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CM10.1-2 | CM10.1-2 | RMNCH Status and High Risk Screening — SDL Guide (Part 2)

High-Risk Screening for Newborns and Children

The neonate and the child under 5 have their own risk profiles that require separate screening frameworks. At birth, the three primary risk markers for a neonate are: low birth weight (below 2,500 g — a single, universally available measurement that predicts neonatal mortality, hypothermia risk, feeding difficulty, and infection susceptibility), preterm birth (before 37 completed weeks of gestation, clinically assessed by the New Ballard Score when gestational age is uncertain), and birth asphyxia (Apgar score below 7 at 5 minutes). A neonate positive for any of these is immediately enrolled in the Home-Based Newborn Care (HBNC) programme — the ASHAs make six scheduled home visits in the first 42 days, using a structured checklist to detect danger signs (hypothermia, fast breathing, not feeding, abnormal movement, jaundice, skin pustules). For children aged 0-5 years, malnutrition screening uses three anthropometric tools: weight-for-age (underweight, WHO Z-score <-2), height-for-age (stunting, Z-score <-2), and mid-upper arm circumference (MUAC) (below 12.5 cm in 6-59 month children indicates moderate acute malnutrition; below 11.5 cm indicates severe acute malnutrition). MUAC is particularly valued at community level because it requires only a colour-coded tape and no weighing scale. Developmental delay screening uses age-appropriate milestones assessed by the ANM at child welfare clinics — delay in gross motor, fine motor, speech, or social domains beyond the expected age of attainment is a referral trigger. Integrating these screens into routine ASHA and ANM visits converts each contact into a risk stratification event.

Programme Linkage and Monitoring for High-Risk Groups

Identifying high-risk groups without a corresponding referral and monitoring pathway produces no reduction in mortality — the linkage between community-level detection and facility-based management is the implementation bottleneck that programme managers must close. Under RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent Health), the care continuum is operationalised through several mechanisms. The Mother and Child Protection (MCP) Card — issued at the first antenatal visit — serves as a portable health record that tracks ANC visits, immunisation, risk flag status, and delivery outcome; community health workers use it to identify overdue contacts and flag high-risk status to the medical officer at the PHC. The Delivery Point (DP) list maintained at the PHC and sub-centre records every expected delivery in the catchment and allows proactive tracking of women who miss their scheduled ANC visits. HMIS (Health Management Information System) indicators that reflect screening quality include: percentage of pregnant women who had ≥4 ANC visits, percentage who received full ANC (4 visits + 100 IFA tablets + 2 TT doses + at least one obstetric examination), and percentage of high-risk pregnancies identified and referred. At the district level, maternal death surveillance and response (MDSR) reviews every maternal death to identify the delay category — this feedback loop converts mortality data into corrective action. Monthly Village Health, Sanitation and Nutrition Committee (VHSNC) meetings review the status of high-risk families in the village, ensuring community-level accountability. These interlocking tools convert screening from a one-time event into an ongoing monitoring system.

Applying RMNCH Indicators in Field Practice

The true test of indicator knowledge is not recitation but application — the ability to use a district's RMNCH figures to identify priorities and design targeted interventions. At the PHC level, a medical officer reviews the monthly HMIS report and compares their facility's IMR, institutional delivery rate, and full ANC coverage against the district average; deviations trigger a field investigation to identify the causal pathway (distance barrier, ASHA inactivity, cold-chain failure, etc.). At the community level, the ASHA conducts a household survey of all married women of reproductive age in her village, recording last pregnancy outcome, current pregnancy status, and immunisation status of children under 5; this produces a community-level denominator for calculating the local IMR and identifying clusters of high-risk families for priority home visiting. For high-risk screening in practice, the ASHA uses the HBNC visit checklist for newborns and the Rashtriya Bal Swasthya Karyakram (RBSK) protocol (four to five disease domain screens) for children aged 0-18 years; she then refers positives to the mobile health team or PHC. The facility-based IMR surveillance at a Community Health Centre calculates IMR from the birth register and death register for babies born in-facility — useful for rapid monitoring of intrapartum quality. Finally, community medicine physicians supervising field postings must be able to critically appraise NFHS-5 district factsheets: understanding confidence intervals, comparing rural vs urban disaggregation, and recognising when a reported indicator is based on a small sample that precludes confident conclusions.