NUTRITIONAL AWARENESS AMONG ANGANWADI WORKERS

AND THEIR IMPLEMENTATION TO NUTRITIONAL SERVICES:

A COMPARATIVE STUDY OF RURAL AND URBAN ZONE OF
AMRITSAR DISTRICT.

JAGJEET KAUR
ENROLMENT No. 130476759

A Report
Submitted to Indira Gandhi National Open University
In partial fulfillment of the requirement
For the degree of

MASTER OF SCIENCE
IN
DIETETICS AND FOOD SERVICE MANAGEMENT

SCHOOL OF CONTINUING EDUCATION INDIRA GANDHI

NATIONAL OPEN UNIVERSITY NEW DELHI
(2019)

1
 AUTHENTICATION CERTIFICATE

The work embodied in this dissertation entitled; “ NUTRITIONAL AWARENESS AMONG

ANGANWADI WORKERS AND THEIR IMPLEMENTATION TO NUTRITIONAL SERVICES:
A COMPARATIVE STUDY OF RURAL AND URBAN ZONE OF AMRITSAR DISTRICT” in
selected anganwadi center of state of Punjab (Amritsar district) has been carried out
by me under the supervision of Dt. Anita
This work is original and not has been submitted by me for the award of any other degree
to this or any other university.

Date:
Place:
(JAGJEET KAUR}

2
 CERTIFICATE OF DISSERTATION COUNSELOR

I certify that candidate JAGJEET KAUR has planned and conducted the research
study entitled “NUTRITIONAL AWARENESS AMONG ANGANWADI WORKERS
AND THEIR IMPLEMENTATION TO NUTRITIONAL SERVICES: A COMPARATIVE
STUDY OF RURAL AND URBAN ZONE OF AMRITSAR DISTRICT” in selected
anganwadi center of state of Punjab (Amritsar district) " under my guidance and
supervision and that the report submitted here with is bonafide work done by the candidate
in Amritsar city from March 2019 to August 2019

Date:
Place: Chandigarh

Dt. Anita
GMCH-32
Chandigarh

……………..…………………..
(Signature of supervisor/guide)

Signature of External Examiner

3
 ACKNOWLEDGEMENT

I register my humble gratitude to the Almighty, for guiding the ship of my life to
sail in the vast ocean of this world and helping me to reach my destination. A research
work of any dimension is really a challenging task and a research worker ventures to accept
the same duty only when he is fortunate enough to receive in plenty the inspiring blessing
of teachers and guides, who patronize the student with benevolent spirit.

Completion of this dissertation was possible with the support of several people. I
would like to express my sincere gratitude to all of them. First of all, I am extremely
grateful to my research guide, Dt. Anita for her valuable guidance, scholarly inputs and
consistent encouragement I received throughout the research work. This feat was possible
only because of the unconditional support provided by guide. A person with an amicable
and positive disposition, Mam has always made her available to clarify my doubts despite
her busy schedule and I consider it as a great opportunity to do my master programme
under her guidance and to learn from her research expertise.

Thank you, Mam, for all your help and support. I would like to thank each and
every respondent of this study, their cooperation and inputs enabled me to complete this
work

I am deeply indebted to my parents for their belief and pride in me. They have been
a pillar of strength throughout my life and they did not fail me at the crucial juncture too.

Last, but not the least, I express my gratitude to all my patients, who peep being
every typed word of this project. I pray to God for giving me strength and capability to
make my acquaintances and my profession proud.

4
 LIST OF CONTENTS

Chapters Titles Page No.

1. INTRODUCTION 1-5

2. OBJECTIVES 6

3. REVIEW OF LITERATURE 7-36

4. METHODOLOGY 37-43

5. RESULTS AND DISCUSSION 44-71

6. SUMMARY AND CONCLUSION 72-76

7. REFERENCES 77-88

8. APPENDIX

5
 LIST OF TABLES

Table No. Particulars Page No.

Table 4.1 Age of Anganwadi Workers 45

Table 4.2 Educational Status of the Anganwadi Worker 46

Table 4.3 Job Experience of Anganwadi Worker 46

Table 4.4 Training Status of Anganwadi Worker 47

Table 4.5 Distribution of Anganwadi Centers According to Its Total Functioning 47

Period*

Table 4.6 Enrollment of Children (0-6 yrs.) in Anganwadi Centre 48

Table 4.7 Enrollment of children (3-6 yrs.) in Anganwadi centre 48

Table 4.8 Building Category of Anganwadi Centre 49

Table 4.9 Availability of Storage Space for Raw Material in Anganwadi Centre 49

Table 4.10 Availability of Separate Space for Cooking in Anganwadi Centre 50

Table 4.11 Availability of Outdoor Space for Play Activity in Anganwadi Centre 50

Table 4.12 Availability of Electricity Facility in Anganwadi Centre 51

Table 4.13 Ventilation Facility in Anganwadi Centre 51

Table 4.14 Hygienic Status of Anganwadi Centre 52

Table 4.15 Toilet Facility for Children in Anganwadi Centre 52

Table 4.16 Drinking Water Facility in Anganwadi Centre 53

Table 4.17 Execution of Nutritional Practices at Anganwadi Centre 53

Table 4.18 Implementation of Supplementary Nutritional Target at AWC 54

Table 4.19 Consumption of Supplementary Nutrition by Children at AWC 55

Table 4.20 Type of Weighing Scale Used at Anganwadi Centre 56

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Table 4.21 Implementation of Growth Monitoring Services 57

Table 4.22 Conduct of Nutrition and Health Education (NHED) Counseling at 57

Anganwadi Centre

Table 4.23 Age and Sex Variation in Anthropometric Characteristics of Urban and 67
Rural Children of Amritsar District

Table 4.24 Classification of Types of Malnutrition Based on Z- Scores for Urban and 68
Rural children (3-6 Years) of Amritsar District

Table Mean Nutrient Intakes of The Children by Structured 24 Hour Dietary 69

4.25. Recall Method

Table 4.26 Children’s Percentage Between 3-6 Years Meeting Recommended Daily 70
Allowance (RDA)

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 LIST OF FIGURES

Figure No. Particulars Page No.

Fig 4.1 Awareness among anganwadi workers regarding health 58
and nutrition
Fig 4.2 Awareness among anganwadi workers regarding 59
functions of food and their sources
Fig. 4.3 Awareness among anganwadi workers regarding 60
nutritional requirement
Fig. 4.4 Awareness among anganwadi workers regarding 61
community nutrition
Fig. 4.5 Awareness among anganwadi workers regarding 62
deficiency diseases
Fig.4.6: Execution of Nutritional Practices at AWC 63
Fig. 4.7 Consumption of Supplementary Nutrition by Children 64
at anganwadi center.
Fig: 4.8 Implementation of Service under Growth Monitoring 65
Fig .4.9: Nutrition and Health Education (NHED) Counseling at 66
Anganwadi Centre

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 ABSTRACT

Nutrition is the science of foods, the nutrients and other substances therein; their action,
interaction and balance in relationship to health and disease. It can be defined as the process
by which the organism ingests, digests, absorbs, transports and utilizes nutrients and disposes
of their end products. Nutrition can also be defined as ―food at work in the body‖. Nutrition
must perforce be concerned with social, economic, cultural and psychological implications of
food and eating. Good, adequate and optimum are the terms applied to that quality of nutrition
in which the essential nutrients in correct amounts and balance are utilized to promote the
highest level of physical and mental health throughout one ‘s life. To assess the implementation
of nutritional services provided to pre- schoolers (3-6 yrs.) at anganwadi centre.

Objective of the Study are :- 1.To assess the nutritional awareness among anganwadi workers
and study the influence of nutrition knowledge for improved performance of implementation
of nutrition services at anganwadi centre.2.To assess the nutritional status of pre- schoolers (3-
6 yrs.) attending anganwadi centers.and Comparison for the level of nutritional awareness
among anganwadi workers and their implementation to nutritional services

Methodology: The procedure followed in sampling, empirical measurement of variables,

devices used for collection of data and the statistical measures used for the analysis of data are
described in this chapter under the following sub heads: 1.Sampling procedure 2. Devices used
for collection of data, and 3.Statistical tools used for analysis of data

Result and Discussion : The present study shows that in spite of the fact that most (72 %) of
the anganwadi workers in study area were trained and had a high range (20-30 years) of work
experience, it was found that performance as well as awareness among anganwadi workers
regarding the importance of implementation of nutritional services was not satisfactory.
Although the anganwadi workers were mostly familiar with the knowledge for various
nutritional services of ICDS but the provision of these services, their importance for the
programme was not clear to them, also the implementation part of these services was
immensely lacking in aspect of effective utilization of these services by the beneficiaries and
for beneficiaries.

IX
 CHAPTER-I

INTRODUCTION

The concept of human development rests on three pillars: knowledge, health and
livelihood. Health of the people has been recognized as a valuable national resource and
the Government ‘s endeavour has been to improve the same and enable them to contribute
to the enhancement of the Nation ‘s productivity. Health is defined by World Health
Organization (WHO) as a state of complete physical, mental and social well-being and not
just avoidance of disease. Physical health implies the perfect functioning of the body
(WHO, 1948). It conceptualizes health as a state in which every cell or organ is functioning
at optimum capacity and is in perfect harmony with the rest of the body.

Nutrition is the science of foods, the nutrients and other substances therein; their action,
interaction and balance in relationship to health and disease. It can be defined as the
process by which the organism ingests, digests, absorbs, transports and utilizes nutrients
and disposes of their end products. Nutrition can also be defined as ―food at work in the
body‖. Nutrition must perforce be concerned with social, economic, cultural and
psychological implications of food and eating. Good, adequate and optimum are the terms
applied to that quality of nutrition in which the essential nutrients in correct amounts and
balance are utilized to promote the highest level of physical and mental health throughout
one ‘s life. (Moorthy, 1993)

Better nutrition means stronger immune systems, less illness and better health. Healthy
children learn better. Healthy people are stronger, are more productive and more able to
create opportunities to gradually break the cycles of both poverty and hunger in a
sustainable way.

The years between 1-6 years, growth is generally slower than in the first year of life but
continues gradually. Activity also increases markedly during the second year of life as the
child becomes increasingly mobile. Development of full dentition by about the age of 2
years also increases the range of foods that can safely be eaten. There is an increased need
for all nutrients, but the pattern of increase varies for different nutrients in relation to their
role in growth of specific tissues. (Srilakshmi, 2000)

1
Pre-school children constitute one of the most nutritionally vulnerable segments of the
population and their nutritional status is considered as a sensitive indicator of community
health and nutrition. However, there has not been any substantial improvement in their
dietary intake over the last couple of decades. Data on energy intake in children,
adolescents and adults from surveys in rural areas in nine states carried out by National
Nutrition Monitoring Bureau (NNMB) in 2000, shows that mean energy consumption, as
percentage of recommended dietary allowances (RDA) is the least among preschool
children, in spite of the fact that their requirement is the lowest. NNMB data on time trends
in intra-familial distribution of food indicate that while the proportion of families where
both adults and preschool children have adequate food has remained at around 30%, over
the last 20 years the proportion of families with inadequate intake has come down
substantially. However, the proportion of families where pre-school children receive
inadequate food intake while adults have adequate intake has nearly doubled. This is
despite the fact that the RDA for preschool children forms a very small proportion (on an
average 1300 Kcal/day) of the family ‘s total intake of around 11000 Kcal/day (assuming
a family size of 5). It would, therefore, appear that young child feeding and caring
practices, and not poverty and lack of food at home, are becoming major factors
responsible for inadequate dietary intake in preschool children.

Every individual requires an adequate supply of nutrients in suitable proportions for

normal growth and development. Malnutrition means disordered nutrition, which may be
due to excessive nutrition (over nutrition) or deficient nutrition (under nutrition). In India,
among the poor sections of the society, even the basic calorie requirement is not met. The
intake of protein is found to be marginal. Vitamins and minerals are not taken at the desired
levels. There is, therefore, a high incidence of nutritional deficiency disorders among the
poorer sections, especially in the vulnerable group of infants and mothers.

Malnutrition can be defined as a pathological state resulting from a relative or absolute

deficiency or excess of one or more essential nutrients, which can manifest into over-
nutrition or under nutrition or imbalance.

2
Malnutrition ‘s most devastating impact is in the womb – when the foetus can fail to
develop properly – and during the first years of a child‘s life, when it can hamper her or
his physical and mental development. Malnutrition takes different forms and a child can
be affected in several ways simultaneously. Millions of children suffer from micronutrient
malnutrition – when the body lacks essential minerals like iodine, iron and zinc and
vitamins like vitamin A and folate. The body needs micronutrients in minute doses to
manufacture enzymes, hormones and other substances required to regulate growth,
development and the functioning of the immune and reproductive systems. Deficiencies
in iodine can lead to severe mental or physical impairment, in iron to life-threatening
anaemia or lowered productivity, in vitamin A to blindness or to a weakened immune
system and in folate to low birth weight or birth defects such as spina bifida (a fault in the
spinal column in which one or more vertebrae fail to form properly, leaving a gap or split,
causing damage to the central nervous system).

Millions of young children today in the developing world live in conditions of poverty.
From the perspective of overall development, they are born and brought up in an
environment which is hostile. Since independence, Government of India's determination
to bring essential services to all these young children is impressive indeed. Human
development programmes focused on care and welfare of children occupied an important
place. Despite significant improvements in the health and education sectors in recent
decades, when it comes to nutrition, all of India ‘s children are not equal. According to
India ‘s third National Family Health Survey (NFHS-3) of 2005-06, 20 per cent of Indian
children under five-years-old are wasted due to acute under nutrition and 48 per cent are
stunted due to chronic under nutrition. Seventy per cent of children between six months
and 59 months are anaemic. Despite a booming economy, nutrition deprivation among
India ‘s children remain widespread.

In absolute numbers, an average 25 million children are wasted and 61 million are stunted.
The state of child under nutrition in India is — first and foremost — a major threat to the
survival, growth, and development and of great importance for India as a global player.
Prime Minister Manmohan Singh has referred to under nutrition as a matter of national

shame (THE HINDU, online edition, 10th Dec.2010).

The need for providing children with improved childhood necessities through a holistic
approach, involving cooperation and liaison between disciplines and agencies are well

3
recognized in India. The National Policy on Education placed high priority on Early
Childhood Care and Development (ECCD). The policy suggested integration with the
Integrated Child Development Services (ICDS) programme which is the largest child
development service in the country. With strong government commitment and political
will, the ICDS program has emerged from small beginnings in 1975 to become India ‘s
flagship nutrition program.

Launched on 2nd October 1975 in 33 Community Development Blocks, ICDS today

represents one of the world’s largest programmes for early childhood development. ICDS
is the foremost symbol of India ‘s commitment to her children – India ‘s response to the
challenge of providing pre-school education on one hand and breaking the vicious cycle
of malnutrition, morbidity, reduced learning capacity and mortality, on the other. It is an
inter-sectoral programme which seeks to directly reach out to children, below six years,
especially from vulnerable and remote areas and give them a head-start by providing an
integrated programme of early childhood education, health and nutrition. No programme
on Early Childhood Care and Education can succeed unless mothers are also brought
within its ambit as it is in the lap of the mother that human beings learn the first lessons in
life.

As the anganwadi worker is the key person in the programme (Udani et al., 1980), her
education level and knowledge of nutrition and the guidance she received from the ANM
individually or synergistically related to her performance in the anganwadi. Knowledge
and understanding of some aspects of basic nutrition and health care is of great importance
for the anganwadi worker's performance (Udani et al., 1980).

The relative coverage of children for the services provided by the programme was higher
where the anganwadi worker had a high school education or more than where her
education was below that level. Sharma (Sharma, 1987), in findings similar to those of the
present study, reported that education was positively related to performance. Perhaps
relatively better educated anganwadi workers are better able to convince parents to have
their children immunized against the six killer diseases and more confident in persuading
children to come to the anganwadi for supplementary nutrition.

It has also been reported that, in addition to education level, training anganwadi workers
about growth monitoring plays a beneficial role in improving their performance (Gopaldas

4
et al., 1990). Under nutrition among preschool children may be the result of faulty feeding
practices rather than the scarcity of the food. It was also assessed that the low status of
woman and their lack of nutritional knowledge are important determinants of high
prevalence of underweight children. Appropriate intervention strategies need to be
developed to educate the mothers regarding the feeding practices of infant and young
children. Despite several nutrition programmes in operation, we could not make a
significant dent in this area. India is even lagging behind with sub Saharan countries, in
spite high economic growth. A study done by Gujral et al (1992) in panchmahals district
of Gujarat state, covering 43 anganwadi centre shows that workers with adequate nutrition
knowledge reached more children with various services than those whose knowledge was
inadequate.

While AWWs tend to be well-educated, they are often poorly trained for ICDS tasks in
spite of the well design training content. Survey data show that while almost all AWWs
have at least matriculated from high school and half of those in urban areas have even
received some college education; pre-service training is scarce with most women
undergoing short-term in-service training (Bredenkamp and Akin 2004). More resources
have been directed towards strengthening the capacity at the central, state and block levels
to provide high quality support and training to functionaries of ICDS programs. In 2002,
a new training program, Udisha (―first rays of the new dawn‖), was initiated with funding
from the World Bank and attempts to shift the focus of training away from the mere
transfer of knowledge and towards the strengthening of AWW competencies. Various
Studies done in past (NIPCCD Lucknow, 2005; Gadkar et al., 2006; Indian Institute of
Development Management, Bhopal, 2008) reflected that in a majority of the AWTC ‘s,
the educational qualifications of the instructors did not match with the subject they taught.
Quality of training also suffered due to lack of specialist speakers. Findings of the study
indicated that very little material or no material was given to the trainees. These studies
also explored the poor availabilities of basic facilities like toilets, furniture, teaching
materials etc.

5
 OBJECTIVES OF THE STUDY:

1. To assess the implementation of nutritional services provided to pre- schoolers (3-6

yrs.) at anganwadi centre.

2. To assess the nutritional awareness among anganwadi workers and study the influence
of nutrition knowledge for improved performance of implementation of nutrition
services at anganwadi centre.

3. To assess the nutritional status of pre- schoolers (3-6 yrs.) attending anganwadi
centers.and Comparison for the level of nutritional awareness among anganwadi
workers and their implementation to nutritional services between rural and urban zone
of Amritsar district.

4. To evaluate the final output and expected output of nutritional services at anganwadi

centres.

6
 CHAPTER-II
REVIEW OF LITERATURE

Proper background information to design the research programme, analyze the research
data and interpret the research findings is provided by comprehensive review of literature.
A critical appraisal of earlier studies is essential for thorough understanding of the
problem. It has been observed that very few research studies were conducted on nutrition
awareness among anganwadi workers. However, a good number of studies are available
on the nutritional status of children. Keeping in view the specific objectives of the present
research, an earnest effort was made to collect the literature related to anganwadi worker
and nutrition awareness either directly or indirectly through other related parameters. The
available literature has been organized and presented under the following heads:

Health and Nutrition Status of India

Training, Knowledge, Awareness, Performance and Job Satisfaction of
Anganwadi Worker

Implementation of nutritional services at anganwadi centre.

Anganwadi Training Institutes.

2.1 Health and Nutrition Status of India

Mishra et al (2000) presented a study under National Family Health Survey, titled as
―Women ‘s Education Can Improve Child Nutrition in India ―. The study estimated the
levels of child malnutrition and examines the effects of mother ‘s education and other
demographic and socioeconomic factors on the nutritional status of children. Results
indicate that more than half of all children under age four are malnourished. Children
whose mothers have little or no education tend to have a lower nutritional status than do
children of more-educated women, even after controlling for a number of other—
potentially confounding—demographic and socioeconomic variables. This finding
suggests that women ‘s education and literacy programs could play an important role in
improving children ‘s nutritional status.

7
Kumar et al (2006) conducted a study to assess the nutritional status of under-five children
and to observe the association of infant feeding practices with under nutrition in anganwadi
(AW) areas of urban Allahabad, Uttar Pradesh. The study was conducted in four selected
AW areas of urban Allahabad, and data was collected from 217 children under the age of
five years. The factors considered were socio-demographic characteristics, age of children,
caste, religion, socioeconomic status (SES), education of mother, infant feeding practices,
initiation of breastfeeding, feeding of colostrum, exclusive breastfeeding upto 6 months,
complementary feeding, and also information about receipt of ICDS benefits by children.
Out of all the children studied 36.4% were underweight, 51.6% stunted and 10.6% wasted.
Maximum prevalence of underweight (45.5%) as well as stunting (81.8%) was found in
the age group of 13-24 months. There was decline in the prevalence of stunting after the
age of 24 months. Wasting was found to be most prevalent (18.2%) in the age group of
13-24 months. There was decline in the prevalence of stunting after the age of 24 months.
Wasting was found to be most prevalent (18.2%) in the age group 37-48 months. In cases
where mothers had higher levels of education, the prevalence of under nourishment among
children was low. There were more male underweight children (37%) as compared to
female children (35.4%), but the prevalence of stunting was more among females (63.3%)
than males (44.9%). Proportion of underweight was significantly less among children
whose mothers reported initiation of breastfeeding within 6 hours of birth (30.6%),
children who were fed colostrum (27.5%), and children who got proper complementary
feeding (28.6%). Wasting was not significantly associated with any infant feeding
practices studied. ICDS benefits received by children failed to improve the nutritional
status of children. The study found that delayed initiation of breastfeeding, deprivation of
colostrum, and improper complementary feeding were significant risk factors for under
nutrition among under five children. The study suggested that there is need for promotion
and protection of optimal infant feeding practices for improving the nutritional status of
children.

