Integrated Child Development Services Research Articles

A STUDY ON KNOWLEDGE AND UTILIZATION OF READY TO EAT FOOD PACKET UNDER ICDS PROJECT IN URBAN AREA YADUNANDAN NAGAR, BILASPUR (C.G.)

BACKGROUND:The Integrated child Development services (ICDS) is India's response to the challenge of meeting the holistic need of the child. ICDS is one of the world's largest and most unique outreach programme for early childhood care and development. In case of children between the age group of 6 months to three years, supplementary food item is provided to carry home. And this is in the form of “READY TO EAT” food packet. OBJECTIVE: 1. To assess the utilization of Ready to Eat food packets by children 6month to 36 month under ICDS project. 2. To assess the knowledge regarding Ready to Eat food packets by children 6month to 36 month under ICDS project. MATERIAL AND METHOD: A community based cross sectional study conducted in 11 Anganwadis. 20 Children of 6 months to 3 years were picked from each Anganwadi by convenience sampling method thus total sample were 220each.Mx-Excel and SPSS 20 was used for data analysis. RESULT: Mean score of knowledge was 5.95. 156 (71 %) had good knowledge scores .80% of respondent knew about the different type of available food packets, its contents and advantages. Mean score of utilization was 16.77. The responses with regard to practice were average only (52%) of the participants although only 72% consumed entire food packet .67% have noticed improvement of health 61% respondents wanted to continue food as it was good for health, 18% as it is free of cost, 14% as food tastes good, 7% as it is timely available. CONCLUSION: According to the study we concluded that knowledge of the Ready to Eat food packet under ICDS were adequate but utilization of the Ready to Eat food packet is just satisfactory in urban aanganwadis

Assess the knowledge, utilization, level of satisfaction of utilization and barriers of non-utilization regarding Integrated Child Development Services (ICDS) among women of Ernakulam District, Kerala, India

IntroductionThe integrated child development scheme (ICDS) was launched in 1975 to provide an integrated package of services to aid the holistic development of the child. The beneficiaries of this scheme are children below the age of six, pregnant and lactating women in the age group of 15–45 years. ObjectivesThe objectives of the present study were to assess the knowledge, utilization, level of satisfaction of utilization and barriers of non-utilization regarding Integrated Child Development Services (ICDS) among women. MethodsThis study adopted a quantitative approach using a descriptive survey design. Convenience sampling technique was used to collect data from 553 women between the age group of 18–45 years residing in Ernakulam district, Kerala, India. Five tools were used to collect the data. The obtained data from 553 women entered in data sheet using SPSS version 20 and was analyzed by using descriptive statistics. ResultsMajority women (68.5%) had average knowledge regarding ICDS services. Mothers who had under five children utilized more ICDS services (90.5%) compared to pregnant women (48.7%) and lactating mothers (27.2%). Majority women (75%) were highly satisfied with utilization of ICDS services. The first and foremost barrier for non-utilization of ICDS services among women was lack of time due to work (60%). ConclusionThe ICDS programme is a globally recognized community based programme, which addresses the basic interrelated needs of young children and mothers, in a holistic manner.

The Functions of Integrated Child Development Services (ICDS): An Assessment of Existing Policy and Practice in Odisha

The Integrated Child Development Services (ICDS) scheme is the world’s biggest and unique programme for nutrition and childcare, launched way back on 2 October 1975 by the Government of India. It is a centrally subsidised scheme implemented by states across the country for the benefit of children, especially for vulnerable groups. The scheme’s main objective is to improve the health and nutritional condition of children below six years of age, along with pregnant women and lactating mothers. The objective of the study is to critically analyse functions of the ICDS Scheme in the state of Odisha about implementation and monitoring. The analysis was done with the help of secondary literature and available data from government documents. The opinion and experience of various stakeholders like Anganwadi workers, supervisors and other government staff have been analysed for this purpose. This article describes existing policies and procedures of food procurement, storing, supply, cooking, production and serving cycle under ICDS Scheme in Odisha. The recommendations of the study may help for future improvement of various thrust areas of the ICDS Scheme. The article brings out critical factors accountable for the efficient implementation of the ICDS programme. Further, the study evaluates the ICDS Scheme based on existing government guidelines to reach out to the masses in Odisha.

