Take-home Ration Research Articles

Status of Nutritional Services to Vulnerable Population in West Bengal and Their Hardship during COVID-19 Pandemic: A Community-based Qualitative Exploration

Introduction: In response to the COVID-19 pandemic, restrictions were imposed on various activities including nutritional services. This study was conducted with the objective to explore the status of the nutritional services and to identify the hardship and barriers faced by the vulnerable population and challenges for service providers and program managers during the initial phase of pandemic. Materials and Methods: A community-based cross-sectional qualitative study was conducted among three vulnerable population groups (slum dwellers, tribal population, and residents of disaster-prone area) in three districts of West Bengal, the reference period being April–September 2020. To assess the status of nutritional services and identify existing barriers or challenges, the study employed a mixed-methods approach utilizing focus group discussions (FGDs) as well as in-depth interviews (IDIs) conducted with beneficiaries, service providers and program managers. One habitation in each district was selected to obtain case scenarios on food insecurity and hardship. Descriptive analysis of household surveys and thematic analysis of FGDs and IDIs were done, and the findings were triangulated. Results: Different nutritional services (supplementary nutrition, micronutrient supplementation, growth monitoring, nutrition counseling, and nutrition rehabilitation) were disrupted. Shifting from hot-cooked meals to dry take-home ration was the most conspicuous change during restoration phase. Food security was absent in majority of the households. Reduction of income affected their affordability, which along with difficult accessibility to diverse food items contributed to their hardship. Service providers identified several challenges, including increased workload due to both COVID-19 activities and a rise in beneficiaries, transportation difficulties, and experiences of stigma and discrimination. Long administrative decision-making process, additional hurdles due to cyclone, and containment zones were identified as challenges by the program managers. Conclusion: As the hardship of vulnerable population was pervasive, it is necessary to formulate mitigating measures in light of the identified challenges and to combat similar crises in future.

Barriers in utilization of fortified take home ration through integrated child development service in urban heath training centre field practice area of Bhavnagar, Gujarat

Background: The integrated child development services (ICDS) in the State of Gujarat, India, freely provides a take home ration to pregnant mother, adolescent, lactating mother and children. Objective was to explore the perception of program functionaries and beneficiaries regarding barrier in utilization of take-home ration infield practice area of urban health training center of Bhavnagar. Methods: We have conducted eighteen in depth interviews of program functionaries and beneficiaries residing in urban health primary centre field practice area regarding barrier in utilization of take-home ration. Results: Wastage, bad taste, sweetness, futile and unawareness were the main reason for non-utilization of take-home ration. Conclusions: There is need for behavior change communication in the community regarding the correct and optimum use of take-home ration.

Utilization and Satisfaction of Beneficiaries Regarding Take Home Ration Provided At Urban Anganwadis of Ahmedabad, Gujarat

Introduction: Nutrition is fundamental to human health and development. The Take Home Ration (THR) program provides fortified rations for 6 months to 3 years normal children and severely underweight children up to 6 years, adolescent girls, pregnant women, lactating women through Anganwadis (AW). The National Nutrition Missions have targeted to decrease under nutrition by 3% each year. Present study was conducted with an objective was to assess the utilization and satisfaction level of beneficiaries regarding THR and to identify challenges faced by AWW related to THR. Method: A cross-sectional study was conducted at 40 Aanganwadis situated in the urban field practice area of the institute. Interview of all the (40) Anganwadi workers were conducted regarding implementation of THR Program. For assessing the utilization and satisfaction regarding THR, total 200 beneficiaries were selected from five different groups viz; 6 months to 3-year children, severely underweight children up to 6 years, Adolescent girls, Pregnant women and lactating women. Purposive sampling was used for selection of beneficiaries considering availability of beneficiaries at the time of study. Frequency and percentages were calculated for quantitative data. Results: Knowledge of AWW regarding THR scheme was good. Out of 200 beneficiaries, 97.5% beneficiaries were obtaining THR packets from anganwadis, out of which 66% beneficiaries were using them regularly. Around 36% of beneficiaries weren’t satisfied with THR provided to them. Major challenges faced by beneficiaries were: Lack of variety, not possible to make separate food items from THR due to time constraints and lack of knowledge.Conclusion: Utilization of THR among beneficiaries was not satisfactory. Most of the beneficiaries were disappointed with taste of the THR. Beneficiaries strongly recommended for improvement in taste and flavour. Awareness regarding THR scheme was satisfactory among AWW. Biggest challenge faced by AWW was to convince beneficiaries regarding intended benefits of THR and regular usage of the same.