Singh et al (2006) conducted a study to assess the impact of drought on childhood illness
and nutrition in under- five children of the rural population. The study was carried out in
24 villages belonging to 6 tehsils of Jodhpur district which was a drought affected desert
district of Western Rajasthan. A total of 914 under 5 children (0-5 years) could be
examined for their childhood illness history, malnutrition, dietary intake and clinical signs

8
of nutritional deficiency. The main childhood illnesses observed during drought were
respiratory (7.5%), gastroenterological (7.5%), and fevers (viral, malaria and jaundice)
(5.6%). Male children were reported to have significantly higher illnesses (28.5%) than
females (18.7%). Other illness observed were ear disease (2.1%), skin problems (0.5%)
and eye disease (0.2%). All childhood illnesses showed increasing trend with age, i.e. 13%
in infants to 26.0% among children in 4-5 years age group. Recent malnutrition (weight
for age) was observed to be 39%. Highest level of recent malnutrition was observed in 1-
2 years age group. Girls were found to be more malnutrition (40.8%) as compared to boys
(36.1%). Overall 25.8% children suffered from chronic malnutrition, i.e. long-term
malnutrition. Chronic malnutrition was also higher in girls (31.2%) than in boys (20.4%),
particularly among children aged 1-2 years. The overall prevalence of Anaemia was
observed to be 30.5%. Prevalence of various signs related to Protein Calorie Malnutrition
(PCM) was observed to be high, i.e. dyspigmentation (20.2%), dryness of hair (21.6%),
and others which accounted for 2.6% only. Prevalence of Marasmus was 1.7%. All signs
associated with PCM were observed to be higher among girls (46.3%) than boys (42.8%).
Vitamin A deficiency sign (Bitot Spot) was observed in just 0.2% children, and no night
blindness was observed. The overall prevalence of Vitamin B complex deficiency was
seen in 3% children, and Vitamin C deficiency was observed in 0.1% children. The study
suggested that firstly, gender differences should be removed by giving proper education
to community people; also, effective measures to make adequate calories and proteins
available to all age groups, especially to under- 5 children through the ongoing nutrition
programmes, needs to be ensured.
Mishra (2007) conducted study to evaluate the achievement of Indian states on 3
anthropometric indicators (Height-for-age, Weight-for-age and Weight-for-height), to
measure the prevalence of child nutrition. Data collected from all 28 states of India through
NFHS-2 (1998-99) and NFHS-3 (2005-2006) was analysed. The rural-urban difference for
states in NFHS-3 showed that Rajasthan had the highest difference of 13.5% points in
child stunting, followed by Punjab (12.5%) among states of northern India. In the western
region in Maharashtra, the rural-urban difference was 10.9% in 1998-99 which came down
to 5.5% in 2005-06. The prevalence of stunting in Gujarat was nearly stagnant in all the 3
rounds, 42.4% in 2005-06, 43.6% in 1998-99 and 43.6% in 1992-93. The rural-urban
difference was also stagnant at around 8%. In Kerala, southern India, the prevalence of
child stunting was minimum and the rural-urban difference was also very nominal (-0.2%)
and Tamil Nadu was the next best state where aggregate prevalence of stunting was about

9
25%. At all India level, the prevalence of stunting showed gradual decline from NFHS-1
(52% in 1992-93) to NFHS-3 (38.4%)
Using weight-for-age of children as an indicator, Punjab had the lowest prevalence of
underweight (27%) children among all other counterparts of northern India. The situation
in Madhya Pradesh had worsened as prevalence of underweight among pre-school children
had increased from 57.4% in 1992-93 to 60.3% in 2005-06. In eastern India the
concentration of under-weight among young children was very high in West Bengal,
Bihar, and Chhattisgarh. For Bihar and Jharkhand, the prevalence of underweight had
increased from 54.3% each in 1998-99 to 58.4% and 59.2% in 2005-06. Among North-
Eastern states, Meghalaya (46.3%) had the highest prevalence of underweight.
Maharashtra had highest decline in prevalence of underweight in all the 3 rounds at State
level, (12.9%), as well as in rural areas (14%). In south India, Kerala continues to be the
best performer in the region, in all the 3 rounds (28.8% in 2005-06, 26.9% in 1998-99 and
28.5% in 1992-93). At all India level, the prevalence of underweight had come down
marginally between NFHS-2 and NFHS-3 (from 47% to 45.9%). For northern India, it was
found that wasting increased over the period of time at aggregate level, especially in the
last phase, for all states in the region.

The situation worsened in Madhya Pradesh, where the aggregate prevalence of wasting
increased from 20.2% in NFHS-2 (1998-99) to 33.3% in NFHS-3 (2005-06). In eastern
India the prevalence of wasting had come down in Chhattisgarh and Orissa in the NFHS-
2, whereas for Bihar, Jharkhand and West Bengal, prevalence of wasting among young
children has shown an increase in all the 3 rounds. Among the North-Eastern states,
Meghalaya had the highest prevalence of wasting. The prevalence of wasting among
young children had come down in the second phase among Western states, especially in
Goa and Maharashtra. The prevalence of wasting among all the Southern states except
Karnataka (where it has come down from 20% to 17.9%) has gone up between the last two
rounds of NFHS. Future intervention programmes aiming at reducing undernourishment
among Indian children should be more focused.

Verma et al (2007) Children participating in the ICDS in India have high rates of iron and
Vitamin A deficiency. This study was conducted in 30 AWCs of Mahestala block in South
24 Parganas, West Bengal to assess the efficacy of a premix fortified with iron and Vitamin
A added at the community level to prepared khichdi, a rice and dal mixture. All attending

10
children received a single 200 gm portion of the khichdi treatment assigned to their AWC
6 times a week for 24 weeks. For each 200-gm serving of khichdi, the premix provided 14
mg encapsulated ferrous fumarate, 500 International Unit (IU) Vitamin A (retinal acetate:
particle size of 250; cold water soluble) and 0.05 mg folic acid. The placebo premix
contained only dextrose anhydrous. Both premixes were packed in reseal able
polyethylene bags in 500 gm increments. Each selected AWC received 500 gm premix at
baseline and after 3 months of the intervention. After 2 weeks of the intervention, 85%
AWWs had minor problems with the packaging of the premix, including breakage of the
polyethylene bag and failure of the bag to properly seal. Total 684 children were screened
and enrolled, 168 (24.5%) were lost to follow-up (dropped out) before the 24-week
assessment; thus 516 completed the 24-week trial. Reasons for loss to follow-up were
refusal of further venepuncture (n=161), change of location (n=5), and low attendance at
the AWC (n=2). Most of the characteristics of the children who dropped out of the study
did not differ significantly from those of the children who completed the trial, including
the age, sex, iron status, and mean haemoglobin concentration.

However, the prevalence of anaemia was significantly greater in the children lost to
follow-up (35.1%) than in those who completed the trial (26.2%) (p<0.05). Prevalence of
anaemia in fortified group was 19.1% at 0 week; 9.8% at 12 weeks; and came down to
4.1% at 24 weeks. Similarly, in non-fortified group it was 32.6% at 0 week; 13.3% at 12
weeks and 20.7% at 24 weeks.

Iron deficiency in fortified group was 22.5% at 0 week; 10.2% at 24 weeks; and in non-
fortified group it was 20.7% at 0 week and 30.4% at 24 weeks. Prevalence of Vitamin A
deficiency of fortified group was 17.5% at 0 week; and 8.1% at 24 weeks; and in non-
fortified group it was 13% at 0 week; and 6.3% at 24 weeks. Low Vitamin A status in
fortified group was 47.9% at 0 week and came down to 21.5% at 24 weeks. Similarly, in
non-fortified group, low Vitamin A prevalence was 40.8% at 0 week, and it came down to
20.4% at 24 weeks. The failure of the fortified khichdi to increase serum retinol
concentrations or to reduce the prevalence of Vitamin A deficiency and low vitamin status
might have resulted because of the deterioration of Vitamin A in the fortified premix. The
addition of a fortified premix to khichdi in ICDS AWCs provides an excellent opportunity
to provide the needed micronutrients to children with or at risk of micronutrient deficiency

11
Sharma (2008) conducted a study to examine the determinants of childhood mortality and
child health in India, and the factors explaining the differential performance of child
immunization and treatment of childhood diseases. Data was taken from 3 rounds of the
National Family Health Survey of India (NFHS) conducted in 1992-93, 1998-99 and 2005-
06. Analysis revealed that on account of interventions for children, the infant mortality
rate in India had gone down from 114 in 1980 to 58 in 2005. Data from NFHS indicated
that under-five child mortality (U5MR) rate was 109.3 per 1000 live births in 1992-93,
declined to 94.9 per 1000 live births in 1998-99, and 74.3 per 1000 live births in 2005-06.
The neonatal mortality rate was 48.6 per 1000 live births in 1992-93, which decreases to
39 in the year 2005-06. It was found that mortality in India was lower for females (37)
than for males (41). As children get older, females had higher mortality than males.

The study found that females had 36% higher mortality than males in the post neonatal
period, but a 61% higher mortality than males at age 1-4 years. It was found that infant
mortality rate was lowest when mother ‘s age was 20-29 years (50), and was substantially
higher when mother ‘s age was less than 20 years (77), and 40-49 years (72). Similar age
differentials were found in neonatal mortality, post neonatal mortality and child mortality
(at age 1-4 years). In India, it was found that STs have the highest infant mortality,
followed by SCs. The situation regarding child immunization was not as clear. Only a
small improvement was found in full vaccination coverage. Only 44% of the children aged
12-23 months were fully immunized in 2005-06, which was a slight improvement from
42% in 1998-99 and 36% in 1992-93. It is estimated that under-nutrition and anaemia were
contributory factors in over 50% of under-5 deaths in the country. The other major causes
of infant mortality were premature births and low birth weight, poor intra-partum and new-
born care, diarrhoea diseases, acute respiratory infections, and other infections. There is
need to strengthen the health system, prioritize essential elements of child health and
nutrition services, and develops and expands community participation for the prevention
and treatment of childhood illness. Also, a multi-sectoral approach should be adopted
which would include female education and nutrition, increasing the use of health services
during pregnancy and delivery, eliminating gender gap in child health services, and
improving nutrition throughout the life cycle.

12
2.2 Training, Knowledge, Awareness, Performance and Job Satisfaction of Anganwadi
Worker

Udani and Patel (1980) The Integrated Child Development Services Scheme of urban slum
of Bombay was launched in April 1977. The evaluation of knowledge and competence of
anganwadi workers employed was carried out in February–March 1979 and again in
February–March 1980. An attempt was made to assess the impact of their knowledge, on
the community in respect of their health and nutrition components. The study reveals poor
knowledge in the community despite a good performance of the related anganwadi
workers in examination. It is suggested that an active participation of the community in
the programme should be encouraged and there should be a closer and frequent supervision
of the anganwadi workers.

Kant et al (1984) conducted a study to assess the profile of 96 AWW of Inder Puri project
areas in Delhi and their knowledge about ICDS was assessed thru a questionnaire.92.71%
AWW were trained only.17.71 % lived and worked in the small locality. The number of
children under age group of 2 yrs. whom they would expect in an awc were known to only
3.12%. Majority 92.71 % could not tell full form of ICDS. Most of them 90.62% could
not enumerate all the services being provided and none could list out their job
responsibilities. It is recommended that the existing training of AWW need to be evaluated
and their continuous education strengthened.

Gujral et al (1992) conducted a study in which forty-three anganwadi workers (community

health workers) in Gujarat state, India, were interviewed to record their education level,
evaluate their nutrition knowledge, and collect information on the number of visits made
by the auxiliary nurse midwife (ANM) in the preceding three months and the activities she
performed for the anganwadi. The coverage of five services delivered or assisted by the
anganwadi worker- supplementary feeding, growth monitoring, vitamin A prophylaxis,
health check-ups, and immunization- was estimated by interviewing the mothers of 3,987
children 0-6 years old.

The anganwadi worker's having at least a high school education, a nutrition knowledge
score of more than 4 out of 7, more than one visit by the ANM in three months, and an
ANM activity score of more than 2 out of 9 were significant determinants, individually or
in combination, for the anganwadi worker's performance. Multiple regression analysis

13
indicated that nutrition knowledge was the most powerful determinant of performance,
followed by guidance from the ANM and education level. It is therefore concluded that
anganwadi workers should receive nutrition health education and regular guidance from
the ANMs, and their education level should be high school or above.

Singh and Vashist (1993) conducted a study on assessment of training needs of anganwadi
workers in relation to infant feeding. The present study was conducted to assess the
training needs of AWWs in relation to infant feeding. Anganwadi Workers (n =82)
working in field practice areas of Preventive and Social Medicine, Department of LHMC,
New Delhi were included. A pretested semi-structured questionnaire covering different
aspects of breast feeding and weaning was administered to them Majority of them
responded correctly about (a) initiation of breast feeding (98%), (b) feeding colostrums
(98%), (c) superiority of breast milk over commercial milk preparations (98%), (d) age of
introduction of semisolids (98%), and (e) unhygienic bottle feeding a major cause of
diarrhoea (95%).Different incorrect responses were (a) top milk should be diluted (43%),
(b) bottle feeding should not be avoided (52%), (c) wet (surrogate)! nursing is harmful
(60%), and (d) breast feeding is not beneficial for health of the mother (41%). Sixty six
per cent, 41 per cent and 24 per cent AWWs responded incorrectly that breast feeding
should be stopped if the mother is suffering from tuberculosis, malaria and diarrhoea
respectively in the light of these findings training of AWWs in relation to infant feeding
should be modified. There is need for continuing education of AWWs for updating their
knowledge.

Bhasin et al (1995) conducted a study in an Integrated Child Development Services

(ICDS) block, Alipur, in Delhi, India, interviews were conducted with 100 anganwadi
workers (one of whose major functions is growth monitoring) to determine their
knowledge on growth monitoring and to identify gaps in that knowledge. Each anganwadi
worker serves a population of 1000. 99% had adequate knowledge about the significance
of the lines on the growth charts that indicate different grades of nutritional status. Yet
only 43% knew that they can begin growth monitoring for any child under age 37% did
not know that assessment of correct age is not essential for growth monitoring. 90-91%
had correct knowledge about weight of a child at 1 and 3 years. Yet only 17-30% knew
the correct mid-upper arm circumference (MUAC) for an optimally nourished child aged
2 years and 4years. These findings suggest that training programs and various meetings

14
have emphasized inputs of growth monitoring but not on age at which growth monitoring
can be started, on correct age for successfully conducting growth monitoring, and on the
cut-off measurements for MUAC. Continued education on various aspects of growth
monitoring is needed for anganwadi worker.

Datta (2001) conducted a study to understand the issues affecting job performance of
AWWs by looking at various dimensions. 6 blocks from three districts of Maharashtra,
namely Nagpur, Nasik and Amravati were covered. A total of 615 AWWs and 72
Supervisors were selected. It was found that the training centers were very old and there
were no additional classes or laboratories for intensive work or doing practical. There was
no feedback taken from training centers. The CDPO does not visit the AWCs to see how
AWWs communicate with beneficiaries. 70% Supervisors were graduates or post
graduates. Their training had been done long ago and there had been no refresher training
courses for them. 70% Supervisors had more than 10 years’ experience. Out of 72
Supervisors, around 52 of them visited AWCs only once a month, while 17 of them visited
twice a month and only 3 Supervisors visited AWCs more than twice a month. 50%
Supervisors looked into the many registers and records maintained like attendance, growth
chart, food record, Mahila Mandal meetings, etc. They also looked at records of severely
malnourished children. 97% AWWs mentioned that training helped them to measure a
child ‘s height and weight. 98% AWWs said training was essential for knowledge about
immunization, distributing nutritious food, and providing parents with nutrition and health
education. Only 74% AWWs mentioned that training was useful to create self-help groups
and conduct adult literacy classes for women. 46% AWWs mentioned they would try and
take interest in children by telling those stories or singing songs, etc. Another 24%
organized interesting activities like picnics or playing with toys. Some said that decorating
the AWC well would induce the children to come, while others mentioned that parents
need to be convinced first to send their children to the AWC. 36% children were neat,
clean, hygienic and obedient, and 12% children looked physically dirty and suffered from
coughs and colds. 89% Supervisors mentioned that attendance of the AWW was regular.
56% Supervisors said that AWWs participated in the block office work and 13%
participated only if there was some important work. 81% AWWs were fully trained and
had adequate information to measure height and weight of children. 43% AWWs were
giving personal attention to each child. 58% taught according to the syllabus. AWWs
mentioned that training prepared them for informal education, nutrition demonstration,

15
home visits, plotting weight charts and health related issues. All AWWs could weigh
children and interpret growth charts. 90% Supervisors agreed that AWWs got average co-
operation from villagers in their work. There is need to improve the quality of training,
improve board and lodging facilities. There is need for Mobile Training Units. Basic text
books should be available in regional language.

Thakare et al (2007) conducted a study on knowledge of anganwadi workers and their

problems in an urban ICDS block. The present study was carried out at the urban Integrated
Childhood Development Services Scheme (ICDS) block of Aurangabad city from June
2006 to June 2007. The objective of the study was to study the profile of Anganwadi
Workers (AWWs) and to assess knowledge of AWWs & problems faced by them while
working. Anganwadi centers were selected by stratified sampling technique. From each
sector, 20% AWWs were enrolled into study. The functioning of AWWs was assessed by
interviewing Anganwadi workers for their literacy status, years of experience, their
knowledge about the services rendered by them and problems faced by them. Most of
AWWs were from the age group of between 41-50 years; half of them were matriculate
and 82.14% workers had an experience of more than 10 yrs. Majority (78.58 %) of AWWs
had a knowledge assessment score of above 50%. They had best knowledge about nutrition
and health education (77.14%). 75% of the workers complained of inadequate honorarium,
14.28% complained of lack of help from community and other problems reported were
infrastructure related supply, excessive work overload and record maintenance. The study
concluded that majority of AWWs were beyond 40 years of age, matriculate, experienced,
having more than 50% of knowledge related to their job. Complaints mentioned by them
were chiefly honorarium related and excessive workload.

Dongre et al (2008) conducted a study on perceived responsibilities of anganwadi workers

and malnutrition in rural Wardha. The objective of the study was to find out the nutritional
status of under-six children attending ICDS scheme and to study Anganwadi workers
(AWW) perceived work load and operational problems. A triangulated research design of
quantitative (survey) and qualitative (Venn diagram, seasonal calendar) methods was used.
Nutritional status of children was assessed by a survey. Participatory methods like Venn
diagram and Seasonal calendars were used to collect qualitative data regarding AWWs
perceived work load and food security with malnourished children. Overall, prevalence of
underweight and severe underweight among children under-six was found to be 53% and

16
15% respectively and among children below three years it was 47% and 15% respectively.
Venn diagram showed AWWs multiple responsibilities. In seasonal diagram exercise, the
mothers of severely malnourished children showed enough food availability in their house
across all months of a year. The study concluded that to efficiently tap the potential of
AWWs for reducing multidimensional problem of malnutrition, ICDS needs to design and
implement flexible, area-specific and focused activities for AWW.

2.3 Implementation of Nutritional Services at Anganwadi Centre

National Council of Economic Research (1998) conducted a pilot study for the evaluation
of ICDS scheme in the selected blocks of five states. It was found that supplementary
nutrition used to be given to pre-schoolers across the states. Supplementary feeding for
preschool children aims at preventing marginal cases of under nutrition for lapsing into
severe or fatal forms. About 75% of the children received the supplements regularly and
also consumed it at spot. Approximate 25% of the beneficiaries were supplied ration in
bulk for consumption at home. Usual practice was to give a fixed quantity of supplement
to all children irrespective of their age and nutritional status. Study showed that in ten
blocks, the food is cooked on spot whereas on other blocks centrally processed ready to
eat food is distributed, corn Soya blend popularly known as CSB is supplied in the blocks
of Darjeeling districts through CARE.

