Integrated Child Development Scheme Research Articles

Educating Anganwadi Workers to Enhance the Mother’s Knowledge and Awareness about Children Eye Health

Background: Blindness, visual impairment, and other eye problems in children are some of India’s major public health issues. In a state-operated integrated child development scheme (ICDS), the government engaged the Anganwadi workers and helpers. There is the advantage of integrating eye health within community health as active engagement of these local community workers spreads and also promotes an increase in the uptake of eye services. Purpose: The study intended to train Anganwadi workers working within the ICDS with knowledge about children’s eye health. The study also aimed to reach mothers or other primary caregivers of children and pro-vide them with knowledge to increase awareness about children’s eye health using the network of Anganwadi workers. Methods: A questionnaire-based study was undertaken to assess the cur-rent knowledge and awareness about children’s eye health among An-ganwadi workers and in randomly selected mothers and primary caregiv-ers of children from two blocks of the Saran District, Bihar, India. Com-prehensive training has been provided to Anganwadi workers through a validated training module which follows the structure of ICDS training modules, and each participant is asked to share the knowledge and edu-cate mothers or primary caregivers in their catchment area. After three months of imparted training, the mother’s or primary caregivers’ knowledge and awareness were assessed through a validated question-naire, and the results were compared. Results: A total of 274 Anganwadi workers participated in the interven-tional program, and 273 (99.6%) agreed that the training about” children’s eye health” was helpful to them. Furthermore, 230 mothers participated in the study, and 222 (96.5%) said that they had increased knowledge and awareness about children’s eye health from Anganwadi workers. Conclusions: A significant improvement was found in the knowledge and awareness of mothers or primary caregivers about children’s eye health as Anganawdi workers had educated them and made them aware of it. Edu-cating Anganawdi workers has a positive impact on spreading awareness in rural areas.

Does socio-economic inequality exist in micro-nutrients supplementation among children aged 6\u201359\u2009months in India? Evidence from National Family Health Survey 2005\u201306 and 2015\u201316

BackgroundGlobally, about 25% of children suffer from subclinical vitamin A deficiency (VAD), and approximately 300 million children globally had anemia as per 2011 estimates. Micronutrient deficiencies are generally referred to as “hidden hunger” because these deficiencies developed gradually. The present study determines the socio-economic inequalities in vitamin A supplementation (VAS) and Iron supplementation (IS) among children aged 6–59 months in India and to estimate the change in the percent contribution of different socio-economic correlates for such inequality from 2005 to 06 to 2015–16.MethodsData from National Family Health Survey (NFHS) 2005–06 and 2015–16 was used for the analysis. Bivariate analysis and logistic regression analysis was used to carve out the results. Moreover, Wagstaff decomposition analysis was used to find the factors which contributed to explain socio-economic status-related inequality among children in India.ResultsIt was revealed that the percentage of children who do not receive vitamin A supplementation was reduced from 85.5% to 42.1%, whereas in the case of IS, the percentage reduced from 95.3% to 73.9% from 2005-06 to 2015–16 respectively. The child’s age, mother’s educational status, birth order, breastfeeding status, place of residence and empowered action group (EAG) status of states were the factors that were significantly associated with vitamin A supplementation and iron supplementation among children in India. Moreover, it was found the children who do not receive vitamin A supplementation and iron supplementation got more concentrated among lower socio-economic strata. A major contribution for explaining the gap for socio-economic status (SES) related inequality was explained by mother’s educational status, household wealth status, and empowered action group status of states for both vitamin A supplementation and iron supplementation among children aged 6–59 months in India.ConclusionSchemes like the Integrated Child Development Scheme (ICDS) would play a significant role in reducing the socio-economic status-related gap for micro-nutrient supplementation among children in India. Proper implementation of ICDS will be enough for reducing the gap between rich and poor children regarding micro-nutrient supplementation.

Integrating Child Protection and Mental Health Concerns in the Early Childhood Care and Development Program in India

Adverse childhood experiences and protection risks such as neglect and abuse and family psychosocial and protection vulnerabilities, beginning in early childhood, are linked to negative development and mental health. Child protection is becoming an increasing concern in India, creating new imperatives to address it amongst all children, but particularly among children below the age of 6 years, who due to their age and developmental abilities, are rendered more vulnerable than older child populations. It is therefore imperative, particularly in developing contexts such as India, for early childhood development (ECCD) to integrate child protection and mental health services into their existing intervention package. Although early childhood programs work with multiple sectors, they have limited collaboration with child mental health and child protection systems. This article addresses the question of how to integrate child protection and mental health interventions into existing ECCD programs by describing the experience of a pilot project in the Indian context. It provides the rationale, methodology and content of service delivery for integrating child protection and mental health interventions into the existing ECCD program, the Integrated Child Development Scheme, highlighting emerging concerns and challenges and drawing from the interventions to show how some of these were addressed.

