This document provides an introduction to the Rashtriya Bal Swasthya Karyakram (RBSK) program in India, which aims to screen over 270 million children aged 0-18 for defects, diseases, deficiencies, and developmental delays. It does this through mobile health teams that screen children in anganwadis and schools. Children identified with issues are referred to primary or community health centers, or district early intervention centers for further examination and treatment if needed. The district early intervention centers are located in district hospitals and have medical professionals and facilities to assess children for conditions like hearing, vision, motor and cognitive impairments. The goal of the program is to identify health issues in children early and ensure they receive
Launched by the ministry of health & family welfare, government of India, under the national health mission.
It envisages Child Health Screening and Early Intervention Services
Launched by the ministry of health & family welfare, government of India, under the national health mission.
It envisages Child Health Screening and Early Intervention Services
RBSK is a government initiative that aims to screen and manage children from birth to 18 years of age for Defects at Birth, Deficiencies, Diseases and Developmental Delays including disabilities.
Icds integerated child development schemeDRISHTI .
this power point presentation describes about the ICDS scheme launched by the government of India. have a look for details. it also gives the SWOT analysis of the scheme,
try these child nutrition books
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Rashtriya bal swasthya karyakram (RBSK) is a health programme launched for screening of over 27 crore children from 0 to 18 years for 4 Ds - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities by the ministry of health and family welfare under national rural health mission (NRHM) in india
RBSK is a government initiative that aims to screen and manage children from birth to 18 years of age for Defects at Birth, Deficiencies, Diseases and Developmental Delays including disabilities.
Icds integerated child development schemeDRISHTI .
this power point presentation describes about the ICDS scheme launched by the government of India. have a look for details. it also gives the SWOT analysis of the scheme,
try these child nutrition books
https://amzn.to/2D8116s
https://amzn.to/3gpQ4LP
https://amzn.to/2VHSHRp
https://amzn.to/3gtrxWl
https://amzn.to/31G01k3
Rashtriya bal swasthya karyakram (RBSK) is a health programme launched for screening of over 27 crore children from 0 to 18 years for 4 Ds - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities by the ministry of health and family welfare under national rural health mission (NRHM) in india
Screening Tool for Developmental Disorders in ChildrenApollo Hospitals
Developmental problems are a diverse group of conditions that affect and limit children and their life-chances. A ready reference for a Paediatrician would be the first six chapters of the latest edition (18th) of the Nelson Textbook of Pediatrics (The Field of Pediatrics, Growth & Development, Psychological Disorders, Social Issues, Children with Special Health Needs and Nutrition and Human Genetics and Metabolic Diseases).
“Morbidity profile of children [6-11 years] attending Municipal Corporation P...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
it is coming under the National ruler health mission. every year various guidelines are published by CENTRAL GOVERNMENT to improve the condition of children.
Early 1 in 5 children in rural areas in U.S.have a developmental disabilityΔρ. Γιώργος K. Κασάπης
New CDC data reveal that U.S. children living in rural areas are more likely to be diagnosed with developmental disabilities and are less likely to get treatment. Here's more from the report:
•Overall trends: Between 2015-2018, nearly 20% of children ages 3-17 and living in rural areas in the U.S. were diagnosed with a developmental disability, compared to 17% of those living in urban areas.
•Diagnoses: More than 11% of kids in rural America were diagnosed with ADHD, compared to around 9% of kids in cities and larger towns. An equal proportion of kids in both geographic areas had autism spectrum disorder diagnoses.
•Treatment: Children living in rural areas were less likely than their urban peers to have seen a mental health professional or had a well-child checkup in the previous year. Children in the rural U.S. were also less likely to have received special education or early intervention services.
