According to global report on birth defects, annually 7.9 million births occur with serious birth defects and 94% of these happen in the middle and low income countries . In India, congenital anomalies were estimated to be the fifth largest cause of neonatal deaths and have contributed to 60699 neonatal deaths in 2013, which accounted for the highest global burden of neonatal mortality .
RBSK program has taken initiative for early identification and treatment of the defects at birth, which will yield rich dividends in nurturing the health of Indian children. In our study of screening of children under 4D’s approach, during the study period, about 255 (3.88%) children had defects at birth, deficiencies were seen in 239 (3.63%) children, diseases during childhood were present in 1277 (19.43%) children and children with developmental delays/disabilities are 4801 (73.05%) out of the total 6572 children.
In the defects at birth, we found 84 congenital deafness (1.27%) cases, which are more prevalent in the children who approached this centre. One of the previous reports on community based disability survey supported by Indian council for medical research (ICMR) has detected the incidence of congenital hearing loss at 10/1000 in rural and 20/1000 in urban India . Another community based study by Garg et al., also showed that in India, four in every 1000 children suffer from severe to profound hearing loss and 100,000 babies are born with hearing deficiencies every year . The second most common disease under birth defects was Club foot found in 53 children. We found the highest number of club foot cases in males in the present study. Many authors have reported previously regarding preponderance of club foot in males. Bakalis et al., reported that the incidence of CTEV is four times more common in males compared to females (4:1) and it was statistically significant . 50 children were found with congenital heart diseases, in which maximum were in 6–18 years age group and were females. Miranovic Vesna formerly reported in their study that incidence of Congenital heart diseases (CHDs) are the most frequent congenital anomalies among infants and account for approximately 4–10 in 1000 live births . A total 0.56% of cleft lip and palate cases were reported in our study. Our findings are supported by the previous reports which show that the incidence of 1.09 in 1000 live births of cleft lip and palate are persisting in the state of Andhra Pradesh, South India . In our study we have reported an incidence of 26 children with down’s syndrome. Previously Gadhia Pankaj et al., reported that the advanced maternal age is classic risk factor attributed to the incidences of down's syndrome in Western India . In the present study, two children (0.03%) were found with congenital cataract, in which one is male from 6 weeks to 3 years and one is female from 6–18 years age group. The findings are supported by Gilbert and Foster that the prevalence of cataract in children has been estimated between 1–15 out of 10,000 children . Only one child was found with Neural tube defect from the study. Sharma et al., reported that their incidence of the disease ranges from 0.5–11/1000 births in different regions of India . One female was reported to have developmental dysplasia of the hip from our study. The previous report by Dezateux and Rosendahl shows that female new-born respond to relaxing hormone releasing from maternal placenta, so they are more likely to develop hip displacement disorders .
On analysis of deficiencies, the incidence of severe acute malnutrition was observed in 236 children out of 6572 children. Global Hunger Index, 2013 has also reported that, in India, 5 million children die every year due to direct or indirect influence of malnutrition (1 child death for every 10 seconds) . The nutritional rehabilitation Centre attached to this institute in the year 2015, which is present in King George hospital, Visakhapatnam is effective in improving the nutritional status of severely acute malnourished children and the follow-up also shows the children are having catch-up growth . In the present study, deficiency of iodine causing goiter was found in 1female child of the age of 6–18 years. Our results are supported by the surveys conducted by Directorate General of Health Services, which reported that the prevalence of iodine deficiency disorders (IDDs) is more than 5% in India . In our study, one male child of 6 weeks to 3 years age group was found with Vitamin D deficiency and one female of 6 years-18 years age group with Vitamin A deficiency showing Bitot’s spot. A previous report by National Institute of Nutrition, ICMR reported in their data that largest part of preschool children had subclinical Vitamin A deficiency and are associated with public health problems . In our study, from the childhood diseases, dental caries were found to be very prevalent and observed in 1219 (18.54%) children. Among them, highest number of cases was found among the children under 6–18 years age group. Mittal et al., supported the findings of our study showing that the prevalence of dental caries in 5 to 12-year-old school children in India were 55.5% and it jumped to 68% in the 1960 and climbed to 89% in subsequent years . Skin diseases totaling to a number of 26 (0.39%) children were the second most common disease observed among childhood diseases. Our findings are in contrast to the previous report by Tiwari et al., Madhya Pradesh, India who found that the skin diseases (64%) were more prevalent than dental caries (6.8%) . The prevalence varied from study to study depending on the study populations.
20 (0.30%) children are found to have convulsive disorders. Third most common disease in children was convulsive disorders 20 (0.30%), which are mostly observed in children of 6–18 years age group. Prasad et al., also reported previously in a community survey from South India, the prevalence of active epilepsy was high . 7 reactive air way disease cases were identified by our study with more number of cases in males. Previously Madhusudhan et al., also reported that the prevalence of reactive air way disease among children to be 0.24 percent . 5 number of otitis media children were found in the study. Chronic suppurative otitis media (CSOM) is a common infectious ear disease in India resulting in serious complications, especially hearing impairment .
On analysis of developmental delays and disabilities, during the study, language delay was observed to be the highest with 941 (14.31%) children. Previously there is a study which has described a high prevalence of language delays and reported that speech and language delay was found in 42 out of 1658 children who attended the OPD of a tertiary care teaching hospital in India . Hearing impairment was the second highest and was observed in 917 (13.95%) cases. Another community based disability survey support by Garg et al. reported that India certainly faces a worse situation regarding childhood deafness . Third most prevalence was Learning disorder with 704 (10.71%) cases, followed by neuro-motor impairment with 584 (8.88%) cases, Vision impairment in 505 (7.68%) cases, motor delay in 462 (7.02%) cases, others (Developmental delays and disabilities) in 411 (6.25%) cases, cognitive delay in 205 (3.11%), autism observed in 68 (1.03%) cases and attention deficit hyperactivity disorder in 4 (0.06%) cases were shown in the study. 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 .
Institutional facilities are important for providing quality services to the children and they include manpower and infrastructural facilities. The manpower analysis shows that the medical officer, psychologist and DEIC manager were not available throughout the study period. The post of dental hygienist was frequently vacant during the study period.The shortage of specialist manpower in semi-urban and rural locations is adversely affecting the treatment of children with disabilities. All the remaining staff from DEIC, Visakhapatnam was well trained by the technical committee of the Ministry of Health & Family Welfare, Government of India. On analysis of the infrastructural facilities available during the study period, we found that furniture, equipment for physiotherapy/occupational therapy, dental equipment, medical equipment, toys for play area and sensory integration equipment were available. There was lack of some of the equipment required for identification of the diseases like vision impairment and convulsive disorders (Epilepsy). Digital hemoglobinometer was not in working condition in the study period. The complete infrastructural facilities are necessary for high quality health systems. Previous studies also reported that the poor availability of laboratory facilities and diagnostic equipment are also obstacles to patient assessment and diagnosis, even when providers are aware of the necessary tests . India learned this with Janani Suraksha Yojana, a cash incentive programme for facility births, which massively increased facility delivery but did not measurably reduce maternal or newborn mortality . High-quality care is determined by thorough assessment, detection of asymptomatic and co-existing conditions, precise diagnosis, proper and timely treatment, referral when needed for hospital care and surgery, and the ability to follow the patient and regulate the treatment course as needed.