Impact of ICDS on health and nutritional status of children

The Integrated Child Development Services (ICDS) in India comprises health, nutrition, and education human resource development in 1745 rural, 716 tribal, and 235 urban projects in about 45% of community development blocks of the country. Research studies have found that in ICDS areas there were fewer children suffering from Grades S II and IV malnutrition compared with non ICDS areas and the percentage of normal children has increased. 6.8% of children aged 0-3 years and 4.0% of children aged 3-6 years in ICDS areas were in Grades III and IV of malnutrition. The ICDS treatment for malnutrition is administration of 16-20 gm of protein and about 600 calories and monitoring monthly; there are 13.9 million children presently receiving supplementary nutrition in the ICDS program. The nutrition program in general aims to provide health and nutrition inputs to expectant mothers throughout the gestation period in order to prevent low birth weight babies; the nutrition supplement distribution has improved, but chronic malnutrition among pregnant mothers persists. The ICDS program provides regular health checkups, immunization, detection of malnutrition, treatment of diarrhea, and deworming of and for children. These services have contributed to improved health among children in ICDS areas. The infant mortality rate (IMR) of 71.3/1000 live births in 1992 in ICDS areas was found to be lower than national estimates in 1989. In ICDS projects more than 3 years old, IMR was found to be 84.5; further decline in IMR in 1990 were found in projects older than 5 years. Morbidity and mortality have been fund to be higher in non-ICDS areas, and declines have been observed in ICDS areas. The incidence of vaccine preventable diseases was not found to have declined in ICDS areas, in spite of increased immunization. ICDS provides anganwadi community workers (AWWs) and services through a network of Primary Health Centers and subcenters, which are not optimally used. However, when compared with non-ICDS areas, prenatal services are used by 71.9% of the pregnant population compared with 40% in a non-ICDS control group. In 1992, there was 90% coverage of children aged 0-6 years with health check ups; this level of usage may be due to the availability of medicine kits through AWWs. ICDS provides potential for enhancing the survival of children.     

Child diarrhea: oral rehydration therapy and rural mother.

The prevalence of diarrhea among children, feeding practices during diarrhea, and knowledge about oral rehydration therapy (ORT) among 2616 mothers and 44 Anganwadi workers (AWWs) of Panchmahals and 2293 mothers and 37 AWWs of Chandrapur districts of Gujarat State and Maharashtra State, respectively, were investigated. The effect of maternal literacy status and nutrition knowledge on mothers' and AWWs' ability to correctly prepare an oral rehydration solution (ORS) was also examined. The prevalence of diarrhea was highest in children less than 2 yr old, and thereafter it showed a consistent decline up to 6 yr. Most of the mothers favored a reduction in the child's food intake during diarrhea, whereas the AWWs favored increasing it. Awareness of mothers about ORT was low, but half of those who were aware could prepare ORS correctly. Maternal literacy status and nutrition knowledge positively affected the mother's understanding of ORT and her ability to prepare ORS. The mother's presence and availability at home positively influenced the utilization of ORS when her child was sick with diarrhea. Thus, poor literacy status, poor nutrition knowledge, and working-mother status appear to limit mothers' ability to utilize ORS to prevent or correct diarrhea-induced dehydration.     

Growth charts only marginally improved maternal learning from nutrition education and growth monitoring in Lesotho.

A study done in Lesotho in 1985-1986 assessed whether growth charts increased the impact of nutrition education and growth monitoring on maternal learning about weaning practices and diarrhea. Seven hundred and seventy six mothers were given three monthly sessions of group nutrition education along with growth monitoring of children and individual counseling. Growth charts, which were taught to one of two groups, fostered learning but only on issues related to diarrhea and only among new clinic attendants, mothers with less than secondary schooling and mothers of malnourished children. These benefits, however, were small (differences less than 10%) compared with the overall impact of the nutrition education and growth monitoring intervention (increases between baseline and post-intervention were greater than 50% for some questions). Our findings suggest that well-designed clinic-based nutrition education and growth monitoring can have a significant impact on maternal nutrition knowledge. Teaching growth charts to mothers may not be necessary for obtaining such results in programs conducted under ideal conditions. More research is needed to determine under what circumstances, for what purposes and for whom growth charts may be beneficial.     

Past,present and future of Integrated Child Development Services (I.C.D.S.)

