Integrated Child Development Services Program Research Articles

IJCM_416A: Health Profile of Anganwadi Workers: a camp-based study conducted at a Tertiary Hospital, Mumbai, India

Background: As part of the Integrated Child Development Services program, The Anganwadi system is mainly managed by the Anganwadi worker (AWW). The fundamental tasks performed by Anganwadi workers are crucial and must be completed as effectively as possible. Hence the good health of Anganwadi workers decides how efficiently they can do their allotted work. So, this study was conducted to assess the health profile of Anganwadi workers. Objective: To assess the health profile of Anganwadi workers attending a Health checkup camp at a Tertiary Hospital. Methodology: A cross sectional descriptive study was conducted at a free health camp in a Tertiary Hospital of Mumbai, India, by the staff and interns of the Department of Community medicine. All AWWs who attended the camp were included in the study. AWWs who attended the health checkup camp were assessed for morbidity. Data collected by semi structured questionnaire was entered into Microsoft Excel and analysed using SPSS version-17.0. Results: Most of AWWs were from the age group of between 41-50 years; more than half of them were matriculate and 34(69.38%) workers had an experience of more than 10 years. Around 49% of them were having abnormal BMI and 53% were anaemic. PAP smear findings were abnormal in 4% AWWs. Conclusion: AWWs are considered cornerstone in providing ICDS services, but in this study, we found that most of AWWs themselves were not at their good health. Regular health checkups of healthcare workers of each level should be done to efficiently deliver the healthcare services to people of our country.

Adolescents and Psychosocial Issues: An Empirical Study

The adolescent period is a time of many upswings and downsides which requires constant support and guidance from parents, guardians and society. Moreover, adolescent girls face more psychosocial problems in contrast to boys, especially in India due to its different social and cultural environment. The psychosocial problems can have an adverse effect on the health of adolescent girls. Thus, social investment in adolescents is important not only for their well-being but also for society as a whole. The Integrated Child Development Services (ICDS) is one of the social investment programmes in India which seeks to address such problems in girls. The present research study has been carried out to explore the psychosocial issues of adolescent girl beneficiaries’ of the ICDS programme in Central Kashmir. Furthermore, the role of demographic and socio-economic factors in relation to psychosocial issues has also been examined. The research was both explorative and descriptive, and the data were analysed with quantitative techniques involving ANOVA in SPSS. The results obtained provide interesting insights into the research problems which can be beneficial for many stakeholders. The study results revealed that most of the beneficiaries had psychosocial issues such as somatic complications, adjustment problems, sleep problems, attention problems and sleep problems. However, these problems varied in relation to different demographic variables such as age, gender, education, district, economic status, etc. The research also provides interesting and valuable suggestions to different stakeholders regarding their role in solving the problems of adolescent girls.

Nourishing the Nation's Future: The Pioneering Role of Integrated Child Development Services in India's Effort to Combat Child Malnutrition

Background: In India, a considerable portion of the population suffers from undernutrition, contributing to poor health. Under and over-nutrition continue to pose a severe threat to the country despite the increase in economic development and significant measures taken by the Indian government to address the issue of the dual implications of malnutrition. India has the highest rates of underweight children worldwide. The Indian government has started several initiatives to address the issue of early childhood development. One such program with goals for nutrition intervention and early child development is called Integrated Child Development Services (ICDS). 
 Method: It focuses on the helping hand given by ICDS in reducing malnutrition in children aged 0-5 years by comparing data from the National Family Health Survey rounds conducted in India during 2005-06 and 2015-16. The study utilizes several parameters to highlight the program contribution, such as the nutritional status of children, Anemia, immunization coverage, antenatal care, health care, and child mortality. It also highlights the main issues and challenges the policymakers face in implementing the ICDS program.
 Results: ICDS program has significantly improved in providing services to the beneficiaries, including children aged 0-59 months and pregnant and lactating women.
 Conclusion: Despite several positive changes in ICDS schemes, the program failed to deliver the services efficiently nationwide. It has great potential to contribute to child development, but several loopholes need to be channelized properly.

