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ORIGINAL ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 1  |  Page : 55-59  

Morbidity profile of children from birth to 18 years of age referred for intervention to the district early intervention centre in a District Hospital, Andhra Pradesh


1 Assistant Professor, Department of Community Medicine, Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, India
2 Professor, Department of Community Medicine, Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, India

Date of Submission09-Jan-2019
Date of Decision19-Apr-2019
Date of Acceptance15-Feb-2020
Date of Web Publication16-Mar-2020

Correspondence Address:
Khadervali Nagoor
Department of Community Medicine, Apollo Institute of Medical Sciences, Murukambattu, Chittoor . 517 127, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_11_19

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   Abstract 


Background: The “Child Health Screening and Early Intervention Services” program aims at early detection and management of the four dimensions prevalent in children-defects at birth, diseases in children, deficiency conditions, and developmental delays, including disabilities. Objective: The objective of the study was to assess the morbidity profile of children from birth to 18 years of age screened in the district early intervention center (DEIC). Methods: A record-based descriptive study was done in the DEIC in Chittoor, Andhra Pradesh. The data were retrieved for 1-year from April 2017 to March 2018 into the excel sheet, and the combined master sheet was prepared for analysis. The analysis was done with SPSS 21.0 Version. Results: A total of 10571 children were screened and referred to the DEIC during the period. Out of them, 5679 (53.7%) were male and 4892 (46.3%) were female. Among all the four types of morbidities screened, majority 4847 (45.9%) were having the childhood diseases, 4177 (39.5%) had developmental delays including disabilities, 1067 (10.1%) had different deficiencies, and 361 (3.4%) had birth defects. Among the adolescent health issues, 119 (1.1%) were screened and sent for the early intervention to the district hospital. Conclusions: A huge number of children were screened and referred to the DEIC every year for intervention. The health sector has to focus more on the resources like workforce, training of peripheral health workers at regular intervals about the different morbidities screened, that would help in identifying the morbidities at the earliest possible time and receive the intervention at the best center.

Keywords: Birth defects, childhood diseases, deficiencies, developmental delays, disabilities, district early intervention center


How to cite this article:
Darivemula SB, Nagoor K, John K R, Kahn P S, Chittooru CS. Morbidity profile of children from birth to 18 years of age referred for intervention to the district early intervention centre in a District Hospital, Andhra Pradesh. Indian J Public Health 2020;64:55-9

How to cite this URL:
Darivemula SB, Nagoor K, John K R, Kahn P S, Chittooru CS. Morbidity profile of children from birth to 18 years of age referred for intervention to the district early intervention centre in a District Hospital, Andhra Pradesh. Indian J Public Health [serial online] 2020 [cited 2020 Dec 5];64:55-9. Available from: https://www.ijph.in/text.asp?2020/64/1/55/280759




   Introduction Top


The National Rural Health Mission (NRHM) launched a new initiative of Rashtriya Bal Swasthya Karyakram (RBSK),[1] a child health screening and early intervention services program to provide comprehensive care to all the children in the community. The objective of this initiative is to improve the overall quality of life of children through early detection of birth defects, diseases, deficiencies, development delays, and disability. The high burden of this childhood ill-health contributes significantly to child mortality, morbidity, and out of pocket expenditure of the poor families.

Children diagnosed with illnesses shall receive follow-up, including surgeries at tertiary level, free of cost under NRHM. Out of every 100 babies born in this country annually, 6–7 have a birth defect. In the Indian context, this would translate to 1.7 million birth defects annually and would account for 9.6% of all newborn deaths.[2] Research has proved that the period from birth to 6 years are the most critical years for all children. This is especially true for children with developmental delay. The children from newborn to 6 weeks; facility-based newborn screening at all delivery points, by existing health workforce and home-based regular postnatal visits, children 6 weeks–6 years at Anganwadi centers, from 6 years to 18 years at the government and its aided school based screening by dedicated mobile health team. The purpose of setting up early intervention center is to provide referral support to children detected with health conditions during health screening. Therefore, it stands that early identification and early intervention programs can significantly improve the quality of their lives. Evidence is required regarding the specific morbidities of these screened conditions. In this context, the objective of the present study was to assess the morbidity profile of children from birth to 18 years of age registered in the district early intervention center (DEIC) Chittoor during 1-year. Identifying the extent of different morbidities referred to DEIC in one division of the district will help focusing targeted attention and strengthening the system accordingly.


   Materials and Methods Top


This was a record based descriptive study done in the DEIC in Chittoor district, Andhra Pradesh.