Integrated Child Development Services (ICDS) Scheme in India - a tired horse or an ignored one. An evaluation in a tribal district of Maharashtra, India

Introduction: The lives of children and women are the true indicators of the strength of communities and nations. UNICEF considers Child Mortality rate as the single best indicator of social development and well-being. Integrated Child Development Services (ICDS) Scheme is one of the largest maternal and child health programs representing a symbol of India’s commitment to its children. The anganwadi centre (AWC) is the grassroot functionary of ICDS and the program is executed through dedicated cadre of female workers named Anganwadi workers (AWWs). Still India records high infant, child and maternal mortality rates. Also, frequent malnutrition related deaths in the state of Maharashtra has raised questions on the implementation of these programmes. This study was conducted to evaluate the functionality of Anganwadi Centres in terms of infrastructure and logistics and assess the satisfaction of Anganwadi workers. Methodology: This was a community based cross-sectional descriptive study in the tribal district of Palghar in Maharashtra. Universal sample of all the Anganwadi centres under the randomly selected PHC was adopted for the study. Data for the study was collected by using personal interview technique with the help of a semi structured questionnaire and by self-observation using a standard checklist. The data collected was analysed using appropriate descriptive statistics with the help of Epi info. Result: Only just about half of the AWCs were functioning in their own building. Among infrastructure and logistics, registers for record keeping was found to be most deficient (88.9%) followed by presence of electricity and baby weighing machine (77.8%). Availability of separate kitchen and storeroom and regularity of supplementary nutrition supply was seen deficient in 69.4% of AWCs. Growth card was the most available amenity (100%) followed by adult weighing machine which was present in 91.7% of AWCs and drinking water facility in 86.1%. Toilet was present in only about half of the AWCs studied. Among the various problems accounting for poor job satisfaction among AWWs, some of the prominent were, lack of own anganwadi building, inadequate space for activities, lack of teaching materials, problems in eliciting the Supplementary Nutrition Programme (SNP) due to inadequacy or irregularity of the supplementary nutrition supply, and absence of separate kitchen. Other problems faced were low government and community involvement, increased workload and a modest honorarium. Conclusion: Studies conducted across the country, has observed that various factors contributed to the efficient service delivery of ICDS. Our study exposes some key factors that affect the effective implementation of the scheme and the felt needs of its implementers at the grass root level.

Assessment of Integrated Child Development Services (ICDS) at Grass Root Level in an Urban Area, Raigad District, Maharashtra

Background: ICDS is an integrated program intended for Maternal and Child Care which adopts a holistic, lifecycle approach. Its main focus is on health, nutrition and education. Urban ICDS caters to the vulnerable urban slum population. Despite the program running for four decades its impact on its beneficiaries is still slow. The Anganwadi worker and helper are the grass-root functionaries running this program through Anganwadi centre. Hence this study was conducted to assess the functioning of the Anganwadi centre. Methodology: A Descriptive Cross-sectional study was conducted at all 15 urban-ICDS Anganwadi Centres of Khopoli during September-November 2019. The Anganwadi workers and helpers were interviewed regarding their sociodemographic details, knowledge and challenges perceived to run the centre. Observational Checklist designed based on guidelines and standard proforma for monitoring of the ICDS projects was used to assess infrastructure, equipment and registers. Results: Out of 14, 11(78.57%) Anganwadi workers had more than a decade experience. Indoor space of 600 sq.ft was available in 7(46.67%) centres. Toilets with running water were available in 9(60%) Anganwadi Centres and 6(40%) were linked to the school. Functional Salter’s weighing scale was available in 11(73.33%) Anganwadi centres. All 12 registers were available in 9(60%) Anganwadi centres. The utilization of services by pregnant women was the highest. Partially immunized children were present in 2(13.33%) Anganwadi centres. The service gap was highest (100%) with health check-up. Conclusions: There is a gap in the availability of infrastructure and utilization of some services. Keywords: urban ICDS, Maharashtra, Service gap.

