|Year : 2015 | Volume
| Issue : 2 | Page : 101-106
Evaluation of nutritional and other activities at Anganwadi centers under integrated child development services program in different districts of Gujarat, India
Rajesh K Chudasama1, AM Kadri1, Pramod B Verma2, Mayur Vala1, Matib Rangoonwala1, Ankit Sheth2
1 Department of Community Medicine, Government Medical College, Rajkot, India
2 Department of Community Medicine, GMERS Medical College, Gandhinagar, Gujarat, India
|Date of Web Publication||4-Aug-2015|
Rajesh K Chudasama
Vandana Embroidary, Mato Shree Complex, Sardar Nagar Main Road, Rajkot - 360 001, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Even after more than three decades of implementation, the success of Integrated Child Development Services program in tackling maternal and childhood problems still remains a matter of concern. The present study was conducted to evaluate nutritional and other activities at Anganwadi centers (AWCs) in different districts of Gujarat state, India.
Materials and Methods: A total of 60 AWCs were selected including 46 AWCs from the rural area and 14 AWCs from the urban area during April 2012 to March 2013 from 12 districts of Gujarat. Five AWCs were selected from one district randomly. Detailed information about various nutritional activities including growth monitoring, information related to preschool education (PSE), and nutrition and health education (NHED) were collected.
Results: Growth chart was present in 96.7% AWCs and accurately plotted by Anganwadi workers (AWWs) in 95.0% AWCs. Weight monitoring of children was done by using Salter scale/spring balance in 75.0% AWCs, followed by weighing pan (18.3%). Overall 18.5% moderately malnourished and 1.5% severely malnourished children were reported. PSE material was available only in 35.0% AWCs. Only in one-third AWCs, NHED training material was available in adequate quantity.
Conclusion: There were gaps in the status of PSE activities in AWCs, which needs to be promptly addressed. The need for PSE should be emphasized to all AWWs. There was also a shortage of supply of PSE and NHED material at the AWCs suggesting need of regular supply of material.
Keywords: Anganwadi center, growth monitoring, integrated child development services, nutrition and health education, preschool education
|How to cite this article:|
Chudasama RK, Kadri A M, Verma PB, Vala M, Rangoonwala M, Sheth A. Evaluation of nutritional and other activities at Anganwadi centers under integrated child development services program in different districts of Gujarat, India. J Med Nutr Nutraceut 2015;4:101-6
|How to cite this URL:|
Chudasama RK, Kadri A M, Verma PB, Vala M, Rangoonwala M, Sheth A. Evaluation of nutritional and other activities at Anganwadi centers under integrated child development services program in different districts of Gujarat, India. J Med Nutr Nutraceut [serial online] 2015 [cited 2018 Dec 9];4:101-6. Available from: http://www.jmnn.org/text.asp?2015/4/2/101/141543
| Introduction|| |
Integrated Child Development Services (ICDS) scheme in the pursuance of the National Policy for Children, was launched on October 2, 1975 - the 106 th birth anniversary of Mahatma Gandhi - the Father of the Nation- India. ICDS program continues to be the world's unique early childhood development program, which is being satisfactorily operated since more than three decades of its existence.  It is the foremost symbol of India's commitment to her children - 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 hand.  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. 
The rich experience of ICDS has brought about a welcome transition from welfare orientation to a new challenging perspective of social change. It aims at enhancing survival and development of children from the vulnerable sections of the society. Being the world's largest outreach program, targeting infants and children below 6 years of age, expectant and nursing mothers, ICDS has generated interest worldwide among academicians, planners, policy makers, administrators, and those responsible for implementation.  The program includes a network of "Anganwadi Center" (AWC) literally courtyard play center, provides integrated services comprising supplementary nutrition, 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 health nutrition education to women in the age group 15-45 years. High priority is accorded to the needs of most vulnerable younger children under 3 years of age in the program through capacity building of caregivers to provide stimulation and quality early childhood care. 
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. She is in charge of an AWCs and is supervised by a supervisor called Mukhya Sevika. AWW is also assisted by helper who works with AWW and helps in executing routine activities at AWCs.
