International Journal of Health & Allied Sciences

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 5  |  Issue : 2  |  Page : 93--98

Assessment of nutritional activities under integrated child development services at anganwadi centers of different districts of Gujarat from April 2012 to March 2015


Rajesh K Chudasama, Umed V Patel, Dhara Thakrar, Aarohi Mitra, Jasmin Oza, Bhavesh Kanabar, Ashutosh Jogia 
 Department of Community Medicine, PDU Medical College, Rajkot, Gujarat, India

Correspondence Address:
Rajesh K Chudasama
Vandana Embroidery, Mato Shree Complex, Sardar Nagar Main Road, Rajkot - 360 001, Gujarat
India

Abstract

Background: The Integrated Child Development Service (ICDS) program aims at enhancing survival and development of children from the vulnerable sections of the society. Aim: The present study was conducted to assess various nutritional activities at anganwadi centers (AWCs) in different districts of Gujarat state. Settings and Design: AWCs, cross-sectional study. Materials and Methods: A total of 130 AWCs were selected including 95 from rural and 35 from urban area from April 2012 to March 2015 including 12 districts of Gujarat and union territory, Diu. Five AWCs were selected from one district randomly. Detailed information about various nutritional activities including growth monitoring, preschool education (PSE) and nutrition and health education (NHED), coverage for supplementary nutrition (SN), type of food provided under SN, and its issues at AWCs was collected. Statistical Analysis: Percentages, proportions, Chi-square/Fischer's exact test. Results: Growth chart was available in 96.9% AWCs. The malnutrition was reported among 14.9% children. PSE received by all children was only in 14.6% AWCs. NHED meeting was conducted in 73.8% AWCs. High coverage of receiving SN among enrolled was reported in pregnant and lactating mothers (84.6%) and adolescents (79.2%). SN was fully acceptable in 91.5% AWCs. Interruption in SN supply during last 6 months was reported in 55.4% AWCs. Conclusion: Regular workshops should be conducted for ICDS staff to sensitize them about the importance of and practices on PSE. Interruption in supply of SN should be corrected by regular and adequate provision of SN foods to the beneficiaries.



How to cite this article:
Chudasama RK, Patel UV, Thakrar D, Mitra A, Oza J, Kanabar B, Jogia A. Assessment of nutritional activities under integrated child development services at anganwadi centers of different districts of Gujarat from April 2012 to March 2015.Int J Health Allied Sci 2016;5:93-98


How to cite this URL:
Chudasama RK, Patel UV, Thakrar D, Mitra A, Oza J, Kanabar B, Jogia A. Assessment of nutritional activities under integrated child development services at anganwadi centers of different districts of Gujarat from April 2012 to March 2015. Int J Health Allied Sci [serial online] 2016 [cited 2019 Oct 14 ];5:93-98
Available from: http://www.ijhas.in/text.asp?2016/5/2/93/180420


Full Text

 Introduction



The Integrated Child Development Service (ICDS) scheme is a unique program which encompasses the main components of human resource development, namely, health, nutrition, and education. The National Policy for children adopted in 1974 has emphasized the need to accord priority to children in the country's developmental efforts.[1] The Government of India initiated the ICDS program in 1975, which continues to be the world's most unique early childhood development program, which is being satisfactorily operated since more than three decades of its existence.[2] It is India's response to the challenge of providing preschool education (PSE) on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity, and mortality on the other.[3] The ICDS scheme is a long-term development program for community and all efforts should be continued to strengthen to make it more successful. It serves as an excellent platform for several development initiatives in India. It serves the extreme underprivileged communities of backward and remote areas of the country. It delivers services right at the doorsteps of the beneficiaries to ensure their maximum participation.[4]

The ICDS has generated interest worldwide among academicians, planners, policy makers, administrators, and those responsible for implementation.[5] The program includes a network of “Anganwadi Center” (AWC) literally courtyard play center, provides integrated services comprising supplementary nutrition (SN), immunization, health check-up, referral services to children below 6 years of age and expectant, and nursing mothers. Nonformal PSE is imparted to children of the age group 3–6 years and nutrition and health education (NHED) to women in the age group 15–45 years.[2]

The program is executed through dedicated cadre of female workers named anganwadi workers (AWWs), who are chosen from the local community and given 4 months training in health, nutrition, and child care. A female anganwadi worker is in charge of an AWC and is supervised by a supervisor called Mukhyasevika. AWW is also assisted by a helper who works with AWW and helps in executing routine activities at AWC.[6]