Evaluation of the impacts of care givers on malnourished children in Ishaka A...PUBLISHERJOURNAL
This study was done to evaluate the knowledge, attitude and practices of care givers of malnourished children less than five years in Ishaka Adventist Hospital, Uganda. This was a cross-sectional descriptive study that targeted care givers of malnourished children below five years. Forty two care givers (using fishers’ method) were sampled using simple random technique and basing on the inclusion and exclusion criteria stated therein. Data was collected using semi structured questionnaires and data was analyzed using SPSS version 22.1 and was also assisted by excel in drawing charts and figures. During data collection, absolute ethical considerations were followed. 100% response rate was achieved, and the results showed that the majority of participants 20 (48%) were aged 18-24 years and 83% were females and majority of care takers were peasants 37(88%) and surprisingly 30(74%) had never completed primary level. 71% of respondents defined malnutrition as when the child is having a big head and a swollen stomach and a majority 26(62%) mentioned poor hygiene, un safe water, diseases and infection were the causes of malnutrition, good enough majority of them had knowledge on signs of malnutrition, care takers had a mixed attitude about malnutrition and some attributed it to bad lack in the family and majority of the mothers were breast feeding their children. In conclusion, participants had good knowledge and the care takers also had good attitude towards different feeding habits and it was recommended that outreach programs targeting care takers should be emphasized.
Keywords: malnutrition, feeding habits, care takers, infection
[[INOSR ES 11(2)134-147 Evaluation of the Infant Mortality rate at Ishaka Adv...PUBLISHERJOURNAL
Evaluation of the Infant Mortality rate at Ishaka Adventist Hospital Bushenyi District
Mugaaga Paul
Department of Clinical Medicine Kampala International University, Uganda.
________________________________________ABSTRACT
Infant mortality is defined as the death of an infant before his or her first birthday, mainly caused by dehydration, diseases, congenital malformations and infections. The main objective of this study was to establish the determinants of infant mortality in Ishaka Adventist Hospital (IAH) in the months of April- July 2017, in Ishaka municipality in Bushenyi district. A descriptive cross sectional study design was used to determine the determinants of infant mortality in the study area. Majority of respondent (98%) were female and among them, 25.5% reported to have lost at least an infant and most of these respondents (70%) were married while 5% were widowed and among these, 40% reported to have lost an infant. Religiously, majority of the respondents (80%) were Christians, while 13% were Muslim and 7% constituted other religions including paganism, which showed the greatest infant mortality rate (71.4%). Most of the respondents (65%) attained primary level of education while 5% did not go to school at all, and the highest infant mortality rate (40%) was reported among these. The respondents who reported to have had preterm births appeared to have a higher infant mortality rate (65%) than those who did not report preterm births. A higher infant mortality rate (32.2%) was realized among respondents who reported their infants to have had such co-morbidities than those who didn’t report any co-morbidities like malaria and also a higher infant mortality rate (50%) was realized among infants who had not exclusively breastfed. Majority of respondents (80%) did not have children with birth defects while only 20% had children with birth defect, and a higher infant mortality rate of 70% was realized among these. Demographically, infant mortality rate is high among teenagers, the unemployed, the widowed, the pagans, and the uneducated. Direct determinants of infant mortality rate included preterm birth, birth defects, comorbidities and failure to breastfeed exclusively. Proximate determinants associated with infant mortality rate included teenage pregnancies, source of water, means of delivery and irregular immunization. Exclusive breast feeding for 6 months, mass immunization campaign up to grass root, intensive health education on health seeking behaviors and highlighting on dangers associated with risky behaviors and high quality monitoring and evaluation for quick action particularly for emergencies. There is also need for intersectional collaboration and initiation of income generating activities to boost their standards of living.
Keywords: Infant mortality, Breastfeeding, Morbidity, Determinants, Respondents.
