CDC Kerala 2: Developmental intervention package for babies <1,800 g--outcome at 6 mo using DASII.

OBJECTIVES: To describe the experience of using developmental intervention package among low birth weight babies less than 1,800 g and developmental outcome at the end of 6 mo monthly intervention. METHODS: Babies below 1,800 g, discharged from neonatal intensive care unit (NICU) of Sree Avittom Thirunal (SAT) hospital, over the last 3 y, were followed at Child Development Centre (CDC) Kerala and offered monthly evaluation by different tools and developmental intervention using a package by trained developmental therapists and mothers were encouraged to continue the same at home. At the end of 6 mo the developmental outcome was assessed using Developmental Assessment Scale for Indian Infants (DASII). RESULTS: Out of a total of 821 babies enrolled for early stimulation program, 740 babies successfully completed 6 mo follow up and stimulation program. Comparing the outcome at 4 and 6 mo, both grading for head holding and gross motor part of DDST showed a statistically significant reduction in abnormal findings. At 6 mo assessment on DASII, motor DQ abnormalities were a high 80% for 600-900 g, as against 17.1% abnormalities for 1,500-1,800 g birth weight group. CONCLUSIONS: The results of this intensive early stimulation program for babies below 1,800 g have shown the importance of monthly early intervention using a mother oriented systematic developmental stimulation package.

A panchayat level primary-care approach for adolescent services.

OBJECTIVE: To develop a model for providing community adolescent care services in the primary care setting METHODS: Need assessment was done among adolescents and perceived problems of adolescents were studied using qualitative and quantitative methods. Based on the results of these studies, a Family Life Education (FLE) module was prepared. Awareness programs were organized for all stakeholders in the community on adolescent issues. All anganwadi workers in the panchayat were trained to take interactive sessions for all the adolescents in the panchayat using the FLE module. Ward based Teen Clubs were formed in all the 13 wards of the Panchayat separately for boys and girls and FLE classes were given to them through anganwadi workers. An Adolescent Clinic was set up to provide necessary medical and counseling facilities. Adolescent Health Card was distributed to all Teen Club members and those who attended the adolescent clinics. RESULTS: The present approach stresses the need and feasibility of adolescent-centered, community-based interventions. The authors' experience showed that before starting any adolescent program, community awareness generation about the need and content of the program is very important for its success. The experience of this model has made it possible to up-scale the program to seven districts of southern Kerala as a service model. CONCLUSIONS: The experiences of the program gave a realistic picture of the needs and problems of adolescents and a simple feasible model for providing services to adolescents in the primary care setting that can be easily replicated in other parts of India.

Validation of Home Screening Questionnaire (HSQ) against Home Observation for the Measurement of Environment (HOME).

This study was done to validate the screening tool Home Screening Questionnaire (HSQ) against the gold standard Home Observation for the Measurement of Environment (HOME) inventory, using diagnostic test evaluation. Both HOME inventory and HSQ were administered by separate observers, with children less than 3 years of age, among 200 families belonging to 14 anganwadi areas. There was a high sensitivity of 83 and a high specificity of 82 observed for a cutoff point of less than or equal to 19 on HSQ against HOME Inventory as Gold Standard, as was also observed in the Receiver Operating Characteristic (ROC) curve. The likelihood ratio (LR) for positive test was 4.6 (95 % CI, 3.3 to 6.9) which implies that the families with poor home environment are 4.6 times more likely to have the HSQ score less than or equal to 19 as compared to normal families. The results of this study imply that we can confidently apply the HSQ in developmental evaluation clinics and reserve HOME inventory for research purposes.

Developmental delay and disability among under--5 children in a rural ICDS block.

We conducted this study to assess the prevalence of developmental delay, deformity and disability among 0-5 age group childrenn in Pattanakkad rural ICDS block, selected at random from among the ICDS blocks in Alappuzha District, Kerala, India. Of 12520 children upto 5 years in this block, there were a total of 311 children with developmental delay, deviation, deformity or disability giving a prevalence of 2.5 % (95 % CI, 2.22 to 2.77). The prevalence of developmental disabilities up to 2 years was 2.31 (95 % CI, 1.91 to .71) and from 2 to 5 years 2.62 % (95 % CI, 2.25 to 2.99). The prevalence obtained in the study has important policy implications for identifying childhood disabilities in the community.