Barman (2001) conducted a study to evaluate the impact of the ICDS programme on
beneficiaries, and assess the performance of AWWs. The study was undertaken in Jorhat
district of Assam. Out of 150 AWCs, 50 AWCs were covered, and a total of 150
beneficiary women were selected for the study. It was found that Community Survey was
conducted very often by 86.67% AWWs. Activities based on community participation and
maintaining liaison with other institutions were given medium level of priority by the
AWWs. Formal sessions of NHE were conducted only in 26.67% AWCs, out of which in
only 6.67% AWCs, NHE sessions were conducted once in 6 months, and in 13.33%
AWCs, NHE sessions were conducted once in a year. 77.33% beneficiaries expressed
dissatisfaction due to irregularity of NHE programme, 65.33% mentioned that teaching
was not satisfactory, and 64% expressed that the content of classes and timing of classes
was unsatisfactory. The immunization status of children below 1 year of age against BCG,
measles, DPT and polio was 52.2%, 49.45%, 41.59% and 86.7% respectively.

17
Immunization of children in the age group 1-3 years for DPT booster and polio drops was
52.16% and 80.40% respectively.

DT was given only to 26.12% of the total children aged 3-6 years. Of the total pregnant
mothers, only 54.25% received Tetanus Toxoid vaccine. 100% of the beneficiaries were
aware of the health services provided, and about 60% were satisfied with the services. 60%
AWWs mentioned that health check-up was carried out for both children and women at
least once in 3 months. Medicine kit was available in all AWCs, which was replenished
regularly. Only 26.67% beneficiaries were aware of referral services, and only 17.33%
were satisfied with the service. Only 26.67% AWW conducted referral services at their
centre, but none of them filled in the referral slips with requisite details. Only 26.67%
AWWs arranged meetings for imparting NHE to mothers, and only 6.67% used aids during
meetings. All the AWWs weighed the children, but only 46.67% of them interpreted the
growth trends. Only 33.33% AWCs had adequate indoor space. Outdoor space and storage
space were available only in 40% and 13.33% of the AWCs respectively. All beneficiaries
were aware that supplementary nutrition was provided by AWWs but none of them were
satisfied with the services due to irregular supply of food, poor quality and insufficient
quantity of food. 100% beneficiaries were aware of the PSE component, but only 26.67%
of them were satisfied with PSE being imparted at AWCs. The reasons for dissatisfaction
were the informal character of PSE and unsatisfactory activities conducted under the
preschool component. The training of ICDS functionaries should emphasize more on
important functions like growth monitoring, health and nutrition education, NPE (Non-
Formal Preschool Education) and referral services. The content of the training course for
AWWs also needs thorough analysis.

Bhasin et al (2001) conducted a study in 13 anganwadi (out of 132) in Nand Nagri, East
Delhi to assess the nutritional status of children in relation to utilization of ICDS during
their early childhood. Information regarding utilization of ICDS facilities, socio-
demographic details, general awareness etc was collected through interviews,
anthropometric and clinical examination of every child and attendance score of every child
at the anganwadi was calculated. Results revealed that most of the children were non-
beneficiaries. Parents of most of the children were illiterates.94.2% children were
attending schools. The proportion of children utilizing ICDS services for more than 6
months ranges from 8.8% to 24.3%. Age and sex of the children, educational status and
total attendance at the anganwadi showed statically significant relation with the degree of

18
malnutrition. Overall, children who attended anganwadi were nutritionally better than their
counterparts who did not attend anganwadi during their childhood.

Bhowmick and Samita (2001) A study was conducted by West Bengal council for child
welfare to assess the health status of mother and children in 3 districts of West Bengal.

The study found that the impact of ICDS was immense in maintaining the health of mother
and children and raising their level of awareness. The study recommended opening more
AWC, s so that the health and nutrition status of women and children could be improved.

National Council of Applied Economic Research, New Delhi (2001) conducted a

nationwide evaluation of the ICDS Scheme to help the Government in initiating corrective
measures to make the programme more effective. Nearly 4000 projects, 60,000 AWCs,
4000 Mukhya Sevikas and 1.80 lakh beneficiary households with children in the age group
of 0-1 years, 1-3 years and 3-6 years were selected. It was found that nearly 66% of the
eligible children and 75% of the eligible women were registered at AWCs. Less than 3%
children were severely malnourished, except in Bihar, where severe malnutrition among
children 13-36 months was 28%, children 6-12 months were 6%, and in children aged 37-
72 months was 5%. Most states indicated low levels of severe malnourishment. About
11.3% of the children were moderately malnourished and children in the age group of 37-
72 months reported higher incidence of moderate malnourishment. More than 75% AWWs
were matriculate in the northern and eastern part of the country. Gujarat and Rajasthan had
the lowest percentage of matriculate functionaries. About 84% of the functionaries had
received training, mainly pre-service training. More than 80% children were immunized
against all major diseases. More than 90% of the women mentioned that they received
tetanus toxoid vaccination, but the referral system was found to be quite weak in many
states. Most AWWs and community leaders were not in favour of ICDS functioning under
the panchayats, either due to lack of interest or inadequate knowledge and awareness of
the importance of women and child development. The community and panchayats, both
provided space and other infrastructural support to AWCs, and helped in identifying
beneficiaries. Community participation was mainly from mothers and family members of
beneficiaries whose children derived benefits from the programme. Participation of
beneficiary women and adolescent girls in AWC activities was very low. Majority of
households reported that they needed the services of SN, PSE, immunization and NHE

19
provided under the ICDS programme, and they were satisfied with the delivery of these
components.

Mizoram, Meghalaya, Orissa, Gujarat and Goa were the top 5 states due to adequate
infrastructure, better profile of functionaries and efficient functioning of the AWCs.
Arunachal Pradesh, Bihar, Jammu and Kashmir, Nagaland and Uttar Pradesh were ranked
low. There was lack of one to one correspondence between the overall performance and
the household perception of the benefits received from the programme in Arunachal
Pradesh, Assam, Goa, Gujarat, Himachal Pradesh, Punjab, Tamil Nadu and Uttar Pradesh.
In a majority of the states, the weight register, health and referral register received less
attention. Orissa, Arunachal Pradesh and Punjab scored over other states in maintenance
of records. The performance of Sikkim was poor. The coordination between various
departments at micro level was weak. There is need for strengthening both inter and intra-
departmental coordination for smooth delivery of the programme services. Training of
functionaries should be more focused, and special skills and training are required to
identify children having disabilities. Package of services provided under ICDS should be
based on local socio-economic and cultural population needs.

Bharti et al (2003) The study was conducted to assess the nutritional services provided at
anganwadi centers and to know the awareness and utilization level of these services. A
sample of 15 anganwadi centers (AWCs), 15 anganwadi workers (AWWs) and 30 parents
of children who attended AWCs was taken from the urban slums of Jammu city. Data was
collected through interview schedules and observations. In spite of the poor set-up of
AWCs they provided supplementary nutrition (SN) to the children, but AWWs were not
keeping in mind the recommendations given by the Government. Only 40% centers were
maintaining growth charts, showing the nutritional status of children. But parents were
satisfied with the type of nutritional supplement provided to their children, and they knew
the health status of their children. It was recommended that supplementary nutrition
provided should be as per the recommendations of the Government, and that growth charts
should be maintained regularly in anganwadi centres.

Dutta (2004) conducted a study to assess the functioning of the AWW in slums of Delhi.
The findings revealed that 5 % of AWC were running in rented house. Infrastructure
facilities like source of drinking water was present in 75% of AWC sanitary facilities was
not allowed for the children to use.55 % of AWC after the gap of 4 yrs. received medicine

20
kit and iron and folic acid since last four years. Nearly 50% of the AWC reported and
adequate space especially for cooking. On an average nearly 66 % of eligible children and
75% women were registered at the AWC. Lack of motivation of AWW in identifying and
registering the population. AWC are not that much popular as expected and the major
reason revealed poor rapport between AWW and community members.

Haryana, Department of Economics and Statistics, Chandigarh (2004) Economic and

Statistical Organization, Planning Department conducted a study to evaluate the
functioning of ICDS in Haryana. In all, 48 AWCs and 576 beneficiaries were selected. In
2001-02, the expenditure on Supplementary Nutrition (SN) component of ICDS was borne
by the Central Government (57%) and by the State Government (43%). The trend of
availing SN by expectant women/ nursing mothers during the years 1999-2000 to 2001-
02 was decreasing. The achievements under immunization for children was 100% or above
whereas for T.T. of mothers was 84%. In non-formal preschool education, the achievement
was 98%. All AWWs were fully trained, while 33 (69%) helpers were not trained. It was
found that the achievements under SNP was 76% in 6 months – 3 years age group for
enrolled children, 83% for 3 years – 6 years children, and 74% for pregnant and nursing
mothers enrolled. A total of 16,324 children were weighed and it was found that 6583
children were normal (40%), 6105 children were in Grade I (37%), 3502 were in Grade II
(21%), 127 were in Grade III (1%), and 7 were in Grade IV malnutrition (0.42%)
respectively. Only 4889 (32%) beneficiaries were medically checked up either by ANM/
LHV or Medical Officers during the preceding three months. Out of a total of 9302
families, 7323 (79%) were visited by ICDS staff. A total of 4839 (83%) children received
PSE benefit, out of which 2549 (53%) were males and 2290 (47%) were females. Around
126 (88%) pregnant women received folic acid tablets from AWCs.
Out of 288, 178 (89%) expecting women got ante-natal care from AWWs and were
satisfied with their advice. Out of 144 nursing mothers, 97% were visited by AWWs after
delivery. Out of 144 sample beneficiary women, 139 (97%) breastfed their babies. 98%
women were taking care of their children and their children were found to be in good
health. Around 88% women adopted family planning norms. SN was distributed on an
average of 25 days in a month. 62% children took SN to their homes thus defeating the
very purpose of the scheme. Around 96% children ‘s mothers mentioned that SN items
were of good quality. 90% beneficiary children came to AWCs for other reasons like
getting non-formal education, health care and learning good habits. 93% beneficiaries

21
were in favour of the prevailing system of SN. Only 18 (56%) Gram Panchayats extended
help to AWWs in organizing cultural functions in AWCs to attract public participation.
60% AWCs were running in Panchayat/ Government buildings, whereas 40% were run in
rented/ private buildings. The weight record of 283 (98%) children out of 288 was
maintained using register/ card system. Members of Mahila Mandals took active part in
AWCs. The performance of ICDS was found to be satisfactory in SN, PSE and
immunization programme, but supervisory staff, P.O., CDPO and supervisors should
increase their visits to further improve the programme. Condition of AWCs need more
attention, the participation of local community like panchayats should be sought, and
public health, PWD and Electricity Departments may provide better facilities in AWCs.

Davey et al (2005) conducted a study on Perception regarding quality of services in urban

ICDS blocks in Delhi. The good quality of the services is an important determinant for
acceptance of a programme in a community. It not only enhances the credibility of a
worker at the ground level but also generate the demand for the services. In this paper
perception for the quality of the services was assessed through the exit interview of the
beneficiaries at the Anganwadi centres (AWCs). 200 beneficiaries were included from 20
AWCs in a period of one and half month. 52.5% respondents were dissatisfied for the
services provided from the AWC for one or more reason. The most common reason
mentioned was the not easy accessibility of the AWC and less space available at the AWC
(68.6%), followed by the poor quality of the food distributed (66.7%) and irregular
preschool education (57.1%) from AWCs.

Lokshin et al (2005) presented an article on, ―Improving Child Nutrition, The Integrated
Child Development Services in India. Levels of child malnutrition in India have fallen
only slowly during the 1990s, despite significant economic growth and considerable
expenditure on the Integrated Child Development Services (ICDS) programme, of which
the major component is supplementary feeding for malnourished children. To begin to
unravel this puzzle, this article assesses the programme ‘s placement and its outcomes,
using NFHS data from 1992 and 1998. The authors find that programme placement is
clearly regressive across states. The states with the greatest need for the programme — the
poor Northern states which account for nearly half of India ‘s population and which suffer
from high levels of child malnutrition — have the lowest programme coverage and the
lowest budgetary allocations from the central government. Programme placement within
states is more progressive: poorer and larger villages have a higher probability of having

22
an ICDS centre, as do those with other development programmes or community
associations. In terms of outcomes, the authors find little evidence of programme impact
on child nutrition status in villages with ICDS centres.

Mustaphi (2005) In West Bengal, almost every second child is underweight, and the State
‘s child malnutrition stands at 49%, above the country ‘s average of 44%. 16.3% children
below the age of 3 years were classed as moderately to severely malnourished (NFHS 2,
1998). More than 66% of the children aged 6-35 months, were anaemic (2000). The system
of data collection and compilation in Integrated Child Development Services (ICDS)
comprised filling out 300 data fields in 2 formats (5 copies at project/ block level). This
data was collated for 12-14 AWCs by Supervisors, and submitted to be forwarded
routinely without being analysed or used by functionaries at any level. Inconsistencies in
the data were not located, nor were data used for monitoring the programme. This project
aimed at streamlining and simplifying the process of data collection by the Integrated
Child Development Services (ICDS) functionaries and making the formats user-friendly
to enable field level analysis and utilization of the data for monitoring and improving the
nutrition levels of young children.

The Surveillance and Monitoring tools were – Mother and Child Protection Card;
Community Growth Chart; SMART Register; Cohort Register; Community Mapping
Sheets; Whiz Map; and Colour Coding (green: good; yellow: intermediate; red: poor). Two
steps made it easier to develop m Pacro-micro linkages in nutrition surveillance and a
focused intervention programme. Firstly, streamlining of data made it easier for all the
stakeholders at state, district, block and project levels to identify geographical pockets of
malnutrition. Secondly, the use of colour coding for streamlining the ICDS Management
Information System (MIS) also improved visibility of malnutrition to a large extent. In
West Bengal in March 2003, barring 2 districts, all others had a weighing efficiency of
less than 50%. After the training intervention, in April 2005, 5 districts have achieved a
weighing efficiency of more than 70%, while the average has reached to over 60%. Purulia
district has 20 ICDS projects and 2,512 AWCs. In March 2003, 10 projects were below
50% in weighing efficiency, but by April 2005 all projects had crossed 70% in weighing
efficiency. Moderate and severe malnutrition in children aged 0-3 years in West Bengal
was 20.41% in March 2003, which reduced to 18.09% by April 2005. Reduction of
moderate and severe malnutrition in 168 AWCs of Dakhin Dinajpur was from 25% to 5%
in two years. The following are some of the highlights of the impact of nutritional

23
surveillance. In Dakhin Dinajpur, a positive deviance district, there was extensive use of
resource map and community growth chart; mothers regularly contributed food for
Nutrition Counselling and Childcare Sessions (NCCS); there was preponderance of girl
children at the entry stage; ripple effect‘ was observed resulting in improvement of
nutritional status of siblings; there was improvement in child care practices and awareness,
and steady improvement in nutritional status of children. To mothers/ caregivers the
position of the child on the growth chart became an important concern. Functionaries at
the project and district levels were motivated when they were able to relate to the data
mapping and colour coding that was being used in spreadsheets and in GIS maps.

Prinja et al (2005) conducted a study on role of ICDS program in delivery of nutritional

services and functional integration between anganwadi and health worker in north India.
The objective of the study was to ascertain the nutritional status and dietary patterns of 1-
3-year-old children in areas served by ICDS program and to assess the nature and extent
of functional integration between the ICDS and health sector. A Community based cross
sectional study was done from June 2005 to November 2005 in 60 anganwadi centres
within 30 ―functional‖ sub centres from 5 community development blocks in district
Rohtak selected by stratified random sampling. A total of 408 children between 1-3 years
age, mothers of 408 children and 60 anganwadi workers were selected from these
anganwadi for the study. All children were weighed to assess the nutritional status using
IAP classification of weight for age. Mothers of all children were interviewed to assess
dietary patterns and nutritional education imparted by anganwadi workers. 60 anganwadi
workers were interviewed to assess the functional integration with Multipurpose health
worker [MPHW(F)]. The study revealed that 199 (48.7%) children were underweight and
19.8% children had dietary calories intake more than 80% of RDA. Advice regarding
breast feeding and complementary feeding was given by anganwadi workers to 179
(43.8%) women only. Involvement of mothers in growth monitoring is very low. The
program is well integrated in functioning with the health sector. The study concluded that
the problem of under-nutrition continues to persist with low involvement of mother. The
program needs to be further revamped with a holistic approach towards child development
and making the mother responsible for the health

Devi and Padmavati (2006) The aim of this study was to investigate the effects of the
nutrition and health education programme of the Integrated Child Development Services
on the nutrition/health knowledge levels and hygienic practices of women, and on the

24
nutritional status of their children. Anganwadi workers carried out the education
programme, which consisted of 12 sessions (one per month). A total of 300 children and
their mothers were included in the intervention were recruited from rural communities in
the Mahaboob nagar District of Andhra Pradesh, India. Mothers in the intervention group
had significantly higher scores on nutrition and health knowledge, and hygienic practices
than the control mothers. The education intervention did not have significant impact on
the nutritional status of children. This study confirms the value of an education programme
in improving the nutrition and health knowledge of rural mothers

Loyola College of Social Sciences, Thiruvananthapuram (2006) observed that

Supplementary nutrition is a high cost input of the ICDS programme. This study was
conducted in Kerala, and a sample of 593 persons was taken for the study, comprising 5
CDPOs, 38 Supervisors, 200 AWWs, 200 beneficiaries and 150 elected representatives.
About 92% of the beneficiary respondents visited the anganwadi centres (AWC) on all
days, either to receive food or to take the preschool children, or for feeding their children
in the 0-3 years age group. 95% beneficiaries of Thiruvananthapuram urban and 75% of
Kashakuttom were happy with the menu. All beneficiaries were punctual in attending the
feeding programme, and they mentioned that there was no wastage of cooked food. 15%
respondents preferred raw food, which they could cook according to their taste.
Respondents said that there were inadequate containers and this problem was felt more in
AWCs functioning in rented buildings. In Thiruvananthapuram urban I, Kazhakuttom, and
rural areas of Medumangad and Parassala projects, children did not have enough space for
play, and beneficiaries had no facilities to sit and take food. 84.2% CDPOs mentioned that
through the feeding programme nutritious food was supplied to the most deserving
beneficiaries in quite a regular manner.

Majority of supervisors of Medumangad said that beneficiaries were not satisfied with the
variety in the menu. 62% respondents felt that only deserving people were selected as
beneficiaries, but members of local self-government institutions (LSGI) were not
confident of this opinion, they expressed the need for more strict procedures for the
selection of beneficiaries. 92.1% Supervisors said that members of LSGIs were very co-
operative in implementing the feeding programme. 55.3% Supervisors mentioned that
there was good co-ordination between gram panchayats (village councils) and block
panchayats in the allocation of funds, but 31.6% said there was no such co-ordination.
75.5% respondents said that there was no interruption in feeding in their AWCs. 51.7%

25
respondents were not making any ad hoc arrangements to overcome interruption as the
problem was not AWWs were not interested in approaching local people for getting
assistance to handle any crisis. Shopkeepers refuse to supply food materials to AWCs due
to delay in payment. 97.7% AWWs mentioned that the beneficiaries showed willingness
to understand the situation when there was interruption in feeding. 76.5% AWWs said that
beneficiaries had no complaints regarding accessibility to AWCs, and there was no
demand for establishing new AWCs in their locality. 44% of the respondents accepted that
the present feeding programme was effective. There is need to construct their own building
for each AWC. AWW should be aware of the quantity of food required for her AWC.
There is need to increase the storage facilities for food materials in AWCs, and the same
food items should be supplied in all AWCs. Funds of LSGIs must be made available to
Supervisors without delay, and ICDS officials must take strong corrective action about
complaints against anganwadi workers or helpers. There is need to increase awareness
about the feeding programme among those people who could be beneficiaries of the
service.

Forum for organized resource conservation and enhancement (FORCES), New Delhi
(2007) conducted a study to evaluate the status of the performance of ICDS services in the
city of Delhi. Out of a total of 28 projects, 27 were covered, including 242 AWCs and
2970 beneficiaries and functionaries. It was found that 96% anganwadi centres (AWCs)
were on rent, 57% centres had toilets and 58% centres had clean drinking water. 82.23%
AWWs mentioned that there was scarcity of equipment like weighing machines, education
kits, etc. In 39% centres there were complaints of poor quality of food.

In Najafgarh area there were specific complaints of insects and dirt found in the food
material supplied. Children over six months had been receiving food from the AWC
regularly. Some beneficiaries mentioned that the quantity of food given was one katori
(bowl). So, the number of beneficiaries was more, but less quantity of food was distributed.
In 26% centres AWWs complained about irregular food supply. Polio vaccination was
irregular, and a major problem was that there was no fixed food supply. Only 82 out of
2861 (2.87%) beneficiaries were taking food in the centre. 76% beneficiaries shared
supplementary nutrition (SN) with their family members and rest of them (21%) took SN
to their home and consumed it themselves. Only 4 centres had data on Grade I and 17%
centres on Grade II malnutrition. Only one centre offered medical intervention, and around
9% centres offered double ration. 85% children were immunized by the ANMs in PHCs

26
and dispensaries in Delhi. 87% AWCs had data on immunization for children below 3
years and only 67% for children aged 3-6 years. Many AWC records were not updated.
Data on Vitamin A distribution was available in 9% of the centres but the survey on
beneficiaries revealed that 25% children below 6 years had received Vitamin A. 84%
AWWs mentioned that the Medical Officer (MO) had not visited the centres for more than
six months. ANMs were more regular visitors, and 51% of them visited AWCs once a
month. But as per the AWWs experience only 28.5% ANMs had been supportive. 93%
AWWs had received job training and 82% had attended the week long refresher course.
Apart from that 10% AWWs were trained on RCH (Reproductive Child Health), 27% on
AIDS and 18% on nutrition. Only 2.89% AWWs had special training on disability. It
showed that enough attention was not given to disability in this scheme, and this should
be specified in the guidelines of the scheme. Awareness, sensitization and community
participation needs to be addressed.

