A Critique of the Proposed National Education Policy Reform
Batch 20-21 Grp B Project PPT for community medicine.pptx
1. Assessment of Developmental Delay among
0-36 months Children Attending Paediatrics
Out-Patient Department, Raiganj
Government Medical College & Hospital,
Uttar Dinajpur.
Undergraduate Project by 3rd Professional Part 1
Students (Group B)
Raiganj Govt. Medical College & Hospital
Dept of Community Medicine
4. Assessment of Developmental Delay
among 0-36 months Children Attending
Paediatrics Out-Patient Department,
Raiganj Government Medical College
& Hospital, Uttar Dinajpur.
Title of the Project:
5. Introduction
• Development is complex and conditions through which an individual
acquires skills and improvement of cognitive function takes place. Majority
of the developmental process takes place within the first few years of life ¹.
• Developmental delay occurs when a child exhibits a significant delay in the
acquisition of skills. The various domains of development include gross
motor, fine motor, language and hearing and social behavior which are
complex and inter-related.
• The value of early identification of children with developmental delay has
been well documented ².
• Any delay in reaching for the milestone during the first four years of life
will ultimately affect the way a person interacts with the surrounding
society. Hence developmental assessment is required at the earliest ³.
6. • If one can diagnose developmental delay in early stages of growth, then
intervention can reduce long-term sequelae⁴.
• The mud for determining the extent of developmental delay and early
interventions has been emphasised in the national Strategies through
Rashtriya Bal Swasthya Kairystram [RBSK].
• Global Developmental Delay is defined as a delay in two or more
developmental domains. In addition to delays in development, physicians
should also recognize deviations in development. Deviance occurs when a
child develops milestones or skills outside of the typical acquisition
sequence. An example of this can be seen in conditions such as cerebral
palsy, in which the infant rolls over early secondary to increased extensor
tone.
• Globally every year 180-200 million under five children exhibit
developmental delay and 86% take place in the developing world like India
compared to a mere 8% in the developed economies [⁵,⁶].
7. • It is common in early childhood affecting at least 10% of the Indian
children ⁷.
• Although many isolated efforts have been undertaken in different parts
of India to assess and document the developmental status of children, a
comprehensive database on the above is still lacking.
• Studies done in West Bengal are scarce and only one rural field-based
study on prevalence of developmental delay in Bhatar block of West
Bengal could be accessed ³.
• In this context, the present study was planned with the objectives to
find out the proportion of developmental delay among children
between 0-3 years age attennding Out patient department(OPD) of
pediatric department of Raiganj Govt Medical college and to
determine its assosiation with several socio-demographic, pregnancy
& childbirth related factors.
8. Objective
1. To find out the proportion of developmental delay among 0-36
months aged children attending the out patient department of
Pediatrics, Raiganj Government Medical College & Hospital.
2. To determine relationship of developmental delay with different
socio-demographic factors and pregnancy-childbirth related factors.
9. Methodology
Study type and design
This is an observational descriptive cross-sectional study with cross sectional design.
Study Setting
Pediatrics Outpatient department of Raiganj Govt Medical college & hospital situated in
Uttar Dinajpur district of West Bengal .
Study duration
This observational study was conducted from September to October 2022 (Specify date as
per Clinical Postiong schedule???) , over a period of one month.
10. Activities No. of Days of Project Work
1 2 3 4 5 6 7 8 9 1
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Project Planning,
Literature Review
Tools Development
Data Collection
Data Entry
Data Analysis
Project Writing
Methodology (Contd.)
Gantt Chart Showing Distribution of Project Activities during Study Period
11. Study Population
0-36 months children attending Raiganj Govt Medical college pediatric
department.
• Inclusion Criteria
a) children aged 0-36 months with the complain of delay disease with their
parents
b) The child’s parents who agreed to provide information about their child were
included in the study.
• Exclusion Criteria
a) Children with parents who were uncooperative and disagreed to provide
information were excluded from the study.
b) Seriously ill children were excluded from the study
Methodology (Contd.)