Optimizing the impact of health and related programmes / policies to address the issue of Childhood Obesity in India----A narrative review.

Non-communicable diseases are already acknowledged as a double burden, and now childhood obesity is putting extra strain on our health system. The current paper aimed to analyze the ongoing health and related programmes/policies in India, and we discussed the existing opportunities in the programmes to address the issue of childhood obesity in India. We searched the “MEDLINE,” “PsycINFO,” “Scopus,” “Web of Science,” and “Google Scholar” databases using the following keywords: (“overweight”) and (“obesity”), (“childhood obesity”), (“nutritional programmes in India”), (“Health policies in India”), (“malnourished children in India”) in combination with each other and in truncated form. All the relevant articles and policy documents (MOHFW, INDIA) available in the public domain were included to support the argument for this narrative review. We found that we have programme gaps like guidelines issues by Food Safety Standards Authority of India to tackle childhood obesity and it has not been strictly implemented due to multiple reasons. School health programme has an opportunity to address the issue of childhood obesity, but at the ground level the outcomes are not very promising. The National Nutrition Mission have only focussed on undernutrition and anemia problem, ignoring the overweight/childhood obesity. Primary care physicians are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke is dealing with health promotion and prevention, early diagnosis, and management of all ages, except children. Diet provided in Integrated Child Development Scheme is calculated based on calories, not by the quality which is a concern to us. The breastfeeding promotion programme named Mothers Absolute Affection programme has not been implemented with letter and spirit. Other than health programmes, we assume that Ministry of Urban Planning, Foreign Direct Investment policy, Advertisement Council of India and many more sector/policy/programme are indirectly responsible for the increasing burden of childhood obesity in India. Lack of awareness and wrong perception also responsible for the development of childhood obesity. We have multiple National Health Programmes and Policies to address the childhood malnutrition, but are focussing the undernutrition component only, ignoring overnutrition problem in the children, which is emerging as quadruple burden to our health system. Appropriate actions and inclusion of suggestions provided in this study for the improvement of the programmes at the practical level needs to be considered by the policy makers to halt the ever-rising trend of childhood obesity and primary care physicians should play a leadership role.

Opportunities for drowning interventions using existing government policy and programmes in India

Abstract Background Children living in coastal, rural India face a particularly high risk of drowning due to rurality, presence of open water, lack of accessible health systems and poor infrastructure. No drowning interventions are currently implemented in India. Interventions that build on existing policy targets or government programs are more likely to be sustainable and scalable. Methods For the first time to our knowledge for an injury-related issue in India, detailed content review of policy was conducted to identify both policy principles and/or specific government programs that may be leveraged for drowning interventions. The reach, enablers and barriers of these programs were assessed through a systematic literature review. Identified policies and programs were also assessed on how they catered for underserved groups and took into consideration equity. Results Three programs may be leveraged for drowning interventions: The Integrated Child Development Scheme (ICDS), Self-Help Group (SHG) and Accredited Social Health Activist (ASHA) programs. All three had high coverage and considered underserved groups such as women and rural populations. Conclusions Programs targeting specific health outcomes should consider interventions outside of the health sector that address social determinants of health. This may enable the program to better align with relevant government agendas and increase sustainability. Key messages This is the first systematic analysis of both policy content and execution of government programs to provide comprehensive insights into possible implementation strategies for an injury intervention. This methodology may be applied by other researchers identifying sustainable intervention options supported by government policy and/or programs.

Socio-demographic Variables Affecting Services Utilization Under Integrated Child Development Scheme (ICDS) in Bikaner - A Cross-Sectional study

Introduction The Integrated Childhood Development Services (ICDS) scheme is India’s foremost program imparting comprehensive and cost-effective services related to women and child beneficiaries. Still the level of coverage of the services is matter of concern in present day scenario. To find utilization of ICDS services and relation of various socio-demographic variables with utilization of services the study was proposed. Objective: To assess utilization and various socio-demographic variables affecting utilization of Integrated Child Development Scheme (ICDS) services. Methods A cross-sectional study was done in 1548 beneficiaries residing in service delivery area of Rural and Urban Health Training Centers of Bikaner, to assess effect of various socio-demographic variables on utilization of services provided under ICDS. The information was collected and entered in MS excel. Results This study revealed that 815(52.65%) beneficiaries utilized at least one service provided under ICDS. 50.69% urban study population and 54.71% of rural study population utilized the services. Among the significant variables affecting utilization of ICDS were religion, caste, nature of family, socioeconomic status and occupation. Conclusion This study revealed that utilization of services among rural and urban beneficiaries was almost similar, nearly half of the beneficiaries utilized the services. The role of various socio-demographic variables was significant in level of utilization of services in a particular group. IEC and BCC activities should be done in community to increase utilization of ICDS services by beneficiaries residing under service area of an Anganwadi.

