Early prevention of childhood disability in developing countries

Abstract

The concept of prevention, while implicit in most early intervention efforts, has not been comprehensively articulated as a basis for conceptualizing early intervention services. The growing recognition of the importance of early identification and intervention for infants and young children, and involvement of the family, are factors which contribute to conceptualizations of services which are preventive in nature. This recognition parallels broader concerns for family support programmes which have a preventive focus and seek to enhance the development of children and families. The purpose of this paper is to present a comprehensive framework for the provision of child and family service by conceptualizing early intervention in terms of levels of prevention. Specifically, the concept of primary, secondary, and tertiary levels of prevention will be presented as a framework suitable to encompass the preventive function of community based rehabilitation. The relevance of early prevention is based on the premise that the condition of childhood disability can be prevented at primary, secondary, and tertiary levels. Viewed in this way, the problem or condition of developmental delay or disability in children can be addressed at each of the three levels to effect a reduction of its expression, its duration or extended impact. Primary, secondary, and tertiary prevention can be implemented in the context of community based rehabilitation to address these goals: (a) enhance development and minimize the potential for delay; (b) minimize the need for special education and related services; and (c) minimize the likelihood of institutional or other restrictive care outcomes.

PIP: The concept of primary, secondary, and tertiary levels of prevention offers a useful framework for the problem of childhood disabilities in developing countries. Such a model is based on the following assumptions: 1) developmental delays and disabilities are preventable both prenatally and postnatally; 2) causal chains can be delineated for differentiating postnatal prevention at the three levels; 3) prevention efforts can be potentiated by capitalizing on lead time in early development; 4) at each level of prevention, there are indicated services for the child and linked services for families; and 5) the levels of prevention provided in a given system will be governed by that system's philosophy, priorities, and resources. At the primary level, the goal is to reduce the occurrence of developmental disability through a reduction of risk factors such as low birthweight and malnutrition and family awareness that child development can be influenced by their efforts. At a secondary prevention level, the goal is to reduce the extent of manifested childhood disability and shorten its duration. infant stimulation and remediation programs operate at this level and are complemented by efforts to foster the family's ability to promote child development. In tertiary prevention, the aim is to prevent or reduce complications of disability (physical and behavioral) that lead to a need for institutionalization. At this level, there may be a need for family counseling and other intensive supports. The intervention program should be conducted within the context of the primary health care system, build upon existing service channels, and strengthen the family's role as the central determinant of child health and development.