Spatial and Structural Design of Anganwadi Center using ETABS and Sketch Up

Anganwadi is a type of rural mother and child care centre in India. It was started by the Indian government in 1985 as part of the integrated child development services program to combat child hunger and malnutrition. Anganwadi means "courtyard shelter" in Indian Languages. A typical Anganwadi centre provides basic health care. It is a part of the Indian public health care system. Basic health care activities include contraceptive counseling and supply, nutrition education and supplementation, as well as pre-school activities. Primary school is a school in which children receive primary or elementary education from the age of about five to twelve, coming after pre-school and before secondary school.Six services like Supplementary Nutrition, Immunization, Health check-up, Referral Services, Nutrition and Health Education and Pre-school Education are provided to children in age group of 06 Months to 06 years, pregnant women and lactating mothers.Despite decades of impressive growth, India has an acute shortage of doctors. The doctor population ratio in 2013 was 1:1800; the recommended level is 1:1000. Through the Anganwadi system, the country is trying to meet its goal of providing affordable and accessible healthcare to local populations. Anganwadi workers have the advantage over the physicians living in the same rural area, which gives them insight into the state of health in the locality and assists in identifying the cause of problems and in countering them. They also have better social skills and can therefore more easily interact with the local people. As locals, they know and are comfortable with the local language and ways, are acquainted with the people, and are trusted.

Evaluation of the Integrated Child Development Services Scheme in a Hilly Tribal District of Manipur: A Cross-Sectional Study

Introduction: The Integrated Child Development Services (ICDS) Scheme, the largest program for promotion of maternal and child health nutrition in India, is operational for more than four decades. Objective: To evaluate Integrated Child Development Services Scheme in Kangpokpi District of Manipur in terms of input, process and outcome indicators. Method: A community-based cross-sectional study was conducted at a tribal hilly district of Kangpokpi in Manipur. The study included ICDS staff and beneficiaries of 35 randomly selected Anganwadi Centres (AWCs). Data related to ICDS was collected by using interview schedules and checklists. The descriptive data were expressed in terms of mean, standard deviation and percentage. Association between important background characteristics and Anganwadi centre attendance was analysed using chi-square test. Ethical clearance was obtained from the institutional Ethic Committee of JNIMS, Imphal before conducting the study (study period: May 2018 to April 2021) Results: Input indicators: The study found that86% anganwadi centres were run in anganwadi worker’s own house. Two-thirds of the anganwadi workers (65.7%) were found to have separate toilet and 22.9% had separate kitchen. Process indicators: Even though the proportions of beneficiaries accessing services from anganwadi centres were high, the number of days Supplementary Nutrition (SN) was provided in a month was comparatively low (mean: 2.97 and SD: 0.618 for under-6 children and mean: 1 and SD: 0.000 days for adolescent girls, pregnant women and lactating mother in a month) due to frequent interruption of supplementary nutrition supply. There was no supplementary nutrition stock in 74.3% of the anganwadi centres on the day of visit. Outcome indicators: Regarding the nutritional status 90% of Under-6 children were found to be normal, 9% underweight and 0.6% severely underweight. Conclusion: The Integrated Child Development Services Programme in the study area was found to have several short-comings both in terms of inputs and process. There were not only inadequate facilities and infrastructure, but the anganwadi centres also lacked essential equipment like weighing machines and medicine kits, rendering a vital activity like growth monitoring to be almost completely absent. Supervisory visits were far below satisfactory.

Accelerating Actions Against Malnutrition: A Call for Strengthening the Capacity of Health and Nutrition Program Staff in Devbhumi Dwarka, Gujarat.

