High Coverage and Utilization of Fortified Take-Home Rations among Children 6-35 Months of Age Provided through the Integrated Child Development Services Program: Findings from a Cross-Sectional Survey in Telangana, India.

Magali Leyvraz,Rajan Sankar,Narottam D Sharma,Grant J Aaron,Bradley A Woodruff,James P Wirth,Prahlad R Sodani,Marly Augusto Cardoso

doi:10.1371/journal.pone.0160814

Magali Leyvraz, Rajan Sankar + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0160814

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Abstract

The Integrated Child Development Services (ICDS) in the State of Telangana, India, freely provides a fortified complementary food product, Bal Amrutham, as a take-home ration to children 6–35 months of age. In order to understand the potential for impact of any intervention, it is essential to assess coverage and utilization of the program and to address the barriers to its coverage and utilization. A two-stage, stratified cross-sectional cluster survey was conducted to estimate the coverage and utilization of Bal Amrutham and to identify their barriers and drivers. In randomly selected catchment areas of ICDS centers, children under 36 months of age were randomly selected. A questionnaire, constructed from different validated and standard modules and designed to collect coverage data on nutrition programs, was administered to caregivers. A total of 1,077 children were enrolled in the survey. The coverage of the fortified take-home ration was found to be high among the target population. Nearly all caregivers (93.7%) had heard of Bal Amrutham and 86.8% had already received the product for the target child. Among the children surveyed, 57.2% consumed the product regularly. The ICDS program’s services were not found to be a barrier to product coverage. In fact, the ICDS program was found to be widely available, accessible, accepted, and utilized by the population in both urban and rural catchment areas, as well as among poor and non-poor households. However, two barriers to optimal coverage were found: the irregular supply of the product to the beneficiaries and the intra-household sharing of the product. Although sharing was common, the product was estimated to provide the target children with significant proportions of the daily requirements of macro- and micronutrients. Bal Amrutham is widely available, accepted, and consumed among the target population in the catchment areas of ICDS centers. The coverage of the product could be further increased by improving the supply chain.

Highlights

In the 1970s, the Government of India adopted a series of policies aimed at improving the health of the country’s population and reducing the prevalence of malnutrition
The services are provided through local centers, called anganwadi centers (AWCs), and include immunization, health care, preschool education, maternal education, family planning, referral services, vitamin A supplementation, iron-folic acid supplementation, provision of iodized salt, basic nutrition and child feeding education, and provision of supplementary food [5, 6]
Bal Amrutham is distributed by the AWCs as 2 kilogram take-home ration bags once per month to children 6–35 months

Summary

Introduction

In the 1970s, the Government of India adopted a series of policies aimed at improving the health of the country’s population and reducing the prevalence of malnutrition. Among these policies was the National Policy for Children, which was adopted in 1974 to improve the development and health of children, as well as to increase access to food for children [1]. The purpose of ICDS is to provide a number of basic nutrition, health, and early child development services to children from birth to 6 years of age and to pregnant and lactating mothers [3, 4]. Results from a recent national survey indicated that about three-quarters of the children under 3 years of age living in an area covered by an AWC do not receive any supplementary food, despite this being part of the core package of services [3]

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