Several studies reported association of improved nutritional status and immunization status of <3 years age, with ICDS services ,, and others reported no such association. , Even after more than three decades of implementation, the success of ICDS program in tackling maternal and childhood problems still remains a matter of concern.  According to 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%.  The need for revitalization of ICDS has already been recommended toward better maternal and child health especially in rural areas.  The present study was conducted to evaluate nutritional and other activities at AWCs in different districts of Gujarat state, India.
| Materials and Methods|| |
The Ministry of Women and Child Development, Government of India, has planned a regular monitoring and supervision mechanism of ICDS scheme through National Institute of Public Cooperation and Child Development (NIPCCD) with Monitoring and Evaluation unit. The national level monitoring of ICDS scheme is being done by the Central Monitoring Unit setup at NIPCCD. The ICDS scheme monitoring and supervision at secondary and primary level involve state level monitoring, district level monitoring, project level monitoring, and community level monitoring. 
Various tasks relating to supervision and monitoring of the scheme are being undertaken at state level with the help of selected academic institutions like community medicine department of the medical college, home science colleges. From Gujarat state with 25 districts, two institutions namely Community Medicine Department, P D U Government Medical College, Rajkot and Community Medicine Department, Government Medical College, Vadodara were approved by 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 NIPCCD. The 12 districts were included namely Ahmedabad, Amreli, Bhavnagar, Gandhinagar, Jamnagar, Junagadh, Kutch, Mehsana, Patan, Porbandar, Rajkot, and Surendranagar.
As per the guidelines provided by NIPCCD, from selected 12 districts, three districts are to be visited in one-quarter and so one district per month. From selected district, randomly one ICDS block was selected first. In the next stage, from each selected block, five AWCs were selected randomly. Hence, a total of 60 AWCs were selected including 46 AWCs from the rural area and 14 AWCs from the urban area during April 2012 to March 2013. An attempt was made to select not >2 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 using a predesigned and pretested proforma as provided by NIPCCD. Information on AWWs background characteristics was obtained. 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, and nutrition and health education (NHED) were collected. Accuracy for use of the 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 the growth chart, available at 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 due to the change in format provided by NIPCCD. Interview was conducted of AWWs at respective AWCs. The collected data were entered and analyzed using Epi Info software version 3.5.1 (Center for Disease Control and Prevention, Atlanta, Georgia, USA). 
| Results|| |
The growth chart was available in 96.7% AWCs [Table 1]. The accurate plotting of height and weight was demonstrated by 95.0% AWWs. Salter scale/spring balance was used mainly (75.0%) by the AWWs to record weight of children. Distribution of iron-folic acid (IFA) tablets to adolescent girls was done in 71.7% AWCs. Reproductive health education to adolescent girls was given in 86.7% AWCs. Nutritional grades of registered children were assessed from visited AWCs according to WHO growth chart. The malnutrition was reported among 20.0% children including 18.5% children with moderate and 1.5% with severe malnutrition [Table 2].
|Table 1: Assessment of nutritional status activities in visited AWCs in Gujarat |
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|Table 2: Nutritional grades of registered children at visited 30 AWCs in Gujarat |
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All registered children were getting PSE in only 20% AWCs [Table 3]. PSE was given as per the timetable in 60% AWCs [Table 4]. The AWCs were using timetable either as prescribed by the state government (21.7%) or as based on a weekly theme (21.7%). Use of low-cost games (66.7%), charts/posters (60.0%), and the play way (60.0%) were mainly used for PSE. Only 35.0% AWCs had availability of material used for PSE. Helpers were assisting to AWWs for PSE in handling of children (80.0%), organizing PSE (53.3%) and coordinating with AWWs (48.3%), looks after children in the absence of AWW (38.3%).