The Chittoor district was divided into three divisions (Chittoor, Tirupati, and Madanapalli) as per census 2011,[3] and the population of the district was 4,174,064 with the spread of 15152.00 area in km2. The sex ratio was 997, and the child sex ratio was 917/1000 males as per 2011 census. Under Chittoor division, a total of 20 mandals were present, and we had taken the registered cases in DEIC Chittoor division only. Those children self-reporting, identified with different morbidities at community health center, primary health center, Anganwadi, and subcenter were referred to the DEIC, Chittoor for early intervention. Once they approach, DEIC complete screening was done for different morbidities by the health team (medical officer, dentist, physiotherapist, clinical psychologist, audiologist cum speech and language pathologist, optometrist, dietician, and laboratory technician) available. This center had the basic facilities to conduct tests such as anthropometry, medical examination, developmental and motor assessment, speech therapy, audiological testing, vision assessment, occupational therapy, physiotherapy, play therapy, behavioral modification, and parent training programs. The developmental intervention requires an interdisciplinary approach of a multidisciplinary team placed under one roof. Since Chittoor DEIC is attached to Medical College, it is easier after screening in the periphery and sending for the intervention. The frequency of screening at the peripheral level was not uniform at all the sites. Since there is no special training for the health-care staff on the DEIC for the identification of the different morbidities.

Before retrieving the data, we had taken permission from in charge medical officer of that particular DEIC. The data for the study were collected for 1-year from April 2017 to March 2018. Data were retrieved into Microsoft excel as the monthly report submitted to the RBSK. We received the 12 monthly reports, and all the reports were merged in one excel master file for the analysis. The analysis was done with the help of SPSS 20.0 version IBM, India pvt. ltd. Data were shown in frequency and proportions.

Ethical clearance was obtained by the Institutional Ethical Committee with reference number IEC06/AIMSR/05/2019 and approved on August 7, 2019. No participant was interviewed; thus, consent form and participant information sheet were not required.


   Results Top


A total of 10571 children were screened and identified with one or the other morbidities in the last 1-year [Table 1]. Of them, 5679 (53.7%) were males; majority 7287 (68.7%) belonged to the 6–18 years, and 2987 (28.2%) belonged to 6 weeks–6 years of age. Amongst those screened nearly half 4847 (45.8%) of children were identified with childhood diseases and 4177 (39.5%) were identified to have developmental delays including disabilities respectively. Only 361 (3.4%) were identified with birth defects, 1067 (10.1%) had different deficiencies and only 119 (1.1%) had adolescent health issues [Table 1].
Table 1: Distribution of children according to their overall health conditions screened in District Early Intervention Centre (n=10,571)

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[Table 2] describes the profile of birth defects, childhood diseases, developmental delays, and deficiencies.
Table 2: Distribution of children according to their various morbidities from birth to 18 years (n=10,571)

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A total of 361 (3.4%) were identified to have birth defects. Of them, nearly one-forth had club foot (24.9%) and congenital heart diseases (24.6%) followed by congenital cataract (13.5%), congenital deafness (11.3%), cleft lip and cleft palate 33 (9.1%), and other defects [Table 2]. Among children with deficiencies, majority 647 (60.6%) were in the age group of 6 weeks–6 years and 904 (84.7%) had severe anemia with hemoglobin <7 g/dl followed by Vitamin A and D deficiencies. Among children with developmental delays including disabilities, nearly three-fourth (71.9%) were 6–18 years of age; more than one-fourth (30.7%) had vision problems, followed by language delays (22.5%), cognitive delay (14.7%), and motor delay 526 (12.5%) [Table 2]. Among children with childhood diseases, nearly three-fourth 3486 (71.9%) were 6–18 years of age. Out of them, more than half 2766 (57.1%) were identified with dental problems followed by reactive airway diseases (16.3%), skin problems (11.1%), and had ear problems (10.1%) [Table 2].

Among children with adolescent health issues majority (39.4%) had substance abuse followed by irregular periods (22.7%) and growing up concerns (20.2%) [Table 3].
Table 3: Distribution of children according to their adolescent health issues (n=119)

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   Discussion Top


The present study identified only those screened and identified with any health problems at the peripheral health centers and referring to the DEIC for the intervention measures for the improvement in the health and quality of life. Here, we had not done any interview with mothers for their gestational age and age of the child born to correlate in relation with their birth defects, deficiencies, childhood diseases, developmental delays, and adolescent health issues. The present study showed 3.4% of birth defects in 1-year in one division of the district in a state. The National birth defects prevention study[4] done in the United States approximately 76% of the cases in the study have only one birth defect that is eligible for the study; 14% have two eligible birth defects, and 9% have three or more eligible birth defects. The prevalence of all birth defects was 18.9/1000 births. Many studies had done for the entire country or for a longer duration of time; hence, we are not able to compare with the other studies. The population-based cohort study.[4] (Utah birth defect network) included 5504 (2.03%) infants with major birth defects among 270,878 total births. In a hospital-based descriptive study,[5] 5661 patients of birth defects admitted, of these, 5156 had a single congenital anomaly and 505 had multiple congenital anomalies.

