Childhood Multimorbidity and Care-Seeking Pathways under India’s National Child Health Programme: A Mixed-Methods Study
1
Community Medicine, Maharaja Krishna Chandra Gajapati Medical College, Berhampur, India
2
Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, United States
3
General Practice and Family Medicine, Medical School OWL, Bielefeld University, Bielefeld, Germany
4
Barwon South-West Public Health Unit, Barwon Health, Geelong, Victoria, Australia
5
IMPACT–Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
6
ICMR-Regional Medical Research Centre, Department of Health Research, Bhubaneswar, India
7
Indian Council of Medical Research, Department of Health Research, New Delhi, India
Popul. Med. 2026;8(Supplement Supplement 1):A2313
ABSTRACT
BACKGROUND:
Childhood multimorbidity, the coexistence of two or more chronic conditions in a child, is an emerging public health challenge.1 In India, the National Child Health Programme (Rashtriya Bal Swasthya Karyakram i.e. RBSK) targets children and adolescents aged 0–18 years for early identification and management of acute as well as chronic conditions.2 However, its responsiveness to childhood multimorbidity remains poorly understood.3 This study examined the burden and care-seeking pathways of childhood multimorbidity under this national programme, alongside stakeholder perspectives on health system responsiveness.
METHODS:
A mixed-methods study was conducted among children with chronic conditions enrolled under India’s National Child Health Programme. Quantitative data were collected from 438 caregivers using structured interviews to assess socio-clinical profiles, multimorbidity patterns, and care-seeking pathways. Care-seeking complexity was measured by the number of healthcare providers visited and analysed using negative binomial regression. Qualitative data were generated through in-depth interviews and key informant interviews with caregivers, frontline health workers, District Early Intervention Centre staff, and programme managers, and analysed thematically to explore lived experiences and system-level challenges.
RESULTS:
Multimorbidity was present in 10.3% of children among those registered under RBSK for any disease condition. Children visited a mean of 6.1 healthcare providers, with multimorbidity significantly increasing care-seeking complexity (adjusted IRR 1.42; 95% CI: 1.27–1.59). Qualitative findings highlighted poor caregiver awareness of multimorbidity, limited coordination across services, inadequate digital tracking of multiple conditions, stigma, and weak convergence with education and disability sectors.
CONCLUSIONS:
Childhood multimorbidity substantially increases care-seeking complexity and exposes critical gaps in health system responsiveness within India’s National Child Health Programme for children aged 0–18 years. Strengthening early intervention centres as coordination hubs, integrating multimorbidity-sensitive information systems, and improving intersectoral convergence are essential to meet the complex, long-term care needs of affected children.
Childhood multimorbidity, the coexistence of two or more chronic conditions in a child, is an emerging public health challenge.1 In India, the National Child Health Programme (Rashtriya Bal Swasthya Karyakram i.e. RBSK) targets children and adolescents aged 0–18 years for early identification and management of acute as well as chronic conditions.2 However, its responsiveness to childhood multimorbidity remains poorly understood.3 This study examined the burden and care-seeking pathways of childhood multimorbidity under this national programme, alongside stakeholder perspectives on health system responsiveness.
METHODS:
A mixed-methods study was conducted among children with chronic conditions enrolled under India’s National Child Health Programme. Quantitative data were collected from 438 caregivers using structured interviews to assess socio-clinical profiles, multimorbidity patterns, and care-seeking pathways. Care-seeking complexity was measured by the number of healthcare providers visited and analysed using negative binomial regression. Qualitative data were generated through in-depth interviews and key informant interviews with caregivers, frontline health workers, District Early Intervention Centre staff, and programme managers, and analysed thematically to explore lived experiences and system-level challenges.
RESULTS:
Multimorbidity was present in 10.3% of children among those registered under RBSK for any disease condition. Children visited a mean of 6.1 healthcare providers, with multimorbidity significantly increasing care-seeking complexity (adjusted IRR 1.42; 95% CI: 1.27–1.59). Qualitative findings highlighted poor caregiver awareness of multimorbidity, limited coordination across services, inadequate digital tracking of multiple conditions, stigma, and weak convergence with education and disability sectors.
CONCLUSIONS:
Childhood multimorbidity substantially increases care-seeking complexity and exposes critical gaps in health system responsiveness within India’s National Child Health Programme for children aged 0–18 years. Strengthening early intervention centres as coordination hubs, integrating multimorbidity-sensitive information systems, and improving intersectoral convergence are essential to meet the complex, long-term care needs of affected children.
| eISSN: | 2654-1459 |
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