Nutritional Status of School Age Children in Private Elementary Schools: Basi...IJAEMSJORNAL
Department of Education (DepEd) organizes nutritional programs to improve the health status of children in public schools. Likewise, the researcher believes that health awareness must be raised in private schools as well. This study aimed to affect the community to be aware and more knowledgeable about nutrition. Specifically, this study focused on the nutritional status of school age children in private elementary schools in Santa Rosa, Nueva Ecija. It sought to determine the profile of the learners, anthropometrics, clinical data and the knowledge of the learners as to dietary and the significant relationship between the profile of the learners and the nutritional status of the school aged children. With all the data gathered a meal management program was proposed. The study employed the quantitative description design. The study manifests that majority of the respondents were not yet aware of what they eat. In addition, age, greatly affects the respondent’s anthropometrics as to height. More so, age, number of siblings and family income, greatly affect the respondents’ anthropometrics as to weight. The researcher adopted the Nutritional Guidelines for Filipino program that was developed by the DOST- FNRI.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Factors Influencing Immunization Coverage among Children 12- 23 Months of Age...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Similar to RBSK : RASHTRIYA BAL SWASTHYA KARYAKRAM : DR. VINAY GUPTA MEDICAL OFFICER DENTAL DEIC KAITHAL (20)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
RBSK : RASHTRIYA BAL SWASTHYA KARYAKRAM : DR. VINAY GUPTA MEDICAL OFFICER DENTAL DEIC KAITHAL
1. International Journal of Pharmacy, Biology and Medical Sciences Vol. 3. No. 2. ISSN 2319 -3026 (July-Dec 2014)
www.gtia.co.in 10
R.B.S.K: A Multi-Crore Mission – An Introduction
and How we can Make it Better
Vinay Gupta
Medical Officer (Dental), District Early Intervention Centre, (Rashtriya Bal Swasthya Karyakram),
Kaithal, Haryana, India
Email: thevinaygupta@gmail.com
Abstract: Rashtriya Bal Swasthya Karyakram (RBSK) is a new initiative by National Rural Health Mission
(NRHM) aimed at screening over 27 crore children from 0 to 18 years for 4 Ds - Defects at birth, Diseases,
Deficiencies and Development Delays including Disabilities. Children diagnosed with illnesses will receive
follow up including surgeries at tertiary level, free of cost under NRHM. The task is gigantic but quite possible,
through the systematic approach that RBSK envisages. Implemented in right earnest, it would yield rich
dividends in protecting and promoting the health of our children.
Keywords: M.H.T, Screening, DEIC, RBSK, 4-Ds, Defects, Diseases, Deficiencies, Development Delays,
Anganwadis, Schools, Dental Diseases, Referral, Diagnosis, Treatment.
Accepted On: 23.10.2014
1. Introduction
The Ministry of Health & Family Welfare under
the National Rural Health Mission has launched
the Child Health Screening and Early
Intervention Services, a systemic approach of
early identification and link to care, support and
treatment to meet these challenges. It is
estimated that about 270 million children (Table
1) including the new-born and those attending
Anganwadi Centres and Government schools
will be benefitted through this programme.
Table 1. Target Group For RBSK
1.1 Magnitude of Birth Defects, Deficiencies,
Diseases, Developmental Delays and Disabilities
In Children
1.1.1 Defects at Birth
Globally, about 7.9 million children are born
annually with a serious birth defect of genetic or
partially genetic origin which accounts for 6 per
cent of the total births. Serious birth defects can
be fatal at times. For those who do not receive
specific and timely intervention and yet survive,
these disorders can cause irreversible life-long
mental, physical, auditory or visual disability.
Atleast 3.3 million children under five years of
age die from birth defects every year and
another 3.2million of those who survive may be
disabled for life. More than 90 per cent of all
infants with a serious birth defect are born in
2. International Journal of Pharmacy, Biology and Medical Sciences Vol. 3. No. 2. ISSN 2319 -3026 (July-Dec 2014)
www.gtia.co.in 11
low and middle income countries. Cutting across
countries and their economic status, 64.3 infants
per thousand live births are born annually with
birth defects. Of these, 7.9 have cardiovascular
defects, 4.7 have neural tube defects and 1.2
have some form of hemoglobinopathy, 1.6 have
Down’s Syndrome and 2.4 have G6PD
deficiency [2] (All figures are in per thousand).