A Study of Maternal Anemia and Utilization of Antenatal and Postnatal Care Services in Devbhumi Dwarka, Gujarat.

Background and objective Despite significant gains and achieving progress in the last decade, maternal anemia remains a major public health concern in India. Both antenatal (AN) and postnatal (PN) women are populations adversely affected by anemia. Reducing anemia among AN and PN women is one of the national priorities of Anemia Mukt Bharat. The present study aimed at assessing the prevalence of anemia, utilization of AN and PN care (ANC and PNC) services, and drivers of anemia among pregnant and lactating women (PLWs) inDevbhumi Dwarka district, Gujarat. Methods A descriptive cross-sectional study was conducted in four blocks ofDevbhumi Dwarka district, Gujarat. A total of 1,185 PLWs were interviewed. Anemia was determined based on the last Hb test record on the Mamta Card (Mother and Child Protection Card). Results The mean age of the study population was 25.19 ±3.91 years: 24.95 ±3.94 years for pregnant women and 25.45 ±4.01 years for lactating women. The prevalence of anemia among pregnant women (Hb: <11 g/dL) was 72.92%; 33.91% had moderate and0.83% had severe anemia. The prevalence of anemia among lactating women (Hb: <12 g/dL) was 26%; 63.93% had moderate and 1.29% had severe anemia. The utilization of nutrition and health serviceswas found to be limited. Of the other sociodemographic factors, age (p=0.045), birth spacing (p=0.014), and education (p=0.017) weresignificant determinants of anemia among pregnant women, whereas parity (p=0.002), birth spacing (p=0.003), religion (p=0.041), and receipt of take-home ration (THR) (p=0.018) were significantly associated with anemia among lactating women. Conclusion The study revealed a high prevalence of anemia among PLWs and sub-optimal utilization of nutritional and healthcare services in Devbhumi Dwarka. Implementing interventions such as comprehensive nutritioneducation and counseling can contribute toward improving maternal and child health outcomes.

A Review: ICDS Programmes: To Develop a New Fortified Nutrient Rich Sugar Free Supplementary Food Product

Integrated Child Development Services (ICDS) is India's flagship programme for infant and young child health, nutrition and development. Supplementary Nutrition Programme (SNP) is one of the core components of ICDS. Balshakti (Energy Dense Micronutrient Fortified Extruded Blended Food) is provided as Take-Home Ration (THR) to children 7 months to 3 years. The feasibility of using a wheat flour mill to refine corn, soya, ragi, moong dal and chickpea was studied. Milling of wheat, ragi, rice, corn, chana dal, moong Dal, and soya grain resulted in fiber content from 1.93, 2.16,2.60 and 2.50 % in raw, finely milled and coarsely milled moong dal and ragi respectively. kcal obtain from BSR and BSM 455.66 &amp; 435.22. Similarly, there was a fat, protein (1.74 &amp;0.70) (25.79 &amp;8.59) content from roasted material, according to ICDS Indian RAD for 12-23 month age group of infant have to required 1060 kcal and 16.7 g protein. our product (THR) provides 500 kcal and 12-15 g protein. aim was this new development to more nutrition and healthy food gave infant.50 % requirement fulfilled by this new product. Keywords: ragi, moong dal, ICDS, THR, protein, nutrition, BS.

