in Secondary and Tertiary Hospitals Under HPNSDP - HSM (FY 2011-2016)


Monitoring and Evaluation by External Experts-2015

Feedback on Shishu Bikash Kendra visit by

Dr. Kate Hall and Victoria Springer,

visitors from New Zealand

20 February 2015


Shishu Bikash Kendra’s Visited

•          Dhaka Shishu Hospital

•          Suhrawardy Medical College

•          Dhaka Medical College Hospital

•          Salimullah Medical College Hospital


Children Seen

•          24 children’s complete clinical management

•          Age range: 5 months to 12 years

•          New and follow up cases

•          Types of disorders: Intellectual disability, global delay, cerebral palsy, autism, epilepsy, genetic disorders, visual impairment



•          Team worked well together, respectful, happy, positive

•          Very consistent across centres in attitudes, strategies and service delivered

•          Good structure for maintaining skills and up-skilling


Family and child interactions

•          Friendly and supportive

•          Good at engaging children

•          Parents seemed satisfied and engaged

•          Parents were trained and supported with advice and physical demonstration

•          History taking and record keeping looked careful and systematic

•          Use of standardized assessments which are validated for local use

•          Overall a great service and a good model for the rest of the world



•          Practices in therapy and medical management change with time and we all need to update continuously

•          Consider ways for the senior team to have regular ongoing contact with mentors


Example of updated practice

•          Oromotor exercises used to be common practice in New Zealand but are not used any longer


Some interventions could do harm

•          Manually manipulating child's jaw:

–        Can make child dislike feeding time- aversive

–        Can increase force feeding

•          Instead, make food to texture that child can easily eat with current skills



•          Baclofen

–        Not for everyone with spasticity. Most spasticity does not need medication

–        Can cause low trunk tone, poor seizure control, constipation

–        Useful for pain from muscle spasm and high tone that interferes with seating for example

•          Most behaviour problems don't need medication

•          Lower parents' expectations to developmental level, use strategies to help child's communication, structured environment and positive parenting

•          Risperidone

–        has serious side effects and should only be used in severe behaviour when other measures failed

–        Methylphenidate is much safer for ADHD and cost-effective


Overall we are very impressed

•          Amazing foundation for future growth and development

•          More suggestions in a document for Prof Naila Zaman Khan



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