The unheard and forgotten warriors of pandemic in India

ABSTRACT This narrative tells the story of two groups: Aanganwadi Group and the Nigrani Group. The former consists of women working under the ICDS (Integrated Child Development Scheme), a flagship program of the Government of India. The latter consists of local youth. The groups’ efforts, during the COVID-19 pandemic, are to ensure food security to migrants and other marginalized people. Despite the high risk of them becoming infected with the coronavirus, the Aanganwadi Group and Nigrani Group are working against all the odds. They are risking their lives to save lives, during the total lockdown in India. My story highlights the value of coordinated efforts between groups to optimize relief efforts for migrant workers during this unprecedented time of forced, sudden lockdown.

Opportunities for the development of drowning interventions in West Bengal, India: a review of policy and government programs

BackgroundFour million people living in the Indian Sundarbans region in the state of West Bengal face a particularly high risk of drowning due to rurality, presence of open water, lack of accessible health systems and poor infrastructure. Although the World Health Organization has identified several interventions that may prevent drowning in rural low-and middle-income country contexts, none are currently implemented in this region. This study aims to conduct contextual policy analysis for the development of a drowning program. Implementation of a drowning program should consider leveraging existing structures and resources, as interventions that build on policy targets or government programs are more likely to be sustainable and scalable.MethodsA detailed content review of national and state policy (West Bengal) was conducted to identify policy principles and/or specific government programs that may be leveraged for drowning interventions. The enablers and barriers of these programs as well as their implementation reach were assessed through a systematic literature review. Identified policies and programs were also assessed to understand how they catered for underserved groups and their implications for equity.ResultsThree programs were identified that may be leveraged for the implementation of drowning interventions such as supervised childcare, provision of home-based barriers, swim and rescue skills training and community first responder training: the Integrated Child Development Scheme (ICDS), Self-Help Group (SHG) and Accredited Social Health Activist (ASHA) programs. All three had high coverage in West Bengal and considered underserved groups such as women and rural populations. Possible barriers to using these programs were poor government monitoring, inadequate resource provision and overburdening of community-based workers.ConclusionsThis is the first systematic analysis of both policy content and execution of government programs to provide comprehensive insights into possible implementation strategies for a health intervention, in this case drowning. Programs targeting specific health outcomes should consider interventions outside of the health sector that address social determinants of health. This may enable the program to better align with relevant government agendas and increase sustainability.

Ensuring availability of food for child nutrition amidst the COVID – 19 pandemic: Challenges and Way forward

Coronavirus (COVID-19) pandemic spread in India is steeply rising. A 21-day lockdown has been imposed by the Government of India, to curtail its spread. This has impacted all walks of life, including the availability of food, and nutrition related services. This will impact nutritional status of children throughout India. The two major schemes, i.e. the Integrated Child Development Scheme and the Mid-day meal services scheme have also been affected leading to a risk of worsening of child nutrition. Some states have evolved their own strategies to mitigate the effect of lockdown during this crisis period. Here we discuss the challenges and way forward related to ensuring availability of food for child nutrition during this health crisis. 

The impact of integration of a dental module into the existing integrated child development services scheme in Chennai, India.

Aim:The aim of this study was to assess the impact of reinforced oral health awareness program to the children, parents and Anganwadi workers on the oral hygiene and oral health status of the children in Anganwadi centers functioning under the Integrated Child Development Scheme (ICDS) services all around Chennai city, Tamil Nadu, India.Materials and Methods:This longitudinal study was conducted among 511 study participants. All the study participants, their parents and Anganwadi workers attended an oral health education program. Oral hygiene and the oral health status of the children were assessed using a debris and WHO Pro forma 2013 at the baseline and after 1 year. Follow-up debris score was collected after 3 weeks, 1, 3, and 6 months in all the 12 zones divided into three groups, i.e., Groups A, B, and C according to the re-intervention schedule.Results:A highly significant reduction in the debris scores of the study participants was observed between each follow-up data collection (P = 0.001) regardless of the groups. A significant reduction (P = 0.001) in terms of the prevalence of dental caries, filled with no caries, missing teeth, gingival bleeding, and oral mucosal lesions were observed in the children between the baseline and final assessment after 1 year.Conclusion:A definite paradigm shift was observed in the present study after incorporation of the dental module, which could be taken up as an example to include oral health education and oral health checkups to the existing ICDS scheme, which was lacking before.