BackgroundThe Integrated Child Development Services (ICDS), a flagship program of the Government of India, is addressing the malnutrition, health, and development needs of young children, pregnant and lactating women, and adolescent girls for more than four decades. Although the program has been implemented for the past four decades, it could not bring the expected outcomes in terms of reducing malnutrition. The program's limited success can be attributed, among others, to insufficient skills of the program staff and inadequate convergence with the existing nutrition programs implemented through the health department. For the success of any program, advanced knowledge, improved skills, motivation, and the right attitude of the program staff are essential and can be instilled through the need-based training of the staff. The present study aimed at identifying gaps in existing training for health and ICDS program staff in the district and developing a capacity-building strategy to strengthen the implementation of the nutrition program in the district, including "Project Tushti," which aimed at combating malnutrition in Devbhumi Dwarka district of the Gujarat state.MethodsThe training needs assessment (TNA) was conducted using a descriptive cross-sectional study design. TNA is a method to determine program gaps and training required to fill in programmatic gaps. Appropriate use of TNA can promote designing effective training and nurture program staff productivity, thereby ensuring efficient use of resources for achieving desired program outcomes within the prescribed timeline. Considering the coronavirus disease 2019 (COVID-19)-led lockdown, convenient sampling was used to reach out to potential study participants. A total of 150 program staff from both health departments (particularly medical officers, taluka health officer, National Adolescent Health Program - Rashtriya Bal Swasthya Karyakram (RBSK) medical officer, community health officer from health and wellness center, female health workers, and Accredited Social Health Activists (ASHAs)) and ICDS team (chief district program officer, supervisor, Anganwadi workers, and helpers at Anganwadi center) were interviewed telephonically using a semi-structured interview guide. Interviews were conducted between May 10 and 16, 2020.ResultsResults reveal that about 49% of the health team and ICDS staff had not received nutrition-specific training in the last year. In terms of coverage, the training coverage was partial, and training content on nutrition was limited. Training contents were divided based on supervisory and implementing cadre feedback. Participants expressed the need for in-depth nutritional refresher training, including topics such as community-based management of acute malnutrition, identification of malnutrition, use of ICDS common application software, and soft skills such as communication skills and supportive supervision. Although 62% of participants preferred the face-to-face medium of training, they agreed with the online mode of training.ConclusionFindings indicate an urgent need for training, particularly in the district's nutrition domain for the staff involved in the implementation, and soft skills for supervisory level staff. Innovative training approaches using the digital platform can be explored for training delivery. The paper discusses innovative capacity-building strategies to address training needs effectively.

The role of complementary feeding in India\u2019s high child malnutrition rates: findings from a comprehensive analysis of NFHS IV (2015\u20132016) data

Relative to its economic growth and poverty levels, Indian children suffer from higher levels of malnutrition than children in many other low- and middle-income countries. Research presented in this article examined the links between infant and young child feeding practices among Indian children and their rates of stunting, underweight, wasting, and anaemia, with a particular focus on the types of semisolid complementary food consumed. It did so through a comprehensive analysis of data on more than 57,000 6-to-23-month-old children obtained from the nationally representative National Family Health Survey IV (2015–2016). One of the key findings was that especially feeding children animal-sourced and vitamin-A-rich food was associated with lower malnutrition rates. The study further interrogated whether livestock ownership and participation in the Integrated Child Development Services programme could be supportive of better complementary child feeding and concluded that daily food receipts from the programme and poultry ownership were indeed linked with significantly higher rates of children following the recommended feeding practices as well as with somewhat lower children’s malnutrition rates.

"A Comparative Study on Community Participation in Integrated Child Development Services Programme in Punjab and Rajasthan States of India"

"A Comparative Study on Community Participation in Integrated Child Development Services Programme in Punjab and Rajasthan States of India"

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.