Rehabilitation of Special Needs Children at Pre-school Level: A Study of Attitude of Integrated Child Development Services Functionaries and Parents

The Integrated Child Development Services (ICDS) is a significant scheme that works for rehabilitation of different categories of children including special needs children at pre-school level in India. For rehabilitation of special needs children at pre-school level, the ICDS functionaries and parents (of the children) play the vital role. For developing the favorable attitude of ICDS functionaries and parents towards rehabilitation of special needs children at pre-school level, it is important to study the attitude of ICDS functionaries and parents towards rehabilitation of special needs children at pre-school level. Hence, in this study an attempt was made to study the attitudes of ICDS functionaries (Child Development Project Officers, Supervisors and Anganwadi workers) and parents towards rehabilitation of special needs children at pre-school level. The study was a descriptive survey-cum-comparative type research. 36 Child Development Project Officers (CDPOs), 108 Supervisors, 108 Anganwadi workers (AWWs), and 216 parents under thirty six ICDS projects from nine administrative districts of Assam were taken as participants of the study. A self-developed attitude scale was used to collect data from the participants. Mainly quantitative data analysis techniques were used to analyze the data of the study. The major findings of the study indicated that all the ICDS functionaries and parents have shown high attitude towards rehabilitation of special needs children at pre-school level; and CDPOs possess better attitude than the supervisors, and parents possess better attitude than the supervisors towards rehabilitation of special needs children at pre-school level. And from the study, it is also found that the background variable ‘experience’ of the supervisors acts as a determining factor in determining the attitude of the supervisors towards rehabilitation of special needs children at pre-school whereas no other background variable of the supervisors and none of the background variables of the CDPOs, AWWs and parents acts as a determining factor in determining their attitude towards rehabilitation of special needs children at pre-school level.

TRENDS OF MALNUTRITION AND UNDER-FIVE MORTALITY AMONG CHILDREN IN INDIA - TROTTING `PUBLIC HEALTH CHALLENGES AMIDST EFFECTIVE STRATEGIES: A REVIEW.

OBJECTIVE: Malnutrition is a complex multitude issue. Global estimates found that malnutrition alone is responsible for the forty five percent of deaths among children under-five years of age which is otherwise preventable. India has started its war against malnutrition way back in 1970. The aim is to analyse: the trends on malnutrition indicators; statewise prevalence of malnutrition among under-five children; the under-five mortality rate in India; the socio-economicdemographic factors common to both malnutrition and U5MR and national nutritional policy in system and its challenges ahead. MATERIALS AND METHODS: Desk review and analysis National Family Health Survey1 to 5 and Combined national nutritional surveys, Sample registration survey – recent and review of the relevant journal articles and editorials. RESULTS: India is one of the worst affected countries of the World and is under 'Very High Category' for all the three major indicators of malnutrition: Stunting, wasting and under nutrition. Integrated Child Development Services, which developed as an experimental initiative in India, has evolved overtime imbibing Millennium development goals, Global nutritional policy, Sustainable development goals to address the overall complexity of malnutrition including immunization, maternal health, adolescent health, primary health care, best feeding practices, sanitation and hygiene practices. Yet, India ranks One hundredth and two rank out of one hundred seventeen countries as per the Global Hunger Index report, 2019. CONCLUSION: A more concerted and intersectoral collaborative actions, a real time monitoring, independent reviewing and progressive efforts would only help India's National nutrition mission to achieve its goal 'Kuposhan Mukt Bharat', malnutrition free India by 2025.

Development and psychometric testing of the FLW-MSC scale for measuring frontline worker multisectoral collaboration in rural India

ObjectivesMultisectoral collaboration (MSC) is widely recognised as a critical aspect of policies, programmes and interventions addressing complex public health issues, yet it is undertheorised and difficult to measure. Limited understanding...