Estimated Deficits in Nutrient Intake of ICDS Beneficiaries Who Receive Take Home Ration at Two Districts in Karnataka

The current estimates of energy and protein to bridge nutrient gap in the beneficiaries of the Integrated Child Development Services (ICDS) supplementary nutrition program use sub-optimal methodology for deficit calculation. To estimate the nutrient deficit and the risk of inadequate nutrient intake in beneficiaries of the ICDS, aged 6-36 months, using individual 24-hour diet recalls, from districts of Chitradurga and Davanagere in Karnataka. Cross-sectional design. Children (aged 6 to 36 months) registered as beneficiaries of the ICDS in these districts. Data were collected on socio-demographic factors, child feeding patterns, perception and usage of take home ration (THR), between August to October, 2019. Three non-consecutive days' 24-hour diet recall data of children were obtained from mothers, and anthropometric measurements were taken. The proportion of children at risk of inadequate nutrient intakes was estimated using the probability approach. Assuming that 50% of a healthy population will be at risk of nutrient inadequacy such that intake and requirement distributions overlap, the proportion at actual risk of nutrient inadequacy (≥50%) was calculated. A combined district analysis showed a median energy deficit of 109 kcal and 161 kcal in children belonging to the age groups of 6-12 month and 13-36 month, respectively. The actual risk of inadequate intake for both age groups ranged between 12-47% for fat and other micronutrient (iron, calcium, zinc, folate, vitamin B12 and vitamin A), despite breastfeeding, complementary feeding and reported THR use. Children who receive supplementary nutrition as part of the national program fail to meet their nutrient requirements that are essential for growth and development. The study results may help in strengthening the IYCF counselling and in modification of the existing THR, with quality and cost implications.

Pulse of Gujarat during lockdown

Background: Coronavirus pandemic has dealt a severe blow to India's poor and socioeconomically disadvantaged group. Among a nationwide lockdown to contain the spread of the infection. This study assessed the availability of food and access to healthcare among the vulnerable population of Gujarat– pregnant women and severe acute malnourished children. Specifically, we assessed events of starvation or skipped meal, availability of healthcare services, and self-reported psychological distress during the lock down. Materials and Methods: A cross-sectional study across 252 talukas and 33 districts of Gujarat was undertaken using a structured questionnaire. A telephonic survey was carried out and positive responses were received from 161 households (HHs) with severe acute malnourished children, 328 pregnant women with severe maternal anemia, and 402 lactating women. Results: We found 79.7% of surveyed HHs received ration where major reliance was on public distribution system (51.7%). Less than half of the beneficiaries (48.6%) received take-home ration under the ICDS program. Despite efforts of the State as well as voluntary agencies, 7.3% of HHs experienced episode of hunger, mostly from Devbhumi Dwarka, and Navsari district. A third of the respondents showed signs of psychological distress associated with lockdown. Conclusion: Food insecurity may lead to malnutrition impairing the immunity of the individuals to cope with the disease. Thus, given the uncertainty around the emergency situation, preparedness measures should not only focus on the availability of healthcare commodities but also to ensure the availability of other essentials, especially to the socioeconomic disadvantaged group.

A comparative study: Dr. APJ Abdul Kalam amrut ahar yojana and take home ration scheme, Armori block, Gadchiroli, Maharashtra

Background: Even after forty-five years of ICDS, nutrition, still, continues to be a major public health challenge in India. The impact of ICDS on child growth and development has been rather slow. The present study is a comparison of Dr. A. P. J. Abdul Kalam amruta ahar yojana and take home ration scheme.Methods: The study adapts a combination approach, i.e. qualitative and quantitative method. Qualitative method is used to study the perception of beneficiaries as well as the providers while quantitative method is conducted among 80 beneficiaries with an aim to identify the utilisation pattern of food and level of satisfaction with both the schemes.Results: A total of 80 pregnant women and lactating mothers participated in this study. This study used a questionnaire containing socio-demographic data and utilisation pattern of one-time square meal and dry ration; socio-demographic questions including concerned age group, their education, religion, employment status and income.Conclusions: The findings depict that the provision of amruta ahar is in demand compared to the dry ration of Take-Home Ration Scheme. According to the beneficiaries, amruta ahar yojana is more advantageous as it leads healthy eating practices which are essential during pregnancy and lactation.

