Observational study of IYCN (Infant and Young Children Nutrition) Practices from 06 – 24 months old children at Anganwadi centre of old Bhopal

 

(A report submitted to IGNOU in partial fulfilment of the Requirement for the degree of Master’s of Science in Dietetics and Foods Science Management)

School of Continuing Education 

Indira National Open University 

New Delhi

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Authentication Certificate

STUDENT CERTIFICATE

The work embodied in this dissertation entitled “Observational Study of IYCN (Infant and Young Children Nutrition) Practices from 06-24 months old children at Anganwadi Centre of old Bhopal” has been carried out by me under the supervision of “Dr. Vandana Shirvastava” This work is original and has not been submitted by me for the award of any other degree to this or any other University. 

Date: - ………………………        ………………………

Place: - . BHOPAL                                               (Signature and Name  of the Candidate)

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CERTIFICATE OF DISSERTATION COUNSELOR

I/We certify that the candidate Mrs.  xyz Bano   has planned and conducted the research study entitled “Observational Study of IYCN (Infant and Young Children Nutrition) Practices from 06-24 months old children at Anganwadi Centre of old Bhopal” under my/our guidance and supervision and that the report submitted herewith is a bonafide work done by the candidate in Anganwadi Centre, Ibrahimpura, Bhopal,   from  1 January, 2019 to 30 April, 2019. 

Date:  ……………………. …………………………………… 

Place: …………………….                                                       

 (Signature and Name, Designation of the Counselor ) …………………………………….. 

                                                                                         Signature of Programme Incharge

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ACKNOWLEDGEMENTS

I would like to thank a few people without whom it would have not been possible to write this thesis. First and foremost, I would like to thank my guide and mentor Dr. Vandana  Shrivastava for the continuous guidance, support motivation and showing me the directions in moments of dilemma.

 I express my heart – felt thanks to Dr. Manjula  Vishwas for her guidance and inculcating good Dietetic practice in my life. 

I would like to thank the entire staff of Anganwadi Centre who helped me a lot in data collection and compilation. This works bears an indelible imprint of their hard works. 

Last but not the least I would like to express my deepest gratitude towards Mrs. Sunita  Sahu Incharge of Anganwadi Centre who have made this project possible and have added immensely to my knowledge. 

Parents are perpetual source of inspiration, I express my sincere gratitude towards my family for inspiring me to take up this research work and this project and guiding me in all my affairs.

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ABSTRACT

Background- The optimal infant and young children feeding practices during the first 2 years of life is of paramount importance as this period is the “critical window for the promotion of health, good growth, behavioral and cognitive development.” 

Aim: To assess infant and young children feeding practices among mothers in the Anganwadi Centre of Ibrahimpura ward-18 of old Bhopal. 

Methods & Materials- In this observational study  Random Sampling method was used. 100 mothers were evaluated in context to exclusive breastfeeding and complementary feeding practices through questionnaire having children of age 06 months to 24 months at Anganwadi Centre of old Bhopal. 

Results: In this observational study it was found that, Percentage of exclusive breastfeeding till six months was 26% and percentage of parents had started complementary feeding at 6 months of age was 46%. 

Conclusion: In present study, awareness of exclusive breastfeeding and complementary feeding is required for proper growth and development of children in the Anganwadi Centre of old Bhopal. It was also found that nutrition and immunization provided by the Anganwadi Centre helps a lot in maintaining proper health of children.