Montessori for all? Indian experiments in ‘child education’, 1920s–1970s

ABSTRACT This article discusses the ‘Indianisation’, ‘nationalisation’, and ‘ruralisation’ of the Montessori method in India at the eve, and in the aftermath of the country’s political independence (1947). From 1914 onwards, Indian nationalists received Montessori’s ideas through publications, the networks of the new education movement, and the Theosophical Society. While innovative pre-schools for elite children worked closely with the ‘original’ method, the Nutan Bal Shikshan Sangh (‘New Child Education Society’, NBSS) adapted it to local conditions (‘Indianisation’). The NBSS aimed to universalise Montessori-based child education, as a contribution to nation-building (‘nationalisation’). With the establishment of the Gram Bal Shiksha Kendra (Rural Child Education Centre), in 1945, the NBSS brought the country’s most marginalised into the modernising reach of the new state, furthering Gandhi’s vision of ‘rural reconstruction’ (‘ruralisation’). From these experiments, the institutional model of the Anganwadi emerged, through which today millions of Indian children receive integrated child development services.

Infrastructure for Delivery of Integrated Child Development Services and Uptake of Pre-school Education Services: Insights from Palghar, India

The Integrated Child Development Services (ICDS) is a flagship programme of the Government of India and is delivered through a vast network of Anganwadi Centres (AWCs)—Courtyard Shelters—across rural and urban areas of the country. The ICDS is, however, affected by low coverage of various ICDS services, in general, and preschool education (PSE) services, in particular. This article aims to understand whether status of AWC infrastructure can have an effect on enhancing the coverage of PSE component. The article has twofold objectives: (a) to develop an AWC infrastructure index (AII), which can be applied to support programmatic monitoring and evaluation by ICDS and (b) to comprehend the association of AII with attendance and uptake of PSE services. Based on descriptive and econometric analysis of the AWC infrastructure data from Palghar (Maharashtra, India), it is demonstrated that better infrastructure is associated with higher PSE service coverage. The article concludes by highlighting the relevance of investing in AWC infrastructure, refurbishments and quality improvements to expand ICDS service coverage, particularly for the PSE services.

An evaluation study of Anganwadis under ICDS in India

Integrated Child Development Services (ICDS) scheme has expanded tremendously over the 30 years of its operation to cover almost all the development blocks in the country. It offers a wide range of health, nutrition and education related services to children, women and adolescent girls. The study wish to find out the impact and efficacy of the ICDS scheme. The study was conducted from April 2019 to December 2019. The study was conducted on purposive random sampling basis covering 19 States/UTs. 510 AWCs were selected and total 15300 children were covered. One of the important findings of the study is that the children in the Normal grade are found to be 77.4% of the total sample size which means that in spite of a lot of bottlenecks, the malnutrition has been reduced among the children of 0 to 5 years of age. As envisages from the field study, people are well aware of the ICDS scheme and are sending their children to AWCs. However, the children from remote areas are not able to avail these facilities. The opening of public nursery school in urban and rural areas poses a great threat to the enrollment of children in AWCs nowadays unless the infrastructural and other facilities of AWCs are upgraded. The working conditions and remuneration of AWC workers needs to be looked at sympathetically. The findings of the study are expected to help policymakers and programme implementing bodies to take appropriate corrective measures to make the ICDS more effective and thereby bringing down the malnutrition in children to zero level.

Augmenting State Capacity for Child Development: Experimental Evidence from India

We use a large-scale randomized experiment to study the impact of augmenting staffing in the world’s largest public early childhood program: India’s Integrated Child Development Services (ICDS). Adding a half-time worker doubled net preschool instructional time and led to 0.29σ and 0.46σ increases in math and language test scores after 18 months for children who remained enrolled in the program. Rates of stunting and severe malnutrition were also lower in the treatment group. A cost-benefit analysis suggests that the benefits of augmenting ICDS staffing are likely to significantly exceed its costs even under conservative assumptions.

