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RBSK · Clinical

The 4Ds

Four categories of condition, screened at birth, at the anganwadi, and in school.

What is screened

And why each category is grouped as it is

D1Defects at birthStructural and metabolic conditions identified earlyD2DeficienciesAnaemia, vitamin and nutritional deficiencyD3DiseasesCommunicable and non-communicable childhood illnessD4Development delaysIncluding disability, hearing, vision and learningScreened at birth, at anganwadi, and in school — then referred and tracked.
The four screening categories
Defects at birth

Structural and metabolic

Conditions present from birth, identified as early as the delivery facility allows. Early identification changes the surgical and medical options available, and in several conditions determines whether intervention is possible at all.

Deficiencies

The commonest finding, and the most treatable

Anaemia, vitamin A and vitamin D deficiency, iodine deficiency and general undernutrition. These dominate the findings in most school screening cohorts. They are also the category where a closed referral loop makes the most difference, because the treatment is cheap and effective and the failure mode is simply that nobody followed up.

Diseases

Communicable and non-communicable

Childhood illness, including skin and dental conditions that are routinely missed because nobody looks. Dental and ENT screening under the EPIC programme exists for this reason.

Development delays and disability

Including hearing, vision and learning

The category that most requires a longitudinal record, because a delay is defined against a trajectory. A single screening can raise a question; only a series answers it. This is the strongest argument for a profile that persists between annual cycles.

Why coding matters here

Development findings recorded as free text cannot be compared year to year. Coded at capture in SNOMED CT, they can.

See the screening platform.

78 screens designed around these four categories.