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India plans universal screening of newborns amid logistical challenges

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7582 (Published 08 November 2012) Cite this as: BMJ 2012;345:e7582
  1. Ganapati Mudur
  1. 1New Delhi

India’s health ministry plans to introduce universal screening of children for disabilities and deficiencies next year, more than a decade after sections of the paediatric profession had first suggested that newborn screening should receive priority on a par with immunisation.

The programme will initially screen 140 million children, from newborns up to children six years of age, India’s health minister Ghulam Nabi Azad told a conference of state health ministers and health officials from across India. A senior health official clarified earlier this week that the programme would begin in district hospitals in early 2013 and eventually expand to primary health centres serving clusters of villages.

“We’ll start screening for hearing, vision, and certain mental disabilities,” said Prasanna Kumar Pradhan, India’s health secretary. “But the plan is to develop this over time into a newborn screening initiative to cover more disorders,” Pradhan told the BMJ.

Private and government hospitals across India have been selectively screening newborns for years, but doctors estimate that less than 5% of the estimated 22 million babies born each year receive routine screening.

“I’m so happy the government has agreed—we’ve been waiting for this for years,” said Akella Radha Rama Devi, a paediatrician at the Rainbow Hospital in Hyderabad, and a member of an Indian Council of Medical Research task force on newborn screening.

But paediatricians warn that India’s large proportion of births—28%—that take place in homes and the need to adequately train healthcare workers in screening techniques will pose severe logistical challenges for the proposed screening programme.

Doctors also say the list of disorders to be covered by the programme should take into account both economics and ethics. “It won’t be ethical to screen for disorders for which we can’t offer appropriate management,” said Seema Kapoor, a senior paediatrician at the Maulana Azad Medical College in New Delhi.

Kapoor, who had first proposed universal screening of newborns to health authorities in 2002, told the BMJ that “management could emerge as an issue with disorders such as phenylketonuria for which appropriate diet is not economically available in India.”

Groups of paediatricians who have been campaigning for newborn screening say there is no justification not to screen for conditions such as sensorineural hearing loss or congenital hypothyroidism that can be managed inexpensively if detected in time.

“The window of opportunity for congenital hypothyroidism is short—within three or four weeks after birth,” Radha Rama Devi told the BMJ. “But early detection can lead to 100% normal outcome,” she said.

The proposed screening programme is expected to draw lessons in logistics and implementation from pilot projects, including one by the Indian Council of Medical Research that has screened about 100 000 newborns in Chennai, Delhi, Mumbai, Kolkata, and Hyderabad for congenital hypothyroidism and congenital adrenal hyperplasia over the past three years. Its findings are yet to be published.

In the southern city of Cochin, for example, paediatrician Abraham Paul and his colleagues, have demonstrated a two tier screening protocol for sensorineural hearing loss.1 The first test looks at otoacoustic emissions and the second, offered only if the first creates a suspicion of hearing loss, examines the auditory brainstem response. Paul is hoping that the protocol he has tested may serve as a model for other parts of India.

Paul, convener of the Indian Academy of Pediatrics’ newborn hearing screening programme, said: “Early detection within the first five months is crucial, as newborn babies with mild hearing loss could be given hearing aids that will allow them to have near normal hearing and speech.”

Notes

Cite this as: BMJ 2012;345:e7582

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