Health conditions screened by the 4d`s approach in a district early intervention centre (deic) under rashtriya bal swasthya karyakram (rbsk) program

ORIGINAL ARTICLE

Health Conditions screened by the 4D`s Approach in a District Early Intervention Centre (DEIC) under Rashtriya Bal Swasthya Karyakram (RBSK) Program

B Rameshbabu¹, KS Kumaravel¹, J Balaji¹, P Sathya², N Shobia¹.

¹Department of Pediatrics, Government Dharmapuri Medical College, Dharmapuri, India,
²District Early Intervention Centre, Government Dharmapuri Medical College, Dharmapuri, India.

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Abstract
Aim: Rashtriya Bal Swasthya Karyakram (RBSK) is aimed at screening children for 4 Ds - Defects at birth, Diseases of childhood, Deficiencies and Development Delays including Disabilities and early intervention of these conditions. This study is aimed at finding the pattern of various health conditions screened under the 4D’s approach.
Methods and Materials: This is a one year observational study done in District Early Intervention Centre (DEIC), Dharmapuri, Tamilnadu. Children referred to DEIC were screened by the pediatrician as per Rashtriya Bal Swasthya Karyakram (RBSK). The profile of the children who attended the DEIC like age, sex, place of referral, diagnosis, treatment given and outcome were tabulated and analyzed. An analysis of the manpower available during the study period was also done.
Results: During the study period, 7416 children were found to have one of the listed 30 conditions under 4D’s approach of screening. Childhood diseases were seen in 3060 (41.3%) children followed by developmental delay in 1432 (19.3%) children, deficiencies in 1087 (14.6%) children and defects at birth in 804 (10.8%) children. Among the defects at birth, congenital heart diseases were the commonest screened condition found in 437 (5.9%) children. About 192 (2.6%) neonates were found to have Retinopathy of Prematurity of varying grades. On analysis of deficiencies, severe anemia was observed commonly in 628 (8.5%) children. There were 250 (3.4%) children with severe acute malnutrition. On analysis of childhood diseases, dental caries were seen in 1719 (23.2%) children and skin conditions in 553 (7.5%) children. About 44 (0.6%) children were found to have rheumatic heart disease. On analysis of delays and disabilities, vision impairment like squint and refractory errors were the commonest screened condition seen in 1080 (14.6%) children. Neuro-motor impairment were seen in 78 (1%) children, language delay in 99 (1.3%) children and learning disorders in 88 (1.2%) children were the less frequently observed disabilities. There were 9 (0.1%) cases of behavioral disorders including autism and were treated with multi modal therapy including sensory integration. All the posts except early interventionist/special educator and dental hygienist were occupied throughout the study period.
Conclusion: Through RBSK India has taken giant step for screening and early intervention for defects at birth, childhood diseases, deficiencies and disabilities. The shortage of specialist manpower like special educator is of major concern and youngsters should be motivated to take up rehabilitation sciences as a career option.

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