India's Integrated Child Development Services (ICDS) was established in 33 projects in 1975 and is spread over 22 states; 67 additional projects were begun in 1977, and over the next 2 years; 100 additional projects were added. By 1991=92, coverage was almost 50% of the country with 2696 projects; the expectation is for 100% coverage by the year 2000. An infrastructure chart identifies the organization and integration between level and social welfare and health departments. Objectives are clearly identified and the departments functionally linked. Linkages are achieved by shared space and activities at various levels. Over the past 17 years, services have included minimum needs programs, integrated rural development and poverty alleviation, national health policy and education policy, universal immunization, and the development of women and children in rural areas. ICDS is sponsored 100% by the status and uniquely relies on the honorary anganwadi worker (AWW), who is a woman, recruited and chosen by the community, aged 21-45 years and middle-school educated. The AWW was responsibility for 2000 households or 1000 persons in rural areas and 700 persons in tribal areas. The AWW is crucial to the functioning of the program and receives an honorarium of Rs. 225-275/month for implementing the ICDs program; AWWs have helpers who are paid Rs. 110/month. Training over a 3-year period is conducted at the Bal Sevika Training Institute by the Indian Council of Child Welfare. Additional health personnel and their role and the number of persons/per area AWWS are responsible for, equipment, and functions are also described. The AWW is responsible for nonformal preschool education, organization of supplementary nutrition feeding, health and nutrition education of women and families, immunization of women and children, treatment and referral of common illnesses, growing monitoring, and community participation. Presently, there are 2506 central sector projects and 190 state sector projects and 250,000 AWWs. The preschool education, health, and nutrition programs are summarized. Future directions will encompass future child and mother development and expansion to cover all 90 districts having a birth rate higher than 39/1000. Lessons learned from the past will be integrated and may involve cost containment, acceleration of development of services, alternative services, and giving mothers more responsibility for improving health and nutrition.     

Growth charts in primary child-health care: time for reassessment

Selected data from the Tamil Nadu Integrated Nutrition Project (TINP) indicated that growth monitoring with the entire package of services (rather than just regular weighing) in TINP was associated with improved child nutritional status. It was maintained that the benefits of growth monitoring existed over and above those of supplementary feeding. Over 85% of the children in poor communities, in the regions where growth monitoring is now being recommended, suffer from undernutrition and growth retardation of varying degrees. An assessment report of the Integrated Child Development Services (ICDS) program in India states that growth charts were maintained only in 51% of anganwadis: although all anganwadi workers had been training in growth monitoring, only 46.3% were found competent with respect to weighing, 30.2% with respect to age assessment, 36.9% with respect to plotting weights, and 32.2% with respect to interpretation. Examination of data covering 3704 children under 6 years old in the ICDS program found that almost half the children had never been monitored and that another 25% were monitored inadequately. The only 3 major interventions that can be undertaken by child health workers serving poor communities are: 1) advice and education regarding appropriate diets and health practices, 2) immunization, prompt diagnosis, and treatment of infections, 3) ORT in diarrhea, and 4) supplementary feeding in selected situations with available resources. Discarding growth monitoring of individual children in the course of domiciliary visits would give the worker sufficient time to provide appropriate advice. Total abandonment of growth monitoring in child-health care programs is not proposed, however, growth monitoring operations should not become so elaborate, expensive, and time-consuming that they become counterproductive.     

Can mothers identify malnutrition in their children?

To assess mothers' perceptions about malnutrition and theirability to identify malnutrition in their own children, 339children aged 3–35 months and their mothers were studiedin two urban hospitals in Dhaka, Bangladesh, and in a communityclinic. The weight, height, and mid-upper arm circumferenceof the children were measured, and their mothers were interviewed.Child nutritional status according to their mother's statementand anthropometrically assessed nutritional status were compared.Sixty per cent of the mothers correctly identified better nutritionalstatus (weight/age >75% of NCHS median) and 67% mothers correctlyidentified malnutrition (weight/age < 75% of NCHS median)in their children. Sixty-one per cent of mothers with less than5 years of formal education correctly identified better nutrition(weight/age >75%) whereas 38% mothers with more than 5 yearsof education correctly identified better nutrition. Correctidentification of malnutrition was made by 70% of mothers withless than 5 years of formal education, and 74% of educated mothersdid the same. As regards causes of malnutrition, 33% of mothers stated thatlack of food at home resulted in undernutri-tion in their children(mean weight-for-age of these children was 65% of the NCHS median).Mothers' suggestions for improving child health were: betterfood in 31% cases; treatment of illnesses in 22% cases; andboth in 42% cases. The results suggest that most of the mothersare able to identify malnutrition in their children, and 95%of them are aware of ways to improve it, and that the provisionof adequate food and health care may improve child nutritionalstatus.     

