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.     

Women's education can improve child nutrition in India

Child malnutrition has long been recognized as a serious problem in India, but national-level data on levels and causes of malnutrition have been scarce. Hence, during 1992-93, a National Family Health Survey was carried out to examine the levels and determinants of child malnutrition in the country. More specifically, this survey estimated the levels of child malnutrition and examined the effects of mother's education and other demographic and socioeconomic factors on the nutritional status of children in India. Based on standards developed by the WHO, 52% of children under age 4 years are stunted, 17% are wasted, and 54% are underweight. Maternal education has the strongest independent influence on child malnutrition. Children whose mothers have little or no education tend to have a lower nutritional status than do children of more-educated mothers, even after controlling potentially confounding demographic and socioeconomic variables. The age of the child, birth order, and household economic status all have independent effects on nutritional status. Considering the very strong impact of maternal education on child nutrition, women's education and literacy programs could play an important role in improving the nutritional status of children.     

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.     

The Social and Environmental Factors Underlying Maternal Malnutrition in Rural Bangladesh: Implications for Reproductive Health and Nutrition Programs

Levels of low birth weight (LBW) and maternal malnutrition in rural Bangladesh are among the highest in the world. We surveyed dietary practices among pregnant mothers in a rural area served by a reproductive health and nutrition program. In total, 30 semi-structured interviews and five focus group discussions were carried out, supplemented by participant observations. Despite high levels of awareness of nutritional dietary requirements, half the women reported unchanged or reduced food intake during pregnancy. Dietary taboos and food aversions were widely practiced. Women consistently received the last and smallest food shares during mealtimes. The findings highlight the need to address traditional dietary taboos and preferenaces, and actively target key household decisionmakers, namely, husbands and mothers-in-law, in nutrition behavior change communication.     

The social and environmental factors underlying maternal malnutrition in rural Bangladesh: implications for reproductive health and nutrition programs

Levels of low birth weight (LBW) and maternal malnutrition in rural Bangladesh are among the highest in the world. We surveyed dietary practices among pregnant mothers in a rural area served by a reproductive health and nutrition program. In total, 30 semi-structured interviews and five focus group discussions were carried out, supplemented by participant observations. Despite high levels of awareness of nutritional dietary requirements, half the women reported unchanged or reduced food intake during pregnancy. Dietary taboos and food aversions were widely practiced. Women consistently received the last and smallest food shares during mealtimes. The findings highlight the need to address traditional dietary taboos and preferenaces, and actively target key household decisionmakers, namely, husbands and mothers-in-law, in nutrition behavior change communication.     

Malnutrition among children in an urban Indian slum and its associations

In a cross-sectional study in Bhopal, India, mothers and other family members were surveyed by questionnaire, then 1000 randomly selected slum children were clinically examined, to detect nutritional deficiency diseases. Anthropometric measurements were also taken. Malnutrition classification followed the Harvard classification (weight in relation to the age of the child) modified by the Indian Academy of Pediatrics. The weight of the children was recorded using the Avery personal weighing machine. Of the 1000 children, 520 were males and 480 were females almost matched in age and birth order. The prevalence of various nutritional deficiency diseases comprised: protein calorie malnutrition (63.4%), vitamin A deficiency (23.4%), vitamin B deficiency (16.2%), vitamin C deficiency (2.6%), vitamin D deficiency (9.4%), fluorine deficiency (2.9%), and anemia (7.2%). The prevalence of malnutrition was 65.0% among females compared to 61.9% in males (p 0.05). However, higher grades of malnutrition (III+IV) were 13.12% among females in comparison to 7.87% among males (p 0.05); whereas lower grades of malnutrition (I+II) were 54.04% among males and 51.87% among females (p0.05). The birth order of the children was positively associated with their grades of malnutrition (p 0.05). On the other hand, an inverse relationship was observed between birth interval and grades of malnutrition (p 0.05). The prevalence of malnutrition was significantly higher among those children whose fathers were illiterate (p 0.05). In general, as the literacy status of father increased, the prevalence of malnutrition among children decreased. The prevalence of malnutrition had a positive association (p 0.05) with children's family size: 3 members (47.0%), 4-6 members (63.9%), and 7 members and above (70.6%). On the other hand, an inverse correlation was observed between socioeconomic status and the prevalence of malnutrition (p 0.05). The prevalence of malnutrition was significantly (p 0.05) higher among the children with a history of infection (81.8%) and worm infestation (77.0%) in comparison to those without history of infection (13.1%) and worm infestation (61.9%), respectively. Similarly, nonimmunized children experienced more malnutrition (66.4%) in comparison to immunized children (57.0%).     

