Assessment of Institutional and Management Capacities Against Health Conditions in Indian Early Intervention Centre
Authors: Pagolu Koteswara Rao , Tamanam Raghava Rao 
Published: August 2020

Abstract
Background: Rashtriya Bal Swasthya Karyakram (RBSK) is aimed at screening children for 4 Ds - Defects at birth, Diseases during childhood, Deficiencies and Developmental delays including disabilities and early intervention of these conditions. The aim of this study is to discover the pattern of various health conditions screened under the 4D’s approach and the institutional capacities like infrastructural, manpower and their training capacities. Methods: This is an observational study done in District Early Intervention Centre (DEIC), Visakhapatnam, Andhra Pradesh, India for a period of one year. Children referred to DEIC were screened by the pediatrician as per Rashtriya Bal Swasthya Karyakram (RBSK) norms. The information of the children who attended the DEIC such as age, sex, source of referral, diagnosis, treatment given and outcome were tabulated and analyzed. An analysis of the manpower available existing at the center during the study period was also done. Results: During the study period, a total number of 6572 children were found to have one of the listed 30 conditions under 4D’s approach of screening. Developmental delays and disabilities were seen in 4801 (73.05%) children, followed by children with childhood diseases which were observed in 1277 (19.43%), children with defects at birth were 255 (3.88%) and children with deficiencies were 239 (3.63%). Among the defects at birth, congenital deafness was the most commonly screened condition found in 84 (1.27%) children. About 53 (0.80%) neonates were found to have club foot of varying grades. On analysis of deficiencies, severe acute malnutrition was observed in 236 (3.59%) children. There was 1(0.01%) child each with Vitamin A deficiency (Bitot’s Spot), Vitamin D deficiency and Goiter (Due to Iodine Deficiency). On analysis diseases during childhood, dental caries were seen in 1219 (18.54%) children and skin conditions in 26 (0.39%) children. About 44 (0.6%) children were found to have rheumatic heart disease. On analysis of developmental delays and disabilities, language delay was the commonest screened condition seen in 941(14.31%) children. Hearing impairment was seen in 917 (13.95%) children, learning disorder in 704 (10.71%) children and neuro motor impairment in 584 (8.88%) children, vision impairment was seen in 505 (7.68%) children, motor delay was seen in 462 (7.02%) and cognitive delay was seen in 205 (3.11%). There were 68 (1.03%) cases of behavioral disorders (Autism) and were treated with multi modal therapy including sensory integration. Regarding manpower at the center, all the posts were occupied throughout the study period except medical officer, psychologist, dental hygienist and DEIC manager.Conclusion: We observed that many curable diseases are undiagnosed among the children and hence they were deprived of treatment for the same. Promotion of Early Intervention Services is most beneficial for improvement in health status of children and therefore RBSK purview should be extended to reach every individual child.