Even after more than three decades of implementation, the success of ICDS program in tackling maternal and childhood problems still remain a matter of concern.[7] According to the National Family Health Survey 3, countrywide though 81.1% children under age 6 years were covered by AWCs, children who received any service from AWC were only 28.4%.[8] One of the important services of AWCs includes SN Program (SNP). The SNP provides supplementary food to children between 6 months and 6 years of age, adolescent girls, and pregnant and lactating mothers.[9] Every beneficiary under SN is to be provided SN for 300 days a year.[10] The need for revitalization of ICDS has already been recommended toward better maternal and child health especially in rural areas.[11] The assessment of nutritional activities will help the program to improve the delivery of nutritional services in Gujarat. Hence, the present study was conducted with a view to assessing various nutritional activities at AWCs in different districts of Gujarat state, India.

 Materials and Methods



The National Institute of Public Cooperation and Child Development (NIPCCD) under the Ministry of Women and Child Development (MWCD), Government of India, is conducting regular monitoring and supervision of ICDS scheme with monitoring and evaluation unit. Central Monitoring Unit at NIPCCD conducts national-level monitoring of ICDS scheme. The monitoring and supervision of the ICDS scheme at secondary and primary level involves state-level monitoring, district level monitoring, project-level monitoring, and community-level monitoring.[12]

Selected academic institutions like Community Medicine Department of Medical Colleges and home science colleges at state level undertake various tasks relating to supervision and monitoring of the scheme. From Gujarat state with 25 districts, two institutions, namely Community Medicine Department, Government Medical College, Vadodara and Community Medicine Department, P D U Government Medical College, Rajkot were approved by the NIPCCD. The present study was conducted by Community Medicine Department, P D U Government Medical College, Rajkot, in 12 districts of Gujarat as directed by the NIPCCD. The 12 districts were included, namely Ahmedabad, Amreli, Bhavnagar, Gandhinagar, Jamnagar, Junagadh, Kutch, Mehsana, Patan, Porbandar, Rajkot, and Surendranagar. In addition, a union territory of Diu is also included in the study. Ethical clearance was not required as the study was conducted as the data collection, analysis, and publication is a part of routine monitoring recommended by NIPCCD, MWCD, the Government of India.

The NIPCCD suggested visiting three districts in one-quarter and so one district per month. As per the availability of grants, the visits were made in the selected 12 districts and also one union territory Diu during April 2012 to March 2015. From selected district, randomly one ICDS block was selected first. In next stage, from each selected block, five AWCs were selected randomly. A total of 60 AWCs were visited during the year 2012–2013, 40 AWCs during 2013–2014 including 5 AWCs from Diu and 30 AWCs during 2014–2015. Hence, a total of 130 AWCs were selected including 95 AWCs from the rural area and 35 AWCs from the urban area. An attempt was made to select not more than two AWCs from each of the supervisory circle. A team of four members from Community Medicine Department, P D U Government Medical College, Rajkot, visited the selected AWCs.

The selected AWC was visited on a preinformed fixed day. AWWs were interviewed after taking their informed consent, using a predesigned and pretested proforma as provided by NIPCCD. All available registers at visited AWCs were reviewed and necessary information was recorded. Detailed information about various nutritional activities including growth monitoring, information related to PSE, NHED, beneficiary's coverage for SN, type of food provided under SN, AWWs response, and various issues related to SN at AWCs were collected. The Government of India has provided the financial norms per beneficiary per day for expenditure under SN.[10]

Accuracy for the use of growth chart by AWWs was made by asking them to demonstrate the weighing and plotting of height and weight of two children each of 0–3 years and 3–6 years age group in growth chart, available at the time of visit to that AWC. The AWW records nutritional status of all registered children in their registers and number of children undernourished was taken from same. Malnutrition status was registered in 30 AWCs because of change in the format provided by NIPCCD. Interview was conducted of AWWs at respective AWCs. The collected data were entered and analyzed by using EpiInfo software version 3.5.1 (Center for Disease Control and Prevention, Atlanta, Georgia, USA).[13]

 Results



Out of 130 visited AWCs, growth chart was available in 96.9% AWCs [Table 1]. Accurate plotting of height and weight on growth chart was demonstrated by 92.3% AWWs. Nutritional grades of registered children were assessed from visited AWCs according to WHO growth chart. The malnutrition was reported among 14.9% children including 13.5% children with moderate and 1.4% with severe malnutrition.{Table 1}

