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Original Article

Nutritional Impact of Millet-based Foods on Pregnant and

Nursing Women from Anganwadi Centers in Mahabubnagar
Devulapalli Sharat Dhruthi1, Devaki Gokhale2
1
Office of the District Collector, Mahabubnagar Collectorate, Mahabubnagar, Telangana, India, 2Department of Nutrition and Dietetics, Symbiosis Institute of Health
Sciences, Symbiosis International (Deemed) University, Pune, Maharashtra, India

Abstract
Background: In 1975, the Government of India initiated the Integrated Child Development Services (ICDS) Scheme. The Supplementary
Nutrition Program (SNP) under the ICDS provides meals to pregnant and nursing women at Anganwadi centres (AWCs) to improve their
nutritional status. Aim: The current interventional study focused on identifying nutritional impact of millet-based foods (such as millet health
mix, millet energy bars, finger millet cutlets, and finger millet biscuits) pre- and postintervention on weight, Body Mass Index (BMI), and
hemoglobin of pregnant women and nursing mothers. Methods: Pregnant (n = 22) and nursing women (n = 16) from four AWCs of Gangapur
village, Mahabubnagar, Telangana voluntarily participated in this study. Statistical analysis was conducted using SPSS and P-value of <0.05
was considered statistically significant. Results: The mean weight gain for pregnant women was 3.63 ± 5.29 kg with mean hemoglobin
improvement of 0.5 ± 1.30 g/dL. Similarly, the mean weight gain for nursing women was 3.0 ± 6.00 kg and mean hemoglobin improvement
of 0.9 ± 1.60 g/dL. A paired t test analysis revealed statistically significant change in weight (P = 0.001, P = 0.002) and BMI (P = 0.001,
P =0.004) pre- and postintervention at 95% CI, indicating a positive impact of these millet-based foods on weight and BMI. Conclusion:
Since these millet-based foods have a positive impact on the nutritional status of pregnant women, it is recommended that these foods be
incorporated into the SNP Program for ICDS beneficiaries.

Keywords: Anganwadi centers (AWC), Body Mass Index (BMI), hemoglobin, millet-foods, Supplementary Nutrition Program (SNP),
weight

INTRODUCTION The Integrated Child Development Services (ICDS) is a

platform for the delivery of nutritional interventions under
Pregnancy is a physiological condition with an increased
the Supplementary Nutrition Program (SNP) at community
demand for nutrients to promote growth and development of
level through Anganwadi Centers (AWCs) operated by
the fetus. Consequently, changes in weight, plasma and blood
Anganwadi Workers (AWWs). Despite the efforts of
volume, and alterations in hormonal activity occur during
ICDS, high rates of malnutrition are prevalent evidenced
pregnancy.[1] Iron-deficiency anemia is one of the immediate
by reports from the National Family Health Survey
concerns resulting due to an inadequate intake, lowered
(NFHS), the United Nations Children’s Emergency Fund,
absorption, poor stores, and infections.[2,3] Similarly,
and the World Health Organization (WHO).[2] The NFHS 5
nursing mothers too experience iron-deficiency anemia due
to iron loss that is further aggravated due to menstruation that
occurs post-delivery.[4] Hence, there is a need to provide
Address for correspondence: Ms Devulapalli Sharat Dhruthi, Office of the
complete nutrition in terms of calories and proteins, with an District Collector, Mahabubnagar Collectorate, Mahabubnagar 509001,
emphasis on iron among pregnant and nursing mothers.[4] A Telangana, India.
study conducted in Kerala indicated that reiterating E-mail: dhruthidevulapalli@gmail.com
nutritional practices in prenatal and postnatal interventions
Received: 18 September 2021 Revised: 6 December 2021
with nursing mothers play an important role in improving
Accepted: 17 December 2021 Published: 10 May 2022
their nutritional status.[5]
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Access this article online others to remix, tweak, and build upon the work non-commercially, as long as
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How to cite this article: Sharat Dhruthi D, Gokhale D. Nutritional

DOI: Impact of Millet-based Foods on Pregnant and Nursing Women from
10.4103/ijnpnd.ijnpnd_60_21 Anganwadi Centers in Mahabubnagar. Int J Nutr Pharmacol Neurol Dis
2022;12:66-71.