Anthropometric measurements of infants and under five children in Riyadh City

The data presented in this paper are part of the ongoing pediatric nutrition surveillance in ten primary health centers from Riyadh City. A total of 21,507 infants and children under five were included. The mean birth weight was 3027 g, and 8.6% of the children had low birth weights. The measurements showed that there had been no obvious change in the weights and heights of children during the past 13 years. In our results the children classified as moderate and severely underweight were 4.5% and 0.8% respectively. The data showed the average growth of all infants, regardless of feeding pattern, was same or faster than the NCHS reference population, up to approximately six months of age after which their growth became slower than that of the NCHS standards. The prevalence of malnutrition in Saudi Arabia is moderately high, in spite of the high per capita income, and the fact that the government subsidizes locally produced and imported food items. The malnutrition among this age group may be attributed to reproductive or social behavior and genetic factors. The reduction of malnutrition in the last ten years could be largely due to the nutrition and health education programs. There is a need for more comprehensive nutritional health education among the local population.     

School lunch program in India: background, objectives and components

The School Lunch Program in India (SLP) is the largest food and nutrition assistance program feeding millions of children every day. This paper provides a review of the background information on the SLP in India earlier known as national program for nutrition support to primary education (NP-NSPE) and later as mid day meal scheme, including historical trends and objectives and components/characteristics of the scheme. It also addresses steps being taken to meet challenges being faced by the administrators of the program in monitoring and evaluation of the program. This program was initially started in 1960 in few states to overcome the complex problems malnutrition and illiteracy. Mid Day Meal Scheme is the popular name for school meal program. In 2001, as per the supreme court orders, it became mandatory to give a mid day meal to all primary and later extended to upper primary school children studying in the government and government aided schools. This scheme benefitted 140 million children in government assisted schools across India in 2008, strengthening child nutrition and literacy. In a country with a large percent of illiterate population with a high percent of children unable to read or write; governmental and non-governmental organizations have reported that mid day meal scheme has consistently increased enrollment in schools in India. One of the main goals of school lunch program is to promote the health and well-being of the Nation's children.     

Temporal Trends in Incidence of Nutritional Deficiency among Older Adults in China: A Secondary Analysis of the Global Burden of Disease Study 1990–2019

Nutritional deficiency is prevalent among the elderly, and it is associated with many adverse health consequences. China is rapidly moving toward an aging society with a large population; however, evidence on the epidemiological trends in nutritional deficiency among the Chinese elderly is limited. Data on the incidence of nutritional deficiency among Chinese adults aged 65 years or above from 1990 to 2019 were extracted from the Global Burden of Disease 2019 database. We used the joinpoint regression method to estimate the average annual percentage change (AAPC) and to describe trend patterns. Age, period, and cohort effects were determined using age–period–cohort models. From 1990 to 2019, the incidence of vitamin A deficiency and iodine deficiency among Chinese older adults decreased from 1784.12 and 8.20 to 304.27 and 7.26 per 100,000, with AAPCs of −0.41 (−0.44, −0.38)% and −5.86 (−6.29, −5.43)%, respectively. A continually increasing trend was seen for incidence rates of protein-energy malnutrition, from 1342.02 to 2275.87 per 100,000 person-years, with an AAPC of 1.70 (1.40, 2.01)%. These trends were more pronounced among men than women. A strong age effect and birth cohort effect were present. Specifically, the population that was older or born later had a lower incidence of deficiencies in vitamin A and iodine but a higher incidence of protein-energy malnutrition. The results show a substantial reduction in vitamin A and iodine deficiencies among the Chinese elderly, and health policies and public awareness are needed to address the burden of protein-energy malnutrition in this population.     

Nutrition in New Zealand: Can the Past Offer Lessons for the Present and Guidance for the Future?

Over the last century, nutrition research and public health in New Zealand have been inspired by Dr Muriel Bell, the first and only state nutritionist. Some of her nutritional concerns remain pertinent today. However, the nutritional landscape is transforming with extraordinary changes in the production and consumption of food, increasing demand for sustainable and healthy food to meet the requirements of the growing global population and unprecedented increases in the prevalence of both malnutrition and noncommunicable diseases. New Zealand’s economy is heavily dependent on agrifoods, but there is a need to integrate interactions between nutrition and food-related disciplines to promote national food and nutrition security and to enhance health and well-being. The lack of integration between food product development and health is evident in the lack of investigation into possible pathological effects of food additives. A national coherent food strategy would ensure all components of the food system are optimised and that strategies to address the global syndemic of malnutrition and climate change are prioritised. A state nutritionist or independent national nutrition advocacy organisation would provide the channel to communicate nutrition science and compete with social media, lead education priorities and policy development, engage with the food industry, facilitate collaboration between the extraordinary range of disciplines associated with food production and optimal health and lead development of a national food strategy.     