Anganwadi worker time use in Madhya Pradesh, India: a cross-sectional study

BackgroundAnganwadi Workers (AWWs) are a group of 1.4 million community health workers that operate throughout rural India as a part of the Integrated Child Development Services program. AWWs are responsible for disseminating key health information regarding nutrition, family planning, and immunizations to the women and children in their catchment area, while maintaining detailed registers that track key beneficiary data, updates on health status, and supply inventory beneficiaries. There is a need to understand how AWWs spend their time on all of these activities given all of their responsibilities, and the factors that are associated with their time use.MethodsThis cross-sectional study conducted in Madhya Pradesh, collected time use data from AWWs using a standard approach in which we asked participants how much time they spent on various activities. Additionally, we estimated a logistic regression model to elucidate what AWW characteristics are associated with time use.ResultsWe found that AWWs spend substantial amounts of time on administrative tasks, such as filling out their paper registers. Additionally, we explored the associations between various AWW characteristics and their likelihood of spending the expected amount of time on preschool work, filling out their registers, feeding children, and conducting home visits. We found a positive significant association between AWW education and their likelihood of filling out their registers.ConclusionsAWWs spend substantial amounts of time on administrative tasks, which could take away from their ability to spend time on providing direct care. Additionally, future research should explore why AWW characteristics matter and how such factors can be addressed to improve AWWs’ performance and should explore the associations between Anganwadi Center characteristics and AWW time use.

Assessment of Nutritional Status of Children between 6 Months and 6 Years of Age in Anganwadi Centers of an Urban Area in Tumkur, Karnataka, India.

Objectives:Nutritional status is the sensitive indicator of a child's health, and they constitute the most vulnerable segment of any community. Undernutrition causes a great deal of physical, mental, and emotional suffering. Anganwadi is a part of the Integrated Child Development Services program started to combat child hunger and child malnutrition. This study was undertaken to assess the nutritional status of the children (6 months–6 years) in Anganwadis and determine the sociodemographic factors associated with malnutrition and to assess their dietary intake.Materials and Methods:This cross-sectional study was undertaken among 580 children in Anganwadis in the urban field practice area of a Medical college in Tumkur.Results:In this study, the overall prevalence of underweight, stunting, and wasting was found to be 34.14%, 45.52%, and 35.52%, respectively. Age, socioeconomic status, immunization status, religion, and mother's education was associated with undernutrition. The deficient intake of calorie and protein was seen in 90% and 64.8% of the study participants.Conclusion:The present study showed that there is still a high prevalence of undernutrition among the Anganwadi children aged 6–72 months. Socioeconomic factors have a significant role in child nutrition, which manifests itself as poor development.

Factors Influencing Nutritional Status of Children Attending Integrated Child Development Services (ICDS) Programme:A Study on Kamrup District of Assam

Children are the most valuable asset of a nation; their good nutrition is the cornerstone for survival, health and development for current and succeeding generations which guarantee the sound and sustained economic development. The nutritional status of children impacts their health, cognition and educational achievements. But underweight and malnutrition are most prominent in India (According to NFHS-3 & NFHS-4).Therefore, government of India has initiated several schemes to develop the health status of people including the children on priority. Integrated Child Development Services (ICDS) programme, which was launched in 1975 with target to prevent the incidence of severe malnutrition of children under the age of 6 years in the country. This scheme also includes pregnant women, nursing mothers and adolescent girls in close combination with the health services for the improvement of health status and overall development of children and other beneficiaries. As a standardpractice, it is expected that the proposed objectives of ICDS should beachieved; it is only the monitoring and evaluation which reflects the clearpicture of the reality/ situation at the ground level. The present study has made an attempt to examine the factor influencing nutritional status of children attending ICDS programme. This study may be able to provide a base line data in effective implementation of the ICDS programme and improvement of nutritional status of children in future.

