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Purpose: To obtain epidemiological data on children with ocular morbidity attending a nodal district early intervention center (DEIC). Methods: After parental consent, we recruited children with ocular morbidity. After detailed history and clinical evaluation, along with pediatric consultation and relevant neuro?radiological and ancillary investigation, information was entered in a pretested proforma: especially looking for perinatal morbidity, including developmental delay (DD). Visual acuity (VA) was assessed by age?appropriate means by an ophthalmic assistant trained to work with children with special needs. We diligently looked for strabismus and performed dilated ophthalmoscopy. Using JASP, we summarized data as means and proportions and reported 95% CIs. We explored the association of disability percentage with possible predictor variables using regression. Results: We enrolled 320 children, with a mean age of 34.43 ± 31.35 months; two?thirds were male; one?third belonged to lower socioeconomic status (36%), with most parents being illiterate. The mean presenting VA was 1.8 logMAR for both eyes, range: 0 to 3. Sixty?one percent were hyperopic and 27% were myopic. High refractive error, (>±6D) occurred in nine; anisometropia in one; strabismus in 149, mostly esotropia; congenital cataract in 25, whereas 63 had abnormal fundus. Seventy?six received a diagnosis of cerebral visual impairment (CVI). On multivariate linear regression (MLR), younger age, presence of DD, and CVI significantly predicted a higher disability percentage. Logistic regression revealed that statutory disability is likely associated with DD (odds ratio [OR]:13.43); whereas older age was protective (OR: 0.977). Conclusion: Our study suggests that in DEIC children with ocular morbidity, younger children, and the presence of DD significantly predict both greater disability and the likelihood of statutory levels
ABSTRACT
Background- Rashtriya Bal Swasthya Karyakram was launched in 2013, to reduce mortality and morbidity in children due to prevalent birth defects, diseases, deficiencies, and developmental delays. The strategy employed is early detection and management of health conditions. Mobile health teams (MHTs) and District early intervention centers (DEIC) are set up for screening, management, and referral of beneficiaries. Methodology – A concurrent mixed method study was conducted in Uttarakhand for exploring challenges faced by clients and to assess client satisfaction regarding services provided under the program. Caregivers of beneficiaries were interviewed telephonically about the challenges they faced while availing the facilities. Result- It was found that out of 41 caregivers of beneficiaries, 13 (31.7%) faced challenges while availing the services, and 2 (4.87%) were dissatisfied with the services. Challenges faced by caregivers were out-ofpocket expenditure on transportation, food and stay, long time in referral and unavailability of beds, unavailability of medicines, and failed treatment. Conclusion- The majority of the caregivers were satisfied with the referral and treatment provided. RBSK provides free-of-cost treatment to children but the indirect cost that the caregivers have to pay for travel, stay and multiple visits pose a challenge for utilization of the services.
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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. (1) Document utilization of RBSK services within a year of referral, (2) Assess reasonsObjectives : for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) takingMethod: 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. Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; majorResults: 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. After referral by RBSK team, only half utilized the services. Among users,Conclusion: 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.
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Background: The objective of this study is to know the gender variation in number of admissions, severity of malnutrition at the time of admission, gaining of weight and adherence to follow up in children admitted to nutrition rehabilitation center and during follow up.Methods: This is a retrospective study involving the review of existing programme records. Children who were admitted to nutrition rehabilitation centre, district hospital, Chamarajanagar, Karnataka, India, between January 2017 to December 2017 with severe acute malnutrition were involved in the study. The programme included 2 weeks of in-patient care, and four follow-up visits to the NRC subsequently as follows; 1st visit at 7 days, 2nd at 14 days, 3rd at 1 month and 4th at 2 months after discharge.Results: Among 57 children who admitted to NRC females were 30 (52.6%) and males 27 47.4%). 25 among 57 children (43.9%) could sustain weight gain of >5grams/kg/day as per one of the discharge criteria. 13 (52%) were females and 12 (48%) were males. 32(56%) among 57 admitted children to NRC, could achieve <-1SD during entire programmed. 15(46.8%) were females and 17 (53.1%) were males.Conclusions: There was no gender variation in either number of admission or severity of malnutrition at the time of admission or weight gain during NRC programme.
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Background: The Rashtriya Bal Swasthya Karyakram (RBSK) aims early detection and management of the 4Ds - Defects at birth, Diseases in children, Deficiency conditions and Developmental Delays including Disabilities in children in the community which are hidden may be due to unawareness or unaffordbility for treatment. Methods: We followed the operational guidelines of ‘Child Health Screening and Early Intervention Services’ under RBSK. Surveys done along with RBSK team for 6 months. Results: Total 26977 children were screened. Out of which 53 children were found to have birth defects, 434 children were found to have some kind of deficiency, 21768 children were found to have diseases and 113 children were found with developmental delay including disabilities. Globally, 200 million children do not reach their developmental potential in the first five years because of poverty, poor health, nutrition and lack of early stimulation. Here in our study 83% children deprived of good health due to 4Ds. Conclusion: We observed that still there are many children are undiagnosed and deprived of treatment for curable diseases. Child Health Screening and promotion of Early Intervention Services is most beneficial for improvement in health status of children in rural community.