Prevention of Disabilities

Prevention at three levels

• Primary Prevention – Action taken prior to the onset of the disease/disability, which will remove the possibility that a disease/disability will occur.
• Secondary Prevention – Action, which halts the progress of the disease/disability at its incipient stage and prevents complications. The specific interventions are early diagnosis and adequate treatment.
• Tertiary Prevention – All measures available to reduce or limit impairments and disabilities, and minimize suffering caused by existing disability. This phase is also called rehabilitation, which includes physical, psychosocial and vocational measures taken to restore the patient back to normal or near normal condition

It is extremely important that the women undertake adequate and effective preventive measures during their pregnancy and immediate postnatal period and also for their children especially during the early childhood period, in order to significantly reduce the incidence of impairment and disabilities in them. Therefore, in this chapter examples of easily understood primary preventive measures, for mother and child are summarized.

General Preventive Measures

1. Marriage between very close blood relations like uncle, niece, first cousin should be avoided for prevention of hereditary disorders.
2. Avoid pregnancies before the age of 18 years and after the age of 35 years.
3. Consult a doctor before planning the pregnancy;

• If there is incidence of birth defects in your family.
• If you have had difficulty in conceiving or have had a series of miscarriages, still births, twins, delivery by operation (Caesarean), obstructed labour/prolonged labour(more than 12 hours) and/or severe bleeding in previous pregnancy .
• If you have RH - negative blood type.
• If you have diabetes.

Care During Pregnancy

1. Avoid hard physical work such as carrying heavy loads, especially in fields, and other accident - prone activities such as walking on slippery ground or climbing stools and chairs.
2. Avoid unnecessary drugs and medications. Even the normally considered safe drugs which are sold commonly can potentially cause serious defects in an unborn child.
3. Avoid smoking, chewing tobacco, consuming alcohol and narcotics.
4. Avoid X - rays, and exposure to any kind of radiation.
5. Avoid exposure to illnesses like measles, mumps etc, especially during the first 3 months of pregnancy.
6. Avoid sexual contact with a person having venereal disease.
7. Take precautions against lead poisoning.
8. Avoid too much use of ‘Surma’ and ‘Kohl’.
9. Eat a well-balanced and nourishing diet supplemented with green leafy vegetables, proteins and vitamins.
10. All women of the child bearing age need 0.4mg of folic acid daily. It is also available in folic acid plus iron tablets which should be taken for at least 3 months during the third trimester when the risk of developing iron deficiency anemia is greatest.
11. Ensure weight gain of at last 10 kgs. Have regular medical checkups.
12. All pregnant women should be given tetanus injection.
13. Woman at ‘high - risk’, whose weight is < 38 Kg, height is less than 152 cm, weight gain during pregnancy <6 kg or who is severly anaemia c (Hb < 8mg), having frequent pregnancies, having a history of miscarriage/ abortion/premature deliveries, must get expert prenatal care so as to have a normal baby.
14. Must consult a doctor, in case of edema (swelling) of feet, persistent headache, fever, difficulty or pain in passing urine, bleeding from the vagina, and yellowness of eyes (jaundice)

Care at the time of birth

1. Delivery must be conducted by trained personnel, preferably in a hospital where all facilities are available.
2. If a baby does not cry immediately after birth, resuscitation measures should be undertaken at once.
3. Babies born prematurely and with a low birth weight (<2.5 Kg) may need Neonatal Intensive Care.
4. If the baby’s head appears to be abnormally small or large then a physician should be consulted, preferably a pediatrician. The approximate head size for a male child at birth is 35 cm and for female child is 34.5 cm.
5. To protect a child from infections, breast - feeding must be started immediately after birth. First milk (colostrum) must be fed to the baby and should not be thrown away, as it has antibodies which are protective.

Early Childhood Care

1. Do not allow a child’s temperature to rise above 101 degree F because of any reason. It can cause febrile seizures
2. If a child gets a fit take him to doctor immediately.
3. Every child should be immunized against infectious diseases as per the recommended schedule of immunization.
4. Do not allow a child to have too much contact with paint, newsprint ink, lead etc. as they are toxic.
5. Take precautions against head injury, and other accidents.
6. Ensure that the child gets a well-balanced diet and clean drinking water.
7. Introduce additional foods of good quality and in sufficient quantity when the child is 4 -6 months old.
8. Vitamin A deficiency and its consequences including night blindness can be easily prevented through the use of Vitamin A supplementation.
9. Protect a child from Meningitis and Encephalitis by providing a hygienic environment which is free of overcrowding.
10. Common salt must be iodized as a precaution against goiter and cretinism.
11. Do not allow a child to use hairpins, matchsticks and pencils, to remove wax from the ears.
12. Use ear protectors to reduce the exposure to high levels of noise, if children are living or working in a noisy environment.
13. Do not slap a child over the face as this may lead to injury of the eardrum and consequent hearing loss

Source: A Handbook for Parents of Children with Disabilities