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Sharat Dhruthi and Gokhale: Nutritional impact of millet-based foods on pregnant and nursing women
statistics indicated that 18.7% of women in India, 18.8% in
Telangana, and 24% in Mahabubnagar had a BMI less than
18.5 kg/m2. Further, the NFHS 5 statistics also highlighted
that 57% of women in India, 57.6% in Telangana, and 54.7%
in Mahabubnagar were anemic between 15 to 49 years.[6]
These statistics clearly depict the poor nutritional status and
compliance to SNP. Further, studies[7] have highlighted that
various factors such as quality, hygiene delivery of the foods
served, and gaps in programmatic policies at AWCs
contribute to poor compliance with SNP.[8] AWWs
prioritized providing preschool education, conducting
home visits or surveys, and record maintenance over the
SNP.[9] On the other hand, the planning commission report
stated that AWWs face challenges in meeting the high
expectations of the communities.[9,10] This further results
in poor utilization of SNP services at AWCs[2] among both
pregnant (46%) and lactating mothers (56.8%).[10] Hence, it is
essential that food-based interventions are planned
considering these challenges.[10]
Previous food-based interventions highlighted that millets
contain 60% to 70% of carbohydrates, 7% to 11%
proteins, 1.5% to 5% fats, and 2% to 7% crude fiber. They
are also a rich source of vitamins and minerals such as B
complex, magnesium, iron, and antioxidants.[11-14] Previous
studies[14,15] demonstrated that malted millet-based foods
such as ladoos, kheer, and porridge have a positive impact
on the nutritional status of pregnant and nursing mothers and
children.[14,15] Hence, this study utilized energy-dense millet-
based formulations to assess the impact on weight,
hemoglobin, and BMI of pregnant and nursing women.
MATERIALS AND METHODS
Study design
This interventional study [Figure 1] was conducted at four
AWCs of Gangapur Village in Jadcherla mandal of
Mahabubnagar district, Telangana. The study was
conducted between November 2018 and February 2019
among pregnant (n = 22) and nursing (n = 16) women who
were ICDS beneficiaries. The study included pregnant and
nursing women enrolled into four AWCs at the beginning of
the intervention, that is, November 2018. All other women
Procurement of raw Machine based cleaning
materials and segregaon
Packaging
Figure 1: The various steps involved in the preparation of millet-based foods undertaken by the food processing company.
International Journal of Nutrition, Pharmacology, Neurological Diseases ¦ Volume 12 ¦ Issue 2 ¦ April-June 2022
enrolled after the stated period were excluded from the study.
Millet-based foods were supplied to these women on all
working days. The formulations of these millet based were
developed by an urban food–producing company Healthy
Farm Foods LLP, Hyderabad. The company was responsible
for the formulation, preparation, sensory evaluation, and
hygiene maintenance of the millet-based foods. These
foods were prepared by the following steps depicted in
Figure 1. The composition, serving size, and nutritional
value of millet-based foods are depicted in Table 1.
The millet-based complementary food products supplied
include:
(1) Mixed millet milk malt: A mixed millet malt was
prepared from the flour of various millets, jaggery,
and milk powder. Jaggery is a sugar product
developed from sugarcane. It contributes to sweetness
and is a source of iron.[16] Milk powder enhances the
nutrient density. Fifteen grams of the malt was served in
100 mL water every day.
(2) Ragi cutlets: Ragi cutlets were prepared from Ragi
(finger millets) flour. Ragi is rich in proteins, iron,
calcium, phosphorus, and fiber.[17] A premix was
prepared and distributed to AWWs. AWWs added
50 g of drumstick/spinach/fenugreek leaves, 15 g
carrot, and 15 g of beetroot to prepare cutlets at
AWCs. Two ragi cutlets weighing 30 g each were
served once a week.
(3) Mixed Millet Energy Bars: Mixed millet malt energy
bars were prepared from various millets and jaggery
flour. The flour was processed into a bar. Two bars of
25 g each were served once a week.
(4) Ragi biscuits: Ragi biscuits were prepared from Ragi
(finger millets). Two Ragi biscuits weighing 20 g each
were served four times a week.
These millet-based foods were first introduced to five
pregnant and five nursing mothers to understand their
acceptance. It was observed that these foods had a strong
acceptability by beneficiaries. The cost of the intervention
was between Rs 4 and Rs 8 per beneficiary per day. The
financial support for the intervention was provided by the
Government of Telangana through the district collector funds.
Preparaon (roasng,
pulverizaon of millets into
flour and blending into
dough)
Processing into malt, bars,
biscuits, cutlets
Cooling
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Sharat Dhruthi and Gokhale: Nutritional impact of millet-based foods on pregnant and nursing women