With a large birth cohort of almost 26 million
per year, India would account for the largest
share of birth defects in the world [1]. This
would translate to an estimated 1.7 million
babies born with birth defects annually.[1] In the
study conducted by National Neonatology
Forum, congenital malformations were the
second commonest cause (9.9%) of mortality
among stillbirths and the fourth commonest
cause (9.6%) of neonatal mortality and that
accounted for 4 per cent of under-five mortality.
Preliminary reports of metabolic studies from
five zonal centres covering 5 lakh new-borns has
revealed an incidence of congenital
hypothyroidism of 1 in 1000 live births[2].
Messages emerging from this study connote that
diagnosis is often delayed due to lack of
awareness among the professionals and
ignorance about the technical expertise required
to handle such cases of birth defects.
A similar prevalence rate of 1 in 1000 was
reported for Down’s syndrome in India [1].
There are several reports of the incidence of beta
thalassemia trait from different parts of the
country which varies from less than 1 per cent to
as high as 17 percent [2] making it imperative to
have a policy on universal screening in selected
geography and population groups.
1.1.2 Deficiencies
Evidence suggests that almost half of children
under age five years (48%) are chronically
malnourished [2]. In numbers it would mean that
more than 47 million children under five years
are stunted, 43 per cent of children under age
five years are underweight for their age and
about 20per cent of children younger than five
years of age are wasted. Over 6 per cent of
children less than five years of age suffer from
Severe Acute Malnutrition (SAM). However,
recent survey conducted in 100 worst affected
districts showed SAM prevalence of 3 per cent
in children less than five years of age. Anaemia
prevalence has been reported as high as 70 per
cent amongst under five children largely due to
iron deficiency. The situation has virtually
remained unchanged over the past decade.
During pre-school years, children continue to
suffer from adverse effects of anaemia,
malnutrition and developmental disabilities,
which ultimately also impact their performance
in the school.
1.1.3 Diseases
As reported in different surveys, the prevalence
of dental caries varies between 50-60 per cent
among Indian school children. Rheumatic heart
disease is reported at 1.5 per thousand among
school children in the age group of 5-9 years and
0.13 to 1.1 per thousand among 10-14 years. The
median prevalence of reactive air way disease
including asthma among children is reported to
be4.75 per cent.
1.1.4 Developmental Delays and Disabilities
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. The prevalence of
early childhood stunting and the number of
people living in absolute poverty could be used
as proxy indicators of poor development in
under five children. Both of these indicators are
closely associated with poor cognitive and
educational performance in children and failure
to reach optimum developmental potential [1].
Further, Special New-born Care Units (SNCU)
Technical Reports have reported that
approximate 20 per cent of babies discharged
from health facilities are found to suffer from
developmental delays or disabilities at a later
age [2].
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Table. 2 Health Conditions Covered Under RBSK
1.2 Mobile Health Teams
Each Mobile Health Team constitutes Two
Ayush Medical Officers (each male and female)
, One Pharmacist and One ANM. The numbers
of teams depend upon the size of the District and
according to the target screening population of
the rural areas. In some areas Urban Teams are
also deployed to cover the government schools
and Anganwadis in urban area of district. These
mobile health teams screen every child
meticulously, from height to weight, blood
pressure, eyesight etc. Each student is given a
unique ID which is quoted in all the future
correspondences among the RBSK staff and for
further follow up of the child. All the students
are given screening cards cum referral card on
which their unique ID, name, parent’s name,
age, class in which they study, their vital
parameters are written by Pharmacists. Online
entries are also done in the software of NRHM
website, means each and every student’s name,
age, school, height, weight, etc. CUG (Closed
User Group) numbers are given to every
member of Mobile Health Teams to
communicate with each other free of cost and to
take follow up. Teams screen all the children for
Different Health Conditions (Table 2) up to 6
years of age registered with the Anganwadi
Centres and all children enrolled in Government
and Government aided schools. In order to
facilitate implementation of the health screening
process, vehicles are hired for movement of the
teams to Anganwadi Centres, Government and
Government aided schools. A tool kit (Table 3)
with essential equipment for screening of
children is also be provided to the Mobile Health
Team members. Some students are given
medicines on the spot by Ayush Doctors like
Albendazole tablets, Iron folic acid tablets,
analgesics etc. Children and students
presumptively diagnosed to have a disease/
deficiency/disability/ defect and who require
confirmatory tests or further examination are
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referred to the nearest PHC (Primary Health
Centres) or CHC (Community Health Centres)
(Table 4) , D.E.I.C (District Early Intervention
Centres) or to the designated tertiary level public
sector health facilities through the DEICs.