A not so innocuous survey: NFHS 1992-93

The National Family Health Survey (NFHS), conducted between April 1992 and September 1993, is one of the largest surveys conducted in India to obtain health-related data at the state and national levels. The main objective of the survey was to have estimates of fertility, infant and child mortality, the practice of family planning, and the use of maternal and child health care services. Other important objectives were to provide high-quality data to academicians and researchers for use in conducting analytical research on various population and health topics and to strengthen the survey and research capabilities of the Population Research Center in India. The International Institute for Population Sciences, Bombay, was the nodal agency providing coordination and technical guidance to the NFHS. The survey covered 24 states and the National Capital Territory of Delhi, comprising 99% of the total population of the country. 89,777 ever-married women aged 13-49 years were interviewed with the use of uniform questionnaires. Useful and informative data were collected. This paper discusses discrepancies in sampling, the use of family planning methods, the findings of state documents, the use of birth spacing methods, maternal and child health care, immunization coverage, vitamin A deficiency, and the country document detailing the overall national situation.     

Malnutrition and food consumption patterns in Malaysia

In a rapidly developing country like Malaysia problems related to nutrition present themselves with contrasting features. While health indicators such as the toddler mortality rate, incidence of low birth weight and food balance sheet data suggest an improving nutritional situation, direct nutrition assessment indicates that chronic protein energy malnutrition is still common amongst children in rural areas and urban slums. Initial surveys of the adult urban population indicate about 10% prevalence of chronic energy deficiency in both sexes. Food consumption data revealed an average energy intake below the recommended daily intake for Malaysia in most age groups. Although death due to malnutrition is rare in Malaysia, it is known to cause considerable ill-health, impaired mental performance in children, loss of productivity in adults and an overall decline in quality of life. This paper reports the prevalence of malnutrition in the last two decades, the possible contributing factors and recommendations for alleviating the problems in Malaysia.     

Vitamin A supplementation for refugees and famine victims

Reports about recent famine victims and refugees have described the occurrence of xerophthalmia and resultant blindness related to severe vitamin A deficiency. These populations are subject to high prevalences of childhood protein—energy malnutrition and infectious diseases, pre-existing marginal vitamin A status, and inadequate levels of vitamin A in relief rations. In order to prevent unnecessary morbidity and mortality when any of these risk factors arise, famine victims or refugees should receive vitamin A supplements as an early and essential component of the nutritional support provided by relief agencies. Such supplementation should not await the results of nutrition or blindness surveys but rather should be a standard component of the maternal and child health care provided to the affected population until sufficiency of dietary vitamin A has been clearly established.     

Prevention and control of iron deficiency in developing countries

Iron deficiency is a global nutritional problem which mainly affects infants, children, and women of childbearing age. Using anemia as an indicator of iron deficiency, an estimated 30-60% of women and children in developing countries are iron deficient. Even in developed countries, iron deficiency warrants significant public health concern. This paper examines iron deficiency and strategies for its control, with an emphasis upon situations commonly found in developing countries. Sections address anemia and mortality, the effect of iron deficit upon child development and behavior, reduced work performance and productivity, meeting the nutritional requirements for iron in young children and women, general issues in the prevention and control of iron deficiency, nutrition promotion and an education-based approach, iron supplementation programs, the elimination of intestinal helminth infections, food fortification-based interventions for infants and younger children as well as adults, concerns about iron overload related to iron fortification, and an agriculture-based approach.     

The health of mother and child in rural Central Africa.

In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric malnutrition, with adverse affects on maternal and child health. Improvement of maternal nutrition would lead to rapid consecutive pregnancies, reducing the length of time each child could be breastfed and reducing the protein available to each child. Hence, the authors recommend modern birth spacing methods in combination with programs to improve the health of mother and child.     

Child survival and development

India is home to over 382.9 million children, the largest number of any country in the world. This number only shows that the country has made commendable progress in various child survival and development indicators such as infant mortality rate, education, and immunization during the last 50 years. However, according to the 1981 census, 53% of young children (0-6 years) suffered from malnutrition and about 13 million infants were being added to the child population annually. This rate of increase poses a significant problem for national development that requires immediate action. It should be understood that early childhood (0-6 years) is a very critical period for a child's physical and socio-psychological development. In view of this, the government, state and the voluntary sector implemented a large number of programs for children and nursing and expectant mothers to enable children to develop their full potential; however, these efforts were far from satisfactory. Nutritional problems of children of urban slums have increased in magnitude and there is a high prevalence of protein malnutrition among preschoolers. In addition, dietary intake of vitamin A is low among pregnant women belonging to poor communities and low-income groups. With all these problems, a tremendous task awaits the government.     