PSE received by all children was only in 14.6% AWCs [Table 2]. PSE was given as per the prescribed timetable method by the state government or based on a weekly theme in 70.8% AWCs. PSE material was available in 60.8% AWCs. NHED meeting was conducted in 73.8% AWCs. One or more meetings were conducted per quarter in 73.9% AWCs by using lectures, demonstrations, and charts/models.{Table 2}

Among 76.2% AWCs, all enrolled children of 6 months to 3 years were receiving the SN, which was 55.4% for age group 3–6 years [Table 3]. High coverage of receiving SN among enrolled was reported in pregnant mothers (84.6%), lactating mothers (84.6%), and adolescents (79.2%). In 7.7% AWCs, less than 50% of enrolled children were receiving SN. Almost two-third (65.4%) AWCs were providing hot cooked food (HCF) to 3–6 years children [Table 4]. Less than half of the AWCs were providing ready to eat (RTE) food to 6 months to 3 years children (28.2%), pregnant (47.3%) and lactating (47.3%) mothers, and adolescents (46.4%).{Table 3}{Table 4}

SN was fully acceptable in 91.5% AWCs, with no acceptability in 4.6% AWCs [Table 5]. Good quality (88.5%) and adequate quantity (92.3%) of SN was reported by AWWs. Interruption in SN supply during last 6 months was reported in 55.4% AWCs including 52.6% rural and 62.9% urban AWCs. Various problems reported by AWWs related to SN are shown in [Table 5].{Table 5}

 Discussion



The Government of India formulated and adopted the National Policy for Children in 1974 besides formulating programs for children as a prominent part of national plans. The Department of Women and Child Development formulated the National Plan of Action for Children in 1992 and in 2003, a National Charter for Children was adopted which refined India's policy commitments toward the child. Recognizing the need for early intervention to ensure the development of a young child's body, mind, and intellect to its maximum potential, the Government of India started ICDS, a centrally sponsored scheme which is a step toward responding to the child's needs in a comprehensive and holistic perspective.[2]

The ICDS program is formulated to enhance the health, nutrition, and learning opportunities of infants, young children, and their mothers, especially targeted for the poor and deprived.[14] ICDS takes holistic view of development of the child and attempts to improve prenatal and postnatal environment. Accordingly, besides children in their formative years (0–6 years), women between 15 and 45 years are also covered by the program as these are child-bearing years in the life of women and her nutrition and health status has a bearing on the development of the child.[1]

Success of growth monitoring depended on the extent to which counseling support, weighing scales, growth charts, etc., were available in AWCs.[2] Availability (96.9%) of growth chart (92.3%) to assess the nutritional status of children was reported, similar to other study (95%).[15] Although previous studies reported that AWWs were not conversant with the plotting of growth curves even after receiving necessary training,[16],[17] 92.3% AWWs were using growth chart accurately in the present study. Growth curves provide the earliest indication of growth failure; hence, AWWs must be adequately trained to plot growth curves and they can specifically be monitored on this by the supervisors and the Child Development Project Officers of the project areas.[18] The present study reported 13.5% moderately malnourished and 1.4% severely malnourished children lower than the previous studies.[19],[20],[21] It may be because of overall coverage of beneficiaries for SN was satisfactory among enrolled children in the present study [Table 3].

The need for PSE considered most pronounced in case of children from culturally and socioeconomically disadvantaged families. Program contents of PSE largely center on organized play activities.[2] It has been reported that PSE enhances early literacy skills, child's ability to learn to communicate ideas and feelings, and to get along with other children.[22] The present study reported that all enrolled children in only 14.6% AWCs receiving PSE (rural-16.9%, urban-8.6%). In 70.8% AWCs for PSE activities, timetable as prescribed by the state government or weekly theme based was used. Studies have reported poor skills development of anganwadi children as against the private nursery school children; hence, there is need to improve the preschool environment of the AWCs.[23],[24]

Previous studies reported NHED was given low priority in improving growth status of children.[25] The present study reported NHED meetings were done in 73.8% AWCs with varying frequency of one to five or more per quarter. The NHED was meant for effective transmission of certain basic health and nutrition messages to enhance the level of awareness of mothers about child's needs and her capacity for care, protection, and development of child within the family environment.