Tandon and Kapil (2008) conducted a study on Integrated child development services
scheme: need for reappraisal. The distribution of supplementary nutrition (SN) to
beneficiaries is an issue of debate in the Integrated Child Development Services (ICDS)
program, discussed in almost all fora in which the scheme is on the agenda. ICDS program
managers rightly decided in 1975 to make SN a program component, and it should remain
so. However, in areas which are relatively better off, where program beneficiaries do not
require SN, the discontinuation of SN can be considered. More than 3 lakh Anganwadi
Centers (AWCs) are operating in India. No solid data are available on how many AWCs
are closed when SN is not available. Many Anganwadi workers are taking innovative
approaches for the holistic development of children even without SN. Although the
process of growth monitoring (GM) is not being conducted as it was conceptualized,
experience is being gained in the field. Based upon feedback received from independent
evaluating agencies, mid-course changes have been made to the ICDS. For example,
training activities have been made more realistic.

2.4 Nutritional Status of ICDS Children

Pratinidhi et al (1998) conducted a study to know the calorie intake of children who were
beneficiaries of supplementary nutrition of ICDS in project area of Pune city. From 11
anganwadi, 165 children were taken, using cluster sampling method. Mothers of these
children were interviewed to know their knowledge and perceptions regarding ICDS as

27
well as the dietary intake of child in the previous 24 hours were also taken. Results revealed
that immunization (93.9%) and nutrition (75.8%) was recognized by mothers as the main
activity in the anganwadi. Preschool education and health check-ups (29.7%) were
relatively found to be less known to be unknown. It was found that majority of the children
(71.4%) used to take supplementary nutrition to their homes and in these, 74% of the
children shared it with other family members. The response of the children to
supplementary feeding was found to be excellent. It was found that 92% of the children
attended anganwadi for more than 20 days in a month. 7.1% attended the anganwadi for
less than 15 days a month. From the diet survey carried out by 24 hours recall, it was
found, calorie intake was more than 90% of the RDA for only12.7% of children, whereas,
2.4% of children were found of consuming grossly deficient diet. The supplementary being
provided at anganwadi was having average nutritive values of 213 calories and 5.1gm
protein as compared to the recommended values of 300 calories and 10 gm protein.

Jindal (1999) conducted a study to investigate the incidence of malnutrition among pre-
school children in ICDS and to evaluate its effect on developmental status of children. 240
subjects (120 each from ICDS and non-ICDS group) from Gadarpur block of Tarai region
of Udham Singh Nagar, Uttar Pradesh were selected using stratified random sampling
technique. Interviews with parents and anthropometric measurements of children were
used to evaluate socio-economic status of parents and nutritional status of children
respectively. Analysis of data revealed that all subjects belonged to lower socio-economic
class, and the status of on-going nutrition intervention services was not satisfactory. The
mean values for body weight, height and circumference of head and chest were higher at
all ages in the ICDS group as compared to those of non-ICDS group. Based on Gomez
classification, the percentage of children falling under normal and mild category of
malnutrition were more in the ICDS group (31.67% and 40% respectively) as compared
to 25% and 35.83% in the non ICDS group. The percentage of children having clinical
signs of nutrient deficiencies was higher among non-ICDS group as compared to ICDS
group. Children suffered most often from diarrhoea and the percentage was higher among
non-ICDS group. The average developmental scores percentage of preschool children
were higher at all ages in ICDS group as compared to those of non-ICDS group. Although
the on-going nutrition intervention service of ICDS scheme was not achieving its full in
terms of objectives set, but children in the ICDS group had lesser incidence of
malnutrition, and their developmental status was better than that of the non-ICDS group.

28
The study recommends that awareness must be created in the community to utilize ICDS
services. Physical infrastructure facilities of the anganwadi complex need to be upgraded
and regular supply of supplementary nutrition and vitamin `A' and iron tablets should be
ensured. Frequent medical check-ups and immunization programmes should be launched
in villages. Regular sessions of nutrition and health education to women need to be
organized.

Kapil et al (1999) evaluated the nutrient intake and consumption pattern of supplementary
nutrition by severely malnourished children in two ICDS projects of the Rajasthan. 25
anganwadi were selected for detailed study. The nutritional status of children in 6 months
to 6 years age group in all these centers was assessed by weight for age criteria as per the
Indian Academy of Paediatrics Classification. Home visits were also made and mothers
were specifically asked about the actual receipt and consumption of supplementary
nutrition by their child. Results of the study revealed that mean calorie intake in 6-11-
month age group was 626 kcal, which was 26% less than recommended dietary allowance
for this age group. In 23-35 months, age group children, the mean calorie and protein
intake was 717 kcal and 22 gm respectively. The calorie deficit for this age group was
42.2%. Supplementary nutrition by 84.6 % severely malnourished children, of those
receiving supplementary nutrition, 45.4% received single and 39.2% received double
ration of supplementary nutrition. Almost 46% severely malnourished children who
should have received double supplementary nutrition were still provided the single ration
of supplementary nutrition.

George et al (2000) The study was conducted among 3633 pre-school children of 108
anganwadi centres (AWCs) in rural Kerala to find out the haemoglobin level, weight for
age status and dietary habits of preschool children. Information regarding their age, sex,
clinical condition and dietary habits was collected on a proforma through interviews. Most
of the children belonged to low income nonvegetarian group (74.5%). The prevalence of
anaemia was 11.4%, and female children were more susceptible to anaemia. Normal
nutritional status was seen among 46.7% of the children, and while 11.78% of the mildly
undernourished children were anaemic, the percentage of anaemia among moderate
undernourished children was 16.37%. Among vegetarians 9.27% children were anaemic,
and among non-vegetarians 12.1% were anaemic. Dietary survey revealed that
consumption of iron from natural sources was below the recommended dietary level.
Changes in eating behaviour have the potential to affect the bio-availability of iron.

29
Mahapatra et al (2000) conducted study in the Kalahandi district of Orrisa. A total of 751
ICDS children aged 4-5 yrs. were studied for anthropometry and clinical signs of
nutritional deficiencies.15 grampanchayats were selected using probability proportionate
to size sampling. There was no significant difference between boys and girls for nutritional
status. According to weight for age, 57.1%of the children were under weight.

Saiyed and Seshadri (2000) investigated the impact of an integrated package of nutrition
and health services on the nutritional status and morbidity profile of preschool children in
Baroda.610 preschool children, under an urban ICDS block were placed in 3 categories of
service utilization, viz. full, partial and none. Data on socio – economic characteristics of
the children included family size and type, religion, education, occupation, per capita
income, house type, toilet facilities and home sanitation. The findings showed that
complete utilization of all services resulted in significant improvement in nutritional status
as assessed through anthropometric indices viz. height/ age, weight/age and weight/ height.
Data on morbidity among children showed that the frequency and duration of illness were
significantly lower when the services were utilized fully, than when utilized partially or
not utilized at all. Thus, major efforts should go into the convergence of services and their
full utilization by the community.

Bhalani and kotecha (2002) undertook a study to measure the prevalence of malnutrition
with gender difference and age trend in 30 anganwadi of urban slums. Weight and sex
records of children less than five years of age were taken from records maintained in
anganwadi. Using Indian Academy of Paediatrics, it was found that 22.4% children were
in the zone of moderate to severe malnourishment (in grade II and grade III), 40.5% were
in mild malnourishment zone (grade I) and 37.1% were not found to be malnourished at
all. No child was found to be in grade IV of malnourishment. Statistically significant
difference was found among malnourishment between boys (58%) and girls (68.2%). The
level of moderate to severe malnutrition in the elder children was found to be higher than
that in the younger children.

Organization for Applied Socio-Economic Systems (OASES), New Delhi (2002)

Malnutrition is a social problem of staggering dimension in South Asia. The present study
was an attempt to evaluate malnutrition among ICDS children upto 6 years of age. The
project aimed to study the level of nutritional status and health care of children in terms of
physical growth i.e. by age, weight and height and its effectiveness. The study was

30
conducted in 3 districts each from Uttar Pradesh ( Rampur, Ambedkar Nagar and
Badauni), Rajasthan ( Dungarpur, Banswara and Jhalawara) and Orissa ( Sundargarh,
Gajapati and Rayagada).From each district ,two blocks were selected and a total of 80
respondents were selected from ICDS centres in 18 blocks, making a total of 1440
respondents for the entire study. The study revealed that among the three states, maximum
percentage of children (26.1%) in grades III and IV malnutrition were from Uttar Pradesh.
The study revealed that overall about 36.8 % of the children whose height measurements
could be taken was short for their age or stunted. In Rajasthan, 19 % of the respondents
affirmed the poor health status of their child. Around 90% respondents from Orissa
affirmed the good health status of their child, and 10.6 % mothers from Uttar Pradesh were
certain of the poor health status of the child. The study recommended to improve nutrition
and health status, strategies to impart comprehensive awareness on malnutrition should be
given prime importance. The study further suggested that it is most important that the issue
of malnutrition should be moved from the ‘Agenda of welfare ‘to the ‘Agenda of Rights
‘. It is the right of child to have adequate care, and to grow the maximum mental and
physical potential.

Kumar (2009) conducted a study on nutritional status assessment of under-five

beneficiaries of Integrated Child Development Services program in rural Karnataka. The
objective of this study was to determine the nutritional status of children aged between 3-
6 years registered in government sponsored maternal and child care Anganwadi centres in
India. A cross-sectional study was conducted in 35 centres in 11 villages situated in the
field practice area of Community Medicine Department of a Medical College situated in
Southern India. Out of the 585 children in the study, 46.5% of the children were aged
between 36 to 48 months. Assessment of nutritional status using the ICDS growth chart
revealed malnourishment to be present among 189 (32.3%) children, of whom 166
children were grade I malnourished and 23 children were grade II malnourished.
Proportionally girls (46.2%) were more malnourished than boys (33.6%). No significant
association was found between the nutritional status of children and their duration of stay
in an Anganwadi centre (p-value=0.56). The findings of this study indicate that
malnutrition is still an important problem even among children attending anganwadi.
Further improvements in functioning of Integrated Child Development Services need to
be made in order to address the problem of malnutrition.

31
2.5 Studies on Anganwadi Training Institutes Regarding Training Provided to
Anganwadi Worker.

NIPCCD, Regional Centre Lucknow, Lucknow (2004) NIPCCD, Lucknow conducted an

intensive overall assessment of Anganwadi Workers Training Centres (AWTCs) in Bihar.
All AWTCs had hostel facilities, though the rooms were too small to accommodate the
trainees, even on the floor. At Patna, the Centre had 5 bathrooms and 5 toilets but they
were not in use due to lack of adequate water supply in them. Participants took bath at
open wells very early in the morning. All centres had safe drinking water. Other facilities
like kitchen were there in 3 centres; ventilation and lighting were appropriate in 7 out of 8
centres; teaching aids were there in all the 8 centres; 6 classrooms had durries (mats), and
2 had tables and benches. Books were there in all centres but the least were in Hajipur
centre; newspapers were received in 4 centres, and medicine kit was not available

even in one centre. Except one centre at Kadamkuan, all AWTCs followed the newly
developed Induction Training Syllabus. Only one centre at Madhubani took the evaluation
of performance of trainees in writing, while the rest took it verbally. To improve the quality
of training, following organizations contributed to AWTCs like Parent Organisation of
AWTC, NIPCCD, State Government, UNICEF and others. There were certain problems
faced by AWTCs such as non-release of funds in time, inadequate training material, etc.
The heads of organizations suggested that co-ordination with the State Government, timely
release of funds and provision of electricity should be enhanced. In training sessions,
lecture was the main method used for instruction. All AWTCs were located in good places
with proper transportation and market facilities. BCCW was getting some funds from the
ICDS Directorate for administrative expenditure. All AWWs were residing in the AWC
villages, and the distance between AWC and their homes was around 5 metres to 500
metres. AWTCs should have adequate physical infrastructure like hostel, kitchen, toilets,
bathrooms, library, classrooms, office, etc. Every AWTC should rearrange
training/communication materials available with them and keep them in a specified place
with some space so that these are used by trainees and trainers. Skill training programs for
Instructors of AWTCs on training methods, organization of preschool education activities,
growth monitoring and mobilization of the community need to be organized.

NIPCCD, Regional Centre Lucknow, Lucknow (2005) A qualitative study of Anganwadi

Workers Training Centres (AWTCs) in Uttar Pradesh was conducted under Project

32
UDISHA by National Institute of Public Cooperation and Child Development, Regional
Centre, Lucknow. A total of six AWTCs comprised the sample of the study. The
respondents included Head of the Organisations, Principals of AWTCs, Instructors and
trainees. Data was collected through interview schedules and an observation checklist.
There was wide variation in the training centres regarding infrastructure and experience of
staff, their orientation to early childhood care and development, teaching methodologies,
etc. Findings indicated that only two centres could provide adequate number of chairs and
tables to trainees in the classrooms, and the rest had to sit on the floor on mats (durries).
At the AWTC, Allahabad, the trainees were paid daily allowance in cash for meals, and
this practice should be checked. Classrooms should be well ventilated and spacious enough
to accommodate 35 trainees. A.V. aids and training equipment were also missing in these
centres. In a majority of the centres, the educational qualifications of the instructors did
not match with the subject they taught. Quality of training also suffered due to lack of
specialist speakers. Findings indicated that very little material or no material was given to
the trainees. Experiential learning, which is an important aspect of training provided
through field visits and supervised practice, had been neglected due to lack of knowledge
about this, in almost all centers. The root cause of these was late release of grants and the
unrealistic budgetary provisions. There is a need to provide funds for a library in the
budget. There is also need to develop a training module for the job training of AWWs in
order send a uniform message to all the AWWs. Skill building training for Instructors of
AWTCs may also be organized from time to time. Facilities like blackboard, projection of
films, display of programme schedule, growth charts, posters, demonstration room, etc.
should be available. Hostels should be located within the premises of the training centres.
The trainees should share the same food, have food in a common place, and it may be
prepared in a common kitchen with the cooperation and help of trainees. International
agencies should put AWTCs on their mailing list so that whatever material is developed
by these organizations could go directly to these training institutions

Gadkar et al (2006) This study was undertaken to assess the existing infrastructure and
training facilities available in the AWTCs; to identify the gaps in training; to assess the
knowledge, understanding and skills of trained AWWs in work situations; to find out the
problems faced by AWTCs in the organization of training; to suggest measures to
strengthen the overall functioning of AWTCs; and to suggest common minimum standards
for AWTCs. At the time of data collection, there were 5 AWTCs functioning since many

33
years in Jharkhand, and 23 more AWTCs were being set up to clear the backlog of training
of ICDS functionaries. The Government of Jharkhand had started 7 additional AWTCs
recently to clear the backlog. Of the five old AWTCs, four had been selected randomly for
assessment. Head of the organizations, principals of AWTCs, instructors, trainee
anganwadi workers and trained AWWs with 1-3 years of work experience at AWCs were
selected for collecting detailed information. Findings revealed that the job training course
(JTC) was of 30 days duration with 26 working days. Of these, three days were allocated
to field visits and four days for supervised practice at the AWC and in the community.
Refresher courses of 6 days duration were also organized for AWWs, who had worked for
at least 21 months in ICDS projects. The syllabus of the JTC and refresher course for
AWWs and helpers was revised by NIPCCD, keeping in view the job functions,
qualifications and the skills required by AWWs to run the programme efficiently. All the
AWTCs selected were run by voluntary organizations with financial support from the
Government of Jharkhand. Holy Cross, Ranchi was oldest among them (1978). The survey
covered rural, urban and tribal areas. It was found that there was wide variation in
infrastructure, experience of staff, teaching methodologies, transaction of training and
management of training centres, etc. among these locations. AWTCs located in urban areas
should provide either a desk or table for writing in classrooms with durries. There is a need
to organize training programmes for instructors on all the new topics like Participatory
Learning and Action (PLA), communication counselling, Integrated Management of
Childhood Illnesses (IMCI), training techniques and guidance for organizations of
observational visits and supervised practices in the field. Thus, AWTCs should be
provided with required component wise training material for conducting training
programmes. The performance of the visiting lecturers should be reviewed at the
conclusion of the course.

Indian Institute of Development Management, Bhopal (2008) Integrated Child

Development Services (ICDS) scheme was launched on 2nd October 1975, in 33 blocks
of the country on experimental basis. It covers the entire nation and is recognized as one
of the most unique community based outreach programmes catering to health and nutrition
needs of children below 6 years of age, their mothers, adolescent girls, pregnant women,
nursing mothers and all women between 15 to 45 years.20% of the total number of MLTCs
(17), that could be accessed for data collection were selected for the study randomly, and
it was ensured that at least 1 MLTC from each state was covered. From each state 20% of

34
the AWTCs, were also selected randomly for the study. The evaluation study was carried
out in 125 AWTCs (out of 127 planned) in 30 states and Union Territories. Most of these
AWTCs were managed by Trusts/ NGOs/ Academic Institutes and State Councils for
Child Welfare. Public transport was found easily in 97 AWTCs (77.6%), hostel facilities
were available in 115 (92%) AWTCs. In 16 AWTCs (12.8%), hostels had rooms (10-12
as per the norms), 5 bathrooms and toilets. In 122 AWTCs (97.6%) electricity and drinking
water facilities were available, 45% AWTCs had tables in the hostels, and chairs were
available in 86.4% AWTCs. in 10 (8.8%) AWTCs blackboards were not available, white
boards were available in only 80 (64%) AWTCs and magnetic boards were available in
only 8 (6.4%) AWTCs. OHPs were available in 76 (60.8%) AWTCs. Film projectors were
available in 39 (31.2%) AWTCs and 98 (78.4%) AWTCs were having VCRs, video
cassettes and audio cassettes, TV sets were available in 84.8% AWTCs and LCD was
available in 25 AWTCs and LCD was available in 25 AWTCs (16%). 94.1% Lesson plans
were finalized by 80.8% Instructors and the plan for guest speakers by 63.1%
Instructors/Principals. 8 MLTCs (46.1%) were housed in rented buildings, 82% MLTCs
were having black/white boards in the classrooms, 9 MLTCs (52.9%) were in their own
buildings, while the remaining 8 MLTCs (46.1%) were housed in rented buildings. To
improve the quality of training at AWTCs and MLTCs it was recommended that training
institutions that are not easily accessible should make alternate arrangements of hiring a
vehicle at the time of organizing the training programme. Hostel facilities should be
improved and required number of toilets, bathrooms, furniture, kitchen facilities, etc.
should be there in all training centres. All the State Governments/ Union Territories should
ensure timely release of grants to all AWTCs and MLTCs to ensure smooth running of
training programmes. There should be a uniform recruitment procedure, and State
Governments/ Union Territories should help AWTCs and MLTCs in developing training
and communication material/ aids. At time, the ICDS functionaries deputed for training
do not turn up, so State Governments should take a serious view of this and see that this
situation is avoided. But State Governments should also give sufficient time to ICDS
functionaries while deputing them for training so that they can make suitable
arrangements.

35
 CHAPTER-III
RESEARCH METHODOLOGY

A Way of Examining Your Practice…

Community-level workers, such as Auxiliary Nurse Midwives (ANMs) and Anganwadi
Workers (AWWs), deliver most of the critical public health services for the poor in India.
Nutrition is the focal point of health and well-being and it is directly linked to human
resource development, productivity and ultimately to the national growth. As the
anganwadi worker is the key person in the ICDS programme, her education level and
knowledge of nutrition plays an important role related to her performance in the anganwadi
centre. It has also been reported that, in addition to education level, training of anganwadi
workers about growth monitoring plays a beneficial role in improving their performance
(Gopaldas et al., 1990).

Research methodology is a way to systematically solve the research problem. It may be

understood as a science of studying how research is done scientifically. The procedure
followed in sampling, empirical measurement of variables, devices used for collection of
data and the statistical measures used for the analysis of data are described in this chapter
under the following sub heads:

36
1. Sampling procedure
2. Devices used for collection of data, and
3. Statistical tools used for analysis of data

Sample Description: The sample for the study consisted of two groups.

