|Year : 2017 | Volume
| Issue : 1 | Page : 1-2
Rashtriya Bal Swasthya Karyakram: Bringing thyroid to center-stage
Naresh Kardwal1, Mudita Dhingra2, Sanjay Kalra3
1 Civil Surgeon Office, Bharti Hospital, Karnal, Haryana, India
2 Department of Paediatric Endocrinology, Rotary Hospital, Ambala Cantt, Haryana, India
3 Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
|Date of Web Publication||20-Feb-2017|
Department of Endocrinology, Bharti Hospital, Karnal, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kardwal N, Dhingra M, Kalra S. Rashtriya Bal Swasthya Karyakram: Bringing thyroid to center-stage. Thyroid Res Pract 2017;14:1-2
|How to cite this URL:|
Kardwal N, Dhingra M, Kalra S. Rashtriya Bal Swasthya Karyakram: Bringing thyroid to center-stage. Thyroid Res Pract [serial online] 2017 [cited 2017 Nov 18];14:1-2. Available from: http://www.thetrp.net/text.asp?2017/14/1/1/200562
With the upsurge in the prevalence of chronic disorders, the Government of India has rightfully focused attention on these conditions. Another chronic noncommunicable disorder which is increasing in prevalence is thyroid disease. Early identification and management of thyroid dysfunction help reduce avoidable morbidity and mortality, with improvement in the quality of life. For best results and maximal impact, such screening and management interventions should be easy to perform, low cost in nature, and embedded in the existing public health structure.
The Government of India operates a comprehensive public health program; focusing on children and adolescents. The Rashtriya Bal Swasthya Karyakram (RBSK) (National Child Health Programme) was launched in 2013 and replaced the earlier Indira Bal Swasthya Yojana. The program targets babies born at public health facilities, and at home, preschool children in rural areas and urban slums, and school going children enrolled in government and government-aided schools.
RBSK's child health screening and early intervention services are envisaged to cover thirty important health conditions. Thyroid health finds apt mention in RBSK's charter of activities as “goiter” (which is listed under deficiencies). “Hypothyroidism” is listed in the “others” category and can be taken up by various states, based on epidemiologic data and availability of testing/specialized support facilities. Various conditions or symptoms, which may be due to hypothyroidism, are also listed by RBSK. These include anemia; developmental delay, including hearing deficit, neuromotor impairment, cognitive, and language delay; and also learning disorders.
Congenital hypothyroidism is reported to be present in 1:2640 births in India. Health workers should be aware of the existence of this endocrine condition, as it is the most common preventable cause of mental retardation. Clinical features suggestive of congenital hypothyroidism include hypotonic posture, puffy facies, macroglossia, umbilical hernia, dry skin, lethargy, delayed developmental milestones and growth failure. Subtle clinical features during early weeks of life are prolonged neonatal jaundice (raised indirect bilirubin), constipation, (hoarse cry with dull expression), an open posterior fontanelle and dry skin.
Hypothyroidism, usually autoimmune, is also found in adolescents, especially girls. This may present as growth retardation, premature breast development or per vaginal bleeding (without pubic hair), goiter, menstrual disturbance, or anemia. Hypothyroid boys may exhibit macroorchidism.
Effective training of paramedical staff can help in the efficient screening of these conditions. Armed with low cost tools such as growth charts, stadiometers, weighing machines, and milestone charts, these workers can detect school going children at risk of hypothyroidism, and refer them to community health centers for biochemical screening.
Inspection, and palpation of the neck, so as to grade goiter, can be taught to medical personnel. The World Health Organization grading  is used for the same. In contrast to earlier decades, when hypothyroidism was usually goitrous, being caused by iodine deficiency, hypothyroidism that is encountered today is usually autoimmune in nature, and is often agoitrous.
Coordination with school teachers can help identify children with poor scholastic performance, who, too, may be hypothyroid.
More emphasis, therefore, is needed on taking a good history in children, so as to elicit symptoms of poor gain in height, developmental delay, or pubertal dysfunction. Simple clinical checklists including a few pertinent symptoms and signs can serve as useful aids to decision making, and as triage tools, to identify children who need to be referred for biochemical investigations. Such an approach will help minimize the burden of untreated thyroid disorders [Box 1] these checklists are complementary to the existing list of health conditions covered in RBSK. The list is such that diagnoses, symptoms, and signs overlap each other to a significant degree, especially when listed as “deficiencies' and “developmental delays and disabilities.”
Health workers can easily be explained the link between undiagnosed thyroid disorders and at least one-fourth of the conditions listed by RBSK. These are congenital deafness, anemia, goiter, hearing impairment, neuromotor impairment, motor delay, cognitive delay, language delay, and learning disorder. Eliciting a history of pubertal abnormalities will complete the list.
Diagnosis needs to be confirmed by hormonal assays. While facilities for measuring serum thyroid stimulating hormone are not available at peripheral centers, modern technology allows collection and transport of dried samples from remote areas to central laboratories. This can be included in RBSK in areas with proven high prevalence of thyroid disorders.
The RBSK is the pillar of health for India's future generation. Collaboration between public health, thyroidology and pediatric experts can help streamline the screening and identification of thyroid disorders through RBSK. Optimal thyroid health, achieved through such secondary preventive measures, will ensure healthy physical and mental growth for India's growing children and adolescents.
| References|| |
Shriraam V, Mahadevan S, Anitharani M, Selvavinayagam, Sathiyasekaran B. National health programs in the field of endocrinology and metabolism – Miles to go. Indian J Endocrinol Metab 2014;18:7-12.
Kalra S, Unnikrishnan AG, Baruah MP. Thyroid: Disorders of a lesser gland. Thyroid Res Pract 2013;10:45.
Kalra S, Julka S, Joshi R, Shah A, Jindal S, Agrawal N, et al.
Strengthening diabetes management at primary health level. Indian J Endocrinol Metab 2015;19:443-7.
Desai MP. Disorders of thyroid gland in India. Indian J Pediatr 1997;64:11-20.
Desai MP. Hypothyroidism. In: Desai MP, Menon PS, Bhatia V, editors. Goitre and Thyroid Neoplasia. Pediatric Endocrine Disorders. 3rd
ed. Hyderabad: Universities Press; 2014. p. 201-3.
Delange F, Bastani S, Benmiloud M. Definitions of endemic goiter and cretinism, classification of goiter size and severity of endemias, and survey techniques. In: Dunn JT, Pretell EA, Daza CH, Viteri FE, editors. Towards the Eradication of Endemic Goiter, Cretinism, and Iodine Deficiency. Washington, DC: Pan American Health Organization; 1986. p. 373-6.
Pollitt RJ. Evidence or enthusiasm? Why yields from UK newborn screening programmes for congenital hypothyroidism are increasing. Arch Dis Child 2016;101:120-3.