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.

THE BENEFITS OF SCHOOL FEEDING PROGRAMME IN WESTERN ZAMBIA

The study sought to establish the benefits of school feeding programme (SFP) in Western Zambia. It also brought out the challenges encountered in the execution of the programme. This article is an extract from one of the objectives of ongoing study. School feeding entails the distribution of food commodities to children who attend school. The commodities may be locally grown and purchased or contributed by international donor community. The food may be consumed by the learners in school. In other settings, it may be given as take-home ration for consumption by the families that regularly send their children to school. The study employed a descriptive survey research design to collect, analyse and interpret both quantitative and qualitative data from 415 respondents. The results of the study showed that the school feeding programme is an intervention which has enormous education benefits; equitable access to education, increased school enrolment, improved attendance, punctuality and academic performance. Other benefits include: health and nutrition, social protection, parent involvement, and opportunities for local farmers. However, challenges were also reported; there were some possible negative attributes to the increase in the enrolment rates, that is, the educational quality may be compromised if the number of learners exceeds available resources such as desks, text books, teachers, and irregular supply of food to schools. The study recommended that plans and measures should be put in place by the government, relevant ministries and development partners on how to increase existing human, physical, and financial resources for the school feeding programme to be effective and sustainable. SFP should also be decentralized to the schools and community levels with more support from provincial offices to ensure a more effective school feeding programme.

Efficacy of Micronutrient Fortified Supplementary Foods (Ready to Cook and Ready to Eat) and Take-Home Ration (THR) in children with Moderate Acute Malnutrition (MAM) using Community Based Approach

Efficacy of Micronutrient Fortified Supplementary Foods (Ready to Cook and Ready to Eat) and Take-Home Ration (THR) in children with Moderate Acute Malnutrition (MAM) using Community Based Approach

School Feeding Reduces Anemia Prevalence in Adolescent Girls and Other Vulnerable Household Members in a Cluster Randomized Controlled Trial in Uganda

ABSTRACTBackgroundFood for education (FFE) programs that include school meals are widely used to improve school participation and performance, but evidence on nutritional benefits is limited.ObjectiveThis study tested whether food fortified with multiple micronutrients provided in FFE programs reduced anemia prevalence of primary-school-age adolescent girls, adult women, and preschool children.MethodsThrough the use of a cluster randomized controlled trial with individual-level repeated cross-sectional data, we measured impacts on anemia prevalence from 2 FFE programs, a school feeding program (SFP) providing multiple-micronutrient-fortified meals and a nutritionally equivalent take-home ration (THR). Camps for internally displaced people (IDP) (n = 31) in Northern Uganda were randomly assigned to SFP, THR, or a control group with no FFE. Rations were provided for 15 mo at SFP and THR schools. A survey of households (n = 627) with children aged 6–17 y was conducted (baseline and 18 mo later). Analyses used difference-in-differences by intent to treat.ResultsAdolescent girls aged 10–13 y in FFE schools experienced a significant (P < 0.05) 25.7 percentage point reduction (95% CI: −0.43, −0.08) in prevalence of any anemia [hemoglobin (Hb) <11.5 g/dL, age 10–11 y; Hb <12 g/dL, age 12–13 y] and a significant 19.5 percentage point reduction (95% CI: −0.35, −0.04) in moderate-to-severe anemia (Hb <11 g/dL) relative to the control group, with no difference in impact between SFP and THR. The THR reduced moderate-to-severe anemia prevalence (Hb <11g/dL) of adult women aged ≥18 y (12.8 percentage points, 95% CI: −0.24, −0.02). All IDP camps initially received micronutrient-fortified rations through a separate humanitarian program; in one district where most households stopped receiving these rations, SFP reduced moderate-to-severe anemia of children aged 6–59 mo by 22.1 percentage points (95% CI: −0.42, −0.02).ConclusionsFFE programs reduced any anemia and moderate-to-severe anemia in primary-school-age adolescent girls and reduced moderate-to-severe anemia for adult women and preschool children. This study was registered with clinicaltrials.gov as NCT01261182.