Group1: Anganwadi workers: The Government of India in 1975 initiated the Integrated
Child Development Service (ICDS) scheme which operates at the state level to address the
health issues of small children, all over the country. It is one of the largest child care
programmes in the world aiming at child health, hunger, mal nutrition and its related
issues. Under the ICDS scheme, one trained person is allotted to a population of 1000, to
bridge the gap between the person and organized healthcare, and to focus on the health
and educational needs of children aged 0-6 years. This person is the Anganwadi worker.
She is a health worker chosen from the community and given 4 months training in health,
nutrition and child-care. She is in charge of an Anganwadi centre. There are an estimated
1.053 million anganwadi centers employing 1.8 million mostly-female workers and
helpers across the country (Wikipedia). They provide outreach services to poor families in
need of immunization, healthy food, clean water, clean toilets and a learning environment
for infants, toddlers and pre-schoolers. They also provide similar services for expectant
and nursing mothers. According to government figures, anganwadi reach about 58.1
million children and 10.23 million pregnant or lactating women. The Anganwadi worker
and helper are the basic functionaries of the ICDS who run the anganwadi centre and
implement the ICDS scheme in coordination with the functionaries of the health,
education, rural development and other departments. Their services also include the health
and nutrition of pregnant women, nursing mothers, and adolescent girls. Anganwadi
workers are India ‘s primary tool against the menace of child malnourishment, infant
mortality, and lack of child education, community health problems and in curbing
preventable diseases. They provide services to villagers, poor families and sick people
across the country helping them access healthcare services, immunization, healthy food,
hygiene, and provide healthy learning environment for infants, toddlers and children.

Group 2: Pre-school children: Early childhood is a crucial developmental period during

which there is considerable scope to influence the growth of malnourished children

37
through growth-monitoring, which is supposed to be performed monthly, and through
encouraging sound child-care and feeding practices.

Sample Size: The sample size for the study consisted of 200 respondents.
Group 1: 50 anganwadi workers were selected with in Amritsar district through 50
anganwadi centers, out of which 25 were from rural areas and 25were from urban areas.

Group 2: 150 pre-school children were selected with in Amritsar district through the
calculation of 3 pre-school children per anganwadi centre, out of which, 75 pre-scholars
belonged to rural anganwadi and 75 pre- scholars were from urban areas.

Sample Locale:
The area for study was selected from following blocks of Amritsar district under urban
and rural zone. There are 1850 operational anganwadi centers in Amritsar district . Out of
these, anganwadi centers from urban zone and rural zone were selected further for study.

Urban zone: In urban zone of Amritsar district, the sample was selected from Amritsar- 1
block, 25 anganwadi centers were randomly selected for the study.

Rural zone: In rural zone, the sample was selected combined from 25 AWC of Rayya block
and Jandiala Guru block.

Sample Technique:
Group 1: Anganwadi Workers: Multi stage sampling technique was adopted for sample
selection of anganwadi workers. Out of various blocks with in Amritsar districts, 50
anganwadi centers were picked randomly from rural as well as urban areas for 25 each.
From these 50 anganwadi centers, 25 anganwadi workers, one from each, was selected to
assess the nutritional awareness and implementation of nutritional services.

Group 2: Pre-School Children: During the pre-testing phase it was observed that
availability of 3-6 yrs. children was more feasible than the availability of younger age
group. Thus, the study aimed at the assessing the nutritional status of 3-6 years children
attending anganwadi centre. From each anganwadi centre out of total 50 centers, 3 pre-
scholars were selected randomly to assess the nutritional status, thus making the total
number of respondents up to 200.

Tools for The Study:

38
 In order to collect data, following tools were applied:

1. Observation: Those aspects which may have been reported through interview yet whose
presence had significant implication for the issues under study, were included here.
Observations were made on various aspects like physical infrastructure of anganwadi
centre and implementation of nutritional services at anganwadi centre.

2. Interview Schedule: Keeping in mind the purpose of the study, interview method was
used for data collection. The interview method was adopted through a schedule. On the
basis of extensive review of available literature and personnel experience, an interview
schedule was prepared for collection of data which consisted of close ended questions.
The schedule is divided into different sections. Under each section, several relevant
questions are raised to elicit all possible information about each of the selected samples
under study.

The information is gathered from respondents using well-structured schedule. Interviews

were conducted individually and duration of each interview was about 1-1½ hours.
Flexibility of the questions was maintained. If the respondent was not able to understand
the question then same question was asked in a different way.

The schedule consisted of following

General health in ICDS
Functions of food and their sources
Nutritional requirement
Community nutrition
Nutritional deficiency and their symptoms and its food sources

Pre testing: The preliminary version of the schedule is pre-tested for its validity and
precision and suitable modifications were made in the schedule of questions wherever
found necessary. This re-structured schedule is used for the collection of data.

3. Anthropometric Measurements: Changes in body dimensions reflect the overall health

and welfare of individuals and populations. Anthropometry is used to assess and predict
performance, health and survival of individuals and reflect the economic and social well-
being of populations. Anthropometry is a widely used, inexpensive and non-invasive
measure of the general nutritional status of an individual or a population group. Data were

39
 gathered by the collection of anthropometric data through measurements of height and
weight. The anthropometric measurement by National Center for Health Statistics (NCHS)
and WHO standards (WHO, 2005) were used for the determination of nutritional status of
preschool children. Standard deviation of scores (Z-scores) for weight-for-age (WAZ),
height-for-age (HAZ) and weight-for-height (WHZ) were calculated. The Z-score (SD
score) is calculated as follows. Z score = (individual value-median value of reference
population)/ SD value of reference population. For each of the anthropometric indicators
of malnutrition a cut-off point of-2 standard deviations (-2 SD) below the median of that
of the WHO reference population was used. Anthropometric method is a quantitative
method; it also considers the different types of measurements like, height-for-age, weight-
for-age and weight for- height.

WHO system
< -1 to > -2 Z-score: Mild Malnutrition

< -2 to > -3 Z-score: Moderate Malnutrition

< -3 Z-score: Severe Malnutrition

Height and weight were two indicators measured. Non stretchable steel tape was used to
measure the height of children. It was standardized at 1mm.The subjects were asked to
stand with bare foot on a flat floor on a floor against a wall with feet parallel and with
heels, buttocks, shoulders and back of the head was held comfortably erect and a mark was
made on a wall with the help of right angled objects i.e., wooden scale, touching the top
of the head horizontally with a vertical edge flat against the wall. The reading was recorded
at 1mm.

The body weight of Children was weighed using a standardized Salter's scale. The grades
of malnutrition were assessed using World Health Organization (WHO) recommended
standards.

4. 24-hour Dietary Recall Sheet: For the 24-hour dietary recall, the respondents were asked
to remember and report all the foods and beverages consumed in the preceding 24 hours
or in the preceding day. The recall typically is conducted by interview, in person by using
a paper-and-pencil form. Well-trained interviewers are crucial in administering a 24-hour

40
 recall because much of the dietary information is collected by asking probing questions.
Ideally, interviewers would be dieticians with education in foods and nutrition; however,
non-nutritionists who have been trained in the use of a standardized instrument can be
effective. All interviewers should be knowledgeable about foods available in the
marketplace and about preparation practices, including prevalent regional or ethnic foods.
The interview is often structured, usually with specific probes, to help the respondent
remember all foods consumed throughout the day. Probing is especially useful in
collecting necessary details, such as how foods were prepared. It is also useful in
recovering many items not originally reported, such as common additions to foods (e.g.,
butter on toast) and eating occasions not originally reported (e.g., snacks and beverage
breaks).

(1) an initial quick list,‘‘ where the respondent reports all the foods and beverages consumed
without interruption from the interviewer;

(2) time and occasion, where the respondent reports the time each eating occasion began and
names the occasion;

(3) a detail pass, where probing questions ask for more detailed information about each food
and the portion size, in addition to review of the eating occasions and times between the
eating occasions; and

(4) final review, where questions about any other item not already reported are asked.

Data collection using the structured interactive 24-hour recalls method:

To assist the parent/ guardian to estimate portion size consumed by the study child and for
easy estimation and calculation of quantity, the interviewers also moved with utensils such
as spoons, cups and plates for the parent to use. The interviewer asked the parent to recite
all the foods and beverages the child had eaten the preceding day, while the interviewer
compared the oral information to what was marked on the calendar. The interviewer
weighed the portion and recorded the weight in the specially developed 24-hour recall
questionnaire

Calculating energy and nutrient intake: The amounts of foods from the weighed record
and the structured interactive 24-hour recall were converted to grams and the nutrient

41
values were computed using reference exchange list from book titled as ―nutritive value
of Indian food‖, written by C Gopalan.

Data Analysis: The present study is mainly qualitative in nature and the data obtained by
using interview schedule and observation method have mainly been analysed using content
analysis methods. After scoring, the data was systematically coded and tabulated
according to exhaustive categories. Both quantitative and qualitative methods were
employed for data analysis. The quantitative data obtained was analysed by calculating
frequencies and computing percentages. Appropriate statistical techniques like
frequencies, correlation, binary logististic regression and chi-square were used for further
analysis, wherever required. SPSS software was used for quantitative analyses. For
computing Z-scores of malnutrition, Anthro software (children between 3-5 years) and
Anthro plus software (children between 5-6 years) were used.

Ethical Issues Considered: Success of any study depends upon whole hearted
cooperation from the respondents. If the respondents are not willing to participate in the
study voluntarily, they might provide haphazard response, which could mislead the overall
findings of the study. In order to ensure the quality data and also for ethical purpose the
following steps were adopted:

 Objectives of the study were briefed to all the study subjects.

 Informed consent was obtained.

 Confidentiality of information was ensured.

42
 CHAPTER-IV

RESULTS AND DISCUSSION

The prime objective of this investigation was to analyze the awareness among anganwadi
workers regarding nutrition. The study was undertaken to assess implementation of
nutritional services at anganwadi centre for pre scholars aged 3-6 yrs. The study also assess
the nutritional status of pre-scholars (3-6 yrs.) attending anganwadi centre. Keeping in
view the specific objective, the empirical evidences obtained in terms of factual data,
through objective research procedures, designed and developed for this study, have been
analyzed in the context of the objectives set for the study by subjecting them to the
appropriate statistical tests and analytical tests. The findings thus arrived are presented as
below:

Demographic profile of anganwadi worker

Enrollment of children at anganwadi centre.

Physical infrastructure of anganwadi centre

Implementation of nutritional services at anganwadi centre provided to pre scholars of

rural and urban zone of Amritsar District

Nutritional awareness among anganwadi workers of rural and urban zone of Amritsar
district.

Influence of nutritional awareness of anganwadi worker on implementation of nutritional

services at anganwadi centre

Comparison for the level of nutritional awareness among anganwadi workers and their
implementation to nutritional services between rural and urban zone of Amritsar district.

Assessment of nutritional status of pre scholars in Amritsar district

Evaluation of the final output and expected output of nutritional services at anganwadi
centers

43
Demographic Profile of Anganwadi Worker

The Anganwadi worker is the basic functionaries of the ICDS who run the anganwadi
centre and implement the ICDS scheme in coordination with the functionaries of the
health, education, rural development and other departments. The distribution of anganwadi
worker based on their age, formal education, work experience, training status, total time
period of training between joining and last training received by anganwadi worker, back
log status of training of anganwadi workers and enrolment of children at anganwadi
centers are presented in this section:

Table 4.1 Age of Anganwadi Workers

AGE FREQUENCY (%)

(IN YEARS) URBAN RURAL TOTAL
(N=25) (N=25) (N=50)
Young AWW 8 (30) 14 (58) 22 (44)
(up to 33yrs)
Middle aged AWW 11 5(18) 16 (31
(34-44 yrs.) (44)
Above all Middle 6 (26) 6 (24) 12 (25
aged AWW (34-44
yrs.)

A perusal of the data of table indicates that 30 % of anganwadi workers working in urban
projects were young for age less than 33 years and 44 % of anganwadi workers were
recorded to the middle aged while 26 % were above middle aged. The trend in percent
distribution remaining same in rural projects. 58, 18 and 24 % were found to be young,
middle aged and above middle aged anganwadi workers respectively. When visualized
overall, young, middle aged and above middle aged anganwadi workers were 44, 31 and
25 percent respectively. In urban projects, middle aged workers were high in number (44
%) while in rural projects young workers (58%) were found to be high in numbers.

44
Table 4.2 Educational Status of The Anganwadi Worker
QUALIFICATION FREQUENCY (%) Total
Urban Rural N=50
(N= 25) (N=25)
Non-Graduates 14 (54) 16(64) 30(59)
Graduates 8(32) 7(28) 15 (30)
Post Graduates 3 (14) 2 (08) 5 (11)

As seen in table majority (54%) of the anganwadi workers in urban projects were non
graduates while 32 % were graduates and remaining 14 % were post graduates. Similarly,
the non-graduates, graduates and post graduates were 64, 28, and 8 % in rural projects
respectively. All the projects put together, majority (59 %) of the workers were non-
graduates.

Table 4.3 Job Experience of Anganwadi Worker

Job FREQUENCY (%) Total

Experience Urban Rural (N=50)
(N=25) (N=25)
0-10 years
(Low) 12 (46) 15(62) 27(54)
10-20 years
(Medium) 04 (16) 6(22) 10 (19)
20-30 years
(High) 9 (38) 04 (16) 13(27)

As seen in table majority of anganwadi workers were found to be low in job experience in
urban (46%) and rural (62%) while only 38 % anganwadi workers in urban and 16 %
anganwadi workers in rural project was found to be high in job experience. All
the projects put together, job experience of anganwadi workers was found to be
low and high in 54% and 27 % of respondents respectively.

45
Table 4.4 Training Status of Anganwadi Worker

TRAINING STATUS FREQUENCY (%) TOTAL

(N=50)
URBAN RURAL
(N=25) (N=25)
TRAINED 22 (90) 17 (66) 39 (78)
UNTRAINED 03 (10) 08 (34) 11 (22)

Table 4.4 reveals that majority of anganwadi workers were found to be trained in urban (90%)
and rural (66%) projects of ICDS. All the projects put together the training status of anganwadi

Table 4.5 Distribution of Anganwadi Centers According to Its Total Functioning

Period*

TIME PERIOD (IN YEARS)

URBAN RURAL TOTAL
(N=25) (N=25) (N=50)
12(46) 16 (66) 28 (56)
0-10 years (low time span)
10-20 years (medium time 5 (20) 06 (24) 11 (22)
span)
20-30 years (high time span) 8 (34) 03 (10) 11 (22)

Total Functioning period = time period between the opening month of AWC and month of
survey.
It is seen from the table that majority of the anganwadi centres were found to be functional in low
time span in urban (46%) and rural (66 %).
Enrollment of Children in Anganwadi Centre

Table 4.6 Enrolment of Children (0-6 yrs) in Anganwadi Centre

NUMBER OF FREQUENCY (%) TOTAL
ENROLLMENT (N=50)
URBAN RURAL
(N=25) (N=25)
0-10 01 (02) ---- 01 (01)
10-20 07 (28) 12 (50) 19 (39)
20-30 15 (42) 13 (48) 28 (55)
30-40 02 (08) ---- 02 (05)

46
The table 4.6 that majority (42%) of anganwadi centres in urban project had enrollment of
20-30 children between age group of 0-6 years while in rural projects, majority of
anganwadi centres had enrollment of 10-20 children between the age group of 0-6years.
All the projects put together; the table revealed that majority (55 %) of anganwadi centres
had enrollment of 20-30 children between age group of 0-6 years.

Table 4.7 Enrollment of children (3-6 yrs.) in Anganwadi centre

NUMBER OF FREQUENCY (%)
ENROLLMENT
URBAN RURAL TOTAL
(N=25) (N=25)
0-5 04 (16) 07 (28) 11 (22)
5-10 13 (54) 15 (60) 28 (57)
10-15 07 (26) 03 (12) 10 (19)
15-20 01 (04) ---- 01 (02)

It is evident from the table that majority of anganwadi centres in urban (54%) projects and
rural (60%) projects had enrolment of 5-10 children between age group of 3-6 years. All
the projects put together; the table revealed that majority (57 %) of anganwadi centres had
enrolment of 5-10 children between age group of 3-6 years. It was found during the study
that the children between 3-6 years were usually belonging to labour class and financially
weak families.
Physical Infrastructure of Anganwadi Centre

Table 4.8 Building Category of Anganwadi Centre

BUILDING FREQUENCY (%)

TYPE TOTAL
URBAN RURAL (N= 50)
(N=25) (N=25)
PACCA 18 (72) 14 (58) 32 (65)
KACCHA -- 02 (08) 02 (04)
SEMI- PACCA 07 (28) 08 (32) 15 (32)
No ROOM --- 01 (02) 01 (01)

The glance at table reveals that majority of anganwadi centres had pacca buildings in urban
(72%) and rural (58%) rural projects of ICDS. In rural projects only, 8 % anganwadi
centres had kaccha building while 2 % had no room and thus were found to be using
veranda as substitute. 28 % anganwadi centres in urban projects and 32 % anganwadi
centres in rural projects were found to have a semi pacca building in which either the floor

47
or ceiling was found to be kaccha. All put together, majority (65%) anganwadi centres had
pacca buildings. It was observed during the study that majority of anganwadi centres with
semi pacca building had kaccha flooring in urban projects wile in rural projects, a larger
section of anganwadi centres with semi pacca building had kaccha flooring but few centres
also had kaccha ceiling of tin sheet or grass roof.
Table 4.9 Availability of Storage Space for Raw Material in Anganwadi Centre

STORAGE SPACE FREQUENCY (%)

URBAN (N=25) RURAL (N=25) TOTAL (N=50)
MAIN ROOM 23(94) 23(96) 46 (92)
SEPARATE ROOM 02(06) 01(04) 03(05)
WITHIN KITCHEN ---- 01 (04) 01 (02)

The table 4.9 reveals that majority of anganwadi centres in urban (94%) and rural (96%)
projects of Jammu district did not have a separate space for storage of raw food and hence
the ration was found to store within the main room of anganwadi centre. Only 6 % urban
and 4 % rural anganwadi centres had a separate room for the storage of raw material.
TABLE 4.10 Availability of Separate Space for Cooking in Anganwadi Centre

SEPARATE FREQUENCY (%)

SPACE TOTAL
URBAN RURAL (N=50)
(N=25) (N=25)
Available 23(94) 3 (14) 27 (54)
Not Available 23(94) 22(86) 23 (46)

The table 4.10 that majority (94%) of anganwadi centres in urban project had separate
space available for cooking purpose and remaining 6% had no separate space. In rural
projects, the trend was opposite. It was found that majority (86%) of anganwadi centres
had no separate space available for cooking. Instead anganwadi workers were using the
main room for cooking. Only 14 % anganwadi centres in rural projects had separate space
available for cooking.

48
TABLE 4.11 Availability of Outdoor Space for Play Activity in Anganwadi
Centre
OUTDOOR SPACE FREQUENCY (%) TOTAL
URBAN (N=25) RURAL (N=25) (N=50)
Congested 6 (24) 05 (20) 11(22)
Non-Congested 08 (32) 17 (68) 25(50)
Not Available 11 (44) 03 (12) 14(28)

It is seen in table that in urban projects, majority (44 %) anganwadi centres did not have
an outdoor space available for play activities. Out of remaining centres in urban projects,
24 % centres found to have congested outdoor space while 32 % had non congested
outdoor space. Similarly, in rural projects, majority (68%) centres were found to have non
congested outdoor space for play activities of children. 20 % anganwadi centres in rural
projects had congested outdoor space.
TABLE 4.12 Availability of Electricity Facility in Anganwadi Centre

ELECTRICTY FREQUENCY (%) TOTAL

URBAN RURAL (N= 50)
(N=25) (N=25)
AVAILABLE 17 (66) 03 (12) 20(39)
NOT 08 (34) 22 (88
CONGESTED 30 (61)

It is seen in table 4.12 that majority (66%) of anganwadi centres in urban project had
electricity facility. Only 34 % anganwadi centres were found with non-availability of
electricity facility in urban project. Instead majority (88%) anganwadi centre in rural
projects were found to have non availability of electricity facility. Only 12% anganwadi
centres had electricity facility in rural projects.
TABLE 4.13 Ventilation Facility in Anganwadi Centre
FREQUENCY (%) TOTAL
VENTILATION URBAN (N=25) RURAL (N=25) (N=50)
Yes 22 (83) 23 (92) 45 (89)
No 03(14) 02(08) 5 (11)

It was seen in table that majority of anganwadi centres in urban (83%) and rural (92%)
projects had good ventilation. Only 14 % in urban and 8 % anganwadi centres in rural
projects were reported with poor ventilation. The rooms were dark without natural light
and a foul smell was observed because of poor ventilation in surroundings. All put together
majority (89%) of anganwadi centres had good ventilation.

49
TABLE 4.14 Hygienic Status of Anganwadi Centre

HYGIENE FREQUENCY (%) TOTAL

URBAN (N=25) RURAL (N=25) (N=50)
Hygienic 17 (68) 17(68) 34 (68)
Unhygienic 08(32) 08 (32) 16 (32)

The glance at table indicated that majority of centres in urban (62%) and rural (68%) had
hygienic conditions in the surroundings.