Nutritional status and social determinants of child height in the Guarita Indigenous Territory, Southern Brazil

The nutritional status of under-five children and the association between social conditions and child stature were examined using data from the program to control malnutrition and mortality in the Guarita Indigenous Territory, southern Brazil, 2001-2002. Anthropometric indices were calculated in z-scores of the CDC 2000 reference. At entrance into the program, 34.7% of the children presented stunting, 12.9% low weight for age, 4.2% wasting, and 8.7% overweight. Stunting was most prevalent among boys and children older than one year. Multivariate linear regression showed that, on average, children were shorter when the drinking water was collected directly in the environment (p = 0.046), there was no refrigerator for food preservation (p = 0.021), maternal age was less than 16 years at the birth of the oldest child among the under-fives (p = 0.019), and the mother was illiterate (p = 0.083). Sewage facilities only had an effect on the unadjusted model. There was no evidence that the number of under-five children had an effect on stature. Social inclusion policies and health and social provision which takes these factors into account are potentially relevant for improving health and nutrition in this population.     

Popular education and child nutrition: experience with women in a rural area of Mexico]

OBJECTIVE: Community intervention was undertaken using the health promotion strategy, the objective being to develop a health education program for women. METHODS: The popular education methodology was used with the purpose of generating organizational and social participation processes to improve hates of child nutrition and survival. RESULTS: The main results are linked with the generation of community self-care processes and the creation of a health promoters' group which has been working with women, focusing their work on improving child nutrition and family health. The health promoters have taken charge of the epidemiological surveillance program for child nutrition and, together with the mothers, have undertaken a series of actions which have helped to decrease the rate of malnutrition among the children participating in this programs. CONCLUSIONS: There would be greater possibility of success if the general population were involved in the solution of this problem. This would be possible by the use of an adequate methodology which brought about greater community participation in such a way as to leave room for its own improvement. Popular education provides such a tool. It is necessary to continue to increase experience in health education with this type of methodology.     

Towards child health: through mother's health and education

In India, mothers and children constitute 62% of the population, but they are also a special risk group as regards their childbearing and survival, respectively. The States of Bihar, Rajasthan, Madhya Pradesh, and Uttar Pradesh account for about 50% of the girls who are married off before age 16. Low levels of female literacy (ranging from 11.4% in Rajasthan to 65.7% in Kerala, with an all India average of 39.4%) are associated with early marriages, which expose girls to pregnancy in their teen years. Many studies report higher rates of low birth weight, prematurity, and neonatal and infant mortality in children of young mothers than in children born to women 20-29 years old. In a study conducted in a slum area of Bombay, teenage pregnancy appeared to be a risk factor for low birth weight when compared with pregnancies of women 21-30 years old. The incidence of low birth weight babies in India ranges from 30% to 40%, and they account for over 80% of neonatal deaths. The incidence of premature labor in teenagers in various Indian studies ranges from 11% to 31%. Perinatal mortality rates for Indian teenager pregnancies vary between 6% and 11%. Poverty associated with adverse sociocultural practices and the low status of women aggravates malnutrition and anemia in pregnant women. Female literacy is particularly important both for utilization and for provision of medical, health, and social welfare services. A national survey has indicated that the number of children born to couples was 4.03 when the husband was illiterate, declining to 2.16 when the husband had intermediate or higher level education. But the number was 3.8 when the wife was illiterate, dropping to 1.6 when the wife had intermediate or higher level education. If the mother is educated she will provide better child care, nutrition, and cleanliness, the factors which affect the health of her child.     

Feeding children: in the beginning--nutrition and pregnancy

The health and well-being of every child is affected by both the quality and quantity of food, but when does nutrition first begin to be important? Is it after the birth or from the moment of conception, or perhaps even before this? This paper will focus on the nutritional status of the mother, before as well as during pregnancy, and its relationship to the birth weight and subsequent health of the child. Pre-pregnant weight is a major factor affecting birth weight; underweight women may be at increased risk of delivering a low birthweight infant and of complications of pregnancy, whilst those who are excessively obese are at greater risk of gestational diabetes and hypertension. Animal studies have demonstrated that severe vitamin and mineral deficiencies have dramatic effects on reproductive outcome, and there is now growing evidence that even marginal deficiencies in women may have deleterious effects on pregnancy outcome. Nutrition interventions which involve low-risk women appear to have little effect but beneficial effects have been demonstrated in interventions directed at high-risk women. Information about nutrition should be the mainstay of any advice given to prospective parents.