Awareness and utilization of maternal benefit schemes among mothers in urban area

Background: Motherhood is the most important stage of a woman’s life but can be a life-threatening condition too. During pregnancy, any woman can develop life-threatening complications that require immediate medical care. Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. Maternal health care services are the measures to ensure safe motherhood through promotive, preventive, curative, and rehabilitative health-care system. In view of the difficulty being faced by the pregnant women along with high expenditure on delivery, Ministry of Health and Family Welfare and state governments have launched many schemes to ensure better facilities for women during pregnancy and delivery. However, the success of these schemes depends on their utilization by antenatal and postnatal mothers. Aim and Objective: This study was planned to estimate the level of awareness about the various government maternal benefit schemes among and also to assess the utilization of maternal benefit schemes among those mothers. Materials and Methods: This was a community-based cross-sectional study. All the mothers who had delivered before 1 year from the start of the study were included in the study. The mothers were identified with the help of Accredited Social Health Activist worker and Anganwadi worker by door-to-door enumeration. A sample of 150 was studied. Non-probability convenience sampling was followed to select study participants. A structured interview method was used. Results: In the present study, most of the mothers (89.3%) were in the age group of 20–30 years with mean age of 24.3 years (± 3.4 years). The participant was considered as aware of the government scheme, if she had heard about the scheme and knows about certain key points of the scheme. Health care workers were the major source of information for mothers (62.5%) in our study area followed by friends and family for 17.5–9.2%, respectively. Majority of the mothers (65%) had utilized Anganwadi Nutrition Supplementation followed by Bhagyalakshmi Scheme and Janani Suraksha Yojana. Conclusion: Overall awareness regarding government maternity benefits scheme ranges from 6.3% (Madilu kit) to 77.6% (Integrated Child Development Services). The awareness about important Government Maternity Benefit Schemes specifically targeted to reduce maternal and neonatal mortality such as Thayi Bhagya scheme and Janani Shishu Suraksha Karyakram was low.

Assessing nutritional status index of anganwadi children attending icds (integrated child development services) centres: A study in Trivandrum District, Kerala

Assessing nutritional status index of anganwadi children attending icds (integrated child development services) centres: A study in Trivandrum District, Kerala

Utilisation of Supplementary Nutrition Service at Anganwadi Centres in a Block of Ganjam District, Odisha: A Cross-sectional Study

Introduction: In India, the Integrated Child Development Services (ICDS) scheme provides a package of services to different groups of the target population. The Anganwadi Centre (AWC) is the focal point for delivery of these services. At AWCs, supplementary food is provided to children below six years, adolescent girls, pregnant women and lactating mothers. Aim: To assess the pattern of utilisation of supplementary nutrition by the beneficiaries and to explore the factors leading to non utilisation of supplementary nutrition. Materials and Methods: This was a cross-sectional study conducted from October 2016 to October 2018 in AWCs in Ganjam district, Odisha, India. Multistage random sampling was used to select the AWCs. By using table of random numbers, 24 AWCs were selected. From each AWC, 12 beneficiaries were selected randomly. So a total of 288 beneficiaries were selected. Out of 288 beneficiaries, 240 beneficiaries were eligible for supplementary nutrition. Rates and proportions were calculated. The Chi-square test was used for testing association between variables. Results: All the AWCs were providing supplementary food as per menu chart and were using standard measure for distribution of raw food. Supplementary food was consumed by 188 (78.3%) beneficiaries. The reason given by most of the respondents {28 (53.8%)} for non utilisation of supplementary nutrition was that they did not like the taste of the food. A statistically significant association was found between utilisation of supplementary nutrition and factors like education, socio-economic status and occupation of women. Conclusion: Although supplementary nutrition was provided by all the AWCs, it was not consumed by some beneficiaries due to lack of variety, taste and bad quality of food. The Take Home Ration (THR) was shared among the family members resulting in dilution of the service.