TABLE 4.15 Toilet Facility for Children in Anganwadi Centre

TOILET FREQUENCY (%) TOTAL

FACILITY (N=50)
URBAN RURAL
(N=25) (N=25)
Available 10 (40) 6 (22) 16 (31)
Indian 9 (38) 6 (22) 15 (30)
English 01 (02) 01 (01)
Not Available 5 (60) 19(78) 34(69)

The table highlights that majority of anganwadi centres in urban (60 %) and rural (78%)
projects did not have toilet facility. In urban projects only 40 % centres had toilet facility
out of which 19 % had Indian toilet facility and 1 % had English toilet facility. In rural
projects only 22 % anganwadi centres had toilet facility and all of them had Indian toilet
facility.

Table 4.16 Drinking Water Facility in Anganwadi Centre

Drinking FREQUENCY (%)

Water TOTAL
Facility (N=50)
URBAN RURAL
(N=25) (N=25)
Available 25 (100) 25 (100) 50 (100)
Tap Water 11 (42) ---- 11 (21)
Hand Pump ---- 13(52) 13 (26)
Water
Stored Water 14 (58) 12 (48) 26 (53)
Not Available ---- ---- ----

It was seen from the table that all (100%) the anganwadi centres of urban and rural projects
of had drinking water facility at anganwadi centres.42 % anganwadi in urban projects had

50
tap water facility while remaining 58 % had stored water facility. In rural projects, 52 %
had hand pump facility while remaining 48 % had stored water facility. All put together,
the table revealed that all (100%) anganwadi centres had drinking water facility. 21 %, 26
% and 53 % had tap water, hand pump water and stored water facility respectively.
To Assess the Implementation of Nutritional Services Provided to Pre-Scholars
The distribution of anganwadi workers based on implementation of nutritional services at
anganwadi centre is presented under this section. In this section, implementation of
supplementary nutrition, growth monitoring and nutrition and health education (NHED)
components have been discussed under various sub headings.

Implementation of Supplementary Nutrition Service At AWC

Table 4.17 Execution of Nutritional Practices at Anganwadi Centre

HYGIENE FREQUENCY (%) TOTAL

URBAN RURAL (N=50) χ² value
(N=25) (N=25)
Follow up of menu 09 (36) 09 (36) 18 (36) 00
Use of standard measures 12(48) 27 (54) 0.98
for weighing of raw foods 15 (58)
Use of standard measure for 04 (16) 5 (10) 0.84
distribution of cooked food 01 (06)
At table indicates that execution of nutritional practices which were applicable at
anganwadi centre was not satisfactory as the majority of anganwadi workers in urban
(58%) and rural (48%) projects were using standard measure only for distribution of raw
food while 8 % anganwadi workers in urban and 2 % in anganwadi workers in rural
projects were using standard measure for distribution of cooked food. Follow up of menu
was another unsatisfactory parameter. Both urban (36%) as well as rural (36%) anganwadi
workers were following the official menu for making supplementary nutrition.

51
Table 4.18 Implementation of Supplementary Nutritional Target at AWC

IMPLEMENTATION OF STANDARD FREQUENCY (%) TOTAL

MEASURES TO ACHIEVE FIXED
QUANTITY OF NUTRITION URBAN RURAL (N=50)
MEASURES TO ACHIEVE FIXED (N=25) (N=25)
Raw but not for cooked 13 (52) 11(46) 25 (50)
Cooked but not for raw 01 (02) --- ---
Both (raw + cooked) 02 (06) 2(02) 03 (07)
None 09 (36) 12 (50 ) 22 (43)
Multiple responses

A glance at the table indicates that there was an irregularity among anganwadi workers
regarding the use of standard measures to achieve fixed quantity of nutrition. In urban
projects the study revealed that majority (52%) of anganwadi workers were using standard
measure only for raw food. The table also highlights that there was a section (36 %) of
anganwadi workers in urban projects who were completely ignoring the use of standard
measures to achieve fixed quantity of nutrition. Only 2 % anganwadi workers in urban
projects were using standard measure for the distribution of cooked food and not using the
same for raw food.
The implementation of nutritional target at anganwadi centres in rural project was more
disappointing as majority (50%) of anganwadi workers were completely ignoring the use
of standard measures to achieve fixed quantity of nutrition. 46 % were using standard
measures only for raw food. It was observed during the entire study in both urban and rural
projects that anganwadi workers were distributing the cooked food among children with
mere experience and choice of their own intellect.

Table 4.19 Consumption of Supplementary Nutrition by Children at AWC

FREQUENCY (%) TOTAL

URBAN RURAL (N=50)
FOOD CONSUMPTION (N=25) (N=25) χ² value
Full 07 (28) 15 (60) 22 (44) --
Partial 15 (52) 08 (34) 23 (48) 10.2*
Nil 03 (10) 02 (06) 05 (08) --
*Significant at 0.05 level, critical χ² =3.84,df =1

52
During the training an anganwadi worker learns about cooking, distribution and serving of
supplementary food, skills of on the spot feeding of a child and take home ration. Table
revealed that there was significant difference in food consumption by children between
anganwadi centres from urban and rural zone. Majority (52%) of anganwadi workers in
urban projects reported for partial consumption of supplementary nutrition by children at
their respective anganwadi centres while 28% were stated that children tend to consume
full meal at the anganwadi centre. Remaining 10 % anganwadi workers stated that children
do not prefer eating at anganwadi centres and thus take their ration home for consumption.

The table 4.4.1.3 also highlights that majority (60%) of anganwadi workers in rural
projects stated that children tend to consume full meal at their respective anganwadi
centres while 17 % anganwadi workers reported for the partial consumption of
supplementary food by children at their anganwadi centres. Remaining 6% anganwadi
workers stated that children do not prefer eating at anganwadi centres and thus take their
ration home for consumption.

Implementation of Growth Monitoring at Anganwadi Centre

Table 4.20 Type of Weighing Scale Used at Anganwadi Centre

FREQUENCY (%) TOTAL

URBAN RURAL (N=50)
PARAMETERS (N=25) (N=25)
Type of scale available at AWC
Salter Scale 21 (82) 20 (80) 41 (81)
Any other scale ---- ---- ----
None 04(18) 05 (20) 09 (19)

The table highlights that majority of anganwadi workers in urban (82%) and rural (80%)
projects had Salter scale for weighing of children while 18 % in urban projects and 20%
in rural projects, anganwadi workers did not had any type of weighing scale. The reasons
observed for the non-availability of weighing scales were non functionality of the
apparatus or no supply of apparatus by the authorities. During the study it was found that
although the anganwadi workers were trained for execution of weighing scale but in
general practice, an ignorant approach was observed as only half of the sample population
was found for accurate handling of weighing scale. Anganwadi workers were not taking
precautionary measures like correction of zero error in weighing scale before weighing of

53
child, removal of maximum clothing and accessories from child ‘s body before weighing
and maintaining a minimum gap of two hours of diet intake before weighing. Thus,
efficiency of handling of the weighing scale used at anganwadi centre for growth
monitoring was found to be affected. It was found that there was lack of knowledge
regarding the use of weighing scale but in spite of that anganwadi workers were not found
motivated enough for discussing their queries with supervisors. Rather they preferred to
practice with limited knowledge.

All put together, it was highlighted by the table 4.4.2.1 that majority (81%) of anganwadi
workers had Salter scale while remaining 19 % did not had a weighing scale at anganwadi
centre.

Table 4.21 Implementation of Growth Monitoring Services

FREQUENCY (%) TOTAL

URBAN RURAL (N=50)
PARAMETERS (N=25) (N=25) χ² value
Record Maintenance at AWC 12 (48) 14 (56) 26 (52) 0.62
Accuracy in plotting weight on 11(46) 25 (49) 0.34
growth chart 13 (52)
Accuracy in proper use of
weighing scale at AWC 15 (60) 13 (54) 29 (57) 0.34
*Significant at 0.05 level, critical χ² = 3.84, df =1

The glance at table indicates that in urban projects, majority (60%) of anganwadi workers
had accuracy in proper use of weighing scale at anganwadi centre but the accuracy in
plotting weight on growth chart was found to be average as, only 52 % anganwadi workers
from urban projects were executing it properly. The record maintenance (48%) was found
to be unsatisfactory among urban anganwadi workers All put together, majority (57%) of
anganwadi workers had accuracy in proper use of weighing scale at anganwadi centre but
the accuracy in plotting weight on growth chart was found to be low as, only 49 %
anganwadi workers were executing it properly. The record maintenance (52 %) was found
to be average anganwadi workers. Negligence by choice and workload both was observed
on part of record maintenance during the study.

54
Implementation of Nutrition and Health Education at AWC

Table 4.22 Conduct of Nutrition and Health Education (NHED) Counselling at AWC

FREQUENCY (%) TOTAL

PARAMETERS URBAN RURAL (N=50)
NHED Counselling at AWC (N=25) (N=25) χ² value
Independent NHED Session 14 (56) 11 (46) 25 (51) 0.04
NHED Sessions with Mahila 10 (40) 18 (36) ----
Mandal Meeting 08 (32)
None 03 (12) 04 (14) 07 (13) ----
*Significant at 0.05 level, critical χ² = 3.84, df =1

The glance at table indicated that majority of anganwadi workers in urban (56%) and rural
(46 %) were organizing independent Nutrition and Health Education sessions at
anganwadi centres. While 32 % in urban and 40 % in rural projects, anganwadi workers
were conducing Nutrition and Health Education sessions with Mahila Mandal meeting and
reporting the same session for both registers i.e. Mahila Mandal and Nutrition and Health
Education. Under these mixed sessions anganwadi workers were discussing general topics
which used to be out of context with Nutrition and Health Education guidelines.

All put together, the table indicated that majority (51%) of sample population of
anganwadi workers were conducting independent Nutrition and Health Education session
while 36 % were organizing it with Mahila Mandals. Remaining 13 % anganwadi workers
were not found to be organizing any Nutrition and Health Education session at anganwadi
centers.

55
Nutritional Awareness Among Anganwadi Workers in Urban and Rural Zone of
Amritsar District

Awareness Among Anganwadi Workers Regarding

Health And Nutrition
Aware AWW (Urban%) Aware AWW (Rural %) Aware AWW (Total%)

Nutritional requirement to be fulfilled by AWC for

54 60 57
malnourished children (3-6 yrs)

Nutritional requirement to be fulfilled by AWC for the

30 66 48
normal children (3-6 yrs)

Balanced Diet 82 22 52

Health 78 90 84

Fig 4.1 Awareness among anganwadi workers regarding health and nutrition.

It was found that majority of anganwadi workers in rural projects had sufficient awareness
about health but they were not clear with the concept of balanced diet as the percentage
(22%) found among anganwadi workers was quite unsatisfactory.

All put together the table revealed that larger section of anganwadi workers had sufficient
awareness about health (84 %) but the awareness regarding the caloric requirement of
supplementary food for pre-schoolers at anganwadi centre (48%), balanced diet (52%) and
caloric need of supplementary food for malnourished children at anganwadi centre (57%)
were not found to be up to the mark.

56
Awareness Among Anganwadi Workers Regarding Functions of Food and Their
Sources

Awareness Among Anganwadi Workers Regarding

Functions Of Food And Their Sources

100

80

60

40

20

0
Aware AWW (Urban%) Aware AWW (Rural %) Aware AWW (Total%)

Energy foods Body building foods Protective foods

Pulses as a rich source Cereals as a rich source

Fig 4.2 Awareness among anganwadi workers regarding functions of food and their
sources
Similarly, it was seen from the above table that majority of anganwadi workers in urban
(84%) and rural (70%) projects had sufficient awareness regarding the pulses and its main
nutrient: protein but again they were lacking in awareness regarding the importance of
cereals and millets which provides carbohydrates as main energy giving food. The
awareness about cereals among anganwadi workers in urban (28 %) and rural (54%)
projects was not found to be satisfactory.

57
 Awareness Among Anganwadi Workers Regarding Nutritional Requirement

Awareness Among Anganwadi Workers Regarding

Nutritional Requirement
RDA for preschoolar Importance of protein Calories in 1gm protein Term RDA

8
Aware AWW (Total%) 80
3 p
13
e
2 r
82
Aware AWW (Rural %)
2 c
e
14
n
Aware AWW (Urban%) 78 t
4
26

Fig. 4.3 Awareness among anganwadi workers regarding nutritional requirement

that majority of anganwadi workers in urban (78%) and rural (82%) projects had sufficient
awareness regarding the importance of protein in children ‘s diet. It is also evident from
the table that in urban projects, only 26 % anganwadi workers were familiar with the term
RDA while 2 % had awareness about the number of calories present in 1 gm protein and
only 14 % anganwadi workers were aware with the RDA ‘s for pre-schoolers.

On the other hand, in rural projects it was found that anganwadi workers were completely
unaware about the term RDA while only 2 % anganwadi workers had awareness regarding
caloric content of 1gm protein and as well as about RDA for pre-schoolers. The data of
table highlighted the fact that anganwadi workers were lacking in technical knowledge of
nutritional requirements as the percentages were found to be unsatisfactory. The rural
anganwadi workers were more unaware regarding these parameters in comparison to urban
anganwadi workers.

58
 A W A R E N E S S A MO N G A N G A N W A D I W O R K E R S
R E G A R D I N G C O MMU N I T Y N U T R I T I O N
Aware AWW (Urban%) Aware AWW (Rural %) Aware AWW (Total%)

T IME PERIOD FOR WEANING 78 92 85

T YPES OF DIARRHOEA 46 34 40

T YPES OF MALNUT RIT ION 50 48 49

GRADES OF MALNUT RIT ION 60 60 60

MAJOR DEAT H CAUSE OF CHILDREN 72 36 54

Fig. 4.4 Awareness among anganwadi workers regarding community nutrition

in urban projects 72 % anganwadi workers were aware about the death cause of children
below five years in country which is malnutrition and 60 % had awareness regarding the
grades of malnutrition but only 50 % anganwadi workers were familiar with the various
types of malnutrition.78 % anganwadi workers in urban projects had awareness about the
time period of inclusion of weaning food in infant‘s diet and 46 % anganwadi workers
were familiar with types of diarrhoea.

Similarly in rural projects, 36 % anganwadi workers were aware about the death cause of
children in country which is malnutrition and 60 % had awareness regarding the grades of
malnutrition but only 48 % anganwadi workers were familiar with the various types of
malnutrition.92 % anganwadi workers in rural projects had awareness about the time
period of inclusion of weaning food in infant‘s diet and 34 % anganwadi workers were
familiar with types of diarrhoea.

59
 Awareness Among Anganwadi Workers Regarding
Deficiency Diseases
Aware AWW (Urban%) Aware AWW (Rural %) Aware AWW (Total%)

94
88 88 88 90 90 92
86 88

70
64 67

38 38 38 38

21

Cause of Weak Cause of Night Cause of Beri - Cause of Cause of Cause of

Eyesight Blindness Beri Scurvy Anaemia Goitre

Fig. 4.5 Awareness among anganwadi workers regarding deficiency diseases

Majority of anganwadi workers were aware regarding the Vitamin A deficiency, Anaemia
and Goitre but they were less familiar with Vitamin B and C deficiency diseases. In urban
projects, 88 % anganwadi workers were aware that Vitamin A deficiency can cause
weakness of eyesight, 70 % anganwadi workers replied that night blindness occurs due to
Vitamin A deficiency, 90 % replied that anaemia occurs due to deficiency of iron and folic
acid, 94 % were familiar that goitre occurs due to iodine deficiency while very less (38%)
anganwadi workers identified the cause of deficiency diseases like Beri Beri and scurvy.

Similarly, in rural projects 88 % anganwadi workers were aware that Vitamin A deficiency
can cause weakness of eyesight, 64 % anganwadi workers replied that night blindness
occurs due to Vitamin A deficiency, 86 % replied that anaemia occurs due to deficiency
of iron and folic acid, 90 % were familiar that goitre occurs due to iodine deficiency while
38% anganwadi workers identified the cause of deficiency disease scurvy and only 4 %
identified the cause of deficiency disease Beri Beri. The table clearly revealed that rural
anganwadi workers were unaware about the Vitamin B deficiency diseases and were also
less familiar with Vitamin C deficiency diseases in comparison to urban anganwadi
workers. All put together, the table indicated that 88 % anganwadi workers were aware
that Vitamin A deficiency can cause weakness of eyesight, 67 % anganwadi workers
replied that night blindness occurs due to Vitamin A deficiency, 88 % replied that anaemia
occurs due to deficiency of iron and folic acid, 92 % were familiar that goitre occurs due

60
to iodine deficiency while 38% anganwadi workers identified the cause of deficiency
disease scurvy and 21 % identified the cause of deficiency disease Beri beri.

Comparison for the level of Nutritional Awareness Among Anganwadi Workers and
their Implementation to Nutritional Services between Rural and Urban Zone of
Amritsar District

Urban AWC Awareness Rural AWC Awareness

60
100
50
80
40
60 30
40 20
20 10
0 0
Low (%) Medium (%) High(%) Low (%) Medium (%) High(%)

Follow up of menu Follow up of menu

Use of standard measure for weighing of raw Use of standard measure for weighing of
food raw food
Use of standard measure for distribution of
Use of standard measure for distribution of cooked food
cooked food

Fig.4.6: Execution of Nutritional Practices at AWC

In urban projects majority (42%) of anganwadi workers with medium awareness were
following the menu for food preparation at anganwadi centre while majority of anganwadi
workers were using standard measures for weighing of raw food (90%) as well as cooked
food (18 %) both.
Similarly, in rural projects, it was seen from table above that majority (43%) of anganwadi
workers with medium awareness were following the menu for food preparation at
anganwadi centre while majority (57%) of anganwadi workers with medium awareness
level were also using standard measure for weighing of raw food. anganwadi workers in
rural projects with low awareness level were using standard measure for distribution of
cooked food. All put together it was revealed by above that majority (42%) of anganwadi
workers with medium awareness were following menu for food preparation while majority
of anganwadi workers with high awareness were using standard measure for raw food
(63%) and cooked food (13%) both.

61
SUPPLEMENTARY FOOD CONSUMPTION BY CHILDREN AT ANGANWADI
CENTRE

Urban Children Rural Children

70 100
60
80
50
40 60

30 40
20
20
10
0 0
Full Partial Nil Full Partial Nil

Low (%) Medium (%) High(%) Low (%) Medium (%) High(%)

Fig. 4.7 Consumption of Supplementary Nutrition by Children at anganwadi center.

In urban projects, majority (45%) of highly aware anganwadi workers were making efforts
for the full consumption of meal by children at anganwadi centre while majority (64%)
anganwadi workers with medium awareness were making efforts for the partial
consumption of meal by children at anganwadi centre. in urban projects, majority (33%)
of anganwadi workers with low awareness were not making any effort for the consumption
of food by children at anganwadi centre and hence children at these anganwadi centres
showed nil consumption of supplementary food instead they found to take their meals at
home for consumption.
Similarly, in rural projects all (100%) highly aware anganwadi workers were making
efforts for the full consumption of food by children at anganwadi centre while majority
(75%) of anganwadi workers with low awareness level were making efforts for the partial
consumption of food by children at anganwadi centre. The table also highlighted that
majority (54%) of anganwadi workers with medium awareness level were not making any
effort for the consumption of supplementary food by children.

62
 URBAN AWC Rural AWC
120
90
80 100
70
60 80
50
40 60
30
20 40
10
0 20
Record Accuracy in Accuracy in 0
maintenance plotting proper use of Record Accuracy in Accuracy in
at AWC weight on weighing maintenance plotting proper use of
growth chart scale at at AWC weight on weighing scale
AWC growth chart at AWC

Low (%) Medium (%) High(%) Low (%) Medium (%) High(%)

Fig: 4.8 Implementation of Service under Growth Monitoring

in urban projects, majority (82%) of anganwadi workers with high awareness were
maintaining records at anganwadi centres. Moreover, it was also found that these highly
aware anganwadi workers were accurate in plotting weight on growth chart (64%) and
were accurate in proper use of weighing scale at anganwadi centre (73%).

In rural projects, all (100%) of the highly aware anganwadi workers were maintaining
records at anganwadi centre and were accurate in plotting weight on growth chart as well
as were accurate in proper use of weighing scale at anganwadi centres.

Urban AWC Rural AWC

None None

Mixed Session With

Mixed Session With
Mahila Mandal
Mahila Mandal Meeting
Meeting

Independent NHED Independent NHED

session session

0 20 40 60 80 100 0 50 100 150

High(%) Medium (%) Low (%) High(%) Medium (%) Low (%)

Fig .4.9: Nutrition and Health Education (NHED) Counseling at Anganwadi Centre

63
In urban projects, majority (82%) of anganwadi workers with high awareness level were
organizing independent Nutrition and Health Education sessions at anganwadi centre
while majority of anganwadi workers with low awareness in urban projects were either
organizing Nutrition and Health Education sessions with Mahila Mandal meeting (67%)
or were completely ignoring the Nutrition and Health Education sessions at anganwadi
centres.

