staff productivity, thereby ensuring efficient use of resources for achieving desired program outcomes within the prescribed timeline. Considering the coronavirus disease 2019 (COVID-19)-led lockdown, convenient sampling was used to reach out to potential study participants. A total of 150 program staff from both health departments (particularly medical officers, taluka health officer, National Adolescent Health Program - Rashtriya Bal Swasthya Karyakram (RBSK) medical officer, community health officer from health and wellness center, female health workers, and Accredited Social Health Activists (ASHAs)) and ICDS team (chief district program officer, supervisor, Anganwadi workers, and helpers at Anganwadi center) were interviewed telephonically using a semi-structured interview guide. Interviews were conducted between May 10 and 16, 2020.ResultsResults reveal that about 49% of the health team and ICDS staff had not received nutrition-specific training in the last year. In terms of coverage, the training coverage was partial, and training content on nutrition was limited. Training contents were divided based on supervisory and implementing cadre feedback. Participants expressed the need for in-depth nutritional refresher training, including topics such as community-based management of acute malnutrition, identification of malnutrition, use of ICDS common application software, and soft skills such as communication skills and supportive supervision. Although 62% of participants preferred the face-to-face medium of training, they agreed with the online mode of training.ConclusionFindings indicate an urgent need for training, particularly in the district's nutrition domain for the staff involved in the implementation, and soft skills for supervisory level staff. Innovative training approaches using the digital platform can be explored for training delivery. The paper discusses innovative capacity-building strategies to address training needs effectively.

Bal Poshan Yojana: A Novel Approach to Facility-Based Severe Acute Malnutrition Management.

IntroductionSevere acute malnutrition (SAM) carries severe implications for a child’s development. The survival of a child suffering from severely acute malnourishment is majorly dependent on the management of SAM, and scaling up the framework for addressing malnutrition is one of its main components. A severely malnourished child has a higher risk of mortality as compared to an ideally nourished child. Bal Poshan Yojana under the aegis of Project Tushti, a public-private partnership (PPP) model, aims at strengthening the framework of treatment for SAM children by working towards building a sustainable eco-system through engaging the government body, private practitioners and implementing bodies.MethodsBal Poshan Yojana is a novel approach implemented for the first time in the Devbhumi Dwarka district of Gujarat for the management of SAM under a PPP model. The private practitioners and centres were empanelled and trained on the treatment of SAM. SAM children with medical complications were screened through anthropometric measurements and appetite tests carried out by Rashtriya Bal Swasthya Karyakram (or RBSK, a program for child health) medical team. High-risk cases were referred to the nearest empanelled Bal Poshan Centre in the area. Children were treated for 14 days at the Bal Poshan Centre as per the protocol of the National Rehabilitation Centre and then discharged if the children fulfilled the criteria. The treatment included a 14-day treatment protocol and three follow-ups in an interval of 15 days each. The data was analyzed with appropriate statistical tests.ResultsSince its inception, a total of 102 severely malnourished children under five years of age have completed their treatment successfully, including three follow-ups. Around 60.79% of SAM children have been found to become normal in their nutritional status. The mean weight gain upon discharge was 0.57 kg and after three follow-ups, it was 1.051 kg.ConclusionBal Poshan Yojana is a one of its kind initiative to tackle the growing burden of malnutrition among under-five age group children. The initiative has a focused approach. Strong referral and verification mechanisms ensure complete transparency and yielding of desired results.

Profile, Quality of Life and the Client Satisfaction of Beneficiaries Registered under Rashtriya Bal Swasthya Karyakram (RBSK) at an Urban Primary Health Centre, Ahmedabad: A Retrospective Cohort Study.

Under Rashtriya Bal Swasthya Karyakram (RBSK), children (0-18 years) are screened for a spectrum of 30 health conditions, categorized under 4D's namely defect (birth), disease (chronic), deficiency disorders, and developmental delay, and referred for treatment at higher centers. The aim of this study is to document demographic, clinical profile of children detected with any of 4D's during 2018-20 at one Urban Primary health center to assess their Quality of Life (QOL) and client satisfaction. A total of 102 children <18 years were selected as per Probability Proportionate to Size for different 4D's; within each category required participants were selected randomly. Information was gathered on designed semi-structured proforma. For QOL, customized World Health organization Quality of Life Brief (WHO-BREF) Questionnaire tool was used. Client satisfaction about the RBSK was assessed among RBSK users (N = 46) with Likert scale. Out of 102 cases, 97 were covered including 8 with more than 1 type of 4Ds. Majority beneficiaries were male (53.1%), from 5 to 10 years age (43.8%), and middle social class (52%). Congenital defects (48.5%) especially heart defects were the most common followed by deficiency disorders (40.2%) mostly severe anemia and/or severe acute malnutrition. Out of 46 who availed RBSK services, 82.6% rated service as very good or good. Most children (81.7%) had good QOL. Most detected 4D's belonged to school going age and middle class. They rated program as very good or good. Congenital defects, specifically heart defects were the most common. Overall, most children (81.7%) had good QOL.