Determinants of Nutritional Status among Under-Five Children in the Tribal Population of The Nilgiris, Southern India: A Cross-Sectional Study.

Background:The tribal populations in The Nilgiris of Tamil Nadu are identified as particularly vulnerable tribal groups (PVTGs) and are “high risk” in terms of health and nutrition.Objectives:The objective of the study is, among the under-five tribal children, to determine the prevalence of undernutrition and the factors associated with it.Materials and Methods:This community-based cross-sectional study was conducted between March and June 2019 among 605 under-five tribal children. The prevalence of underweight, stunting, and wasting was expressed as proportion; the association with determinants was assessed using log-binomial regression model.Results:The prevalence of underweight, stunting, and wasting was 63% (95% confidence interval [CI] 57–70), 62% (95% CI 54–70), and 31% (95% CI 24–38), respectively. Among them, 29%, 35%, and 10% were severely underweight, stunted, and wasted, respectively. Among 605 participants, 80% utilized supplementary nutrition program of the Integrated Child Development Services; only 21% of whom utilized it as per the ICDS recommended quantities prescribed for different category of beneficiaries. Male child, age >2 years, and illiteracy of father were significantly associated with underweight. Age >2 years and illiteracy of mother were significantly associated with stunting. Male child and low family income were significantly associated with wasting.Conclusion:Nearly three out of four children in the community were undernourished. Poverty alleviation programs are required to combat undernutrition among backward communities.

Implementing a “convergent” framework of action against childhood malnutrition in urban informal settlements of Mumbai: Frontline perspectives

Context:The National Nutrition Mission (POSHAN Abhiyaan) intends to “converge” nutrition-related program components across sectors (nutrition, health, water, and sanitation). In this study, we have examined the perspectives of Anganwadi workers (AWWs), the frontline workers of the Integrated Child Development Services, on working in convergence with the public health sector.Methods:This exploratory qualitative study was done between June 2018 and June 2019 in two urban informal settlements in Mumbai. We conducted in-depth interviews with 26 AWWs and their supervisors, purposively sampled and diversified in terms of age, education, and years of experience. We used the software NVivo version 12 to aid analysis.Results:Most AWWs acknowledged that a convergent framework of action between “nutrition” and “health” was likely to be beneficial to the community. However, they also shared that cross-sector convergence was currently limited due to technical unfamiliarity with “health-sector” issues in the frontline, discomfort with data sharing, and lack of meaningful incentives for joint work. Broader organizational challenges such as poor infrastructure and lack of supervision, as well as challenges in the urban context (migration and cultural barriers) further hindered joint activities.Conclusions:The findings indicate that critical structural gaps in the urban setup of ICDS need to be addressed and AWWs need to be better familiarized with the changing roles expected from them under POSHAN Abhiyaan. To work better with the health sector, the work timings of AWWs need to be aligned with those of the health sector and meaningful financial incentives need to be put in place for cross-sector activities.

Age Variations and Sexual Dimorphism in Linear Body Segments among Children Aged 2-6-Years of Bengalee Ethnicity from Arambagh, West Bengal, India

Background Sitting height (SH), sub ischial leg length (SILL) and the sitting height/leg length ratio (SH/SILL) are useful tools for assessing human body proportions. They are often used to detect the presence of abnormal growth, especially in school-aged children. Materials and Methods Our cross-sectional study was conducted among 1012 preschool children aged 2 to 6-years from Integrated Child Development Services (ICDS) scheme centers at Bali Gram Panchayat, Arambagh, Hooghly District, West Bengal, India. Anthropometric measurements like height, weight, SH were measured following standard protocol. Results There was no age combined significant sex difference in any variable. However, age specific sex differences were there in few age groups. Highly significant (p<0.001) age variations existed in all variables. The body mass index (BMI) was significantly (p<0.01) negatively correlated with SILL (r=-0.443), SILLP (r=-0.302) and UTL (r=-0.346) in both sexes. It was significantly (p<0.01) positively associated with UTLP (r=0.302). Moreover, SILL was significantly positively correlated with UTL in both sexes (boys, r=0.821 and girls, r=0.871; p<0.01), whereas it was significantly negatively associated with UTLP (boys, r=-0.590 and girls, r=-0.552; p<0.01) in the participants. Conclusion Our results suggest that, in both sexes, there were significant age differences in SILL, SILLP, upper trunk length (UTL) and unified technology learning platform (UTLP). The BMI had significant associations with these variables in both sexes. Moreover, SILL had significant correlation with UTL and UTLP among the participants.

