Appraisal of Health Problems Experienced by Specially Challenged School Going Children in North Karnataka

Introduction

Children with disabilities are defined as, ‘those who have enduring physical, mental, intellectual, or sensory impairments that, when combined with various obstacles, may restrict their complete and active involvement in society on an equal basis with others’. Currently, there are approximately 240 million children globally living with some form of disability, accounting for 1 in 10 children worldwide.¹

According to UNESCO, there are 7.8 million children with disabilities in India, and among them, 3.30 lakh children between the ages of 5 and 19 are living with disabilities in Karnataka.² The Census of India (2011) reports that among individuals with disabilities aged 0-19 years, 20% experience hearing impairment, 18% have visual impairments, 8% are intellectually disabled, and 9% have multiple disabilities.³ According to information obtained from community-based studies, the prevalence of visual impairment ranged from 2.05 per thousand to 13.6 per thousand in India.⁴ India has the highest number of children with hearing impairment globally, with 1.57 million in the age group of 0-19 years facing hearing disabilities.⁵

Children with disabilities experience more limitations and conditions such as visual impairment, hearing impairment and intellectual disability can significantly affect their ability to develop communication, language and social skills, as well as hinder their overall growth and development. Children with developmental disabilities are more likely to experience certain health conditions, including asthma, gastrointestinal symptoms, eczema, skin allergies, and migraine headaches.⁶ Moreover, these disabilities have greater impact on their lives.

Children with disabilities rely on a combination of primary and specialty services to maintain or improve their functioning. However, they face a range of challenges, including inadequate access to primary and preventive services, obstacles in obtaining subspecialty care and specialized therapies, limited coordination of services, and unequal accessibility to schools and other direct-service providers.⁷

The present study was planned to evaluate the general health status of disabled children as a comprehensive summary of an individual’s health status, medical history and health-related information. It will be helpful to assess the overall well-being of disabled children and to plan the health care interventions in schools for these needy children.

Materials and Methods

A cross sectional study was conducted to assess the health problems experienced by specially challenged school going children from urban areas of Belagavi city, North Karnataka. This study was conducted in the month of August 2023 in three randomly selected schools meant for specially challenged children - one for visually impaired children, one for deaf and dumb children and one for intellectually disabled children. All children enrolled in these schools were included in the study. Participants who were not present on the first visit were revisited in subsequent days to collect the data. The guardians/parents of all the enrolled students gave consent for participation in the study.

A total of 211 students were examined, comprising 123 visually impaired children, 64 deaf and dumb children and 24 intellectually disabled children. The study was reviewed and approved by the Institutional Ethics Committee. After getting permission from all the school authorities, the consent from parents/guardians of study subjects was also sought. Confidentiality was maintained at all stages of the study.

Data was collected from guardians/parents by personal interviews and or by contacting through mobile phones, school records and by general physical examination including anthropometric measurements using a predesigned, pretested, and structured questionnaire. The questionnaire included sociodemographic characteristics, questions about their disability and health, birth history and family history of study subjects. General physical examination followed by recording of anthropometric measurements like weight (in kg) and height (in cm) were done. Age and gender specific Body mass index (BMI) centiles were calculated according to Indian Academy of Pediatrics (IAP) boys & girls BMI chart for 5-18 years and BMI was categorized as underweight (<5th centile), normal (5th to 85th centile), overweight (≥85th to <95th centile) and obese (≥95th centile).⁸ The blood investigations, such as the measurement of hemoglobin level and random blood sugar (RBS) level, were conducted using a digital hemoglobinometer (Hemospark) and a glucometer (Control D), respectively. The grading of anemia was done according to WHO recommendation as follows: Mild (11 to 9 g/dL), Moderate (9 to 7 g/dL), Severe (<7 g/dL).⁹ An RBS value of 200 mg/dL or higher indicates the presence of diabetes.¹⁰ The Barthel Index was used to assess their dependency in Activities of Daily Living (ADL) such as feeding, bathing, grooming, dressing and walking, etc.¹¹ The total score ranged from 0 to 100 with interpretation of total dependence (0-20), severe dependence (21-60), moderate dependence (61-90) and slight dependence (91-99).

Collected data were compiled, tabulated, and analyzed by expressing the data in proportions, percentages and Chi-square test was applied to determine the association between health problems and other variables. P value <0.05 was considered statistically significant.

Results

A total of 211 specially challenged school going children in the age range of 6 to 17 years were included in the study. Majority of the study subjects were in the age group of 11-15 years (64.4%) and more than half of them were females (54.5%). 115 subjects (54.5%) were residing in urban areas and 201 (95.3%) were Hindus by religion. Most of the parents of the study participants were educated up to secondary level (31.8%), followed by primary level (25.6%). Most of the subjects’ parents were skilled workers (41.2%) and 90 subjects (42.7%) belonged to class 4 socio-economic status. More than half of the subjects (65.4%) belonged to nuclear family. It showed significant association between age, gender and residence with disabled study subjects (Table 1).

More than one-third of the subjects’ parents (34.6%) were married within relationship. Most of the parents’ age at pregnancy (55.5%) was between 21-25 years. Fifteen (7.1%) and seven (3.3%) parents of the study subjects had complications during pregnancy and delivery, respectively. Around 60 (28.4%) reported history of Neonatal Intensive Care Unit (NICU) admission and 33 (15.6%) subjects had similar complaints in the family. Maternal complications during delivery like prolonged labour, perinatal asphyxia (P<0.001) and history of NICU admission (P<0.001) showed significant association with disability (Table 2).

More than three-fourth of subjects (79.6%) were independent, and 31 subjects (14.7%) were moderately dependent in their daily activities as per Barthel Index (Table 3).

