Determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS)
Manas Ranjan Pradhan1, Mahesh Rajendra Shete2
1Assistant Professor, Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India.
Insights
Undernutrition remains a major concern for Indian children under five, even those utilizing Integrated Child Development Services (ICDS). Key factors influencing child nutrition include age, gender, maternal education, and socioeconomic status, not ICDS utilization itself.
Area of Science:
- Public Health
- Nutrition Science
- Pediatrics
Background:
- Undernutrition is a critical public health issue in India, contributing significantly to the nation's disease burden.
- Children under five are particularly vulnerable, with undernutrition posing a major risk factor for morbidity and mortality.
- The Integrated Child Development Services (ICDS) program aims to address these challenges through various interventions.
Purpose of the Study:
- To investigate the determinants of nutritional status among Indian children under five who are beneficiaries of ICDS.
- To analyze the association between ICDS service utilization and the nutritional outcomes (stunting, wasting, underweight) of young children.
- To identify key socioeconomic and demographic factors influencing undernutrition in this vulnerable population.
Main Methods:
- Utilized data from the National Family Health Survey-4 (2015-16) for a large cohort of under-five children (n=1,27,813) with ICDS service access.
- Assessed stunting, wasting, and underweight based on World Health Organization guidelines as primary outcome variables.
- Employed binary logistic regression to examine the influence of ICDS utilization and other predictors on children's nutritional status, using STATA V.13 for analysis.
Main Results:
- A significant proportion of under-five children receiving ICDS services exhibit undernutrition, with prevalence varying by socioeconomic and demographic factors.
- ICDS utilization showed an insignificant association with the nutritional status of under-five children.
- Children who were not immunized through ICDS centers were paradoxically less likely to be stunted, wasted, or underweight, suggesting potential program inefficiencies or confounding factors.
Conclusions:
- The study highlights that while ICDS services are available, their direct utilization is not significantly associated with improved nutritional status in children under five.
- Child's age and gender, maternal education and nutritional status, wealth index, social group, and region are significant determinants of undernutrition among ICDS beneficiaries.
- Recommendations include ensuring comprehensive service delivery within Anganwadi Centers (AWCs), emphasizing nutritional practices, and enhancing parental education on child health and nutrition.
Abstract:
Background: Undernutrition is a significant public health problem and the leading risk factor for India's disease burden. Aim: To understand the determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Methods: The study used the National Family Health Survey-4 (2015-16) data. The analysis was carried out for under-five children who have availed of any ICDS services in the 12 months preceding the survey (n = 1,27,813). Stunting, wasting, and underweight were estimated following the World Health Organization guideline and used as the outcome variables. The binary logistic regression was conducted to examine the association of ICDS utilization and socioeconomic-demographic predictors with under-five children's nutritional status. STATA (V 13) was used for statistical analyses. Results: A sizable proportion of under-five children receiving any ICDS services suffer from undernutrition. The undernutrition prevalence varied considerably by socioeconomic and demographic characteristics. Logistic regression found an insignificant association of ICDS utilization with the nutritional status of under-five children. Children not immunized in ICDS centers were less likely to be stunted (OR: 0.93; P < 0.01), wasted (OR: 0.93; P < 0.01), and underweight (OR: 0.90; P < 0.01) than their counterparts. The child's age and gender, maternal education and nutrition status, wealth index, social group, region, residence, and region were significant determinants of undernutrition among ICDS beneficiaries. Conclusion: The study suggests the need to ensure all available services to children enrolled in the Anganwadi Center (AWC). The program should also emphasize feeding practices and educate parents about improving child health and nutrition.
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