Clinical profile and referral pattern among children with congenital heart disease (CHD) before and after introduction of the RBSK scheme
Journal Title: Medpulse International Journal of Pediatrics - Year 2018, Vol 6, Issue 1
Abstract
Background: Congenital Heart Disease (CHD) is the most common congenital malformation among children, often requiring intervention for survival. The nature of the defect, availability of optimum intervention at the right time and nutritional status of the children are the key determining factors of outcome. The Rashtriya Bal Swasth Karyakram (RBSK) Scheme was launched in India in 2013, to address 4D's; defects, deficiencies, diseases and developmental delay/ disability among 0-18-year-old children. RBSK is a big boon in this regard and has resulted in better coverage and cashless intervention in children with CHD. This programme is implemented through Govt. and accredited private facilities. Objective: To assess the clinical profile, nutritional status and referral pattern among children with CHD attending two tertiary care teaching institutions, one from Govt. and one from private sector, after the implementation of the RBSK Scheme and to compare the data with that from the Govt. facility, before implementation. Methods: Consecutive cases with CHD attendingtwo South Indian Centres, after the introduction of RBSK Scheme; SAT Hospital, Govt. Medical College, Thiruvanathapuram, Kerala, South India, a tertiary care teaching hospital in Govt. Sector (Centre A) and Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari Dst., Tamil Nadu, a tertiary care teaching hospital in Private Sector(Centre B), during the period, 2015- 2016, were enrolled. The children in subgroups A and C, were mostly in-born babies or those referred from other hospitals. The children in subgroup B were older children, referred from medical camps and school health programme. Referral pattern, type of CHD and nutritional status were recorded. These parameters were compared with similar unpublished data collected in 2010, from the Govt. facility, before the introduction of the Scheme. Results: There were 70 children in Centre A (subgroup A), 63 children in Centre B (subgroup B), compared to 64 in the pre-RBSK subgroup C. The socio-economic status was comparable in all three subgroups and majority belonged to middle and lower class. There was a significant increase in the referral of infants and those with critical CHDs in the Govt. facility, in comparison to older children and those with non-critical CHDs in the Private facility. There was a significant favorable trend (P <0.05) towards female referral in the Govt. facility after the Scheme. In all three subgroups, majority were underweight and had varying grades of stunting and wasting, indicating both chronic and acute malnutrition. ACHD was more, compared to CCHD, in all three subgroups. Among ACHD, VSD and among CCHD, TOF were the most common defects. There was a positive trend in the referral of children who were severely underweight, stunted and was tedunder the scheme. Conclusion: There was significant difference in the clinical profile and referral pattern among children with CHD after the implementation of the RBSK Scheme and between the Govt. and the private facility. Majority were underweight, stunted and wasted, indicating both chronic and acute malnutrition. More children with critical CHD, infants, females and those with malnutrition were getting referred to the Govt facility and more older children and those with noncritical CHD were getting referred to the private facility under the Scheme. This comparative study is presented in view of its public health importance.
Authors and Affiliations
Elizabeth K E, Vidhya V K, Nargis R, Geetha V
Keywords
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