Rashtriya Bal Swasthya Karyakram Research Articles

Competency mapping among Rashtriya Bal Swasthya Karyakram nurses in Kerala

Background: In India, birth defects, nutritional deficiencies, disabilities, and developmental delays among children cause significant public health challenges. The Ministry of Health and Family Welfare, aims to address these issues through the Rashtriya Bal Swasthya Karyakram (RBSK) program. RBSK nurses are the crucial part of this program. They screen the children between zero to eighteen years as a part of early intervention. This study mainly aimed to map the competencies among RBSK nurses from randomly selected districts of Kerala. Methods: This qualitative study employed key informant interviews with the state nodal officer, district early intervention centre managers, and district coordinators; and in-depth interviews (IDIs) with RBSK nurses, as well as report and document review. Inductive coding was applied to two selected interview transcripts from each district, followed by deductive coding with the rest of the transcribed data to derive themes. Results: The findings are presented using the ‘core competencies of public health professionals’ as revised and adopted by the council on linkages between academia and public health practice in 2021. RBSK nurses in Kerala exhibited proficiency in multiple domains, including knowledge of child health issues, clinical skills, communication, patient education, care for vulnerable population, organizing activities, electronic health record usage, multitasking, teamwork, and problem-solving skills. Conclusions: This dedication and proficiency demonstrated by RBSK nurses in Kerala, serve as a global model for emphasising the importance of early intervention and comprehensive care for children.

Epilepsy Among School-Children in a Rural District in Northwest India: Prevalence Estimates Using Three Different Approaches.

To estimate and compare the prevalence of epilepsy during childhood using several approaches and also to determine whether school-based screening campaigns can capture epilepsy cases efficiently. Epilepsy prevalence determined from cases captured through the Rashtriya Bal Swasthya Karyakram (RBSK), a nationwide school-health screening framework, were compared with estimates derived from school- and community-based surveys in one Indian district. Level-1 screen comprised perusal of child health registers maintained by the RBSK teams over one year to estimate the documented number of children with epilepsy; Level-2 screen comprised a questionnaire-based school survey among 10,000 school children; and Level-3 screen-a door-to-door community-based survey among 10,000 children in the district. Prevalence estimates of childhood epilepsy varied significantly across screening methods. The child health register identified lower crude and age-adjusted prevalences of 40 (95%CI, 24 to 55) and 36 (95%CI, 20 to 51)/1,00,000 vis-à-vis both the school survey [crude and age-adjusted prevalences of 354 (95%CI, 221 to 487) and 340 (95%CI, 181 to 517) per 100,000] and the community survey [crude and age-adjusted prevalences of 759 (95%CI, 591 to 927) and 746 (95%CI, 579 to 914) per 100,000]. The community survey identified 15 children with epilepsy (20%) who had dropped out of school. Also, it recaptured a small number of children previously identified by the school or child health register surveys. The present findings underscore the need to scale up the capacity of public programs to screen epilepsy among school children and underline the high frequency of school dropouts among children with epilepsy in resource-limited settings.

Multidisciplinary, Interdisciplinary, and Transdisciplinary Approaches to Neurodevelopmental Disability Interventions: A Brief Overview

Neurodevelopmental disabilities in children, affecting personal, social, academic, or occupational functioning, present a global challenge. Neurodevelopmental issues contribute significantly to learning disabilities, emphasizing the need for early intervention. The Rashtriya Bal Swasthya Karyakram (RBSK), a government program launched in 2013, is a multidisciplinary initiative addressing child health. This article compares three distinct approaches – multidisciplinary, interdisciplinary, and transdisciplinary – in the context of early intervention. Multidisciplinarity utilizes knowledge from various disciplines, while interdisciplinarity synthesizes links between disciplines, and transdisciplinarity integrates sciences beyond traditional boundaries. Challenges in early intervention, particularly with RBSK, include limited awareness and accessibility, necessitating ongoing efforts and innovations. This study concludes by emphasizing the transformative potential of embracing innovative solutions to create a more inclusive and equitable future for children with neurodevelopmental difficulties and their families.

Cost-effectiveness of portable-automated ABR for universal neonatal hearing screening in India.

The World Health Organization considers Universal Neonatal Hearing Screening (UNHS) essential to global public health. Rashtriya Bal Swasthya Karyakram has included newborn hearing screening in India since 2013. The program faces human, infrastructure, and equipment shortages. First-line hearing screening with improved diagnostic accuracy is needed. The Portable Automated Auditory Brainstem Responses (P-AABR) can be used in remote areas for UNHS due to its low infrastructure needs and diagnostic accuracy. This study evaluated the cost-effectiveness of P-AABR in UNHS. We employed an analytical model based on decision trees to assess the cost-effectiveness of Otoacoustic Emission (OAE) and P-AABR. The total cost to the health system for P-AABR, regardless of true positive cases, is INR 10,535,915, while OAE costs INR 7,256,198. P-AABR detects 262 cases, whereas OAE detects 26 cases. Portable Automated ABR costs INR 97 per case detection, while OAE costs INR 67. The final ICER was 97407.69. The P-AABR device is cost-effective, safe and feasible for UNHS Rashtriya Bal Swasthya Karyakram (RBSK) programs. Beyond reducing false referrals and parent indirect costs, it detects more hearing-impaired infants. Even in shortages of skilled workers, existing staff can be trained. Thus, this study suggests integrating this device into community and primary health centers to expand UNHS coverage.

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

Awareness of nursing students regarding Rashtriya Bal Swasthya Karyakram and District Early Intervention Centre

Awareness of nursing students regarding Rashtriya Bal Swasthya Karyakram and District Early Intervention Centre

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.

Building healthy foundations: Screening for 4 D’s (defects at birth, diseases, deficiencies, and development delays) among under-five children under the Rashtriya Bal Swasthya Karyakram program in Bengaluru, South India

Abstract Introduction: The 1st 2000 days of a child’s life from conception to five years of age are the most crucial days for early childhood development. The Rashtriya Bal Swasthya Karyakram (RBSK) is an ongoing screening screening program aims to screen the children not only in these crucial years but until they are 18 years of age and routinely refers them to higher centers for further management. Our study aimed to determine the 4 Ds – defects, deficiency, disease, and disability for children under five years of age, screened under RBSK. Methods: A cross-sectional study was conducted in one rural and two urban Primary Health Centers (PHCs) under the field practice area of government medical college in Bengaluru, South India. All the children registered under the anganawadi centers of the selected PHCs were included. Anthropometric measurements including weight, height, and mid upper-arm circumference were collected. Data was also collected from RBSK reports. Results: Among the 760 children screened, 41.6% deficiencies, 2.6% childhood diseases, and 0.3% disabilities and zero (0) defects were detected. Conclusion: The reporting of deficiencies was substantial (41.6%) under the RBSK program. But, the reporting of developmental delay and defects was not regular and was very low. To enhance its effectiveness, strategies include improving infrastructure and resources, strengthening screening and early detection through trained health-care workers, and standardized tools. Capacity building and training for health-care professionals are essential, as is community engagement through awareness campaigns and collaboration with local organizations.

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.