Assessment of community contribution to the ICDS scheme in district Agra: a case study

This study was conducted to assess community contribution to the Integrated Child Development Services (ICDS) program, which promotes mother and child health in the Agra district, Uttar Pradesh, India. Three rural ICDS projects in the district were selected, out of which a total of 74 Anganwadi centers (AWCs) were chosen for the study. The Anganwadi workers (AWWs) were interviewed through a semi-structured questionnaire to assess the community?s contribution during the previous 6 months. Results revealed that about 68% of AWWs had been able to receive assistance in bringing the children to the AWC. 53.3% had received free accommodation for AWC, and 42.6% had obtained assistance in implementation of health activities. Only 4% and 12% of the AWWs reported community assistance in the preparation and distribution of nutritional supplements, respectively. There had been no contribution received in terms of raw food for supplementary nutrition and fuel for cooking. The study concludes that rural area free accommodation for the AWC and community assistance in bringing children to the AWC were the most common forms of community contribution to the ICDS program.     

Integrated Child Development Services scheme (ICDS) and its impact on nutritional status of children in India and recent initiatives

Integrated Child Development Services (ICDS) scheme is the largest national programme for the promotion of the mother and child health and their development in the world. The beneficiaries include children below 6 years, pregnant and lactating mothers, and other women in the age group of 15 to 44 years. The package of services provided by the ICDS scheme includes supplementary nutrition, immunization, health check-up, referral services, nutrition and health education, and pre-school education. The distribution of iron and folic acid tablets and megadose of vitamin A is also undertaken, to prevent iron deficiency anaemia and xerophthalmia respectively. The scheme services are rendered essentially through the Anganwadi worker (AWW) at a village centre called "Anganwadi". The ICDS had led to (i) reduction in prevalence of severe grades of malnutrition and (ii) better utilization of services of national nutritional anaemia prophylaxis programme and the national programme for prevention of nutritional blindness due to vitamin A deficiency by ICDS beneficiaries. The ICDS scheme is being modified continuously to strengthen the programme.     

Nutritional interventions through primary health care: impact of the ICDS projects in India

In 1975 the Government of India initiated an integrated approach for the delivery of health care as well as nutrition and education services for deprived populations at the village level and in urban slums through centres, each of which was run by a local part-time female worker (anganwadi) who was paid an honorarium and had a helper. This national programme, known as the Integrated Child Development Services (ICDS), began with 33 projects but, by March 1986, had expanded to 1611 projects covering 23% of the country's population and representing about 50% of the population in the socioeconomically backward areas. The ICDS can therefore be considered to function as a primary health care programme for preschool children (under 6 years old), pregnant women, and lactating mothers. The present study investigated the impact on the nutritional status of the target population after 3-5 years and after 8 years of ICDS interventions, compared with the nutritional status of non-ICDS (control) groups. The results showed that the ICDS nutrition intervention programmes achieved better coverage of the target population and led to a significant decline in malnutrition among preschool children in the ICDS population, compared with the non-ICDS groups that received nutrition, health care and education through separate programmes. This example may lead other developing countries to introduce integrated programmes with certain modifications to suit local conditions. International agencies and national governments should strive to bring about the integration of nutritional services with primary health care and development programmes for children because of the good results in terms of child survival and child development.     

Integrated Child Development Services (ICDS): harbinger of safe motherhood and child development

