ESTABLISHMENT OF SHISHU BIKASH KENDRA (Child Development Center)
in Secondary and Tertiary Hospitals Under HPNSDP - HSM (FY 2011-2016)

RESEARCH AND DEVELOPMENT

Determining  children at-risk for neuro-developmental impairments presenting to  general outpatients services in five government medical college hospitals

PI: NZ Khan

National Coordinator, Establishment of SBK in Government MCHs

January to June 2012

 

Background

•    Bangladesh lacks a surveillance system for children with neurodevelopmental disorders (NDDs).  Management solely depends on parents accessing services which they deem to be appropriate, most often within government medical college hospitals (MCHs).

•     Early identification of NDDs is essential for optimum benefits to be gained from the Shishu Bikash Kendra (SBK) services which are operating within major government MCHs.

Objectives

     To determine the numbers of children who are at-risk for neurodevelopmental impairments (NDIs) and neurodevelopmental disabilities (NDDs) attending the various out-patients services of medical college hospitals who are  likely to benefit from SBK services, if referred early and appropriately.

 

Methods and Materials

•   Community workers with high school degrees were trained, 5 per MCH, to ask mothers (or other care-provider) attending the OPD in the following clinics (a) orthopedic (b) eye (c ) ENT (d) Physical Medicine (e) EPI.

•   Inclusion criteria: All children aged 0-9 years

•   Exclusion criteria: None

•   Screening instrument:

     -Developmental Screening Questionnaire (DSQ) for children aged 0- <2 years*;

    Ten Questions Plus (TQP) for children aged 2-9 years**. 

•Timeline: Data collection March – April, 2012

Ethical Considerations: Verbal Consent was obtained from the mother/care-provider. Protocol was approved by the Ethical Review Committee of the Bangladesh Institute of Child Health, Dhaka Shishu Hospital

  Table 2:   Screen Positivity  for NDDs by specific OPD in 5 Medical
                  College Hospitals
 

MCH

OPD

Total no. pts

DSQ+

% DSQ +

TQP+

% TQP +

Total Scr+

% Scr+

CMCH:

EPI

105

15

14.71

0

0

 

 

Ctg

ENT

218

2

11.76

41

20.4

 

 

 

EYE

143

1

3.85

26

22.22

 

 

 

Ortho

56

0

100

7

13.46

 

 

 

Physical M

9

0

100

3

37.5

 

 

KMCH:

EPI

109

14

40

35

47.29

 

 

Khulna

ENT

180

7

16.27

41

29.92

 

 

 

EYE

0

0

0

0

0

 

 

 

Ortho

41

2

18.18

15

50

 

 

 

Physical M

201

13

27.65

60

38.96

 

 

MMCH:

EPI

212

5

2.35

0

0

 

 

M'singh

ENT

186

2

5

6

4.1

 

 

 

EYE

151

5

11.11

28

26.16

 

 

 

Ortho

36

2

10

6

37.5

 

 

 

Physical M

3

0

0

2

66.66

 

 

RMCH:

EPI

200

9

4.5

0

0

 

 

Rajshahi

ENT

252

2

2.98

11

5.94

 

 

 

EYE

187

4

8

9

6.56

 

 

 

Ortho

1

0

0

0

0

 

 

 

Physical Medicine

 

0

0

0

0

 

 

RMCH:

EPI

226

1

0.45

1

16.66

 

 

Rangpur

ENT

225

11

35.48

34

17.52

 

 

 

EYE

212

3

5.17

24

15.58

 

 

 

Ortho

7

0

0

1

14.28

 

 

 

Physical  M

14

0

0

5

35.71

 

 

TOTAL

 

2974

98

 

355

 

453

15.23

 

Discussion

      Of the 2974 screened 15.23% were positive, ie, at risk for any NDD.

      Of the <2 year olds 7.97% screened positive

      Of the 2-9 year olds 20.33% screened positive

    All of these children require assessment to determine the underlying pathophysiology of the NDD

     Older children had a higher rate of positivity. This may imply  (a) improving PHC services in the recent past (b) or that  parents may not be able to identify mild NDDs early in life (c ) newly emerging NDDs in older children

 

Conclusion

•      All health care physicians working in tertiary hospitals should be trained to screen for NDDs utilizing simple screening tools

 

   

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