Evaluation of Services Provided Under Integrated Child Development Services Scheme in Three Urban Health Centres of Belgaum District

Abstract

Background and Objectives Integrated Child Development Services (ICDS) was introduced with the aim of improving the nutritional and health status of children in the age group of 0-6 years and enhancing the capabilities of mother to look after the normal health and nutritional needs of the child. Delivery of services under ICDS scheme is managed in an integrated manner through Anganwadi centres (AWC), which acts as a focal point for the nutritional, health and educational delivery of services for mothers and children. Previous studies indicate that the overall impact of ICDS on maternal and child health appears to be limited, which may be due to poor implementation of the scheme. While most Anganwadis function merely as point of distribution of supplementary nutrition with poor emphasis on other services, the quality of food as well as the regularity of its supply is poor in many places. This study was conducted to evaluate the services rendered by AWC in the urban areas and to identify the gaps and thereby suggest appropriate rectifications. Methodology A Community based Cross Sectional Study was undertaken over a period of one year, in 76 AWCs under three Urban Health Centres, Ashok Nagar, Ram Nagar and Rukmini Nagar, which are field practice areas of J. N. Medical College, Belgaum. Twelve beneficiaries were chosen from each AWC, which included two children aged between 7 months to 3 years, two children aged between 3 to 6 years, two Adolescent girls, two Pregnant women, two Lactating mothers and two non-pregnant non-lactating (NPNL) women in the reproductive age group (15-45 years). A Field Survey Questionnaire designed by Right to Food Campaign was used after making modification to suite our study. Results The mean (± SD) age of children aged 7 months to 3 years was 24.92 ± 5.64 months, and that of children aged 3 to 6 years was 4.35 ± 1.06 years. Among adolescent girls, 46.05% were in middle adolescence and 52.63% were in late adolescence; the mean age (± SD) was 16.71 ± 1.59 years. The mean ages (±SD) of the pregnant and lactating women were 22.05±2.36 years and 21.71±2.47 years respectively. Among the NPNL Women, the mean age (± SD) was 32.47 ± 5.06 years. Nearly three-fourths of children in age group 7 months to 3 years never attended AWC, while 60.53% of the children aged between 3 to 6 years attended the AWC regularly. More than half the children aged 7 months to 6 years were taken to the AWC by the Anganwadi Helper (AWH). Nearly 60% of the mothers said that Anganwadi Worker (AWW) or AWH motivated them to enrol the child at the AWC. Majority (95%) of the mothers said that the AWC opened regularly. Over three-fourths (78.29%) of the respondents found the timings of the AWC functioning to be convenient. All the mothers of children below 6 years were aware of the Supplementary Nutrition Services at the AWC. Nearly three-fourth of the children aged 7 months to 3 years received Take Home Ration (THR). Similarly, 90% of the children aged 3 to 6 years received cooked meals at the AWC. All the adolescent girls, pregnant and lactating women were receiving THR. Nearly 60% of the respondents said that food was provided very regularly at the AWC. Regarding the quantity and quality of food supplied, 84.87% felt that it was adequate and satisfactory. About 65% of the children were weighed regularly and immunisation coverage was over 80%. The AWW had a role to play in getting 92.45% of the children immunised, the most often cited role being organising the vaccination session. Majority (83.88%) had received advice from AWW on use of Oral Rehydration Solution (ORS) during diarrhoea; about 40% approached the AWW to procure the same. While 46.71% of children aged 7 months to 3 years were de-wormed, in the age group 3 to 6 years it was 65.79%; about 36% had received advice from AWW on de-worming. Among the adolescent girls, 27.63% had been weighed, 52.63% had undergone health check-up and 49.34% were referred / helped to obtain medical treatment by the AWW at least once in the preceding six months. Among the girls aged above 16 years in our study, 78.75% were immunised against Tetanus and Albendazole tablets were reportedly consumed by 55.93%. All the girls in our study agreed that first pregnancy should ideally be after 18 years of age and 58.55% considered ideal birth interval to be 2 years. In our study 17.76% of the adolescent girls were involved in income generating activates; 62.96% of them were motivated by the AWW for the same. Nearly all of the lactating women (99.34%) and 88.82% of the pregnant women had received at least four antenatal check-ups during pregnancy; 85.53% had received at least one health check-up by the health staff from the UHC at the AWC, 85.53% received adequate doses of Tetanus Toxoid and 86.85% said they received IFA tablets regularly. About 30% had not fed their child colostrum, and 50% felt weaning needs to be started before completion of 6 months. Over 92% had received advice from AWW regarding breast feeding practices. Majority (88.16%) of the lactating mothers were advised by the AWW regarding immunisation. The AWW made house-visits to 31.58% of the children, 30.92% of the adolescent girls, 63.82% of pregnant women and 33.55% of lactating women. In the study, 70.74% had attended Nutritional and Health Education (NHE) sessions, 80.51% of them said it caused some change in practices. Awareness amongst mothers regarding Pre-School Education (PSE) was 95.38%; as many as 92.74% of the parents of children attending PSE found it beneficial. In the study, 85.86% of the respondents said the AWW’s motivation to work was high, 75.55% said the AWW was kind and 60.63% felt that ICDS was very important. Conclusion The awareness regarding the various services was good. Almost all the mothers were availing Supplementary Nutrition services and majority were satisfied with the same. A considerable number of the beneficiaries were sharing the food that was provided. House visits by the AWW were poor except during pregnancy. The NHE was utilised by only two-thirds of the beneficiaries. Services related to antenatal and postnatal care were utilised by over 90% of the beneficiaries. Most of beneficiaries opined that the motivation of the AWW was high and that she was kind. Around two-thirds considered ICDS as very important for the respective group of beneficiaries.