Editorial comment was provided on the features that made the Integrated Child Development Services (ICDS) program in India unique and on whether or not the system could focus on younger age groups (e.g., 2-3 years of age). As part of a worldwide effort, India's ICDS program has been directed to human resource development. Over the past 17 years, the program has expanded to include almost 50% of the country's most vulnerable and deprived population. The focus on children aimed to improve their nutrition and health by reducing the incidence of morbidity, mortality, malnutrition, and school dropouts. The concern encompassed physical, social, and psychological development. The focus on mothers stressed enabling them to better care for the health and nutrition of their children. The program included prenatal care, safe delivery, and post natal concern for lactation, breast feeding, and physical growth monitoring in the early years. The program's unique features were its voluntary membership of community health workers, integrated services, and targeted coverage of economically weaker and deprived populations during critical child development periods. Indigenous Indian resources provided the primary financial support. Nation coverage was given for universal immunization, family welfare, child and maternal health, diarrheal disease control, vitamin A supplementation, and anemia screening and treatment. The multisectoral nature of the program has been realized at the village, sector, block, and district levels with linkages within Health, Education, and Social Welfare sectors, and with the Medical Colleges and Home Science Colleges. Feedback from operations research studies and other research activities was provided at the local program level, and interactions occurred between students in training programs and health care delivery systems. The program will be expanded to include the entire country. Health and nutrition education were considered the weakest part of ICDS. IEC has been expanding, but community participation has not kept pace. The strong community based infrastructure needs additional support particularly from the health sector. Program expansion into adolescent health and sex education was considered desirable. ICDs should be viewed as a development activity at the village level to astute women an integrated learning for life experience.     

Immunization coverage in India for areas served by the Integrated Child Development Services programme. The Integrated Child Development Services Consultants.

The Integrated Child Development Services (ICDS) programme was launched by the Indian government in October 1975 to provide a package of health, nutrition and informal educational services to mothers and children. In 1988 we studied the impact of ICDS on the immunization coverage of children aged 12-24 months and of mothers of infants in 19 rural, 8 tribal, and 9 urban ICDS projects that had been operational for more than 5 years. Complete coverage with BCG, diphtheria-pertussis-tetanus (DPT) and poliomyelitis vaccines was recorded for 65%, 63%, and 64% of children, respectively, in the ICDS population. By comparison, the coverage in the non-ICDS group was only 22% for BCG, 28% for DPT, and 27% for poliomyelitis. Complete immunization with tetanus toxoid was recorded for 68% of the mothers in the ICDS group and for 40% in the non-ICDS group. Coverage was greater in the urban and lower in the tribal projects. Scheduled castes, scheduled tribes, backward communities, and minorities (groups that have a high priority for social services) had immunization coverages in ICDS projects that were similar to those of higher castes.     

宁夏六县农村3岁以下儿童营养状况分析

目的：为了解宁夏农村3岁以下儿童的营养状况,对宁夏6县进行了随机抽样横断面调查。方法：以身高和体重作为衡量儿童营养状况的指标,并同时调查有关社会环境因素。结果：该地区生长迟缓（HAZ＜－2）、低体重（WAZ＜－2）和消瘦（WHZ＜－2）的总患病率分别为：15．0％、11．7％、2．7％。回族高于汉族,经济好的县高于经济差的县。与NCHS／WHO标准分布比较,提示宁夏6县3岁以下儿童整体的营养状况较差。进行因素,分析发现腹泻,母亲文化程度,儿童数,喂养及辅食添加为营养不良的影响因素。结论：应积极开展营养健康教育,加强 儿童常见病的防治,提高孕妇和乳母的保健知识,在重点干预的同时,还要注意改善整体儿童的营养状况。     

Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh

This prospective randomized trial was carried out to test the efficacy of a specific intervention for reducing the extent of their malnutrition and to change behaviour of mothers relating to child-feeding practices, care-giving, and health-seeking practices under the Bangladesh Integrated Nutrition Project (BINP). The study was conducted in rural Bangladesh among 282 moderately-malnourished (weight-for-age between 61% and 75% of median of the National Center for Health Statistics standard) children aged 6-24 months. Mothers of the first intervention group received intensive nutrition education (INE group) twice a week for three months. The second intervention group received the same nutrition education, and their children received additional supplementary feeding (INE+SF group). The comparison group received nutrition education from the community nutrition promoters twice a month according to the standard routine service of BINP. The children were observed for a further six months. After three months of interventions, a significantly higher proportion of children in the INE and INE+SF groups improved (37% and 47% respectively) from moderate to mild or normal nutrition compared to the comparison group (18%) (p < 0.001). At the end of six months of observation, the nutritional status of children in the intervention groups improved further from moderate to mild or normal nutrition compared to the comparison group (59% and 86% vs 30%, p < 0.0001). As the intensive nutrition education and supplementation given were highly effective, more children improved from moderate malnutrition to mild or normal nutritional status despite a higher incidence of morbidity. The frequency of child feeding and home-based complementary feeding improved significantly (p < 0.001) in both the intervention groups after three months of interventions and six months of observation. Body-weight gain was positively associated with age, length-for-age, weight-for-length, frequency of feeding of khichuri, egg, and potato (p < 0.05). Ability of mothers to identify malnutrition improved from 15% to 99% in the INE group and from 15% to 100% in the INE+SF group, but reduced from 24% to 21% in the comparison group. Use of separate feed pots, frequency of feeding, and cooking of additional complementary feeds improved significantly in the INE and INE+SF groups compared to the comparison group after three months of interventions and six months of observation. It can be concluded from the findings of the study that intensive nutrition education significantly improves the status of moderately-malnourished children with or without supplementary feeding.     