Evaluation of Integrated Child Development Services Program in Kashmir, India

Aims: Evaluation of Integrated Child Development Services (ICDS) program in the vale of Kashmir in terms of status of Anganwadi workers, facilities at Anganwadi centers, delivery of services to beneficiaries including children, pregnant women, lactating women and adolescent girls.
 Study Design: Study based on facility at Anganwadi centers.
 Place and Duration of Study: The present study was conducted by visiting Anganwadi centers in Kashmir Division of Jammu and Kashmir during the year 2017-2018.
 Methodology: The valley of Kashmir was divided into three zones; North Kashmir comprising of three districts Baramulla, Bandipora, Kupwara, Central Kashmir comprising of three districts Srinagar, Ganderbal, Budgam and South Kashmir comprising of four districts Anantnag, Kulgam, Pulwama, Shopian. Lottery method was used to select two districts for each zone. Through multistage sampling a total of 48 anganwadi centers were evaluated.
 Results: The coverage of supplementary nutrition was almost complete for all the beneficiaries. All the other services were not delivered properly. 31.51% children reported to receive pre-school education, 13.54% reported of having had health check-ups and 1.82% reported of being immunized at anganwadi centre (AWC). 94.79% of the pregnant and lactating women are covered under supplementary nutrition. Immunization and health check-ups were not available for pregnant and lactating women, however, 53.3% received iron and folic acid (IFA) tablets and 4.17% were provided with referral services. 71.53% of adolescent girls received IFA tablets. Health check-ups and basic skills programmes were not conducted for adolescent girls, however, 5.56% were provided with referral services.
 Conclusion: The performance of ICDS in Kashmir in terms of coverage is very low and almost all the services except supplementary nutrition are not delivered properly. There are many reasons for the underperformance of the scheme including socio-economic and other aspects of the grassroot workers including anganwadi workers (AWWs) and anganwadi helpers (AWHs), inadequacy of equipment for proper implementation, undesirable condition of AWCs, lack of professionalism in implementing staff, lack of co-ordination between AWCs and other associated personals like Lady Health Visitor (LHV)/Auxiliary Nurse Midwife (ANM). In Kashmir the political environment makes the implementation of ICDS scheme even more complicated and difficult. A realignment is the need of hour and the state government must identify the specific problems faced by the scheme and convey them to all the stake holders so that a better and modified version of the scheme is implemented.

INFRASTRUCTURE, RESOURCES, SERVICES EVALUATION AND GAP ANALYSIS OF INTEGRATED MATERNAL AND CHILD DEVELOPMENT SERVICES IN INDIA

Background. Integrated Child Development Services (ICDS) is an Indian community-centric government program organized under Anganwadi centres catering to supplementary nutrition, health and preschool education, primary healthcare, growth monitoring and counselling the children under six years old along with their mothers. It is the world’s largest outreach program in a developing country covering a population of 1.35 billion; the variations in service delivery were analysed involving cross-sectional rural and urban Anganwadi centers in New Delhi.
 Methods. Data were collected by assessment of children and mothers, interview of Anganwadi workers and observation of service delivery parameters and conduction of activities. Infrastructural, beneficiaries, services and content were evaluated by a suitable pre-tested questionnaire based on the National Institute of Public Cooperation and Child Development (NIPCCD) evaluation proforma. The data was analysed by a descriptive statistics.
 Results. Gaps were found in respect of infrastructure, resources, health and nutrition facilities especially at rural Anganwadi centre which was inadequate in terms of implementation of nutrition and health program, supplementary nutrition, preschool education and nutrition rehabilitation centre for existing beneficiaries. Both Anganwadi centres were not catering for new WHO growth standards and adolescent health.
 Conclusions. Gaps found in respect of infrastructure, resources, health and nutrition facilities can affect performance of ICDS program and the services delivered by Anganwadi centres, which need a boost. Both urban and rural centres have a direct opportunity towards delivering adolescent health program focusing on nutrition and education of girls prior to their pregnancy, and adoption of new WHO growth standards.