12. Sample size calculation
Based on a study finding done in India by [ref] the report. Sample size calculated using The formula 4pq/L² Where
P = 0.57 and (q=1-p), with an absolute error margin of_______
Minimum sample size thus estimated is 160.
Sampling Technique
The participants were chosen consecutively based on the inclusion with exclusion criteria.
Methodology (Contd.)
13. Methodology (Contd.)
• Tools:
1. A pre-designed pre-tested schedule for socio-
demographic and pregnancy-childbirth related
characteristics of the respondent (caregiver of the
child where caregiver may be father or mother or any
other guardian available along with)
2. Developmental delay in children was assessed with
the Trivandrum Developmental Screening Chart
(TDSC) [9].
3. Records like mother and child protection card,
discharge certificate & OPD prescriptions etc was
done as and when required.
• Techniques:
1. Interview
2. Observation
3. Review of records
15. Trivandrum Developmental Screening
Chart(TDSC)
• TDSC consists of seventeen items which are represented as horizontal bars.
• Left end of the bar represents the age at which 3% of children should have
achieved the milestone. Whereas the right end represents the age by which 97% of
the children should have achieved the milestone.
• A plastic ruler is kept vertically at the level of chronological age of the child being
tested. If the ruler is beyond the right end of the horizontal bar, the child has failed
to achieve that particular milestone and is considered to have developmental delay.
• The tool has positive predictive value 100% and negative predictive value
96.8%.[10] Those children found to be delayed were referred to early intervention
centres.
• The tool is designed to be a simple method for community health workers to assess
a child’s development and recommend interventions as necessary.
• It is not for assessing the developmental age of the child or for the diagnosis of a
developmental disability.
16. Methodology (Contd.)
• Study variables
• Main Dependent Variable-
• Presence of Developmental Delay as per Trivandrum Developmental
Screening Chart (TDSC) [9]
• Socio-demographic variables-
• Age of the child, Gender of the child, Family type, Parent's
education, Occupation of father, place of residence, Socioeconomic status
• Pregnancy-childbirth related variables-
• Birth weight, Maternal age at the time of gestation, Parity, Gestational age at
birth, Mode of delivery, Place of delivery, history of birth spacing, Anganwadi
Centre (AWC) supervision. Family history of Developmental Delay
17. Operational Definition
• Developmental delay of 0-36 months children- Present, if children do not complete
there age appropriate developmental milestones as per Trivandrum Developmental
Screening Chart(TDSC).
• Economic Status- The economic status of the family was categories as per Modified
B. G. Prasad Scale (……………………….) [ref] using per capita monthly income
parameter.
• Birth Weight- It was categorized into Normal Birth weight (≥2.5 Kg) & Low Birth
Weight (<2.5Kg)
• Maternal Age at Conception- It was categorized into Early (<19 years), Normal (19-
34 years) & Elderly (≥ 35 years)
• Parity- It was categorized into Primi-para & Multi-para
• Gestational age at birth- It was categorized into Preterm (<34 weeks) & Term (≥ 34
weeks)
Methodology (Contd.)
18. Data Collection:
• Data collection procedure started from the second week of our one
month clinical posting.
• We prepare data collection and data entry team schedule for weekly 6
days data collection.
• 10 persons for each team assigned for data collection each day during
OPD hours and remaining 15 person for data entry.
• A data collection target of 14 or more children per day to complete the
sample size of 160 within two weeks (considering Sunday as holiday).
• Data were collected by interviewing the participants (caregiver’s of
child) face to face and examining the child with TDSC.
Methodology (Contd.)
19. Methodology (Contd.)
Data analysis
• Collected data were entered in Microsoft Excel version ? and double checked for
completeness and consistency of data.
• After checking collected data, the data was analyzed using the principles of
descriptive statistics.
• The continuous data were analyzed with principle of Mean ± Standard Deviation
and the nominal data were analyzed using percentages.