|Table 3: Proportion of children attending PSE in visited AWCs in Gujarat |
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Nutrition and health education meeting was done more in rural areas (87.0%) than in urban (64.3%) as shown in [Table 5]. 1-5 or >5 NHED meetings were conducted per quarter in 81.6% AWCs. Mainly lectures (73.3%) were used for NHED meeting, followed by use of demonstrations (18.3%) and charts/models (18.3%). In one-third AWCs, training material was available in adequate quantity, but in 23.3% AWCs NHED material was not available.
| Discussion|| |
As a key indicator of progress toward the Millennium Development Goal (MDG) of eradicating extreme poverty and hunger, the global community has designated halving the prevalence of underweight children by 2015. However, it appears that economic growth alone, though impressive, will not reduce malnutrition sufficiently to meet the MDG nutrition target.  Health of women, adolescent girls, and children is of prime importance.
India's history of child welfare goes back to 1920 when the first children's organization called Balkanji Bari was formed with child membership with headquarters in Mumbai. In 1958, the Indian Council of Child Welfare, a nongovernmental organization made a representation to the government for a specific child welfare plan. 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. Department of Women and Child Development formulated the National Plan of Action for Children in 1992 and in 2003, the 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. 
Success of growth monitoring depended upon the extent to which counseling support, weighing scales, growth charts, etc., were available in AWCs.  Availability (96.7%) and accurate use of the growth chart (95.0%) to assess the nutritional status of children were reported, similar to Puducherry (95%),  but reported low in other studies among the AWWs (25-59%). ,, For recording weight of children, mainly use of Salter scale (75.0%) or weighing pan (18.3%) was reported in the present study. Studies have reported that AWWs were not conversant with the plotting of growth curves even after receiving necessary training. , 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.
Distribution of IFA tablets to the beneficiaries was done in 71.7% AWCs which was high compare to previous studies (10-35%). ,, Deworming tablets were distributed in (43.3%) AWCs and recorded in the present study, which was not even recorded in Puducherry.  Reproductive health education to adolescent girls was given in 86.7% AWCs.
This study reported 18.5% moderately malnourished and 1.5% severely malnourished children, which was lower than reported in other areas. ,, The record keeping by AWWs was inadequate related to the nutritional aspect of children in the present study and can be improved by sensitizing them about the importance of same and also by providing good quality training.
The crux of human resource development lies in providing an enabling environment to the young children so that they are able to grow as healthy and productive adult. These efforts initiated through ICDS program by placing children on the priority agenda of the program. PSE has been envisaged in ICDS program as an essential component for children who are on the verge of going into formal education system. The importance of PSE recognized universally because it caters to those children who, during this phase of their life, undergo the most important educative process. The need for PSE considered most pronounced in the case of children from culturally and socioeconomically disadvantaged families. Program contents of PSE largely center on organized play activities.  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.  Present study reported that all enrolled children in only 20% AWCs receiving PSE (rural-23.9%, urban-7.1%). In 60% AWCs for PSE activities, timetable as prescribed by state government (21.7%) or weekly theme-based was used. Use of low-cost games (66.7%), charts/posters (60.0%) and play the way (60.0%) was reported for PSE. Studies have reported poor skill development of Anganwadi children as against the private nursery school children, which could be attributed to poor stimulating environment including lack of play materials, hence, there is a need to improve the preschool environment of the Anganwadis. ,
Previous studies reported NHED was given low priority in improving growth status of children. , Present study reported NHED meetings were done in 81.6% AWCs with varying frequency of 1-5 per quarter. Mainly lectures (73.3%) were given during meeting, but in 18.3% AWCs demonstrations and display of charts/models was also done. NHED material and also PSE material was available only in one-third AWCs indicating a shortage of supply as reported by other studies.  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 the child within the family environment. All women in age group of 15-45 years entitled to get this education which also tackles problems of ignorance, ill-health, and malnutrition. 
| Conclusion|| |
There were gaps in the status of PSE activities in AWCs, which need to be promptly addressed. The need for PSE should be emphasized to all AWWs. It is recommended that regular workshops for ICDS staff to improve and strengthen the knowledge and practices on PSE should be conducted. There was also a shortage of supply of PSE and NHED material at the AWCs suggesting need of regular supply of material.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]