Developmental Difficulties Prevalence and Management Capacities Among Children Including Genetic Disease in a Coastal District of India

the period. From the side of deficiencies, severe acute malnutrition has mostly occurred (66.80 %) and a small number of children were affected with goiter (1.70%). Conclusion: Through this study, it is observed that the incidence of birth defects, as well as genetic disease burden, is high in the Visakhapatnam district. Hence there is a need for strengthening of management services for these diseases in this region. the prevalence the screened to find out in


Introduction
Birth defects (BD's) are one of the most frequent conditions that pediatricians experience in clinical practice. The major clinical conditions can be grouped as genetic disorders and congenital anomalies [1]. When the child fails to meet developmental milestones related to daily living, it is considered as developmental delay (DD) [2]. Over the past 12 years, the occurrence of DD's has increased by three percent in children under the age group of five and has reached up to 15 % [3]. Worldwide, 1.5% -19.8% of children have DD. In India, the children who are discharged from the sick newborn unit have a high prevalence of DD's. The government of India initiated the 4D's approach through District early intervention center (DEIC) for the treatment and support of these challenged children [4]. For ensuring proper health care for children, it is necessary for early detection and in time management of disorders [5]. If the DD's are not intervened in time, it can lead to manifested functional disabilities in children. In such cases, the children are being subjected to treatment after the identification of these disabilities [6].
DEIC is engaged with a team consisting of medical officers, Pediatrician, Paramedics, and staff nurses and also provides referral support to children (1month-18 years) diagnosed with health conditions during the screening period. The present study investigates the prevalence of the conditions screened among the children attending the DEIC center at Visakhapatnam for the period of 5 years (January-2016 to December-2020) and also to find out the adequacy of institutional capacities in child health screening.

Materials and Methods
The present study was aimed to assess the burden of DD's and their trend in the DEIC, Visakhapatnam, and also to analyze the availability of manpower as well as infrastructure, so as to suggest possible improvements in the management of such diseases.
Necessary permission was obtained from the institutional ethics committee, Andhra University, and also from the Andhra Medical College in this regard. In this center, BD's were diagnosed by the pediatrician through a medical examination. As part of the study,

Results
Total 26423 children with DD's consulted the DEIC during the investigation time frame. These children were classified under the 4D's (i.e., defects, deficiencies, diseases, and disabilities) approach.       On investigation of the institutional amenities like manpower and diagnostic services accessible in the DEIC, it is observed that the posts of a pediatrician, dental specialist, physiotherapist, optometrist, audiologist cum speech therapist, early interventionist cum exceptional instructor, lab technician, staff nurse-1, staff nurse-2, and social worker were filled as per the sanctioned strength and they were working throughout the study period.
The post of a medical officer, psychologist, and manager stayed empty all through the examination time frame. Pediatricians and and awareness towards genetic disease management. Regular record maintenance is taking place in this center; however, much information related to genetic disorders is missing. Also observed that the center does not have genetic counselors. It was found that there are no investigation facilities for genetic diseases. Related diagnostic tests were virtually non-existent in the center with the exception of basic blood, serum, and urine diagnostic tests. The needy children are being referred to KGH or private diagnostic laboratories for specific genetic tests and for confirmation.

Discussion
BD's are persisting throughout the world. Due to the high mortality rate of affected infants in low-income countries, it can be admitted that the impact of birth defects is higher in these countries. Even in the children who have BD's and still survive, due to no timely intervention, these disorders are causing irreversible lifetime complications with mental or physical disabilities and these children are about 3.2 million in number around the world per each year [7]. The present study found a significantly increased prevalence of BD's in children in the selected region. Our study revealed that a total of 26,423 cases were admitted through the 5 years period. This prevalence is higher than that reported by prajna Bhide and Anita Kar wherein it was stated that the affected births with surveillance of congenital anomalies are as many as 472,177 in India each year [8].
The findings of the present study reveal that the gender distribution of admitted patients is 14932 (56.51%) male and 11491 (43.48%) female. Such a study is also made in the past by Valla et al and it was identified that the male sex is associated with a high risk of having DD's [9]. Another previous study by Dabar et al. illustrates that there is no relationship between gender and DD's [10]. With regard to BD's, our findings provide evidence of the rise of these defects over time. Majority children had congenital deafness (218; 22.66%) followed by cleft lip & palate (212, 22.03%). Our study confirms the findings of several other studies which reported that the prevalence of congenital deafness is more in India and 63 million people suffer from significant auditory loss, due to a lack of skilled manpower and human resources for the management of these defects [11]. The second most common defect was cleft lip & palate. Our estimates however have to be considered as bestavailable data, as previous analysis on the cleft lip in south India also reported similar findings [12,13].
In respect of deficiencies, during the selected study period the most common deficiency was severe acute malnutrition with 1519 (68.14%) cases followed by severe anemia with 430 (19.29%) cases.
Our findings are also supported by one of the previous surveys conducted by measuring weight for height during a ten-year period which states that children under the age of five years are mostly suffering from severe acute malnutrition [14]. Regarding anemia, similar findings reported by Avina Sarna et al., who identified that the prevalence of anemia is higher from newborns to adolescents in India [15].
Regarding diseases, it is observed that most of the children had dental caries. The admission trend of these cases is high in 2016 and then declined in the next year and again rises from 2017 to 2019. Previous findings by Abhishek Mehta et al., are supporting these trends, wherein it was reported that a large number of Indian children have been affected by dental caries [16]. In the present study, we also observed a gradual declining trend of otitis media, skin conditions, and reactive airway disease. Similar findings were observed in the previous studies that the prevalence of otitis media [17], skin conditions [18], and reactive airway disease [19] are low during the past years. This is probably due to the reason that the people are now much aware of these diseases, and they approach the health care personnel in time.
From the side of disabilities, vision impairment has occurred in most of the children in about 3231 (20.55%) numbers and the occurrence was alternatively rising and declining through the years.
Similar findings were observed by Murthy et al., that the incidence and prevalence of loss of sight in children is varying during their study period in India [20]. This was followed by language delay with (2438, 15.51%) cases, and their occurrence has risen from 2016 to 2018 and then declined. Overall, these results are slightly higher when compared to the prevalence in developed countries as reported by Wren [21]. The present study reveals that the trend of admission of neuromotor impairment cases was being consistent with a large number up to 2019 and then diminished. In the past, population-based studies reported that the neurological disorders in rural India are higher and were found in about 6-8 million people [22]. The present study divulges that the peak incidence of deafness was during 2018; and this finding corroborates with the study findings of Nagapoornima et al. wherein it was reported that due to failure of timely screening of newborns, most of them are facing hearing impairment in India [23].

Conclusion
Through this study, the institutional facilities at DEIC, Visakhapatnam as well as the high incidence of birth defects in Visakhapatnam district were observed. The study discloses the need for strengthening management services for these disorders in this region so that the prevalence of birth defects can be minimized.

Statement of Ethics
This is a case report study and does not include the experiment on animal and human subjects. Written informed consent was taken from the study health organization before the data collection and personal identifiers were removed during the data analysis. The approval for this study was obtained from the Andhra University

Conflicts of Interest
The authors declare that there are no conflicts of interest regarding the publication of this article.

Funding
The present research work was funded by the Indian Council

Data Availability Statement
This is an observational study done at the DEIC Visakhapatnam and the availability of the data is accessible upon request to the corresponding author.