A community-based pragmatic, controlled trial for preventing and reducing oral diseases among 1\u20136-year-old children visiting Anganwadi centers, under the Integrated Child Development Scheme, India

BackgroundEarly childhood caries (ECC) has reached epidemic proportions affecting millions of children worldwide. Its prevention becomes imperative owing to the significant morbidity and financial implications involved with its treatment. The Integrated Child Development Scheme (ICDS), launched in India to provide mid-day meals, pre-school education and primary healthcare to children, can be utilised to counsel and deliver oral health education to mothers. The purpose of the study is to compare the effect of an oral health care package (OHCP) with usual care on the change in dental disease status among 1 to 3-year-old children at Anganwadi centres (AWC) in periurban areas of Chandigarh and rural areas of Cuttack, Orissa over a follow-up period of three years.MethodsTwo geographically distant ICDS blocks would be selected at each of the two study sites and would be randomly allocated to intervention and control group. Closely located AWCs under each of the selected blocks shall constitute the study setting. OHCP would be delivered to the mothers of the 1–6-year-old children enrolled in the AWCs of the experimental group whereas mothers under control group would receive usual care advice available at the AWCs.DiscussionECC prevention had conventionally focused upon testing effectiveness of programs targeting behaviour change among the caregivers and children, but surprisingly minimal efforts have been made to seek translation of these efforts into reduction of ECC at the community level. The present study has two components; testing effect of altering maternal and child behavioral aspects on ECC incidence through cohort follow up of 1–3-year-old children for three consecutive years and cross-sectional follow up of all available 1–6-year old children at the selected AWCs at regular intervals to look for change in prevalence of ECC at community level. In other regions of the world surveys of ECC prevalence before and after the intensive educational programs have shown a significant reduction in ECC prevalence. A similar decline can be anticipated through this program.Trial registrationThis trial has been prospectively registered at Clinical Trials Registry, India (CTRI/2019/02/017556, 08 February 2019).

Socioeconomic determinants of nutritional status among 'Baiga' tribal children In Balaghat district of Madhya Pradesh: A qualitative study.

The Baigas due to their primitive agricultural techniques, poor education status and poor population growth have been conferred the status of ‘Scheduled Tribe’ by the Government of India. The community bears the brunt of inequities, reflected in their poor nutritional and socioeconomic status. We have employed qualitative design for the study, as we wanted to understand the contextual factors for Baiga tribal children’s inferior nutrition status. Twenty in-depth interviews with the mothers of the children suffering from moderate to severe malnutrition and several other interviews were conducted with the key stakeholders like anganwadi workers, Integrated Child Development Scheme supervisors, Accredited Social Health Activists, public distribution system shopkeeper and registered medical practitioners. Interviews with the key informants were conducted in the Balagahat district of Madhya Pradesh. Key factors responsible for perpetuating malnutrition were then identified through thematic analysis. It was found that dissatisfaction with public services and indifferent attitude of public servants resulting in poor uptake of public services further accentuated the problem. A qualitative enquiry into the issue of high and persistent levels of malnourishment among these tribal children revealed several aspects which quantitative method may not have captured. This implies that while framing a policy for improvement in the nutrition status in such population, a holistic approach is required instead of focussing on one aspect such as supplementation of nutrition alone.

Integrated Child Development Scheme (ICDS) Interventions in India: A Grassroots Level Perspective

Integrated Child Development Scheme (ICDS) Interventions in India: A Grassroots Level Perspective

A Study of the Management of Early Childhood Education in the Nalgonda District of Telangana

The management of early childhood education (ECE) in Nalgonda District as part of the Integrated Child Development Scheme (ICDS) in Nalgonda is highlighted in this study. The program was first implemented in 1975. It was launched on a holy day, the birthday of Mahatma Gandhi, the founding father of our country. With its need-based initiatives, the program has gained widespread acceptance across the nation, which is in the best interests of the millions of children who make up the nation's true assets. The investigation looks into several ECE-related issues, including organizational structure, learning environment, health and hygiene, monitoring and supervision systems, and Anganwadi Center infrastructure. The researcher analyses the system's assets and weaknesses and offers recommendations for improved performance.