SN leads to the fulfillment of the deficiencies of calories, proteins, minerals and vitamins in the existing diets, avoiding cutbacks in the family diet, and taking other measures for nutritional rehabilitation of severely malnourished children and also mothers. NIPCCD reported that ICDS program has reduced the prevalence of malnutrition and brought significant change in the anthropometric measurements and nutritional status of children.[2]

Overall high coverage of beneficiaries was reported for pregnant and lactating women (84.6%), adolescent girls (79.2%), and 6 months to 3 years children (76.2%) at AWCs indicating good rapport of AWWs with adolescents and reproductive age female. Only 55.4% children of 3–6 years age group receiving SN higher than other study (27%)[26] indicates that the AWWs have to give more emphasis to attract children from their community to anganwadi by improving other services like PSE and also by celebrating NHED.[6]

In the present study, AWCs were providing HCF mainly in 3–6 years children (65.4%), and RTE food to other beneficiaries such as 6- month to 3-year-old children (30.0%), pregnant women (47.3%), lactating women (47.3%), and adolescent girls (46.4%), higher than previous study by NIPCCD (RTE – 33.3%).[2] The supply of take-home ration in the current study was inadequate for all the beneficiaries of AWCs. The local authority has to give attention on this issue and provide timely supply of take-home ration at AWCs. The state government has recommended supply of energy dense extruded fortified blended food to children of both 6 months to 3 years age (125 g/day) and 3–6 years (185 g/day). Moreover, provision of take-home ration was made for adolescent girls, pregnant and lactation mothers (130–140 g/day).[27]

It has been proved that SN not only improves the nutritional level of children and reduces malnutrition, but also works as an incentive for promoting attendance of children and mothers to participate in the activities of AWCs and as such plays a key role in ICDS program.[2] Acceptability of SN was reported in overall 91.5% of AWCs. Overall good quality (88.5%) and adequate quantity (92.3%) of SN supply was reported by the AWWs. In last 6 months, interruption in the supply of SN was reported in 55.4% AWCs, more in urban areas (62.9%) than in rural areas (52.6%) almost similar to NIPCCD (overall – 52.9%, rural – 52.0%, and urban – 45.0%).[2] The main reason for interruption in the supply of SN was shortage of supply of SN material/food from the authority followed by nonavailability of separate kitchen, inadequate storage space, inadequate supply, and fuel supply in the present study.

It was observed that interruption in the supply of SN also affected the image of AWWs and credibility to the activities of AWCs and had a negative impact on community support and participation. This will also impact on the delivery of other services due to poor attendance of children in AWCs.[2] Regular supply of SN is expected to attract the beneficiaries and make them available at AWCs for other services also,[28] but interruption in SN supply may affect those services at AWCs. The nonsatisfaction regarding SN sometime has resulted in dissatisfaction among parents of overall ICDS services.[15],[26]

 Conclusion



The study identifies gaps in the PSE activities at AWCs, which needs to be addressed promptly. Regular workshops should be conducted for ICDS staff to sensitize them about the importance of and practices on PSE. Interruption in supply of SN should be corrected by regular and adequate provision of SN foods to the beneficiaries as per the norms, leads to improvement of overall nutritional status of the community.

Financial support and sponsorship

I gratefully acknowledge the financial support provided by the National Institute of Public Cooperation and Child Development (NIPCCD).

Conflicts of interest

There are no conflicts of interest.