On the other hand, in rural projects, majority (54%) anganwadi workers with medium
awareness level were organizing independent Nutrition and Health Education sessions at
anganwadi centre while majority (100%) of anganwadi workers with high awareness in
rural projects were organizing Nutrition and Health Education sessions with Mahila
Mandal meeting. The table also highlighted that majority (63%) of anganwadi workers
with low awareness were completely ignoring the Nutrition and Health Education sessions
at anganwadi workers.

64
 Assessment of Nutritional Status of Pre-Schoolers Attending AWC In Amritsar
District

Table 4.23 Age and Sex Variation in Anthropometric Characteristics of Urban and
Rural Children of Amritsar District

Urban Rural

BMI
Age N Weight ( Kg/Cm2 N Height (Cm) Weight ( BMI
Height
(Cm) Gender
Kg) Mean
Mean ± SD Kg) Mean ± Mean ± SD ± (Kg/Cm²)
Gender
SD Mean ± SD SD Mean ± SD

3-4 years Boys 25 96.04± 6.54 13.70±1.81 NA Boys 16 90.50±10.07 14.13±2.52 NA

Girls 24 95.40±5.52 12.64±1.61 NA Girls 24 90.83±8.56 14.22±2.32 NA

4-5 years Boys 9 103.75±8.54 15.68±2.57 NA Boys 10 96.52±9.95 16.36±2.38 NA

Girls 8 101.35±7.54 14.94±1.85 NA Girls 14 97.98±7.91 16.71±1.94 NA

5-6 years Boys 4 109.71±4.63 16.30±2.20 13.60±2.22 Boys 5 105.53±8.84 16.07±2.33 14.53±1.99

Girls 5 108.60±8.53 16.53±1.81 14.10±1.51 Girls 10s 105.95±8.01 15.78±2.24 14.02±1.01

Assessment of Nutritional Status by Anthropometric Measurements

It was indicated from the table 4 that mean height of urban children (boys and girls) aged
between 3-6 years was found to be higher than the mean height of rural children (boys and
girls) of same age groups.

Similarly, the mean weight of rural children (boys and girls) aged between 3- 5 years was
found to be higher than the mean weight of urban children (boys and girls) of same age
group. Within the age group of 5-6 years, it was found that the mean weight of urban
children (boys and girls) was higher than the mean weight of rural children (boys and girls)
of same age group. Within the age group of 5-6 years, it was found that the mean BMI of

65
 rural boys was found to be higher than the mean BMI of urban boys while the mean BMI
of rural girls was found to be higher than the mean BMI of urban girls

Table 4.24 Classification of Types of Malnutrition Based on Z- Scores for Urban and
Rural children (3-6 Years) of Amritsar District

Age Nutritional URBAN (N= 150) RURAL (N= 150)

Group Status Frequency (%) Frequency (%)
χ²

Malnutrition

Malnutrition

Malnutrition

Malnutrition

Malnutrition

Malnutrition
Moderate Value

Moderate
Normal

Normal
Severe

Severe
Total

Total
N

N
3-6 WFA 75 59 13 3 15 75 63 12 01 12 1.7
years (Underweight (79.3%) (17.3%) (3.3%) (20.6%) (84%) (15.3%) (0.6% (16%)
) )

3-6 HFA 75 56 13 6 18 75 38 17 18 35 20.6*

years (Stunting) (75.3%) (17.3%) (7.3%) (24.6%) (52.6%) (23.3%) (24% (47.3
) %)

3-5 WFH 66 30 2 1 3 33 28 3 2 4 0.31

years (Wasting) (92%) (6%) (2%) (8%) (88.4%) (8.4%) (3%) (11.5
%)

5-6 BMI 9 7 02 01 02 10 9 01 01 02 1.1

years (82.3%) (11.7%) (5.8%) (17.6%) (90%) (5%) (5%) (10%)

*Significant at 0.05 level, critical χ² =5.99, df =2

Concluding comments:
Weight for Age: It was seen from the table that 20.6% urban children and 16 % rural
children between 3-6 years were found to be underweight. Table data indicated that 17.3
% urban children showed higher percentage of moderate underweight than rural children
(15.3%). Similarly, 3.3 % urban children showed higher percentage of severe underweight
than rural children (0.6%). Chi square calculation showed insignificant difference in
underweight between urban and rural children.

Height for Age: it was seen from the table that 24.6 % urban children and 47.3 rural
children between 3-5 years showed prevalence of stunting according to height for age
parameter. Table data also revealed that 23.3 % rural children showed higher prevalence
of moderate stunting than their urban counterparts (17.3 %). Similarly, 24 % rural children

66
showed higher percentage of severe stunting than their urban counterparts (7.3%). There
was found a high significant difference between the prevalence of stunting between urban
and rural children of 3-5 years according to height for age parameter.
Weight for Height: it was seen from the table that 8 % urban children and 11.5% rural
children between 3-6 years showed prevalence of wasting according to weight for height
parameter. Table data also revealed that 8.4% rural children showed higher prevalence of
moderate stunting than their urban counterparts (6%). Similarly, 3% rural children showed
higher percentage of severe stunting than their urban counterparts (2%). There was found
an insignificant difference between the prevalence of wasting among urban and rural
children of 3-6 years according to height for age parameter.

BMI for age: it was seen from the table that 3 % urban children and 2 % rural children
between 5-6 years showed low BMI index. Table data also revealed that 11.7 % urban
children showed moderate malnourishment than their rural counterparts (5%). Similarly,
5.8% urban children showed higher percentage of severe malnourishment than their rural
counterparts (5%). There was found an insignificant difference between the BMI index
among urban and rural children of 5-6 years.
Assessment of Nutritional Status By 24-Hour Dietary Recall Method
Table 4.25. Mean Nutrient Intakes of The Children by Structured 24 Hour Dietary
Recall Method

URBAN RURAL
(N=25) (N=25)
NUTRIENT RDA MEAN % RDA MEAN %
±SD adequacy ±SD adequacy
Energy 1690 737.55± 43.6 1690 53.6
(kcal) 250.7 907.16±527
Protein 30 112 30 41.6
(gm) 33.6 ±19.7 42.5±22.7
CHO 211.25 63 211.25 88.8
(gm) 133.6±80.5 187.8±62.6
FAT (gm) 25 18±10.8 72 25 21±20.1 84
*RDA - Recommended Dietary Allowances,
**SD - Standard Deviation
*** % adequacy = Subject’s nutrient intake of a day/ RDA of the respective nutrient × 100

67
The 24-hr recall is a retrospective dietary assessment method that provides information on
the respondent ‘s exact food intake during the previous 24-hour period. Such information
can be used to characterize the mean intake of a group (Gibson, 1993). The table 4.25
indicated that mean daily intake of energy and protein in urban child population of
Amritsar district was 43.6% and 112% respectively while the mean daily energy and
protein intake in rural child population of Jammu district was 53.6% and 141.6%
respectively. It was found through the table data that the urban child population showed
higher percentage adequacy of mean energy intake than rural child population while rural
child population showed higher percentage adequacy of mean protein intake than urban
child population. Although it also revealed through the table 4.8.2.1 that percentage
adequacy of mean energy was found to be less than 100 percent but the percentage
adequacy of mean protein was found to be more than 100 percent within the child
population of study sample. It was observed during the study that major protein sources of
diet in urban as well rural population were found to be through pulses and milk. Quality
protein sources like eggs, milk products, meat, fish, Soya bean etc. was either found to be
less popular choice of dietary intake or consumed in lesser amount if eaten. Similarly, the
table data indicated that percentage adequacy of daily mean intake of carbohydrates and
fat was found higher (88.8 % and 84 %) among rural child population than urban child
population.

68
 Table 4.26 Children’s Percentage Between 3-6 Years Meeting Recommended Daily
Allowance (RDA)

Frequency (%)
Percentage of children meeting

Recommended 75 %and above of

75% of RDA 50% of RDA 25% of RDA
Dietary RDA

Allowances Urban Rural Urban Rural Urban Rural Urban Rural

(RDA) N=75 N=75 N=75 N=75 N=75 N=75 N=75 N=75
Energy RDA
(1690 kcal/day) 03(04) 04(06) 18(23) 29(39) 46(61) 41(55) 09(11) -
Protein RDA
(30 g/day) 51(68) 68(91) 20(27) 7(9) 03(4.6) 01(0.6) - -
Carbohydrate
RDA ( 15(21) 51(67) 33(44) 19(26) 25(33) 04(5.3) 01(2) 02(1.3)
211.25gm/day)
Fat RDA
28(37) 61(41) 22(29) 30(39) 15(21) 14(19) 8(13) 01(0.6)
(25g/day)
The RDA estimates are based on: “Nutritive value of Indian food” by
C.Gopalan, B.V Rama Shastri and S.C. Bala Subramanian, National Institute
of Nutrition, Indian Council of Medical Research, Hyderabad (2010)

It was seen from the table that majority of urban child population (61%) and rural child
population (55%) was meeting the energy needs of 50 % RDA while majority of urban
child population (68%) and rural child population (91 %) was meeting the protein needs
of 75 % and above RDA. Similarly, majority of urban child population (44%) was meeting
the carbohydrates needs of 75 % RDA but majority of rural child population (67 %) was
meeting the carbohydrates needs of 75 % and above RDA. Thus, cereal consumption and
other carbohydrates food consumption was found more in frequency in rural child
population than urban child population both in terms of quantity and quality. Table 4.26
also indicated that majority of urban child population (37 %) and rural child population
(41%) was meeting the fat need of 75 % and above RDA. Thus, the table indicated that
rural child population was closer in meeting higher needs of nutrients like protein,
carbohydrates and fats as per recommended dietary allowances (RDA) than urban child
population. Energy needs was fulfilled up to only 50 % of RDA in both populations, urban
as well as rural.

69
 CHAPTER-V
SUMMARY AND CONCLUSION
The findings of the study showed that the majority of anganwadi workers in urban and
rural projects were using standard measure only for distribution of raw food while very
few anganwadi workers in urban and rural projects were using standard measure for
distribution of cooked food. It was found through observations during study that
anganwadi workers were not disciplined enough to follow guidelines for the execution of
supplementary nutrition. Further it was revealed by the study that there was an irregularity
among anganwadi workers regarding the use of standard measures to achieve fixed
quantity of nutrition. It was found that majority (49%) of anganwadi workers were using
standard measure only for raw food while 1% anganwadi workers were using it only for
cooked food. A prominent section (43%) of anganwadi workers were completely ignoring
the use of standard measures for achieving the fixed quantity of nutrition while only 4 %
anganwadi workers among entire sample were using standard measures for both raw as
well as cooked food and thus were implementing the nutritional guidelines of ICDS for
the achievement of nutritional target. It was observed during the entire study in both urban
and rural projects that anganwadi workers were distributing the cooked food among
children with mere experience and choice of their own intellect. Anganwadi workers were
usually following the criteria of feeding the child on the basis of child ‘s own intake
capacity of food rather than the actual need of supplementation fixed under ICDS for
children. Thus, a low interest for taking the efforts for feeding the full fixed meal to child
by anganwadi workers was observed during the study.

The findings of the study revealed that majority of anganwadi workers had accuracy in
proper use of weighing scale at anganwadi centre but the accuracy in plotting weight on
growth chart was found to be low. Calculation of chi square further revealed insignificant
difference between anganwadi centres from urban and rural zone for accuracy in plotting
weight on growth chart and accuracy in proper use of weighing scale at anganwadi centre.
On Further exploration through the findings of the study, it was revealed that although
majority (42%) of anganwadi workers were accurate in using weighing scale as well as
growth chart but there was a next higher prominent population (34 %) of anganwadi
workers with in the sample population who were not trained enough for the proper
execution of growth monitoring either by proper use of weighing scale or growth chart.
The remaining percentage of sample population was also not up to mark with execution

70
skills of growth monitoring as 8 % anganwadi workers were accurate in plotting weight
on growth chart but were found to be inaccurate with proper use of weighing scale.
Similarly, 14 % of anganwadi workers had accuracy in using weighing scales but were
found to be inaccurate for the use of growth chart. During the study, it was found that
although the anganwadi workers were trained for execution of weighing scale but in
general practice, an ignorant approach was observed as only half of the sample population
was found for accurate handling of weighing scale. Anganwadi workers were not taking
precautionary measures like correction of zero error in weighing scale before weighing of
child, removal of maximum clothing and accessories from child ‘s body before weighing
and maintaining a minimum gap of two hours of diet intake before weighing. Thus,
efficiency of handling of the weighing scale used at anganwadi centre for growth
monitoring was found to be affected. It was found that there was lack of knowledge
regarding the use of weighing scale but in spite of that anganwadi workers were not found
motivated enough for discussing their queries with supervisors. Rather they preferred to
practice with limited knowledge. Similarly, for judging the accuracy of skills for plotting
the weight on growth chart these workers were observed for putting a right mark on growth
chart and making a right starting point for coding child data of weight and height.

The table indicated that majority of sample population of anganwadi workers were
conducting independent Nutrition and Health Education session while 36 % were
organizing it with Mahila Mandals. There was found a section of anganwadi workers who
were not organizing any Nutrition and Health Education session at anganwadi centers.
Calculation of chi square further revealed insignificant difference between anganwadi
centers from urban and rural zone for services of nutrition and health education at
anganwadi centre. During the study it was observed that the anganwadi workers who were
organizing Nutrition and Health Education sessions with Mahila Mandal were interacting
with the few members of Mahila Mandal on various topics like breast feeding,
immunization, diet for pregnant woman, education of girl child, pulse polio drops, winter
care for kids, safe drinking water etc., ranging from Nutrition and Health Education topics
to Mahila Mandal. It was observed during the study that the Nutrition and Health
Education sessions organized at anganwadi centers, whether independent or mixed session
with Mahila Mandal, were all unstructured and unplanned in nature. No pre planning for
the conduction of these sessions by anganwadi worker was found.

The findings of the study further highlighted that majority (71%) of anganwadi workers

71
were organizing Nutrition and Health Education session for once a month only while 9 %
were doing the same for twice a month. 20 % anganwadi workers were completely
ignoring the conduction of Nutrition and Health Education session. During the study, it
was observed that many of the anganwadi workers were even not aware of mandatory
guidelines of organizing two independent sessions of Nutrition and Health Education in a
month. It was also observed that anganwadi workers were not confident and motivated
enough of personating themselves as a nutrition and health educator for these sessions.
They also reported the non-cooperation of community for these sessions and thus found
helpless enough to conduct the sessions within the schedule.

It has been analyzed by the study that there is positive influence of nutrition awareness on
implementation of nutritional services at anganwadi centre. For every percent increase in
nutritional awareness, positive implementation of nutrition services at anganwadi centre
increases by 0.055. Nutrition awareness significantly predicted implementation of
nutrition services.

All put together, the study highlighted that majority (73%) of anganwadi workers had
medium awareness regarding nutrition. 16 % of anganwadi workers had scored for high
awareness of nutrition. The reason observed were less interactions between
supervisors/CDPO ‘s and anganwadi workers, less visits by supervisors to rural anganwadi
centres because of their location in far flung areas and low confidence and motivation
among anganwadi workers to seek guidance from supervisor regarding any query.
Calculation of chi square further revealed insignificant difference between nutritional
awareness among anganwadi centers from urban and rural zone of Jammu district.

The study concluded that majority (73%) of anganwadi worker in the sample locale have
shown medium awareness level. On the basis of the findings of the study, it is evident that
majority of anganwadi workers with high awareness level have participated in
implementation of nutritional services in both zone of sample locale. Anganwadi workers
with low awareness level showed least participation in the implementation of nutritional
services while anganwadi workers with medium awareness level have participated in
between the line. With the help of regression analysis, it has been established by the study
in advance that awareness does have a positive influence on the implementation of the
services. Thus study depicted that there is scope of improving the training quality of
anganwadi workers with medium awareness and converting them into a highly aware

72
worker in order to improve the quality of implementation of nutritional services. This
effort, in result, will lead to successful achievement of nutritional targets of ICDS. The
comparison between urban and rural zone showed that urban anganwadi workers with high
awareness level showed better participation for implementation of nutritional services in
comparison to rural anganwadi workers with high awareness.

Malnutrition were reported in all age groups of the sample population. There was found a
significant difference in nutritional status between the urban and rural children on the
parameters of height for age, weight for height and body mass index.

The results of the study revealed that majority of child population in urban and rural zone
of sample area were consuming 50% of RDA ‘s of Energy. It was also reported that
majority of child population of urban and rural children of sample area were consuming
75% and above of RDA‘s for protein and fats. The study further highlighted that in spite
of higher percentage adequacy of nutrient intake by rural children, they were significantly
reported to be more malnourished for stunting (HFA) in comparison to urban preschool
children.

There is a huge difference between the expected and final output of nutritional services at
anganwadi centre. An astonishing difference was reported for use of standard measure for
raw and cooked food at anganwadi centers. Only 4 % anganwadi workers were using
standard measure for raw and cooked food against mandatory practice. Similarly, an
extensive difference was reported for follow up menu, consumption of supplementary
nutrition by children, record maintenance, accuracy in proper use of children and plotting
weight on growth chart and conduct of NHED sessions against mandatory practice.

Conclusion:
The present study shows that in spite of the fact that most (72 %) of the anganwadi workers
in study area were trained and had a high range (20-30 years) of work experience, it was
found that performance as well as awareness among anganwadi workers regarding the
importance of implementation of nutritional services was not satisfactory. Although the
anganwadi workers were mostly familiar with the knowledge for various nutritional
services of ICDS but the provision of these services, their importance for the programme
was not clear to them, also the implementation part of these services was immensely
lacking in aspect of effective utilization of these services by the beneficiaries and for

73
beneficiaries. The study concluded that chaos and irregularities at work place was the
common practice among anganwadi workers. The study concluded that although the
knowledge was sufficient among anganwadi workers but the quality knowledge was one
of the neglected features among job profile of anganwadi worker. Their nutritional
knowledge regarding the role of supplementary nutrition and ICDS norms was not up to
the mark as expected from a trained worker and hence an utmost need of regular quality
training as well as on spot training programme was strongly felt. The study also suggests
that the quality of training being provided to anganwadi workers at training centers should
be strictly scrutinized as it is the first step towards the achievements of goals of ICDS.

74
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WEBSITES LINKS
MINISTRY OF WOMAN AND CHILD DEVELOPMENT http://wcd.nic.in/
NATIONAL INSTITUTE OF NUTRITION http://www.ninindia.org/

NATIONAL INSTITUTE OF PUBLIC COOPERATION AND

CHILD
DEVELOPMENT http://nipccd.nic.in/ SHODHGANGA

http://shodhganga.inflibnet.ac.in/

UNITED NATION INTERNATIONAL CHILDREN EMERGENCY

FUND
http://www.unicef.org/india/

WIKIPEDIA http://en.wikipedia.org/wiki/Main_Page

WORLD HEALTH ORGANIZATION http://www.whoindia.org/en/index.htm

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 ANNEXURE
Observation Sheet for Anganwadi centre
Demographic profile of anganwadi worker:
 Name of anganwadi worker:
 Age:
 Qualification:
 Date of joining:
 Years of experience in ICDS:
 Training status: trained/untrained If trained, which category:
 Orientation
 On job
 Referral
 Any other Last training received:
 Does anganwadi worker belong to same village/area? Yes/ no If no,
how far is her residence from anganwadi centre?
Basic information about anganwadi centre:
 Selected zone of anganwadi centre: urban/rural
 Total number of enrollment of children (0-6 yrs)
 Total number of enrollment of children (3-6 yrs) If enrollment is low, what is
the reason?
Comments:

Physical infrastructure of anganwadi centre

 Building of anganwadi centre:
a) pacca b) kaccha c) semi pacca If semi
pacca, 1) ceiling 2) flooring
 Storage space for raw material
a) Separate room b) within kitchen area c) with in main room
 Indoor space for anganwadi activities
a) Congested b) non congested

 Outdoor space for play activities

a) Congested b) non congested c) not available
  Outdoor space is safe from
a) Animals b) road traffic c) thorny bushes
 Separate space for cooking facility
a) Available b) not available
 Availability of utensils in anganwadi centre:
 Cooking utensils number condition Pressure
cooker
Big vessels Small vessels Spatula
 Serving utensils number condition Plates
Katori Spoons Glass
 Storage utensils number condition Big
drum
Small containers
 Ventilation of anganwadi centre yes/ no
a) Ventilated b) not ventilated
 Hygienic conditions of anganwadi centre yes /no
a) Dust and dirt b) Stagnant water
c) Foul smell d) Mosquitoes /cockroaches/lizards
 Toilet facility available in anganwadi centre yes / no
a) Indian b) English
 Source of drinking water available with in anganwadi centre yes/ no
a) Tap water b)hand pump c) stored water

 Type of ration provided to anganwadi centre

Type details of food items quantity
a) Raw food ( sukha ration)
b) Ready to eat mixture
c) Packed food
Implementation of services in anganwadi centre:
 Type of food supplied to children
a) Locally cooked b) ready to eat c) any other
 Follow up of weekly menu yes/ no
Monday
Tuesday

Wednesday
Thursday

Friday
Saturday

Comments:

 Is there any use of standard measure for weighing of raw food in

anganwadi centre used for preparation of supplementary nutrition
for children? Yes/no
Comments:

 Is there any use of standard measure in anganwadi centre for

distribution of cooked food to children? Yes/no
Comments:

 Acceptability of food by children

a) Full b) partial c) nil
Comments:

 Quality of food served to children:

Name of the dish:

Grades
Parameters
Poor Good Excellent
Appearance
Aroma
 Palatability
Texture

Comments:

 Is record and maintenance register are properly maintained? Yes/no

Types Of Records Daily Weekly Monthly 2 Month Quarterly More

 Is there accuracy in plotting the weight on growth charts by the anganwadi centre?
Yes/no
Comments:

 What type of scale being used in anganwadi centre for weight records?
a) Salter scale b) any other scale c) none
 Does anganwadi worker use d it properly? Yes/no
Comments:

 Does anganwadi worker organize counseling sessions with mothers under nutrition
education program? Yes/no
If yes, a) what is the frequency?

b) Topic of last meeting?