中国西部40县农村3岁以下儿童营养状况浅析

目的 综合评价中国西部贫困农村儿童的营养状况，探讨影响贫困地区儿童营养的有关因素，寻找适当的干预措施改善当地儿童的营养状况。方法 采用分层随机抽样的方法，对中国西部5省40个县的7302户有3岁以下儿童的家庭进行调查。将所有资料采用EPI6.0软件建立数据库及检错程序，采用两次录入法，并用SPSS10.0统计软件完成所有统计分析。结果 40个县儿童的身长、体重均明显低于1995年中国9市标准和WHO推荐标准。儿童营养不良主要表现为生长迟缓（24.0%）和低体重(22.4%）。与儿童营养不良相关的主要因素有喂养方式、儿童有月龄、腹泻、家庭收入以及蛋肉的添加频率等。结论 普及科学喂养知识，增加儿童蛋白类辅食的添加，降低常见病的忠现率将有 地改善当地儿童的营养状况。     

中国农村地区婴幼儿辅食添加状况

对较贫困农村地区 146 49名 4～ 2 4月龄婴幼儿的辅食添加情况进行分析 ,结果显示婴幼儿平均从出生后 6个月开始添加食物 ,约 1 3的婴幼儿在 4～ 6个月开始添加 ,有 16 4%的婴幼儿在 4个月以前就添加了谷类食物 ;大多数婴幼儿 (74 4% )从 7个月开始每天进食谷类食物 ,蔬菜水果类食物的摄入频率随着年龄的增加有所增加 ,但 1岁以后也只有 5 0 %的的婴幼儿能够每天食用蔬菜水果。蛋白质类食物的摄入频率较低 ,1岁以上婴幼儿能够每天食用的占 38% ,有 15 8%的婴幼儿从未添加过肉蛋类及豆制品类食物。农村地区的大多数婴幼儿是以母乳喂养的 ,但断奶以后只有 2 0 %的婴幼儿能够每天饮奶 ;婴幼儿的食物摄入情况受家庭食物状况的影响 ,随着年龄的增加 ,影响程度增加 ;婴幼儿辅食添加的状况直接影响婴幼儿的生长发育 ,长期不合理的喂养模式 ,就会造成营养不良。应通过营养教育 ,提高婴幼儿看护人的营养知识 ,及时合理地添加辅食对婴幼儿的生长发育非常重要。     

Action for tackling malnutrition: growth monitoring or surveillance?

Malnutrition is an important Public Health problem globally as well as in India. Mortality is a multi-causal phenomenon in which malnutrition is but one factor directly or indirectly contributing 55% mortality of children under-five years of age. Authors observed higher prevalence of severe degree of Malnutrition in the underserved section of population with specific reference to girl child, under 3 years of age, where there were large number of children in the family, repeated infections and Measles. Growth monitoring Services in the ICDS scheme meant only weight recording and was not at all satisfactory. Even the majority of the Anganwadi workers (AWW) stated that it meant monthly weight recording of children while only few knew it is in addition plotting these on growth charts and advising mothers if growth was not proper. Around 60% of caregivers did not know about growth monitoring. The concept of growth monitoring should be changed to Growth surveillance to emphasize more on the action components of it.     

Direct nutrition intervention and the control of diarrheal diseases in preschool children.