Group Work Practices of Social Work Effecting In Changing the Integrated Child Development Programes in India and How Can It Change the World Problem

Nineteen per cent of world’s children live in India. Of all the children in the world, one in five is an Indian. India is home to more than one billion people, of which 42 per cent are children, defined as persons under 18 years of age. Women and children constitute seventy two percent of the population of India. The women and children homogenous whole. A great deal of heterogeneity exist. The form of marginalize and vulnerable group of sc, st, obc, and other religious minorities suffer multiple challenge. Women from these group and even more disadvantages as they are subject to additional discrimination on account of societal construct of gender and the consequently adverse power balance. The main problem with the minorities is that no proper database of these have been done. The Integrated Child Development Services (ICDS) Scheme since 1975 for delivery of an integrated package of services relating to health, nutrition and non-formal education to children in the age group 0-6 years, pregnant women and nursing mothers. This package is aimed at improvement in the nutritional and health status of children in this age group, reduction in the incidence of mortality, morbidity, malnutrition and school drop-out rates, and enhancement of the capability of the mother to look after the health and nutritional needs of the child through proper nutrition and health education In short, these objectives which envisage the laying of the foundation for the proper psychological, physical and social development of the child, with appropriate support from the mother, aim at the ultimate goal of human resource development, in its broadest sense. The twin objective of this strategy being comprehensive child development and family welfare, effective coordination in the states, between the departments and agencies that are responsible for the major inputs in the program Wherever this convergence of the maternal and child health services and the ICDS program have been achieved Early childhood period (0-6 years) deserves special attention. It is due to the fact of accumulated scientific evidences that powerfully demonstrates in instituting either family and or centre based early childhood interventions so as to nurture (i) psycho - social development (cognition, motor, social, emotional and language) through maturation and interaction in an properly designed appropriate environment suiting to the child and (ii) generating long term social, economic and educational benefits in terms of lower rates of grades repetition; increased earning potential; reduction in juvenile delinquency; increased social mobilization; reduced social and economic inequalities; psycho - social readiness for school; reduction of drop out rate ; expanding universalization of elementary education ; improved parent - child interaction and finally reducing high developmental costs at later stage of life due to inadequate care. Numerically also, children less than 6 years of age constitute about 15 % of the total population. Of the total child population, 2.07 crore (6 per cent) are infants who are below 1 year; 4.17 crore (12 per cent) are toddlers in the age group of 1-2 years; and 7.73 crores (22.2 per cent) are pre scholars in the age group of 3-5 years. Thus one of the salient demographic features of our country is that it has a sizeable proportion of young population. India is not only home to 21 per cent of developing world’s young children but its young child population size is larger than the total population size of many countries. In 2016, about 25 million infants were immunization services and their mothers will require maternal health services. Similarly, pre school education services will need to be provided for 72 million children in 2016. No other nation in the world including China is likely to enjoy the benefits of such a large young population. This was done with the help of ICDS Programe. By using group work Today, social workers are not only the bridge linking clients to other helpers, they also provide their clients with hope, and encourage their first steps towards a new life. Social workers usually stand in the front line, and reach out to the clients soon after problems occur. They provide an initial assessment of the situation and mobilize other needed services. Social work uses a team approach and is multi-disciplined. Its goal is to provide a service to those who need help.

Determinants of Micronutrient Fortified Blended Food (Balbhog) Consumption among Children 6-35 Months of Age Provided through the Integrated Child Development Services Program in Gujarat, India.