Equity and Accessibility of Antenatal Care Utilization in India

Aims and Objectives: In this paper, we examine the determinants at both the person and household level, and the connexion of the population to health facilities in childcare, wealth, caste, education and others are responsible for the stability found in Antenatal Care utilization. For this study, data used from the Indian National Family Health Survey (NFHS-4 2015-2016) three rounds are available. The findings of the analysis are given in three parts. First, at least 1 Injection of tetanus toxoid (TT), the Iron Folic Acid tablets (IFA), identified as four or more prenatal visits at least 100 days. Second, state profiles of NFHS-4 antenatal care usage are provided to compare patterns. Third, the impact of demand and access variables calculated from multi-level logistics.
 Methods: In India, we analyzed a group of 190, 898 women in the Nationwide Family Health Study 4. In order to measure Equity for the maximum ANC usage, concentration and index curves were employed. The multivariable logistic regression model has used to analyze the relevant variables to the usage of complete ANC.
 Results: 21% of pregnant women in India use complete ANC, which is 2.3-65.9% throughout the world. 51.6% received four or more ANC visits, 30.8% had at least 100 days of IFA and 91.1% had tetanus toxoid in one or two doses. Complete usage of the ANC in the family, caste and maternal education were unequal. The utilization of the Integrated Child Development Services (ICDS) government register, birth registration and health care coverage has related to improved chances of complete ANC utilization. Lower maternity schooling, lower-income, father intrusiveness during prenatal visits, a higher birth order, puberty and accidental pregnancy were related to lower odds of maximum ANC use.

Guava with an institutional supplementary meal improves iron status of preschoolers: a cluster-randomized controlled trial.

The Integrated Child Development Services of India provides Supplementary Nutrition Program (SNP) to preschoolers. Using this platform, the current study examined the impact of diversifying a cereal/pulse-based SNP-meal with guava on iron status and cognitive development among 24-48 months old children.A three-arm, nonblinded, cluster-randomized controlled trial (CTRI/2014/09/004983) included 399 beneficiaries from 28 preschools in 16 villages in Telangana state, India. The villages were randomly assigned to receive 25 g of guava (guava group (GG)), banana (banana group (BG)), or cucumber (cucumber group (CG)) along with a SNP meal for 140 days. Nutrient biomarkers (iron status, plasma vitamin C, vitamin B12 , and folate), cognitive development, anthropometric indicators (WAZ, HAZ, and WHZ), and morbidity were assessed at baseline and endline. A linear mixed model and a generalized estimating equation were applied to compare changes in outcomes across the groups. All outcome variables were comparable across groups at baseline. The iron to vitamin C molar ratio improved in the GG from 1:1.4 to 1:12 but remained unaltered in control groups. Higher hemoglobin (P=0.002), serum ferritin (SF; P < 0.001), vitamin C (P=0.047), and lower soluble transferrin receptor (sTfR; P < 0.001) causing decreased prevalence of iron deficiency (ID) (P=0.003) were observed in the GG compared with BG and CG. Prevalence of acute respiratory infection (ARI) was lower in the GG (P=0.035) versus controls. No impact was observed on cognitive development or growth. Thus, diversifying a cereal/pulse-based meal with guava increased meal vitamin C content, thereby reducing ID and ARI-related morbidity. This approach represents a valid and scalable strategy to address ID among young children.