Introduction

According to WHO slogan “Healthy child is a nation wealth”. India being a third world country contains 40% of the undernourished children in the world. Undernutrition occurs mostly because of insufficient access to adequate food, marriage at a younger age and early births of children, thoughtful weaklings, delivery horrors, tallness and weight of babies, breastfeeding support or other poverty-related matters (1). The problem of malnutrition is most pronounced in central India, including states such as Chhattisgarh and Madhya Pradesh (2). A number of recent studies have shown high levels of malnutrition in children under the age of five years in India (3). In pursuance, the Government of India started on October 2, 1975, to implement a comprehensive Integrated Child Development Service (ICDS) scheme in all territories and States as welfare programmes for children for better health. The initiative helps control malnutrition and childhood morbidity, as well as the generation of mortality among children under 6 years old, turning in this way into the largest development program for early childhood growth (4). The Aanganwadi -A word derived from Hindi which is the language spoken by majority of the population – it has a enormous in every house meaning Angan is courtyard and Wadi means to sit; here children come, have supplementary food /pre-school education plays and goes back home (5). One of the services provided by Anganwadi centres (ADCs) is that they immunize children, conduct health check-ups and referral services, and provide health and nutrition education for the well-being of the children (6). Anganwadi center is a childcare facility in village level, managed by Anganwadi (meaning courtyard shelter) worker who trained to deliver nutrition and other related service (7). This worker is a community-based, frontline voluntary worker of the ICDS program (8). She plays a crucial role in supporting families, particularly mothers in providing proper health and nutrition-care capabilities, as well as timely detection and treatment of diseases (9). In remote areas the program is dedicated to the poorest strata while delivering services at local grass root level with full beneficiaries’ involvement (10).

Good nutrition provides children with several immeasurable benefits such as the acquisition of speech, critical thinking, learning, and relationship building and adaptation skills. Growth and development is something that has existed since conception and will continue until full maturity. This leads to low nutrition in children which leads to diseases and eventually malnutrition. This may lead to irreversible physical and mental damage (11). There is a range of factors, both internal and external factors which determines the nutritional status of children. Internal factors include such things as age, sex, nutrition, behavior, physical activity and diseases, whereas the external factors are food supply, cultural practices and socio economic factors (12). The objective of this study is to assess the impact of Anganwadi centres (under ICDS) on the nutritional status of the children involved in the program.

Material and Methods

Study Overview

The study utilized a cross-sectional method, involving 780 children aged 2-5 years from 50 anganwadi centres in Bilaspur, Chhattisgarh, India. A random sample method was used to get the data.

Data Collection

Anthropometric measurements, socio-demographic profiles, supplementary food, and other basic facilities provided in ICDS Centres were gathered from anganwadi workers. The age of the children was recorded from their “Jaccha-Baccha” cards. An interview schedule was used as the primary method for data collection, which was conducted after obtaining necessary approvals from relevant authorities.

Evaluation of the Incidence of Undernutrition

The prevalence of undernutrition among children in the study was evaluated applying the WHO (2006) classification of Z-Scores (13). Among the causes of undernutrition three main causes were found. The first one is:

1. Stunting (low height-for-age) – This implies a ‘chronic’ type of malnutrition, which results from deficient caloric intake affecting the child’s cognitive and physical development.
2. Underweight (low weight-for-age) – It refers to under nutrition as a consequence of malnutrition that pertains to acute conditions and greatly increases the chance of death of children.
3. Wasting (BMI-for-age) - This refers to a state of short-term deficiency disease that is due mainly to the infection with or malnutrition caused by other illnesses (14).

Using the cap for BMI of a population as quoted above Wilson (1995) provides the following classification of prevalence if BMI is lower than 18.5kg/m². (15)

• Low prevalence - 5-9%
• Medium - 10-19%
• High - 20-39%
• Very high - 40%

Statistical Analysis

All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS/PC - Version 23), including percentages, frequency analysis, chi-square tests, and regression analyses. A statistical significance level was established at (p < 0.05). Microsoft Office Excel was utilized for graphical representations of the data.

Sample Size Calculation

The estimated sample size of the studied children was calculated using the formula: n = (z2pq)/d2 (16)

Results

Table 1 summarizes the descriptive analysis and mean comparisons of anthropometric data reported and total number of children in the study. The findings reveal the presence of a significant positive sex difference in mean weight for 24 months age children at t-value 0.022 (df = 148; p = 0.009). Moreover, there was a greater variation in height (t-value = -0.427; df = 148; p = 0.001) and BMI (t-value = 0.512; df= 148; p = 0.051) for the same age group. At 36 months of age also mean weight showed significant positive difference about sex, with weight with t-value of 0.896 (df= 187; p= 0.003). The height difference was statistically almost significant (t-value = -1.592; df = 187; p = 0.050) and for BMI a statistically significant difference was recorded (t-value = 0.794; df =187; p = 0.012).

Table 2 shows the age and sex-specific prevalence of stunting, underweight, and wasting among the children under study. More than two-fifths of the total 780 children were stunted (41.3%). The highest levels of stunting were seen in 36 months boys (35.3%) and girls (25.5%) and in the least number of months for 24 boys (14.6%) and girls (12.0%). In moderate stunting, it was most marked for 24 months boys (41.3%) and 48 months girls (30.7%), while it was least marked for 36 months boys (28.8%) and girls (13.3%). The table shows significant relationship between Boys to Girls at ages 36 months (χ2=12.352; df=2;p=0.002 and 48 months (χ2=4.381;df=2;p=0.021 for height-for-age.

