Handicapping Conditions among Children under Six Years in Family Medicine Centers in Alexandria. Part I: Screening and Detection

Early identification of children with developmental delays is important in the primary health care [PHC] setting. The PHC practitioner’s office is mostly the place where the majority of children younger than 5 years of age are seen and is ideal for developmental and behavioral screening by the use of age-appropriate developmental checklists to record milestones during preventive care visits as a part of developmental surveillance. The aim of the present study was to screen children under 6 years in 5 family medicine [FM] facilities in Alexandria, Egypt for the early detection of some handicapping conditions [visual, hearing, speech, and orthopedic] and to review the family files of the screened children to assess the number of suspicious cases missed by the family physician. Data were collected using a pre-designed screening sheet for the early detection of the above mentioned handicapping conditions among 550 children attending the study FM facilities and by family file review of the screened children. Screening of children under 6 years old had yielded the following results: orthopedic abnormalities represented 14.2%, followed by visual abnormalities [9.3%], speech abnormalities [8.9%], hearing abnormalities [6.2%], and mental retardation [2%]. Risk factors found to affect the occurrence of the study handicapping conditions were found to be mostly positive family history, consanguinity between parents, maternal age at the aim of pregnancy, and complications during pregnancy; labour; and in the post natal period. Recording was incomplete as only 11.6% of the screened children had both complete files including growth and development charts. Poor performance of the family physicians in the study facilities was evident regarding detection and referral or handicapped cases in children as only 75 handicapped cases [46.3%] could be detected by the family physicians in the study facilities out of the 162 handicapped cases detected by the researcher. Family physicians in the study facilities referred only 57.3% of the detected. Therefore, screening for risk factors of handicap should be performed by the family physicians during routing daily activity as well as during the well-baby clinic schedules. This is best achieved by proper development and application of guidelines and protocols for screening, follow up, and management of handicapping conditions including proper recording and referral.