Table 1: Description of millet-based recipes

S. no Millet based food Description and protocol
1 Mixed millet milk malt Ingredients: Multigrain − 50% (Oats, bajra, ragi, jowar, barley, soyabean, green gram, Bengal gram), milk
powder − 30%, jaggery − 15%, cardamom- 5%)
Yield:15g
Serving size: 1 tablespoon
Energy:386 kcal
2 Mixed millet energy bars Ingredients: Multigrain − 75% (Oats, bajra, ragi, jowar, barley, soyabean, green gram, bengal gram), Flax
seeds- 5%, Jaggery − 15%, cardamom- 5%)
Yield:20g
Serving size: 2 pieces
Energy:452 kcal
3 Ragi cutlets Ingredients: Potato flakes (60%), Ragi (35%), Vegetable oil, spices, and condiments (5%)
Yield:20g
Serving size: 2 pieces
Energy:381 kcal
4 Ragi biscuits Ingredients: Wheat flour (50%), Ragi (35%), jaggery (12 %), Baking powder (3%)
Yield:20g
Serving size: 2 pieces
Energy:402 kcal

Sampling version 27. Descriptive statistics were conducted to determine

Purposive sampling technique was followed to select the
mandal based on its proximity to the district headquarters.
Gangapur village was chosen because it was the biggest
village in the mandal. All four AWCs in this village were
included in this study.
Data collection
Data on weight, BMI, and hemoglobin were collected during
baseline and endline. An AWW measured the monthly weight
gain through an adult weighing scale and the height through a
stadiometer during the baseline. These measurements were
used to calculate the BMI using a standard formula of weight
in kilograms/(height in meters)2.[18] Data on hemoglobin
were collected by official laboratory technicians using
Sahli hemoglobinometer. The beneficiaries were categorized
into various categories of anemia based on WHO (2007)
standards[19] and BMI based on Institute of Medicine (IOM
2009) guidelines[20] for pregnant women, respectively.
Human research
The institutional review committee from Government
Medical College Mahabubnagar reviewed and approved
the study. Although pregnant (n = 37) and nursing (n = 27)
women under the ICDS system women were enrolled in the
study, only 22 pregnant and 16 nursing mothers consumed the
millet-based foods continuously for 3 months and were
considered as the final sample. The research was conducted
as per the ethical standards of the review committee and verbal
consent was taken from the participants.
Statistical methods
The collected data were entered in Microsoft Excel, cleaned,
and exported to SPSS. Data were analyzed using SPSS (IBM)
the frequency, percentage, mean, and standard deviation. A
paired t test was conducted to observe the difference of means
for weight, hemoglobin, and BMI on pre- and post-
intervention parameters at 95% confidence interval (CI)
and P-value of <0.05 was considered statistically
significant.
RESULTS
The objective was to introduce millet-based foods to pregnant
and nursing women at AWCs and to assess their impact on
weight, hemoglobin, and BMI. The findings are presented in
Table 2.
An improvement in mean weight from 51.1 ± 2.76 kg to
52.23 ± 5.81 kg was observed with an increase in the
number of pregnant women weighing between 51 to
60 kg and more than 61 kg. It was observed that
preintervention 18.1% and postintervention 31.8% of the
pregnant women weighed between 51 and 60 kg [Table 2].
Similarly, an improvement in hemoglobin was observed. An
improvement in mean hemoglobin from 8.9 ± 1.17 to
9.44 ± 0.75 g/dL with an increase in the number of
pregnant women having blood hemoglobin levels within
10.0 to 10.9 g/dL (WHO, 2007) was observed.
Preintervention 9% and postintervention 31.8% of the
pregnant women had hemoglobin between 10.0 and
10.9 g/dL [Table 2]. Furthermore, an improvement in
BMI was also observed. An improvement in mean BMI
from 20.96 ± 3.45 to 22.54 ± 3.99 kg/m2 with an increase in
the number of pregnant women having BMI in the
overweight category (IOM, 2009) was observed.
Preintervention 4.50% and postintervention 18.2% of the
pregnant women had BMI in overweight category (25–29.9)
[Table 2].

