Saturday, May 20, 2017

Early Detection and Referral : The Better Prognosis

In a recent household survey on disability (Study on Living Conditions among people with disabilities in Nepal, 2015) 33% of respondents reported birth or congenital defects as cause of their condition. The same study also highlighted that 0-10 years of age bracket consisted of the highest number of children with disabilities. Many birth impairments cannot be prevented, however their negative effects on the development of children can be minimized through early intervention.
Early suspicion, identification, proper diagnosis and screening of the cases are the major vitalizing steps for each health professionals to spot  the "Early Detection" of impairments.  Following "Early Detection" of the impaired children "Referral Mechanism" is next extensive gait of rehabilitation. Once the impairments are detected earlier and referred for appropriate service, the prognosis is much better compared to the neglected cases.

Prevention, treatment and rehabilitation are possible for 70% of birth impairments in children. Of the visible birth impairment 25% are very severe resulting in early death, 50% are treatable or correctable whereas 25% result in long term disabling impairment despite of best of treatment.  Here, "Impairments" are specific decrements in body functions and structures, often identified as symptoms or signs of health conditions such as club foot, cleft lip/palate and spina bifida. Most of the impairments such as Club foot, Spina bifida, Congenital Torticollis, Hydrocephalus, Down Syndrome can be easily visible during birth. If these impairments are early detected by  Health workers involved in newborn and child care (Auxiliary health workers (AHW), Health assistants (HA), Auxiliary nurse midwifes involved in delivery, post-natal care and immunization) then it could be the first line of intervention which would downturn the long term disability. 

Let's take an example of a child born with Club Foot in some health post at Jajarkot (Remote district of Nepal). Health worker attending a child at birth if happens to detect the club foot at that very first stage and counsel the parents on pros and cons of early rehabilitation to take a child to the near by center for Ponsetti management at Hospital and Rehabilitation Center for Disabled Children, Banke, would help prevent a long term disability. This piece of information to the parents would mark a significant guidance to the family.  Unfortunately, what i have been observing is  most these children appear to receive rehabilitation service at age of 10-15, by that time disability is neglected and the cost for rehabilitation soars high with poor  prognosis. Isn't this due to the lack on the knowledge of early detection???  that results into late prognosis and generating long term disabilities in the country.

Consequently,  training/educating Community Health workers, Female community health volunteers on how to early detect an impairment in child and provide the appropriate referral service to the detected cases  would be one of the biggest  investment in the country to strengthen the human resource for health. As per my experience, prior to training, conducting training need assessment to different levels of Health professionals such as Health workers who are posted in health post, primary health centers, Female community Health Volunteers who are the local women working voluntarily in the community is the fundamental step. The findings from training need assessment will provide a clear vision on the existing knowledge of each health professionals on the early detection, difference between impairments and disability, referral mechanism, management and follow up mapping of an impaired child. Therefore, creating a base of it, developing the content of Training materials can be decided.  In addition to it, encouraging  care givers to be  the part of "Parent counseling" session would also some how mark a sense of satisfaction, determination, peace of mind and acceptance on the reality that they are not only the ones who have been blessed with that particular "Special Child".