Context:The state of Gujarat had introduced Extruded Fortified Blended Food, Balbhog, as take-home ration for children 6–35 months of age. The study aimed to understand awareness, availability, and consumption pattern of Balbhog and gain insights on factors influencing its regular use.Aims:This study aims to understand coverage and feeding practices of micronutrient fortified blended food (Balbhog) and determine factors for its regular use.Subjects and Methods:A cross-sectional survey of 1623 households with children of 6–35 months of age registered in Anganwadi centers was conducted in the four districts of Gujarat. Household and dietary survey were conducted to understand child care and feeding practices at household level.Results:The results showed high awareness about Balbhog (88.6%) among caregivers, with majority reporting using it (81.7%) before. Regular Balbhog consumption (42.2%), however, declined considerably across all population characteristics. Monthly distribution of adequate Balbhog packets, taste of Balbhog preparations, meal frequency of children, and caregivers' participation in the monthly Integrated Child Development Services (ICDS) event emerged as strong predictors of regular Balbhog consumption. No disparity in consumption was observed across socioeconomic characteristics of the population.Conclusion:Household feeding practices and ICDS program factors mediated regular use of Balbhog among children. Improving availability of entitled Balbhog packets, raising awareness about Balbhog preparations, and improving child feeding practices could help in increasing Balbhog consumption in the community.

Implementing innovative and sustainable methods to tackle grassroot level problems at anganwadi centers in Virpapura Village, Karnataka (India)

Background: Anganwadi center is a part of the Integrated Child Development Services program, which was implemented by the government for reducing maternal and childhood malnutrition. However, the anganwadi centers lack few essential elements necessary for the progressive development of children. Aim: To identify the lack of facilities in the anganwadis and implement innovative and sustainable solutions to tackle grass-root level problems at anganwadi centers. Materials and Methods: A descriptive survey was carried out among 15 anganwadis of Kudur block in Karnataka for 30 days. A 10-item self-designed checklist was used for the survey. Virpapura's anganwadi was selected for the implementation of the program. Innovative and sustainable solutions were implemented for supplemental diet, hygienic practices, creative activities, and dental care. Results: The current study shows that, while all anganwadis served sufficient two meals to children, only 59.49% of children aged 2–6 years fell within normal body mass index category, and 73.3% anganwadis had moderate attendance. All anganwadis were made of pucca building; 46.6% of them were clean, 33.3% shared compound with a primary school, and 66.6% had sanitation facilities but was not put to use. Handwashing habit was absent in children, and there was poor dental knowledge among anganwadi workers. Occasionally, creative activities were conducted for the children. Conclusion: A sustainable solution to any problem can arise from the people themselves; all they need is encouragement and environment to step forward. Solutions to problems of rural India can be ingrained successfully with community participation.

Quality assessment of nutritional components of Integrated Child Development Services provided in rural Puducherry

Background: The Integrated Child Development Services (ICDS) is a large program started with the main objective of improving health, nutrition, and development of children. Over a period of 37 years, the system laid foundation for integration of health services to children. The three forms of nutritional benefits are hot cooked meal (HCM), take-home ration (THR), and ready-to-eat food. This made the utilization varies from place to place. To explore more information on the quality of nutrition provided by ICDS program, this community-based study was planned and undertaken in selected rural areas of Puducherry. Objective: The objective of this study was to assess the nutritional components of ICDS schemes provided for under-five children in rural Puducherry. Materials and Methods: A cross-sectional study was conducted in March, 2015 in 14 villages of Bahour Commune, Puducherry. A total of 27 Anganwadis were selected by simple random method. A checklist was prepared based on the guidelines issued by Government of India. Details regarding child’s attendance to the Anganwadi centre during past 2 months, number of days HCM were consumed by the child, THRs issued to the child, quality of food served, and relish of food among children was recorded. Data analysis was done using SPSS version 22.0 computer software. Results: The mean days of attendance of the children to the Anganwadi centre during past 1 month were 19 ± 3 days. About 83.7% of children attended more than 15 days in a month. In majority of the Anganwadis (81.5%), food was stored in safe place, free from rodents, and pests. In 77.8% of the Anganwadis, food was served to the children in a clean area, and in 70.4% of Anganwadis, safe drinking water was amenable. Overall, about half of the children (225) relished the food served. Conclusion: The quality of supplementary nutrition services in the ICDS centres was good. Attendance proportion of the children to Anganwadi centres was increased when HCM was served.

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.

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.