Interview Schedule for Anganwadi Worker

1) What do you understand by health?
A. A state of Physical well being
B. A state of Social well being
C. A state of Physical and Mental well being both
D. A state of complete physical, mental and social well being and not merely the absence of
disease or infirmity.
Comments:
2) What do you understand by balanced diet?
A. Intake of adequate amount of cereals and pulses
B. Intake of adequate amount of cereals and pulses and fruits
C. Intake of adequate amount of cereals and pulses and vegetables
D. Intake of different types of foods in such quantities and proportion that the need for all
nutrients is adequately met.
Comments:

3) Energy giving foods are

A. Carbohydrates, fats C. Proteins, minerals
B. Vitamins, minerals D. Water, roughage
Comments:

4) Body building foods are

A. Proteins, minerals C. Carbohydrates, fats
B. Vitamins, minerals D. Water, roughage
Comments:

5) Protective foods are

A. Water, roughage C. Proteins, minerals
B. Carbohydrates, fats D. Vitamin, minerals
Comments:

6) What is RDA?
A. Revised dietary allowance C. Recommended dietary
allowance
B. Revised disease allowance D.Recommended duplicate
allowance Comments:

7) One gm proteins contain

A. 6 kcal C. 5 kcal
B. 8 kcal D.4 kcal
Comments:
 8) Pulses are rich source of
A. Carbohydrates C. Vitamins
B. Protein D. Fats
Comments:

9) Cereals and millets are rich source of

A. Carbohydrates C. Vitamins
B. Protein D. Fats
Comments:

10) Proteins are mainly important for children because

A. It provides energy to body
B. It provides growth and repair of body
C. It provides protection to body
D. None of the above
Comments:

11) RDA for pre school children are

A. 1240 kcal,22 gm protein,25 gm fat
B. 1690 kcal,30 gm protein,25 gm fat
C. 1950 kcal,41 gm protein,25 gm fat
D. 1650 kcal, 25 gm protein, 15 gm fat.
Comments:

12) Major cause of death among children below five

A. Diarrhea C. Dehydration
B. Malnutrition D. None
Comments:

13) In how many grades malnutrition is categorized

A. 2 C. 4
B. 3 D. 5
Comments:

14) Two types of malnutrition are

A. Marasmus and kwashiorkor C. Grade 1 and grade 2
B. High malnutrition and low malnutrition D .Acute and chronic
Comments:

15) Diarrhea is categorized into how many types

A. 4 C. 2
B. 5 D. 3
Comments:

16) When should be the appropriate time to add adequate supplements in

baby‘s diet along with breast milk?
a) 4 months c) 8 months
b) 6 months d) 5 months
17) How much nutritional requirement does anganwadi centre fulfills for the
children of 3-6 yrs under ICDS project?
a) 200 kcal c) 300 kcal
b) 5ookcal d) 600kcal
18) How much nutritional requirement does anganwadi centre fulfills for the malnourished
children of 3-6 yrs under ICDS project?
a) 150 kcal c) 300 kcal
b) 600kcal d) 500 kcal
Check list for nutritional deficiency disorders and its symptoms
 Kwashiorkor and Marasmus are two diseases occur due to PEM
a) True b) False
Comments:

 Deficiency of vitamin A can cause weakness of eyesight.

a) True b) False
Comments:

 Anaemia occurs due to deficiency of iron and folic acid

a) True b) False
Comments:

 Goiter occurs due to deficiency of iodine in diet

a) True b) False
 Comments:

 Paleness of nails and eyes is the symptom of anaemia

a) True b) False
Comments:

 Night blindness occurs due to deficiency of vitamin A

a) True b) False
Comments:

 Beriberi is deficiency disease occurs due to deficiency of vitamin B ( Thiamin)

a) True b) False
Comments:

 Scurvy is deficiency disorder which occurs due to deficiency of vitamin C

a) True b) False
Comments:

 Bleeding gums is a symptom of vitamin C deficiency in body

a) True b) False
Comments:

 Growth failure ,thin and dry hairs ,discoloration of hairs, wrinkled skin and bony
structure, low body weight etc are symptoms of PEM
a) True b) False
Comments:

Assessment Of Nutritional Status Of Preschool Children

Name of child:
Sex of child: Male / Female Age of child (yrs):
Height of child (in cms):
Weight of child (in kgs):
Ideal weight:

24-Hour Dietary Recall Sheet

 Meal Meal time Menu Quantity
Early morning
Breakfast

Mid morning
Lunch

Mid noon
Dinner

Bed time

Total calories:
Carbohydrates:
Proteins:
Fats:
NUTRITIONAL AWARENESS AMONG ANGANWADI WORKERS AND
THEIR IMPLEMENTATION TO NUTRITIONAL SERVICES: A
COMPARATIVE STUDY OF RURAL AND URBAN ZONE OF
AMRITSAR DISTRICT.

JAGJEET KAUR
ENROLMENT No. 130476759

A research proposal
Submitted to Indira Gandhi National Open University
In partial fulfilment of the requirement
For the degree of

MASTER OF SCIENCE
IN
DIETETICS AND FOOD SERVICE MANAGEMENT

SCHOOL OF CONTINUING EDUCATION INDIRA GANDHI

NATIONAL OPEN UNIVERSITY NEW DELHI
(2019)
 INTRODUCTION

The concept of human development rests on three pillars: knowledge, health and livelihood.
Health of the people has been recognized as a valuable national resource and the Government
‘s endeavour has been to improve the same and enable them to contribute to the enhancement
of the Nation ‘s productivity. Health is defined by World Health Organization (WHO) as a state
of complete physical, mental and social well-being and not just avoidance of disease. Physical
health implies the perfect functioning of the body (WHO, 1948). It conceptualizes health as a
state in which every cell or organ is functioning at optimum capacity and is in perfect harmony
with the rest of the body.
Nutrition is the science of foods, the nutrients and other substances therein; their action,
interaction and balance in relationship to health and disease. It can be defined as the process
by which the organism ingests, digests, absorbs, transports and utilizes nutrients and disposes
of their end products. Nutrition can also be defined as ―food at work in the body‖. Nutrition
must perforce be concerned with social, economic, cultural and psychological implications of
food and eating. Good, adequate and optimum are the terms applied to that quality of nutrition
in which the essential nutrients in correct amounts and balance are utilized to promote the
highest level of physical and mental health throughout one ‘s life. (Moorthy, 1993)
Malnutrition can be defined as a pathological state resulting from a relative or absolute
deficiency or excess of one or more essential nutrients, which can manifest into over-nutrition
or under nutrition or imbalance.

ICDS Launched on 2nd October 1975 in 33 Community Development Blocks, ICDS today
represents one of the worlds ‘s largest programmes for early childhood development. ICDS is
the foremost symbol of India ‘s commitment to her children – India ‘s response to the challenge
of providing pre-school education on one hand and breaking the vicious cycle of malnutrition,
morbidity, reduced learning capacity and mortality, on the other. It is an inter-sectoral
programme which seeks to directly reach out to children, below six years, especially from
vulnerable and remote areas and give them a head-start by providing an integrated programme
of early childhood education, health and nutrition.
OBJECTIVES OF THE STUDY:

1. To assess the implementation of nutritional services provided to pre- schoolers (3-6 yrs.) at
anganwadi centre.
2. To assess the nutritional awareness among anganwadi workers and study the influence of
nutrition knowledge for improved performance of implementation of nutrition services at
anganwadi centre.
3. To assess the nutritional status of pre- schoolers (3-6 yrs.) attending anganwadi centers and
Comparison for the level of nutritional awareness among anganwadi workers and their
implementation to nutritional services between rural and urban zone of Amritsar district.
4. To evaluate the final output and expected output of nutritional services at anganwadi

centers.
 REVIEW OF LITERATURE

Proper background information to design the research programme, analyse the research data
and interpret the research findings is provided by comprehensive review of literature. A critical
appraisal of earlier studies is essential for thorough understanding of the problem. It has been
observed that very few research studies were conducted on nutrition awareness among
anganwadi workers. However, a good number of studies are available on the nutritional status
of children. Keeping in view the specific objectives of the present research, an earnest effort
was made to collect the literature related to anganwadi worker and nutrition awareness either
directly or indirectly through other related parameters. The available literature has been
organized and presented under the following heads:

Health and Nutrition Status of India

Training, Knowledge, Awareness, Performance and Job Satisfaction of Anganwadi
Worker

Implementation of nutritional services at anganwadi centre.

Anganwadi Training Institutes.

HEALTH AND NUTRITION STATUS OF INDIA

Mishra et al (2000) presented a study under National Family Health Survey, titled as
―Women‘s Education Can Improve Child Nutrition in India ―. The study estimated the levels
of child malnutrition and examines the effects of mother‘s education and other demographic
and socioeconomic factors on the nutritional status of children. Results

Singh et al (2006) conducted a study to assess the impact of drought on childhood illness and
nutrition in under- five children of the rural population. The study was carried out in 24 villages
belonging to 6 tehsils of Jodhpur district which was a drought affected desert district of Western
Rajasthan. A total of 914 under 5 children (0-5 years) could be examined for their childhood
illness history, malnutrition, dietary intake and clinical signs of nutritional deficiency.

TRAINING, KNOWLEDGE, AWARENESS, PERFORMANCE AND JOB SATISFACTION OF

ANGANWADI WORKER

Udani and Patel (1980) The Integrated Child Development Services Scheme of urban slum of
Bombay was launched in April 1977. The evaluation of knowledge and competence of
anganwadi workers emplyed was carried out in February–March 1979 and again in February–
March 1980. An attempt was made to assess the impact of their knowledge, on the community
in respect of their health and nutrition components.

Gujral et al (1992) conducted a study in which forty-three anganwadi workers (community

health workers) in Gujarat state, India, were interviewed to record their education level,
evaluate their nutrition knowledge, and collect information on the number of visits made by
the auxiliary nurse midwife (ANM) in the preceding three months and the activities she
performed for the anganwadi.

IMPLEMENTATION OF NUTRITIONAL SERVICES AT ANGANWADI CENTRE

National Council of Economic Research (1998) conducted a pilot study for the
evaluation of ICDS scheme in the selected blocks of five states .It was found that
supplementary nutrition used to be given to pre schoolars across the states. Supplementary
feeding for pre school children aims at preventing marginal cases of under nutrition for lapsing
into severe or fatal forms. About 75% of the children received the supplements regularly and
also consumed it at spot.

Bhasin et al (2001) conducted a study in 13 anganwadi (out of 132) in Nand Nagri, East Delhi
to assess the nutritional status of children in relation to utilization of ICDS during their early
childhood. Information regarding utilization of ICDS facilities, socio-demographic details,
general awareness etc was collected through interviews, anthropometric and clinical
examination of every child and attendance score of every child at the anganwadi was
calculated.

2.4 NUTRITIONAL STATUS OF ICDS CHILDREN

Pratinidhi et al (1998) conducted a study to know the calorie intake of children who were
beneficiaries of supplementary nutrition of ICDS in project area of Pune city. From 11
anganwadis, 165 children were taken, using cluster sampling method. Mothers of these children
were interviewed to know their knowledge and perceptions regarding ICDS as well as the
dietary intake of child in the previous 24 hours were also taken. Results revealed that
immunization (93.9%) and nutrition (75.8%) was recognized by mothers as the main activity
in the anganwadi.

RESEARCH METHODOLOGY
 RESEARCH:
A WAY OF EXAMINING YOUR PRACTICE…

Community-level workers, such as Auxiliary Nurse Midwives (ANMs) and Anganwadi

Workers (AWWs), deliver most of the critical public health services for the poor in India.
Nutrition is the focal point of health and well-being and it is directly linked to human resource
development, productivity and ultimately to the national growth. As the anganwadi worker is
the key person in the ICDS programme, her education level and knowledge of nutrition plays
an important role related to her performance in the anganwadi centre. It has also been reported
that, in addition to education level, training of anganwadi workers about growth monitoring
plays a beneficial role in improving their performance (Gopaldas et al., 1990).

Research methodology is a way to systematically solve the research problem. It may be

understood as a science of studying how research is done scientifically. The procedure followed
in sampling, empirical measurement of variables, devices used for collection of data .

Sample of study
Sample size 50
Sampling procedure descriptive study and multistage random sampling will be done
Sampling unit anganwadi workers

Tools of sampling
Observation
Interview schedule
Sample locale
Anganwadi centers of rural and urban zone of Amritsar district.

Observation Sheet for Anganwadi centre

Demographic profile of anganwadi worker:

 Name of anganwadi worker:
 Age:
 Qualification:
 Date of joining:
 Years of experience in ICDS:
  Training status: trained/untrained If trained, which category:
 Orientation
 On job
 Referral
 Any other Last training received:
 Does anganwadi worker belong to same village/area? Yes/ no If no, how far
is her residence from anganwadi centre?
Basic information about anganwadi centre:
 Selected zone of anganwadi centre: urban/rural
 Total number of enrollment of children (0-6 yrs)
 Total number of enrollment of children (3-6 yrs) If enrollment is low, what is the
reason?
Comments:

Physical infrastructure of anganwadi centre

 Building of anganwadi centre:
a) pacca b) kaccha c) semi pacca If semi
pacca, 1) ceiling 2) flooring
 Storage space for raw material
a) Separate room b) within kitchen area c) with in main room
 Indoor space for anganwadi activities
a) Congested b) non congested

 Outdoor space for play activities

a) Congested b) non congested c) not available
 Outdoor space is safe from
a) Animals b) road traffic c) thorny bushes
 Separate space for cooking facility
a) Available b) not available
 Availability of utensils in anganwadi centre:
 Cooking utensils number condition Pressure
cooker
Big vessels Small vessels Spatula
 Serving utensils number condition Plates
 Katori Spoons Glass
 Storage utensils number condition Big drum
Small containers
 Ventilation of anganwadi centre yes/ no
a) Ventilated b) not ventilated
 Hygienic conditions of anganwadi centre yes /no
a) Dust and dirt b) Stagnant water
c) Foul smell d) Mosquitoes /cockroaches/lizards
 Toilet facility available in anganwadi centre yes / no
a) Indian b) English
 Source of drinking water available with in anganwadi centre yes/ no
a) Tap water b)hand pump c) stored water

 Type of ration provided to anganwadi centre

Type details of food items quantity
a) Raw food ( sukha ration)
b) Ready to eat mixture
c) Packed food
Implementation of services in anganwadi centre:
 Type of food supplied to children
a) Locally cooked b) ready to eat c) any other

 Follow up of weekly menu yes/ no

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Comments:

 Is there any use of standard measure for weighing of raw food in anganwadi centre used for
preparation of supplementary nutrition for children? Yes/no
Comments:
 Is there any use of standard measure in anganwadi centre for distribution of cooked food to
children? Yes/no
Comments:

 Acceptability of food by children

a) Full b) partial c) nil
Comments:

 Quality of food served to children:

Name of the dish:

Grades
Parameters
Poor Good Excellent
Appearance
Aroma
Palatability
Texture

Comments:

 Is record and maintenance register are properly maintained? Yes/no

Types Of Records Daily Weekly Monthly 2 Month Quarterly More

 Is there accuracy in plotting the weight on growth charts by the anganwadi centre? Yes/no
Comments:

 What type of scale being used in anganwadi centre for weight records?
a) Salter scale b) any other scale c) none
 Does anganwadi worker use d it properly? Yes/no
Comments:

 Does anganwadi worker organize counseling sessions with mothers under nutrition education
program? Yes/no
If yes, a) what is the frequency?

b) Topic of last meeting?

Interview Schedule for Anganwadi Worker

1) What do you understand by health?
A. A state of Physical well being
B. A state of Social well being
C. A state of Physical and Mental well being both
D. A state of complete physical, mental and social well being and not merely the absence of
disease or infirmity.
Comments:

2) What do you understand by balanced diet?

A. Intake of adequate amount of cereals and pulses
B. Intake of adequate amount of cereals and pulses and fruits
C. Intake of adequate amount of cereals and pulses and vegetables
D. Intake of different types of foods in such quantities and proportion that the need for all
nutrients is adequately met.
Comments:

3) Energy giving foods are

A. Carbohydrates, fats C. Proteins, minerals
B. Vitamins, minerals D. Water, roughage
Comments:

4) Body building foods are

A. Proteins, minerals C. Carbohydrates, fats
B. Vitamins, minerals D. Water, roughage
Comments:
 5) Protective foods are
A. Water, roughage C. Proteins, minerals
B. Carbohydrates, fats D. Vitamin, minerals
Comments:

6) What is RDA?
A. Revised dietary allowance C. Recommended dietary allowance
B. Revised disease allowance D.Recommended duplicate
allowance Comments:

7) One gm proteins contain

A. 6 kcal C. 5 kcal
B. 8 kcal D.4 kcal
Comments:
8) Pulses are rich source of
A. Carbohydrates C. Vitamins
B. Protein D. Fats
Comments:

9) Cereals and millets are rich source of

A. Carbohydrates C. Vitamins
B. Protein D. Fats
Comments:

10) Proteins are mainly important for children because

A. It provides energy to body
B. It provides growth and repair of body
C. It provides protection to body
D. None of the above
Comments:

11) RDA for pre school children are

A. 1240 kcal,22 gm protein,25 gm fat
B. 1690 kcal,30 gm protein,25 gm fat
C. 1950 kcal,41 gm protein,25 gm fat
 D. 1650 kcal, 25 gm protein, 15 gm fat.
Comments:

12) Major cause of death among children below five

A. Diarrhea C. Dehydration
B. Malnutrition D. None
Comments:

13) In how many grades malnutrition is categorized

A. 2 C. 4
B. 3 D. 5
Comments:

14) Two types of malnutrition are

A. Marasmus and kwashiorkor C. Grade 1 and grade 2
B. High malnutrition and low malnutrition D .Acute and chronic
Comments:

15) Diarrhea is categorized into how many types

A. 4 C. 2
B. 5 D. 3
Comments:

16) When should be the appropriate time to add adequate supplements in baby‘s diet
along with breast milk?
a) 4 months c) 8 months
b) 6 months d) 5 months
17) How much nutritional requirement does anganwadi centre fulfills for the
children of 3-6 yrs under ICDS project?
a) 200 kcal c) 300 kcal
b) 5ookcal d) 600kcal
18) How much nutritional requirement does anganwadi centre fulfills for the malnourished
children of 3-6 yrs under ICDS project?
a) 150 kcal c) 300 kcal
b) 600kcal d) 500 kcal
 Check list for nutritional deficiency disorders and its symptoms
 Kwashiorkor and Marasmus are two diseases occur due to PEM
a) True b) False
Comments:

 Deficiency of vitamin A can cause weakness of eyesight.

a) True b) False
Comments:

 Anaemia occurs due to deficiency of iron and folic acid

a) True b) False
Comments:

 Goiter occurs due to deficiency of iodine in diet

a) True b) False
Comments:

 Paleness of nails and eyes is the symptom of anaemia

a) True b) False
Comments:

 Night blindness occurs due to deficiency of vitamin A

a) True b) False
Comments:

 Beriberi is deficiency disease occurs due to deficiency of vitamin B ( Thiamin)

a) True b) False
Comments:

 Scurvy is deficiency disorder which occurs due to deficiency of vitamin C

a) True b) False
Comments:

 Bleeding gums is a symptom of vitamin C deficiency in body

a) True b) False
Comments:
 Growth failure ,thin and dry hairs ,discoloration of hairs, wrinkled skin and bony structure,
low body weight etc are symptoms of PEM
a) True b) False
Comments:

Assessment Of Nutritional Status Of Preschool Children

Name of child:
Sex of child: Male / Female Age of child (yrs):
Height of child (in cms):
Weight of child (in kgs):
Ideal weight:
24-Hour Dietary Recall Sheet

Meal Meal time Menu Quantity

Early morning
Breakfast

Mid morning
Lunch

Mid noon
Dinner

Bed time

Total calories:
Carbohydrates:
Proteins:
Fats:
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