Inequalities in Demand and Access to Early Childhood Education in India

Global investment in early childhood education is a key policy to address social and economic disadvantage for children and families. Since 1975, India has one of the world’s largest provisions for free, public early childhood education, under a program called the Integrated Child Development Scheme. However, almost half of the children in India still do not have access to early childhood education and the reasons behind this inequality are largely unidentified. This study investigates the nature of factors affecting demand and access to preschool and how parental decisions may be influenced by parents’ education and other socio-economic factors, societal status, and awareness of the value of preschool attendance. The analyses draw on survey data collected from 1373 households in two districts in West Bengal with data gathered through extensive fieldwork in 2015. A key factor affecting preschool non-attendance was found to be lower levels of parent education. This explained the largest variation in the data. It is important to increase parental awareness on the value of preschool, as well as to increase the availability of early childhood education in rural, as well as in urban districts, in India.

Labour room violence in Uttar Pradesh, India: evidence from longitudinal study of pregnancy and childbirth

ObjectivesThe major objective of this study was to investigate the prevalence of labour room violence (LRV) (one of the forms of obstetric violence) faced by the women during the time...

National Nutrition Strategy: The Needed Timely Modification to Make Integrated Child Development Scheme More Effective.

India is undergoing not only economic, demographic and nutritional transformational change but also indicators of health are improving remarkably. But, Integrated Child Development Scheme (ICDS) is striving hard to improve the nutritional and health status of children in the age-group 0-6 y even after 4 decades of its implementation, so there is a need to reconsider strategies to bring desired improvement in children's health. For better governance in the delivery of the Scheme, convergence is one of the key features of the ICDS Scheme for providing all services under the Scheme. The National Nutrition Strategy (NNS) has been launched, which reflects renewed focus on nutrition and it lays down a roadmap for effective action, among both implementers and practitioners in achieving our nutritional objectives. The NNS framework envisages a KuposhanMukt Bharat- linked to Swachh Bharat and Swasth Bharat. Specific nutritional interventions under KuposhanMukt Bharat are Infant and Young Child care and Nutrition, Infant and Young Child Health, Maternal Care, Nutrition and Health, Adolescent Care, Nutrition and Health, addressing micronutrient deficiencies-including anemia and Community nutrition. All districts having high burden of malnutrition will be targeted, and the nutritional status will be measured through a real time ICT enabled system by providing smart phone to Anganwadi workers (AWW). Newer interventions included are eliminating of registers used by AWWs, measurement of height of children at the Anganwadi centres (AWCs), social audits and setting-up Nutrition Resource Centres, involving masses through Jan Andolan for their participation on nutrition through various activities, among others.

Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation

IntroductionMillions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme...

Time spent being malnourished during the first five years of life! An unseen aspect of child malnutrition.

The burden of malnutrition is often estimated in terms of 'prevalence' without considering two important contributing factors: incidence and duration. To illustrate this, we conducted a community-based retrospective cohort study involving 24,278 children enrolled in an integrated child development scheme in India. Anthropometric data of study participants from birth to five years of age were collected from the growth charts maintained by Anganwadi workers. Of all the growth charts reviewed, 1460 (6.0%) children died before their fifth birthday and 4013 (16.5%) were excluded after initial screening because either the growth chart was incomplete (4.8%) or had missing entries (11.7%). Of the remaining 20,265 children included in the study, in the first five years of their life, 35.6% suffered from exclusive moderate malnourishment and 9.4% from severe malnourishment. The most common age groups for the onset of moderate and severe malnutrition were 9-11 months and 12-15 months, respectively. The mode, median and mean duration of time spent by children being severely underweight was 3, 7 and 8.4 months respectively, and being moderately underweight was 8, 11 and 15.1 months, respectively. Thus, a comprehensive strategy for preventing the onset of malnutrition (both moderate and severe) among children is urgently needed.

Does the ICDS Improve Children’s Diets? Some Evidence from Rural Bihar

Although there are several studies documenting the impact of the Integrated Child Development Scheme (ICDS) – the largest preschool intervention – in India, few have documented to what extent it improves the quantity and quality of food consumed by young children. This paper attempts to provide causal estimates of the impact of the ICDS on calories, protein, iron, and Vitamin A intakes of children. Using matching techniques to define an appropriate counterfactual, and a primary survey in four villages in rural Bihar, our results suggest that: (a) for older children three to six years who benefit from cooked meals, the ICDS did result in higher intakes of calories, protein, and iron, and no substantive evidence that as a consequence there was substitution away from food at home. However, there was no impact on vitamin A intake; (b) for younger children whose mothers are given take-home rations, there is no evidence the ICDS improved intakes of calories or any other nutrients. Thus, even though the monetary value of the transfer was the same across both age groups, there is evidence to suggest the mode of transfer does seem to matter to ICDS effectiveness, consistent with other literature.