Comparison of Health-care Utilization Pattern and its Correlates among the Tribal and NonTribal Population of Kerala.

Background:The isolation from mainstream development activities, together with poverty and inaccessibility to health facilities made the tribal communities specifically vulnerable to various health problems.Objectives:This study aimed to compare the utilization of antenatal care, immunization, and supplementary nutrition services by tribal and nontribal mothers and its correlates in the selected districts.Materials and Methods:The study was a comparative cross-sectional study. The study population comprised tribal and nontribal mothers utilizing antenatal care, immunization, and supplementary nutrition services. A multi-stage cluster sampling strategy was employed for the study. The Chi-square test was used to assess the association between antenatal care services utilization, utilization of immunization services, supplementary nutrition services utilization and sociodemographic variables, and other service characteristics.Results:Effective utilization of antenatal care services was not seen in 5.6% of tribal mothers. The incidence of low-birth weight (≤2500) was significantly more among tribal mothers (31%) when compared to nontribal mothers (15%). The proportion of tribal children receiving complete immunization without delay was 74%, and among nontribal children, it was 78%. Effective immunization coverage was significantly lower among children of tribal mothers with education below high school level. Receipt of take-home ration was reported by nearly 90% of tribal and nontribal mothers. 90% of tribal mothers felt that quality of take-home ration that they received was of good quality.Conclusions:The comparison of health-care utilization restricted to the domains of antenatal care, immunization services, and supplementary nutrition suggests that the tribal mothers and children had a relatively comparable utilization pattern in most of the indicators measured.

Progress of children with severe acute malnutrition in the malnutrition treatment centre rehabilitation program: evidence from a prospective study in Jharkhand, India

BackgroundIn Jharkhand, Malnutrition Treatment Centres (MTCs) have been established to provide care to children with severe acute malnutrition (SAM). The study examined the effects of facility- and community based care provided as part the MTC program on children with severe acute malnutrition.MethodA cohort of 150 children were enrolled and interviewed by trained investigators at admission, discharge, and after two months on the completion of the community-based phase of the MTC program. Trained investigators collected data on diet, morbidity, anthropometry, and utilization of health and nutrition services.ResultsWe found no deaths among children attending the MTC program. Recovery was poor, and the majority of children demonstrated poor weight gain, with severe wasting and underweight reported in 52 and 83% of the children respectively at the completion of the community-based phase of the MTC program. The average weight gain in the MTC facility (3.8 ± 5.9 g/kg body weight/d) and after discharge (0.6 ± 2.1 g/kg body weight/d) was below recommended standards. 67% of the children consumed food that met less than 50% of the recommended energy and protein requirement. Children experienced high number of illness episodes after discharge: 68% children had coughs and cold, 40% had fever and 35% had diarrhoea. Multiple morbidities were common: 50% of children had two or more episodes of illness. Caregiver’s exposure to MTC’s health and nutrition education sessions and meetings with frontline workers did not improve feeding practices at home. The take-home ration amount distributed to children through the supplementary food program was inadequate to achieve growth benefits.ConclusionsRecovery of children during and after the MTC program was suboptimal. This highlights the need for additional support to strengthen MTC program so that effective care to children can be provided.

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.

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.

Assessment of nutritional status and preference of nutritional supplements among anganwadi children