Table 3. Tools Provided to Mobile Health Teams
Table 4. Referral Process for Different Health Conditions
1.3 District Early Intervention Center (DEIC)
An Early Intervention Centre is established at
the District Hospital. The purpose of
EarlyIntervention Centre is to provide referral
support to children detected with health
conditionsduring health screening. A team
consisting of Paediatrician, Medical officer,
Dentist, Staff Nurses, Paramedics, etc.(Table 5)
are engaged to provide services. There is also a
programme managerwho carries out mapping of
tertiary care facilities in Government institutions
for ensuringadequate referral support.
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Table 5. Composition of Staff in DEIC
The DEIC team promptly responds (Table 6) to
and manage all issues related to developmental
delays, Hearing defects, vision impairment,
neuro-motor disorders, speech and language
delay, autism and cognitive impairment. Beside
this, the team at DEICs are involved in new-born
screening at the District level. This Centre has
the basic facilities to conduct tests for hearing,
vision, neurological tests and behavioural
assessment. Once a referred patient comes to
DEIC, Data Entry Operator at DEIC makes and
entry of student’s/child’s unique ID and send her
to the respective Staff for which he/she has been
referred. Every staff member has his own entry
register in which against the entry of the child,
his final diagnosis, treatment plan and treatment
given to the child is recorded. A status to this
child is allotted (either treated or Under
treatment) the under treatment children are
contacted and called for further follow ups.
Some Patients can be treated at the DEIC level,
but some need to be referred to higher institutes
for tertiary level treatments (Fig.1.), mostly
surgeries.
Table 6. Goals of DEIC
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Fig. 1. Flow Chart of Referral System
Obviously it’s a wonderful programme with a
huge mission to achieve, we have to have make
extra efforts and make some of the changes and
additions to this programme to make it a
successful edition of the National Rural Health
Mission.
2. How Can we Make R.B.S.K.
Better
2.1 By Changing the Objective Diseases and
Format of Reporting
The present format contains only 29 or 30
diseases and also the diagnosis cannot be made
on the spot my Mobile Health Team, because a
pain in ear cannot be said Otitis Media on the
spot. Also there are vast numbers of diseases
which also need to be included in the screening
format. The formats for the DEIC and mobile
health teams need to be changed, instead going
into complications of males females columns,
age group columns, the main objective should be
how many total are diseased and referred to
DEIC and how many of them are treated or
under-treatment. The format of the mobile health
team should be in the form of organ systems,
like we have in physiology and medicine
subjects. There should be a list of organs
systems, like if any child complains of weak
eyesight the disease should be noted as
provisional diagnosis in the neurosensory
system. Later on the disease should be
diagnosed in the DEIC. This will help in
thorough screening of children’s organ systems
and full body and will simplify the procedure
and chief complaint of the child can be more
properly understood and a final diagnosis is
reached. The reporting format of DEIC should
be disease wise because here the final diagnosis
is made. In the above example the disease will
come as refractive error. I cite you a loophole in
the present format of reporting. There is a point
in format Dental Conditions or Dental Diseases.
This point slips the other oral health problems.