Table 3 reveals that out of a total of 780 children, 46.3% were underweight. The highest prevalence of severe underweight was noted in boys at months (21.2%) and girls at months (16.8%). Conversely, the lowest rates were noted in boys at months (12.0%) and girls at months (7.8%). Moderately underweight children were predominantly boys at months (50.5%) and girls at months (45.5%), while the lowest prevalence was among boys at months (24.8%) and girls at months (23.6%). There is a significant relationship between boys and girls at age 36 concerning their weight-for-age, with a chi-square value of (Χ²=6.18, df =2, p=0.045).

Among the 780 children, 28.8% were found to be wasted. The most common severe wasting was in boys at age 36 months (21.2%) and girls at age 24 months (13.3%), while it is least likely in boys at age 60 months (7.8%) and girls at age 60 months (3.5%). The highest prevalence of moderate wasting is in boys at age 24 months (38.6%) and girls at age 24 months (36.0%) and the lowest in boys at age 60 months (7.8%) and girls at age 48 months (5.3%). The prevalence of overweight was highest at age 60 months (6.7%) for boys and at age 36 months (8.8%) for girls, while the lowest prevalence was noted in boys at age 24 months (1.3%) and in girls at age 60 months (3.5%). At ages 24 months (Χ²=14.056, df=5, p=0.026), 36 months (Χ²=23.328, df=4, p=0.000), and 48 months (Χ²=10.102, df=2, p=0.034), there were significant relationships between BMI-for-age of boys and girls.

Table 3 also illustrates the relationship between receiving supplementary food through the Integrated Child Development Services (ICDS) and the nutritional status of children in terms of weight-for-age, height-for-age, and BMI-for-age. Children not receiving regular supplementary food showed higher rates of severe stunting (32.1%) compared to moderately stunted children (23.9%). Approximately 20.7% of the children were underweight due to irregular consumption of supplementary food, with around 16.4% and 19.6% identified as severely and moderately wasted, respectively. Many parents work as wage laborers or cultivators, leading children to accompany them instead of attending the anganwadi. The data reveals significant relationships between receiving supplementary food and height-for-age (x²= 17.57; df=2; p=0.01), weight-for-age (x²= 20.98; df=2; p=0.000), and BMI-for-age (x²= 27.90; df=5; p=0.000).

Likewise in table 3 below we see the dependency of supplemental food from Integrated Child Development Services (ICDS) and the weight/height-for-age and BMI-for-age of the children. Children who do not receive supplementary food regularly: children 32.1% are under severe stunting. Overall 20.7 % of the children were moderately stunted (23.9%). Size-wise, percentage of children was underweight in terms of normal weight for their age (because of irregular consumption of supplementary food). Whereas, about children were severely wasted 16.4% and % children were moderately 19.6% (See Table 3).The data shows significant relationships between supplementary food and height-for-age (Χ²= 17.57; df=2;p=0.01), weight-for-age (Χ²= 20.98; df=2; p=0.000), and BMI-for-age (Χ²= 27.90; df=5; p=0.000).

Discussion

The findings clearly show that the parents’ job and subsequently their food instability of the family due to the nature of their work are the socio-economic factors that really affect the nutritional outcomes of the children. Programs that guarantee the constant provision of supplementary food programs can solve these issues thus enhancing children's overall health. At the age of 24 months, boys had a significantly mean weight difference compared to girls, and at the age of 36 months, boys again were the ones who had a positive difference in mean weight. The age group of 36 months had the difference that was almost significant at the height. The highest proportion of stunted growth was in 36-month boys (35.3%) and girls (25.5%).

The data showed that children lacking the supplementation food had a higher rate of severe stunting (32.1%) and underweight (20.7%). The highest prevalence of underweight among both boys (21.2%) and girls (16.8%) is observed at 36 months of age. The highest prevalence of severe wasting for boys (21.2%) are noticed at 36 months of age and for girls (13.3%) is at 24 months of age.

From the analysis on anthropometric status it can be conceived that there exist significant differences in nutritional status between the children when classified according to their sex as well as with reference to their age, thus stressing the need for sex-age specific intervention strategies. Boys have got higher mean weight than girls at 24 and 36 months of age which are statistically significant (p<0.05). Prevalence levels of stunting among both boys and girls are a cause for concern but it is more so in case when supplementary food in form of ICDS is not received.

Conclusion

The present study brings out alarming levels of malnutrition in the study children with 48.7% stunting, 46.3% underweight and 28.8% wasting evident in the studied population depicting that undernutrition continues to be a serious problem.9 Regular nutrition surveillance is required and vulnerability oriented especially for those belonging to the poorest of the poor and severe forms of malnutrition should form the base for supplementation as far as children attending anganwadis are concerned. There is a need for locally available diet feeding programmes being linked to ICDS using locally available low cost food stuffs should be given priority on need basis to preponderantly affected children while who suffer from moderate grades of undernutrition attend MTCs along with preschool non-malnourished beneficiaries. Supervisors and ICDS functionaries should be adequately trained regarding its best use, care etc., Delivery system for higher quantity as well as quality food must strengthened also ensure higher responsiveness in management of any adverse incident following immunization by medical authorities among others so that prompt care may be provided without making any loss of time at least two days hazards can occur due inability to reach health facility due lack /poor road connectivity during September−April−May months characterized by rainy seasons being common.

Conflicting Interests: The authors declared no potential conflicts of interest.

Funding sources: None

Acknowledgements:

The authors would like to thank all of the research participants for their tremendous support during the study. Authors are also grateful to GGV for logistical support and Financial assistance has been received by MG from (UGC Letter No.: 688(NET-JUNE 2014) was highly acknowledged.

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