Background: Integrated Child Development Scheme (ICDS) was launched in India during 1975, to tackle the high prevalence of malnutrition among under 5 children. NFHS 3 (2005-06) reports that only 33% of ICDS services were utilized by them. To ensure the effectiveness of the scheme, nutritional status of under 5 children and the form of nutritional supplement - either Hot Cooked Meals (HCM) or Take Home Ration (THR), preferred by the beneficiaries must be assessed. Methods: A Cross sectional study was done among under 5 children in 2015 for a period of 2 months, in three randomly selected villages, Rural Field Practice Area, Sri Venkateshwaraa Medical College Hospital &amp; Research Centre, Puducherry. Weight and Height were measured for all the eligible children using standard procedures. World Health Organization (WHO) growth standards were used to assess their nutritional status. The mothers were enquired about the nutritional supplement utilization, type of nutrition supplement (HCM/THR) utilized by their children and the reasons for preference. Statistical significance was assessed by chi-square test. Results: Among 153 children enrolled, 138 (90%) were consuming HCM and 15 (10%) were THR utilizers. The overall prevalence of under nutrition was 59%. The prevalence of underweight, stunting and wasting were 28%, 28% and 38.5% respectively and it was found significantly (p value &lt;0.05) higher among THR utilizers (74%, 60% and 53% respectively) than those receiving HCM (25%, 36% and 23%). Conclusions: HCM was preferred more than THR. The children receiving HCM were better nourished than THR utilizers.

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.

Acceptability of new formulations of corn-soy blends and lipid-based nutrient supplements in Province du Passoré, Burkina Faso

The objective of this study was to evaluate the acceptability of new formulations of six corn-soy blended flours (CSB) and six lipid-based nutrient supplements (LNS) with different quantities of milk and qualities of soy to be used for the treatment of moderate acute malnutrition (MAM). Furthermore, we wanted to explore the acceptability of foods currently used for the prevention and treatment of malnutrition in Burkina Faso to identify possible barriers that could affect the acceptability of the new formulations of supplementary foods. The study was carried out prior to a randomized controlled trial evaluating the effectiveness of these new formulations. The study involved an observed test-meal and a three-day take-home ration of the experimental food supplements to 6- to 30-months-old healthy children, followed by questionnaire-based interviews about the acceptability of these supplements. Interviews and focus group discussions were carried out to explore the acceptability of foods currently used for the prevention and treatment of malnutrition. The results suggest that both LNS and CSB products with different quantities of milk and qualities of soy are equally well accepted among healthy children in rural Burkina Faso based on general appreciation of the supplements and organoleptic properties. All experimental foods received good ratings and there was no significant difference between the foods. However, after the take-home ration, 58% of participants receiving CSB reported having left-overs at the end of the day compared to 37% (n = 33) of the participants receiving LNS (p = 0.004), suggesting that CSB was not as readily consumed as LNS. Yet, both CSB and LNS products were perceived as easy to administer and the frequency of feeding was estimated to be adequate. The study also found that similar foods, used for the prevention and treatment of malnutrition, were well appreciated in the study location. LNS were to a higher degree associated with medicine or foods with medicinal properties, but both LNS and CSB were perceived as beneficial to child health.

Production of fortified food for a public supplementary nutrition program: performance and viability of a decentralised production model for the Integrated Child Development Services Program, India.

Integrated Child Development Services in India through its supplementary nutrition programme covers over 100 million children, pregnant and lactating women across the country. Providing a hot cooked meal each day to children aged between 3-6 years and a take-home ration to children aged between 6-36 months, pregnant and lactating women, the Integrated Child Development Services faces a monumental task to deliver this component of services of desired quality and regularity at scale. From intermediaries or contractors who acted as agents for procuring and distributing food to procurement directly from large food manufacturers to using women groups as food producers, different State Governments have adopted a variety of strategies to procure and distribute food, especially the take-home ration. India's Supreme Court, through its directive of 2004, encouraged the Government to engage women's groups for the production of the supplementary food. This study was conducted to determine the operational performance, economic sustainability and social impact of a decentralised production model for India's Supplementary Nutrition Program, in which women groups run smallscale industrialised units. Data were collected through observation, interviews and group discussions with key stakeholders. Operational performance was analysed through standard performance indicators that measured consistency in production, compliance with quality standards and distribution regularity. Assessment of the economic viability included cost structure analysis, five-year projections, and financial ratios. Social impact was assessed using a qualitative approach. The pilot unit has demonstrated its operational performance and cost-efficiency. More data is needed to evaluate the scalability and sustainability of this decentralised model.