The child is only screened for dental caries. A
child with fluorosis is referred to the DEIC
because the MHTs cant properly diagnose and
differentiate between extrinsic and intrinsic
stains of teeth, in a normal child with erupting
teeth they may diagnose as malocclusion, a
proper orientation and training in this regard
should be made. These cases are false positives
and only create hindrance in detecting and
following up the true positives. The column
name can be changed to Oro-Dental System,so
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that the screening can be done much better
because the chief complaint will be much better
addressed. Most important is, in present system
child is screened physically by the mobile health
teams, many serious diseases which are blood
borne and students may be carrier of such
diseases goes undetected, like Hepatitis B and C,
HIV, typhoid etc. A blood sample collection
arrangement should also be made in the Mobile
Health Team, a lab technician post can be
created in MHT.
2.2 Monitoring OF MHT
There should be regular monitoring of Mobile
Health Teams on weekly or daily basis, to check
whether they are screening children and students
properly according to the guidelines. In some
states G.P.S is fitted in the vehicles of Mobile
Health Teams to track their locations. But
besides location there are other things too to be
monitored. The monitoring is not an easy task;
every time state headquarters can’t make a vigil
on the working of field. The DEIC staff should
be engaged in this. Members of DEIC turn by
turn can randomly check any mobile health team
about their punctuality, presence and screening
procedure and should report to the Manager or
Civil Surgeon of the District.
2.3 Take Private Medical and Dental Colleges
on Panel of RBSK
Our government hospitals and Government
institutes already remain packed with patients,
but our goal is to treat every child with care and
on first preference basis. We have large number
of private medical and dental colleges, in which
under the supervision of expert staff medical and
dental students provide treatment to the public
and too at very low cost or sometimes free of
cost. In the present system suppose a child has
fluorosis, the treatment is capping of teeth. But
in RBSK now we don’t arrange the cosmetic
treatment for the patient, but if we will take the
private dental colleges on the panel the child can
be referred there and treatment can be done
without any charges or minimal charges. The
treatment in these colleges is done by students
under supervision of the senior professors. The
same can be done in the case of medical
treatments. The child can be referred to nearby
empaneled private medical colleges for smaller
and prosthetic treatments.
2.4 Screening of Children in Slums
There are many children who are in slums who
either don’t go the school or anganwadi, a
special Mobile Health Team should be created
for such children in every district, or monthly or
weekly duties can be assigned for screening of
such children. There is a column in reporting
format labelled as ‘self’, such children can be
screened and treated under this column.
2.5 Software’s should be Designed for Easy
Reporting
The register system should totally be discarded.
Because a lot of manpower and time is wasted in
managing registers. There should be special
softwares designed for on the spot entry of the
screened children that operate without internet
connection. Because 3G internet connection or
network is not everywhere, also it will cut off
the expense that comes on the individual internet
connections given to the Mobile Health Teams.
Entries can be made easily in the specially
designed softwares and later on after week’s end
or month’s end the software can be connected to
internet in DEIC by all teams that automatically
uploads all the data to the internet without
manual entries. Digital Thumb Impression
should be taken on the spot and should be saved
in the software so that tracking of child can be
easily done because the students’ class change
from year to year, time wasted in searching the
child’s card will be saved also the fake entries if
any can be prevented, also it will be ensured that
same child is receiving the treatment at DEIC or
Tertiary Centres who is screened in field. See
we have to make work more clinical not clerical.
The whole reporting should be revised and made
more efficient.
2.6 M.H.T should have More Powers
There are reports that the Anganwadis and
school staff does not co-operate well with the
mobile health teams. Strength of the students in
school may differ as routine, but it must be full
or near full on the day of screening of Mobile
Health Team. Teachers or Principal should be
made responsible for this and to provide full
technical and other support to the Mobile Health
Teams. These kind of problems can be solved by
giving MHT more teeth by giving them
feedback form for the behaviour and co-
operation of school and anganwadi staff, that
should be directly reportable to the District
Commissioner. Also the MHT are going in each
and every school and anganwadi of India, It’s a
brilliant chance to inspect these for the basic
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infrastructure and basic facilities that directly
relates to the children’s health, like toilets,
drinking water facility, first aid boxes etc. and
they can also be used to take a vigil on the other
school health programmes like Weekly Iron
Folic Acid Supplement (WIFS) etc.