Only 16 (7.6%) subjects had pallor which showed significant association (P<0.001) and among them, most of the study subjects were deaf & dumb school children (87.5%). BMI status of study subjects showed that 155 (73.4%) were normal followed by 31 (14.7%) who were overweight, 16 (7.6%) were underweight and 9 (4.3%) were obese. One hundred twenty six study subjects (59.7%) had vision impairment, 65 (30.8%) had hearing impairment and three (1.4%) subjects had suppurative otitis media. Around one-fourth of the subjects with disability (24.2%) had dental caries which showed statistically significant association (P=0.033) and among them, most of the subjects were visually impaired (70.6%). Five (2.4%) study subjects had skin problems and 11 (5.2%) subjects had musculoskeletal deformities. The majority (96.3%) showed normal Hb levels, while 6 (2.8%) and 2 (0.9%) study subjects had mild and moderate anaemia, respectively. None of the study subjects had diabetes (Table 4).

Discussion

Disability is acknowledged as a major public health concern and is given high priority within health care services due to the higher risk of long-term health problems among individuals with disabilities.¹² In the present study, 51.7% specially challenged children were experiencing one or the other health problems, which included malnourishment (26.5%), dental caries (24.2%) and pallor (7.6%).

In the present study, 54% specially challenged children were females, which could be because all the deaf and dumb school children included in the study were females. However, according to a recent report by the National Sample Survey Organization (NSSO), disability is more common in males than females.¹³

In the present study, 37.5% of parents of intellectually disabled children had consanguineous marriages, which is slightly higher (15.7%) than the study done by Sasinthar K et al. ¹⁴ Additionally, it was found that more than one-third of the parents of deaf and dumb children (42.2%) had consanguineous marriages, a prevalence slightly lower than that was reported by Pehere NK et al. (64.2%).¹⁵ Additionally, the prevalence of visual impairment among them was noted to be 7.2%, while it was found to be significantly lower (1.6%) among the deaf and dumb study participants in the present study. This suggests the necessity for genetic counselling and increased social awareness regarding the potential risks to children born from consanguineous marriages.

This study found that 12.5% and 25% of mothers of intellectually disabled children experienced complications during pregnancy and delivery, respectively. It may be due to lack of adequate diet, maternal infections, parental illness, complicated delivery, birth trauma, psychological causes or brain infections as mentioned in the study done by Kalgotra R et al.16

In the present study, 20.4% of specially challenged children were dependent on others for their daily activities, which was lower compared to the study done by Karadağ G, where 77.8% of the children were found to be dependent on others for their personal needs.¹⁷

Most of the vision impaired children were overweight than underweight in present study as compared to study done by Acil D et al., which shows more subjects were obese followed by underweight.12 This finding suggests a connection between restricted physical activity, improper dietary habits, sedentary behaviour and psychosocial factors such as stress, anxiety or low self-esteem along with underlying medical conditions observed in visually impaired children.

In the present study, greater number of subjects with intellectual disability were overweight than under weight as compared to study done by Pise V et al., which reported more underweight subjects.¹⁸ But the meta-analysis done by Maïano C et al.¹⁹ emphasized that a significant percentage of children with intellectual disability were overweight and obese in comparison to their typically developing peers. Individuals with disabilities may experience malnutrition due to reduced nutrient intake, increased nutrient loss, and higher nutrient requirements. This heightened vulnerability often exposes them to a greater risk of various health issues.²⁰

Dental caries was noted in most of the vision impaired children compared to deaf and dumb school children and this finding is similar to a study done by Goud V et al. ²¹ Another study conducted by Tefera AT et al., reported that a significant proportion of special needs school students were suffering with oral health problems.²² Bennadi D et al. also conducted a study indicating that intellectually disabled children had significantly poorer oral hygiene.²³ Inadequate oral hygiene, lack of awareness regarding good oral care practices and lack of supervision by parents or caregivers, coupled with substantial unmet dental treatment needs among visually impaired children, could be linked to their compromised oral health.

In the present study, skin problems, including eczema, dry, scaly, and itchy skin as well as hypopigmentation were found in 2.4% of the study population, which contrasts with the 53.2% differently abled children with skin problems as reported by Rao C et al.²⁴ Specially challenged children may be particularly susceptible to skin problems, either as a direct result of their disability hindering their ability to maintain regular skin care or due to lack of awareness about personal and environmental hygiene.

About 5.2% of the specially challenged children were found to have musculoskeletal deformities, and all of them were intellectually disabled. This could be attributed to developmental issues during pregnancy, lack of mobility, poor posture or neuromuscular disorders such as cerebral palsy. A multidisciplinary approach is needed to address these deformities, including medical interventions, physical therapy and the use of assistive devices.

In the present study, 9% of the specially challenged children had RBS values ranging between 140-199 mg/dL and are expected to be followed up with an Oral Glucose Tolerance Test (OGTT) according to the ICMR guidelines for management of type 2 diabetes.¹⁰ This was informed to their respective school teachers and parents, who were then advised to proceed with follow-up accordingly.

Limitations

There were 21 types of disabilities present, but this study was conducted including children from three schools designated for individuals with disabilities. Therefore, these findings cannot be generalized to all specially challenged children. Clinical examination findings, along with the specific laboratory diagnostic tests would have helped to identify other health issues.

Conclusion

This study highlights the significance of conducting screening camps to identify health issues among specially challenged children. The health problems of specially challenged children such as malnutrition, hearing problems, oral hygiene issues and skin problems are to be focussed during the periodic intervention programmes, like timely treatment of various health issues, health screening, preventive measures including creating health awareness and behaviour change communication for their overall growth and development.

Conflict of interest

None

Financial support

None

Acknowledgements

We extend our sincere gratitude to all school principals, parents and study participants for their cooperation during the study.