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Sharat Dhruthi and Gokhale: Nutritional impact of millet-based foods on pregnant and nursing women

Table 2: The pre- interventional and post-interventional weight, hemoglobin, and BMI of pregnant and nursing women
Category Pregnant women Lactating women
Pre-intervention n (%) Post-intervention n (%) Pre-intervention n (%) Post-intervention n (%)
Weight (Kg)
30–40 2 (9.0) 1 (4.5) 5 (31.3) 1 (6.3)
41–50 15 (68.1) 12 (54.5) 9 (56.3) 12 (75)
51–60 4 (18.1) 7 (31.8) 1 (6.3) 2 (12.5)
>61 1 (4.5) 2 (9.1) 1 (6.3) 1 (6.3)
Hemoglobin (g/dl)
<7 1 (5) 0 (0) 2 (12.5) 0 (0)
7–9.9 19 (86) 15 (68.2) 13 (81.3) 11 (68.8)
10–10.9 2 (9) 7 (31.8) 1 (6.3) 3 (18.8)
>11 0 (0) 0 (0) 0 (0) 2 (12.5)
BMI (kg/m2)
Underweight (<18.5) 4 (18.20) 1 (4.5) 4 (25) 4 (25)
Normal (18.5–24.9) 16 (72.70) 16 (72.7) 11 (69) 9 (56)
Overweight (25–29.9) 1 (4.50) 4 (18.2) 1 (6) 3 (19)
Obese (>30) 1 (4.50) 1 (4.5) 0 (0) 0 (0)

Table 3: T-test for pre-interventional and post-interventional comparison of weight, hemoglobin, and BMI of pregnant and
nursing women
Category Parameter Pre-intervention mean ± SD Pre-intervention mean ± SD n (P-value)
Pregnant women Weight (Kg) 51.1 ± 2.76 52.23± 5.81 22 (0.000**)
Hemoglobin (g/dl) 8.9 ± 1.17 9.44 ± 0.75 22 (0.565)
BMI (kg/m2) 20.96 ± 3.45 22.54 ± 3.99 22 (0.000**)
Nursing women Weight (Kg) 50.92 ± 0.57 51.5± 2.68 16 (0.002*)
Hemoglobin (g/dl) 6.26 ± 0.23 7.70± 0.16 16 (0.522)
BMI (kg/m2) 19.85 ± 2.56 21.19 ± 3.22 16 (0.004*)
**Significant correlation at the 0.01 level (P<00.1), *Significant correlation at the 0.05 level (P<00.5).

An improvement in mean weight from 50.92 ± 0.57 to
51.5 ± 2.68 kg was observed with an increase in the
number of nursing mothers weighing between 41 to 50
and 51 to 60 kg. It was observed that preintervention 56.5%
and postintervention 75% of the nursing women weighed
between 41 and 50 kg [Table 2]. Similarly, an
improvement in hemoglobin was observed. An
improvement in mean hemoglobin from 6.26 ± 0.23 to
7.70 ± 0.16 g/dL with an increase in the number of
nursing mothers having blood hemoglobin levels within
10.0 to 10.9 g/dL and more than 11.0 g/dL (WHO, 2007)
was observed. Preintervention 6.3% and postintervention
18.8% of the nursing mothers had hemoglobin
between 10.0 and 10.9 g/dL [Table 2]. Furthermore, an
improvement in BMI was also observed. An
improvement in mean BMI from 19.85 ± 2.56 to
21.19 ± 3.22 kg/m2 with an increase in the number of
nursing women having BMI in the overweight
category (IOM, 2009) was observed. Preintervention
6% and postintervention 19% of the nursing
mothers had BMI in overweight category (25–29.9)
[Table 2].
A paired t test was conducted to analyze the difference
between mean values of pre- and postintervention weight,
hemoglobin, and BMI [Table 3]. It was observed that the
mean weight gain for pregnant women was 3.63 kg and
hemoglobin improvement was 0.5 g/dL. Similarly, the
mean weight gain for nursing women is 3.0 kg and
hemoglobin was 0.9 g/dL [Table 3]. The results also
indicate that the intervention showed a statistically
significant impact on weight gain (P = 0.000, P = 0.002)
and BMI (P = 0.000, P = 0.004) for pregnant and nursing
women, respectively [Table 4].
DISCUSSION
This study aimed to assess the impact of millet-based foods
on the weight, BMI, and hemoglobin of pregnant and nursing
mothers. Millet-based foods were used because they have
high nutritional properties, and they contribute to
improvement in weight and hemoglobin.[21] The results
showed an average increase in weight (3.64 ± 5.29 kg),
hemoglobin (0.5 ± 1.30 g/dL) and BMI (1.58 ± 2.2 kg/m2)
for pregnant women. Moreover, a similar increase in