In the past 1 year, 8.5% of the severely anemic children of 0–18 years were referred to DEIC and when it was compared to the National Family Health Survey (NFHS)-4 (2015–2016) children of age 6–59 months with anemia (<11 g/dl) in the district was 46.6% and for the Andhra Pradesh state it was 58.6% and for overall India, it was 58.5%. In NFHS-4, only 6–59 months of age group was included, thus findings of our study among birth to 18 years cannot be compared. Very less number of children (3.7%) with severe acute malnutrition were referred to DEIC. In terms of NFHS-4 data, for the district 4.6% were severely stunted, 4.5% in the state, and 7.5% in the country. As NFHS-4 was broadly given the data for the entire country, and our study showed only for the part of the district; hence, we can only show the difference.

In the present study, we found 39.5% of the children had developmental delays and disabilities referred for early intervention in the past 1-year. The WHO and the World Bank estimate that more than a billion people live with some form of disability, which equates to approximately 15% of the world's population.[6] Among these, between 110 million (2.2%) and 190 million (3.8%) adults have very significant difficulties in functioning.[7] Early identification and intervention are critical to optimize language, cognitive, motor, and socio-emotional development as well as educational success,[8] yet only an estimated 10% of children with delays are identified and receive intervention.[9] Globally,[10] 52.9 million children younger than 5 years (54% males) had developmental disabilities in 2016 compared with 53 million in 1990. A population-based study[11] showed the incidence of the developmental delays in children <6 years an increasing trend over the study period, ranging from 7.0 to 16.3/1000 person-years. The adolescent health issues reported were 1.1% in the last 1-year and referred to DEIC for the early intervention.

The study had some limitations being a record-based study with 1-year records in one division in Chittoor district, we could not compare with the national statistics done at different settings. There would have been school dropouts, not attending the Anganwadi centers, and not screened even in the house-to-house visit by the health workers and not found in the catchment area. Hence, the screening was done by the gross-root level workers (Health workers and Accredited Social Health Activist) at the village level. Since the peripheral health-care staff are overburden being involved in many health programs during their daily work. Thus, some of the catchment areas (hamlets and hard to reach areas) might have missed. To minimize the missing cases and improve the effective and early identification of all the morbidities, the training has to be given to the health-care staff or special mobile team has to be recruited for the screening at the peripheral level on periodic basis.


   Conclusions Top


Since a huge number of children from birth to 18 years of age were screened and referred to the DEIC every year for the intervention. The majority of the children were having childhood diseases, especially dental caries and developmental delays and disabilities such as vision, language, cognitive, and motor delays in more number with respect to other morbidities. The screening and identification, if done at the earliest, we can reduce the burden of disease and disability-adjusted life years and improve the quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Operational guidelines Rashtriya Bal Swasthya Karyakram (RBSK) Child Health Screening and Early Intervention Services under NRHM, Ministry of Health and Family Welfare, Government of India. February, 2013.  Back to cited text no. 1
    
2.
March of Dimes Report, White Paper on Preterm Birth, The Global and Regional Tool; 2009.  Back to cited text no. 2
    
3.
Census of India 2011 Andhra Pradesh Series 29, Part XII-A, District Census Handbook Chittoor, Village and Town Directory. Available from: https://censusindia.gov.in/2011census/dchb/2823_PART_A_DCHB_CHITTOOR.pdf. [Last accessed on 2019 Jan 02].  Back to cited text no. 3
    
4.
Yoon PW, Rasmussen SA, Lynberg MC, Moore CA, Anderka M, Carmichael SL, et al. The National Birth Defects Prevention Study. Public Health Rep 2001;116 Suppl 1:32-40.  Back to cited text no. 4
    
5.
Feldkamp ML, Carey JC, Byrne JLB, Krikov S, Botto LD. Etiology and clinical presentation of birth defects: Population based study. BMJ 2017;357:j2249.  Back to cited text no. 5
    
6.
Banu T, Chowdhury TK, Das SK, Chowdhury MZ, Hoque MM, Rahman MAM. Birth Defects: A Hospital Based Study in Chittagong, Bangladesh. Chattagram Maa-O-Shishu Hospital Medical College Journal 2014:13;19-33.  Back to cited text no. 6
    
7.
World Health Organization, World Bank. World Report on Disability. Geneva, World Health Organization; 2011. Available from: http://www.who.int/disabilities/world_report/2011/en/index.html. [Last accessed on 2019 Jan 02].  Back to cited text no. 7
    
8.
Institute of Medicine. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: The National Academies Press; 2000.  Back to cited text no. 8
    
9.
Rosenberg SA, Zhang D, Robinson CC. Prevalence of developmental delays and participation in early intervention services for young children. Pediatrics 2008;121:e1503-9.  Back to cited text no. 9
    
10.
Global Research on Developmental Disabilities Collaborators. Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Glob Health 2018;6:e1100-21.  Back to cited text no. 10
    
11.
Lai DC, Tseng YC, Guo HR. Characteristics of young children with developmental delays and their trends over 14 years in Taiwan: A population-based nationwide study. BMJ Open 2018;8:e020994.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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