Referral Pathway and Clinical Profile of Children Aged 0–12 Years under the 4Ds Framework of the Rashtriya Bal Swasthya Karyakram (RBSK) at a Tertiary Hospital District Early Intervention Centre in Ahmedabad, India: A Cross-Sectional Study

Abstract

Introduction: Under India’s Rashtriya Bal Swasthya Karyakram (RBSK), children with the “4Ds” (defects at birth) are referred from community screening to District Early Intervention Centres (DEICs). National referral compliance is only 46–50%, with no primary data on referral-pathway dynamics at a tertiary-level DEIC in Gujarat. This study aims to assess the referral pathways, time-lag, and clinical profile of children attending a tertiary DEIC. Methods: A hospital-based, descriptive cross-sectional study was conducted among 243 children aged 0–12 years attending the DEIC at a tertiary Civil Hospital in Ahmedabad (March–April 2026). Caregivers of consecutively enrolled, consenting children were interviewed. Results: Among children attending tertiary DEIC, self-referral was the leading pathway (40%), while formal RBSK Mobile Health Team (MHT) routes Anganwadi and school screening combined contributed only 9%. A referral (Sandarbh) card was documented in 59% of assessed low-income families. Only 55% of children reached the DEIC within three months of first detection (timely referral); 25% experienced delay exceeding one year. Developmental Delay and Disability (D4) was the dominant 4Ds category (56%). Low birth weight was significantly associated with Birth Defects (p=.03) and Deficiencies (p=.02). Conclusion: At this tertiary DEIC, community-based RBSK screening contributes only a small share of referrals, and one in four children arrives more than a year after first detection. Strengthening urban Mobile Health Team coverage, Sandarbh card issuance and tracking, and government scheme linkage at the point of DEIC registration are priority actions to close the referral gap.