• The analysis regarding developmental delay and its relation with different factors
were presented using suitable tabular and graphical presentation.
Ethics
• Permission was obtained from the Medical Superintendent cum Vice Principal
(MSVP) , On- duty doctor and staff's present in Pediatrics OPD .
• Verbal informed consent was taken from the child’s caregiver informing that the
paitent's personal information will remain confidential.
21. Table-1: Distribution of children
as per presence of developmental
Delay (N= 160)
Developmental
Delay
Frequency (%)
Present A (b)
Absent C (d)
Total 160 (100)
Note: Parenthesis are showing
(Column Percentages)
Fig-1: Pie diagram showing
distribution of children as per
presence of developmental Delay
(N= 160)
22. Results:-
Table-1: Distribution of patients
according to Gender (N= ?)
Fig-1: Distribution of patients
according to Gender (N= ?)
Male
50%
Female
50%
Male
Female
33. Reference
• 1. Illingworth R. Developmental testing: An overview. In: Illingworth Ronald S, Nair MKC, Russell Paul., editors. The Development of the
Infant and Young child: Normal and abnormal. 10th ed. Elsevier; 2012. p. 408. [Google
Scholar]https://scholar.google.com/scholar_lookup?title=The+Development+of+the+Infant+and+Young+child:+Normal+and+abnormal
&author=R+Illingworth&publication_year=2012& https://pubmed.ncbi.nlm.nih.gov/17015506/
• 2. Rydz D, Srour M, Oskoui M, Marget N, Shiller M, Birnbaum R. Screening for developmental delay in the setting of a community
paediatric clinic; A prospective assessment of parent-Report questionnaires. Pediatrics. 2006;118:1178–86. [PubMed] [Google
Scholar]https://pubmed.ncbi.nlm.nih.gov/15064509/
• 3. Bhattacharya T, Ray S, Das DK. Developmental delay among children below two years of age: A cross-sectional study in a community
development block of Burdwan district, West Bengal. Int J Community Med Public Health. 2017;4:1762–7. [Google
Scholar]https://scholar.google.com/scholar_lookup?journal=Ministry+of+Health+and+Family+Welfare.+Rashtriya+Bal+Swasthya+Karya
kram+(RBSK)-operational+guidelines.+February,+2013&
• 7. Government of India. Ministry of Health and Family Welfare. Rashtriya Bal Swasthya Karyakram (RBSK)-operational guidelines.
February, 2013 [Google Scholar]
• https://scholar.google.com/scholar_lookup?journal=J+Evid+Based+Med+Healthc&title=To+identify+clinical+utility+of+TDSC+in+screeni
ng+of+developmental+delay+in+children+(0-
3+yrs.)+as+compared+to+DDST&author=KK+Kishore&author=P+Sharma&author=DV+Chavan&author=BK+Madhusudhan&author=E+A
darsh&volume=6&publication_year=2019&pages=2146-50&
• 10. Kishore KK, Sharma P, Chavan DV, Madhusudhan BK, Adarsh E. To identify clinical utility of TDSC in screening of developmental
delay in children (0-3 yrs.) as compared to DDST. J Evid Based Med Healthc. 2019;6:2146–50. [Google Scholar]
https://scholar.google.com/scholar_lookup?journal=J+Evid+Based+Med+Healthc&title=To+identify+clinical+utility+of+TDSC+in+screeni
ng+of+developmental+delay+in+children+(0-
3+yrs.)+as+compared+to+DDST&author=KK+Kishore&author=P+Sharma&author=DV+Chavan&author=BK+Madhusudhan&author=E+A
darsh&volume=6&publication_year=2019&pages=2146-50&
34. Acknowledgement
• We would like to express our sincere gratitude towards
• Principal Sir and MSVP Sir
• Dr. Jadab Chandra Sardar, HOD, Department of Community Medicine
• Faculties of Department of Community Medicine
• for extending their generous help towards the completion of this project.
• Faculties & staff members of Pediatrics Department.