2.7 More and More on the Spot Treatments
We cannot wait for every detected screened
child to come to DEIC and receive treatment,
because there are many factors associated with
it. The students we screen in the government
schools are so poor to bear travel expenses to the
DEIC, parents of children are daily wagers who
cannot miss a single day of their work as they
earn their daily bread from it, we have to bridge
up that gap. On the spot treatments by DEIC
staff should be made available on monthly basis,
like organising DEIC camp in the area where
most number of diseased children is found.
Mobile dental van should be deployed in every
district, the mobile dental vans from nearest
dental colleges can be hired on weekly or
monthly basis, because on the spot dental
treatment for dental patients is nearly impossible
without proper setup. And number of dental
patients is highest among screened children.
Roadways buses can be hired to transport
students from their areas to DEIC. Students who
can be treated in a single visit and could not bear
travel expenses can be filtered out and they
should be taken to DEIC.
2.8 Taking Parents and Guardians into
Confidence and Provision of Consent Form
In the dealing with the diseases and treatment of
children and students, we cannot surpass
parents, because they know better about with
which problem their ward is suffering from, also
they must be taken into confidence before doing
any treatment of their child. There should be a
provision of consent form on which parents and
guardians must sign before rendering any
treatment specially surgical treatment, suppose a
child arrives in the clinical setup and needs
dental extraction, we must take child’s parent
into confidence and their guardians before
proceeding, sometimes child comes with sibling,
or relatives or teacher, in that case the surgical
treatment should be put on hold, if no
emergency and proper follow up of that child
should be taken.
2.9 Incentives to Mobile Health Teams
and DEIC Staff
Mobile Health Teams are backbone of this
programme, to increase their efficiency, there
should be special incentives for teams which are
performing outstandingly. This will help
pumping confidence in them, because we need
extraordinary efforts to make our mission
accomplished, this can only be done if give
credit is given to persons who are really working
towards this mission from their body and soul.
Likewise for the DEIC staff special incentives
should be granted, who work efficiently. If we
can sanction lakhs to a referred child for his / her
operation, can’t we give incentives to those who
are making this programme to function and a
success.
3. Future of R.B.S.K.
India, a country where implementation of a
programme at a level of billion populations
becomes a mission, and we have seen many
missions that are completed and targets have
been achieved. Best to mention is Pulse Polio
Programme. Although the RBSK is in its
budding stage and it needs un tired efforts to
make it a successful carnival, but if grown fully
it will not stop to the boundaries of Anganwadis
and Government schools, but its reach would be
widened to private schools and colleges, because
future not only lies in the toddlers and school
going children, but also in the youthful
generation that is being nurtured in the colleges
and private schools and healthy life is after all
their right too.
4. Conclusion
Needless to say, those dividends of early
intervention would be huge including
improvement of survival outcome, reduction of
malnutrition prevalence, enhancement of
cognitive development and educational
attainment and overall improvement of quality
of life of our citizens. Bringing down both out of
pocket expenses on belated treatment of diseases
/ disabilities (many of which become highly
debilitating and incurable) and avoidable
pressure on health system on account of their
management are among obvious benefits.
Additionally, the Child Health Screening and
Early Intervention Services will also provide
country-wide epidemiological data on the 4 Ds
(i.e., Defects at birth, Diseases, Deficiencies and
Developmental Delays including Disabilities).
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Such a data is expected to hold relevance for
future planning of area specific services.
References:
[1] Ministry of Health and Family Welfare,
Government of India. Operational
Guidelines: Rashtriya Bal Swasthya
Karyakram. Page–5 . National Rural Health
Mission : New Delhi. 2013. Print.
[2] Ministry of Health and Family Welfare,
Government of India. Operational
Guidelines: Rashtriya Bal Swasthya
Karyakram. Page - 6. National Rural Health
Mission: New Delhi. 2013. Print.