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Sharat Dhruthi and Gokhale: Nutritional impact of millet-based foods on pregnant and nursing women
Table 4: T test for preinterventional and postinterventional comparison of weight, hemoglobin, and BMI of pregnant and
nursing women
Parameter
Pre- and postintervention weight (kg)
Pre- and postintervention hemoglobin (g/dL)
Pre- and postintervention BMI
BMI, body mass index. *Significant correlation at the 0.01 level (P < 0.01). †Significant correlation at the 0.05 level (P < 0.05)
weight (3.00 ± 6.00 kg), hemoglobin (0.9 ± 1.60 g/dL), and
BMI (1.34 ± 2.43 kg/m2) for nursing mothers.
Postintervention, a 13% improvement in the BMI of pregnant
and nursing women was observed. These findings were
similar to another study that demonstrated a positive
impact of millet-based foods on weight and BMI.[22] It
was also observed that there was a 13.8% increase in the
number of pregnant women in the overweight category.
However, these findings were contradictory to those of
another study which showed that a millet-based
intervention reduced BMI.[23] A paired t test showed a
statistically significant impact on weight (P < 0.01), on
BMI (P < 0.01) for pregnant women and on weight (P <
0.05), BMI (P < 0.01) for nursing women at 95% CI. Similar
results (P < 0.01) for weight gain were observed in another
study conducted among nursing women.[15] The significant
improvements in weight and BMI evidenced in this study are
attributed to the energy-dense formulation of millet-based
foods. Similarly, another study also proved that these millet-
based formulations have a positive impact on the
anthropometric indicators because they are calorie-rich
formulations with required quantities of carbohydrates,
proteins, and fats.[22]
Postintervention, a 5% decrease in the number of pregnant
women with hemoglobin less than 7 g/dL and a 17.8%
decrease in the number of pregnant women with 7 to 9.9 g/
dL was observed. These findings were similar to those of
other studies showing that millet-based foods contribute to an
increase in blood hemoglobin levels of beneficiaries.[15,22,24]
Furthermore, a study evidenced that these millet-based food
products were beneficial to children, teenagers, and anemic
patients and contribute to the improvement in weight, BMI,
and hemoglobin of beneficiaries.[15]
Millets have superior nutritional properties, and hence, there
exists a vast scope to optimize them to produce processed
products.[14] Thus, these value-added, nutrient-dense millet-
based food formulations possess a strong potential to improve
nutritional outcomes and should be introduced into the
nutrition program of various states in India.[22,25] They can
be used for large scale utilization in various forms such as
baby foods, snack foods, powders, porridges, and wine.[26]
Therefore, this study presents a strong case for introducing
millet-based foods in nutrition programs across AWCs.
70 International Journal of Nutrition, Pharmacology, Neurological Diseases ¦ Volume 12 ¦ Issue 2 ¦ April-June 2022
Pregnant women Lactating women
N (P-value) N (P-value)
22 (0.000*) 16 (0.002†)
22 (0.565) 16 (0.522)
22 (0.000*) 16 (0.004†)
The limitation of this study was the small sample size due to
dropouts. These dropouts occurred majorly due to
sociocultural reasons such as migrations and family
traditions. Furthermore, assessing the exact impact of the
intervention was limited in a community setting. However,
this study emphasized on findings that highlighted the
positive impact on the anthropometrical and clinical
parameters of pregnant and nursing mothers.
CONCLUSION
Millet-based foods such as mixed millet malt, ragi biscuits,
ragi cutlets, and mixed millet energy millet bars developed
with ragi, jowar, and bajra demonstrated a positive impact on
weight and BMI for pregnant and nursing women in a
community setting. This study highlights that the
intervention can be rolled out on pregnant and nursing
women across all the AWCs of the district as a part of the
ICDS program. The introduction of these foods at AWCs has
the potential for improving the footfall and increasing for the
utilization of SNP services. Consequently, these foods will be
accepted by the communities and will contribute to the
improvement in the nutritional status of the community at
large.
Authors’ contribution
DD worked closely with the government authorities and was
involved in conducting the study on the field. DD was
involved in study design, sampling, data collection,
analysis of results, and manuscript writing, and DG
contributed to guiding the scientific content and structuring
of the manuscript.
Acknowledgments
The authors sincerely acknowledge all the government
officials of Mahabubnagar district, Telangana for funding
the intervention and extending immense support while
implementation. They also thank all the stakeholders
involved viz anganwadi workers, supervisors, pregnant
women, and nursing mothers for participating in the study.
Financial support and sponsorship
The financial support for intervention was from Government
of Telangana.
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Sharat Dhruthi and Gokhale: Nutritional impact of millet-based foods on pregnant and nursing women
Conflicts of interest
There are no conflicts of interest.
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