This is a report of the reduction in frequency of diarrheal disease in malnourished school children, which was an unanticipated result of a nutrition intervention program in Candelaria, Colombia, during 1964-65. In a late 1963 baseline study all preschool children were weighed and measured and the mothers interviewed. Mothers of the malnourished were invited to participate in a supplementation program. Weekly records were kept of the episodes, and diarrheal disease decreased in the 182 children observed for a full calendar year. Each malnourished child was given 1 pound of dried skimmed milk (DSM) per week. In the 6-week program the mothers were educated about food and nutrition. At monthly intervals the children were weighed and measured. Among the 101 children with first degree malnutrition at the start of the program, almost two-thirds had improved; of the 72 with second degree malnutrition, three-fourths improved; and, all of the 9 with third degree malnutriton improved after the first year. Mothers commented that after receiving supplement for about 6 weeks their children had less diarrhea. Exclusive breastfeeding plays a protective role against diarrhea in the early months of life. The association between nutritional status and diarrheal disease is stronger than that of environmental sanitation.     

Assessment of the nutritional status of Nigerian rural children and mothers'' perceptions of quality of life

One hundred and fourteen preschool school children and their 30 mothers from three selected villages in Ile-Ife, Nigeria were assessed for nutritional status using selected and sensitive anthropometric techniques. The mothers' dietary patterns, their perceptions as to components of a good quality of life, infants' immunization status and major cause of infant death were also examined. Approximately 56% of the children and 80% of the women were identified to be suffering from mild to moderate malnutrition. The major cause of infant death as reported by the mothers was high fever and convulsion. Practically all the children under 3 years had not received any form of immunization. Ability to have plenty of children, good health and money, were highly perceived as measures of essential components of quality of life by all the mothers, while 20% listed good feeding, housing, clothing, and only 7% listed potable water. The need for effective health services, regular home visits, supplementary feeding programmes for school children and an effective health education campaign on the importance of immunization and nutrition for rural people are discussed. The training of agricultural extension workers in the use of simple anthropometric techniques to identify covert malnutrition is also highlighted.     

1604例儿童营养不良结果分析

目的了解本市儿童营养不良情况及其相关疾病。方法回顾性分析随访2011年6月至2012年6月我院儿童保健门诊1604例营养不良患儿,年龄分布在0-7岁。结果中度营养不良占营养不良患儿的99.75%,体重低下型占79.86%,消瘦型占61.85%,生长迟缓型占36.72%,营养不良在6月龄至1岁之间发病率最高,男、女分别为32.09%、38.59%,具有统计学差异;在其他年龄段男女发病率不具有统计学差异。伴随营养不良的疾病中居于前四位的分别是腹泻、呼吸道感染、佝偻病、贫血。结论营养不良高发于6月龄至1岁之间,营养不良最常见的相关疾病是腹泻与呼吸道感染。应加强喂养宣教与护理。     

Health and development of mothers through system of ICDS

In order to accelerate welfare and nutrition programs for women and children in tribal, hilly, and backward areas of India, the government of India has accepted the National Program of Integrated Services. Delivery of these services is coordinated by the Integrated Child Development Services (ICDS). The package of services for prenatal women include physical and obstetrical exams; serial recording of weight, blood pressure, hemoglobin, and urinalysis; tetanus immunization; iron (60 mg) and folic acid (.5 mg) tablets; food supplements; identification and referral of high-risk mothers; and health education on antenatal care, breast feeding, child rearing, and family planning. Postnatal women received 2 home visits within 10 days of delivery and make 1 visit after 1 month of delivery. These visits cover general health, breast feeding, delivery records, infant health, and birth control measures. Food supplementation continues for nursing mothers. All women 15-44 years of age receive health and nutrition education. Specially organized courses, campaigns, home visits by anganwadi workers, cooking demonstrations, and mass media emphasize simple messages regarding health and nutrition. Areas that are covered include family welfare; antenatal, intranatal, and postnatal care; breast feeding; immunization; prevention of such common communicable diseases as malaria, tuberculosis, and leprosy; weaning and supplementary feeding; improvement of children's nutritional status; balanced diet; food storage, preparation, cooking, and serving; eye and ear care; personal and environmental hygiene; sanitation; management of acute respiratory infections; management of diarrhea; and control and treatment of internal parasites. The mobile food and extension units of the Department of Food are utilized. Pregnant and nursing mothers belonging to families of landless agricultural laborers, of marginal farmers, of the scheduled caste, of the scheduled tribe, and of poorer sections of the community are chosen for this program. Special care is given to pregnant women who: are pregnant for the 1st, 3rd, or 4th time; have gained less than 6 kg; are younger than 18 or older than 35; have had frequent or twin pregnancies; have a history of miscarriage or preterm delivery; are anemic; or have a history of edema, hypertension, or seizure. Personnel, who are monitored, receive training supplemented by reorientation and continuing education.