References

1Joseph JE. ICDS scheme to the growth development in preschoolers: A systematic review of literature. Int Public Health Sci 2014;3:87-94.
2Three Decades of ICDS – An Appraisal. National Institute of Public Cooperation and Child Development (NIPCCD); 2006. Available from: . [Last accessed on 2015 Mar 15].
3Integrated Child Development Services (ICDS) Scheme. New Delhi: Ministry of Women and Child Development, Government of India. Available from: http://www.wcd.nic.in/icds.htm. [Last accessed on 2015 Jan 05].
4National consultation to review the existing guidelines in ICDS scheme in the field of health and nutrition. Indian Pediatr 2001;38:721-31.
5Patil SB, Doibale MK. Study of profile, knowledge and problems of anganwadi workers in ICDS blocks: A cross sectional study. Online J Health Allied Sci 2013;12:1. Available from: http://www.ojhas.org/issue46/2013-2-1.html. [Last accessed on 2014 Dec 21].
6Chudasama RK, Kadri AM, Joshi N, Bhola C, Zalavadiya D, Vala M. Evaluation of supplementary nutrition activities under Integrated Child Development Services (ICDS) at anganwadi centres of different districts of Gujarat. Online J Health Allied Sci 2013;12:1. Available from: . [Last accessed on 2015 Apr 04].
7Gragmolati M, Bredenkamp C, Dasgupta M, Lee YK, Shekar M. ICDS and persistent undernutrition: Strategies to enhance the impact. Econ Polit Wkly 2006:1193-201. Available from: . [Last accessed on 2015 Feb 20].
8National Family Health Survey, India 2005-06. (NFHS 3) Mumbai: International Institute for Population Science and Macro International; September, 2007.
9Avula R, Frongillo EA, Arabi M, Sharma S, Schultink W. Enhancements to nutrition program in Indian Integrated Child Development Services increased growth and energy intake of children. J Nutr 2011;141:680-4.
10Supplementary Nutrition – Performance Audit of ICDS Scheme. Report No. 22; 2012-13. Available from: . [Last accessed on 2015 Apr 18].
11Tandon M, Kapil U. Integrated Child Development Services Scheme: Need for reappraisal. Indian Pediatr 1998;35:257-60.
12Integrated Child Development Services (ICDS) Scheme – Guidelines for Monitoring and Supervision of the Scheme. New Delhi: Central Monitoring Unit (ICDS), National Institute of Public Cooperation and Child Development; 2010.
13Centers for Disease Control and Prevention. Epi Info Version 3.5.1, 2008. Available from: http://www.cdc.gov/epiinfo/. [Last accessed on 2011 Aug 21].
14Chudasama RK, Patel UV, Verma PB, Vala M, Rangoonwala M, Sheth A, et al. Evaluation of anganwadi centres performance under Integrated Child Development Services (ICDS) program in Gujarat state, India during year 2012-13. J Mahatma Gandhi Inst Med Sci 2015;20:60-5.
15Gurukartick J, Ghorpade AG, Thamizharasi A, Dongre AR. Status of growth monitoring in anganwadi centres of a primary health centre, Thirubhuvanai, Puducherry. Online J Health Allied Sci 2013;12:2. Available from: http://www.ojhas.org/issue46/2013-2-2.html. [Last accessed on 2015 Feb 22].
16Manhas S, Dogra M. Awareness among anganwadi workers and the prospect of child health and nutrition: A study in Integrated Child Development Services (ICDS) Jammu, Jammu and Kashmir, India. Anthropologist 2012;14:171-5.
17Gopalan C. Growth charts in primary child-health care: Time for reassessment. Indian J Matern Child Health 1992;3:98-103. Available from: http://www.popline.org/docs/1078/095242.html. [Last accessed on 2012 Jun 16].
18Chudasama RK, Kadri AM, Verma PB, Vala M, Rangoonwala M, Sheth A. Evaluation of nutritional and other activities at anganwadi centres under Integrated Child Development Services program in different districts of Gujarat, India. J Med Nutr Nutraceutical 2015;4:101-6. [Doi: 10.4103/2278-019X.141543].
19Surwade JB, Mantri SB, Wadagale AV. Utilization of ICDS scheme in urban and rural area of Latur district with special reference to pediatric beneficiaries. Int J Recent Trends Sci Technol 2013;5:107-10.
20Thakur JS, Prinja S, Bhatia SS. Persisting malnutrition in Chandigarh: Decadal underweight trends and impact of ICDS program. Indian Pediatr 2011;48:315-8.
21Mandal GC, Bose K, Bisai S, Ganguli S. Undernutrition among Integrated Child Development Services (ICDS) Scheme children aged 2-6 years of Arambag, Hoogly district, West Bengal, India: A serious public health problem. Ital J Public Health 2008;5:28-33.
22Panday V. Community participation towards anganwadi services in Kakori block of Lucknow district. Indian J Matern Child Health 2011;12:1-5.
23Thajnisa M, Nair MK, George B, Shyamalan K, Rema Devi S, Ishitha R. Growth and development status of anganwadi and private nursery school children – A comparison. Teens 2007;1:23-4.
24Nair MK, Mehta V. Life cycle approach to child development. Indian Pediatr 2009;46:S7-11. Available from: . [Last accessed on 2013 Jul 25].
25Kapil U, Saxena N, Nayar D, Gnanasekaran N. Status of growth monitoring activities in selected ICDS projects of Rajasthan. Indian Pediatr 1996;33:949-52.
26Sharma M, Soni GP, Sharma N. Assessment of coverage of services among beneficiaries residing in area covered by selected anganwadi in Urban project I and II of Raipur city. J Community Med Health Educ 2013;3:195.
27Women and Child Development Department – Government of Gujarat. New Nutritional Norms Circular, 2010. Available from: . [Last accessed on 2013 Sep 24].
28Sood AK, Sood VP. The evaluation of supplementary nutrition component of ICDS – A study at block Beri, Rohtak, Haryana. Health Popul Perspect Issues 1987;10:207-12.