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INTRODUCTION

Nutrition of infants and young children is critical for their survival, cognitive development and growth not only during the childhood but for their whole life span. Malnutrition is young children is attributed to various factors including female illiteracy, ignorance about nutritional needs of infants and young children and poor access to health care. Adequate and regular complementary feeding of infants with home based foods from the age of six months, while continuing breastfeeding, is crucial for their healthy growth and development. In children, growth is most rapid at the younger age. While the child is in the mother’s womb, it grows many times from a tiny egg to a baby weighing between 2.5kg-3kg at birth. The baby grows most rapidly during the first year of life called infancy. A healthy baby gains about 800 grams each month during the first two months of life, about 600 grams from 3 months to 4 months, around 400 grams from 5 months to 6 months, and thereafter healthy child gains around 200 grams each month up to 3 years. The faster growth in infancy makes these babies vulnerable to factors like inadequate nutrition or illness, which might slow or stop growth. As per new WHO child growth standards, there are separate growth charts for girls and boys, As they have different weights and lengths beginning at birth and grow to different sizes according to age. Nutritional deficiencies are widely prevalent in India in the rural areas, particularly among the poor families. Nutrition disorders occurring due either to deficiency of macro-nutrient I.e. energy and proteins or micro-nutrients like vitamin A and B complex. Human beings require balanced diet to live, thrive and survive to carry out various activities. Any imbalance or inadequacy in foods and nutrients could cause ill health, lead to nutritional disorders and even cause death. The main purpose is to focus on the nutritional problems and importance and adequacy of complementary feeding in M.P. BHOPAL. Complementary feeding has remained an important component to control under nutrition. Considering the dietary inadequacy in the diets of poor rural families, various programs provide daily supplement food providing about 300 k cal of energy and 8-10 g of protein per child under various feeding programs.

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ICDS 

In India, Integrated child Development Services (ICDS) is one of the largest nation – wide child development programmes. It is currently in operation in most of the community development blocks in the country and as per the National Nutrition Policy (NNP) it will be expanded to the entire rural and 50% of the urban areas of the country. In addition to ICDS, the Department of Health, which has extensive infrastructure in the rural areas, can also be considered as the delivery mechanism surveillance. In fact, the nutrition surveillance should be a combined approach both by the Health and ICDS departments. 

ICDS and Health department to collect information on several health and nutrition indicators. Some key indicators which are critical for a successful nutrition surveillance programme are: 

Enrolment and attendance of different beneficiaries for supplementary nutrition and preschool education.

 Nutritional status of children and its trends. 

Growth faltering among children.

 Prevalence of nutritional deficiency signs like oedema (kwashiorkor), wasting (marasmus), Bitot spots, night blindness and visible goitre. Coverage under national programmes namely

 a. Immunization of children and expectant women. 

b. Vitamin ‘A’ distribution to children 

Bhopal is the capital of the  Madhya Pradesh. Bhopal is known as the city of Lakes for its various natural as well as artificial lakes and is also one of the greenest cities in India. It is the 17th largest city in the country and 131st in the world. 

    Bhopal has an average elevation of 500 metres (1401ft). It is located in the central part of India and is just north of the upper limit of the Vindhya Mountain ranges. Located on the Malwa Plateau, it is higher than the north Indian plains and the land rises towards the Vindhya Range to the South. The city has uneven elevation and has small hills within its boundaries. The prominent hills in Bhopal are Idgah hills and Shyamala hills in Southern region. City's geography has in it two lakes namely upper lake and lower lake. Bhopal city is divided into two parts where one part which is near the VIP and lake is old Bhopal (north) and the other is where mainly malls are situated New Bhopal (south). 

    Bhopal current population is now estimated at 23,33,106. In 1950, the population of Bhopal was 1,00,258. Bhopal has grown by 2,24,619  since 2015, which represents a  2.56%   annual change. These population estimates and projections come from the latest revision of the UN World Urbanization Prospects. 

    This observational study was conducted in old Bhopal, Ibrahimpura, Bhopal, Madhya Pradesh. 100 mothers were randomly selected who came at Anganwadi Centre (ward-18) Ibrahimpura, old Bhopal and having children from the age of 6 months to 24 months.

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Aims & Objectives

• To study the breastfeeding practices among lower income group at Anganwadi centre of old Bhopal, Ibrahimpura, whether exclusively breastfed till six months or not. 
• To study that the infants are getting approximate complementary foods after six months at their home and through Anganwadi Centre. 
• To study the growth monitoring of 06-24 months children according to WHO standard for boys & girls whether the weight and height is according to their age or not. 
• To study whether immunization schedule is properly followed at the Anganwadi Centre of old Bhopal. 
• To study  the dietary habits and sanitary conditions in preparing and serving the food to their children.

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REVIEW OF LITERATURE

Breast-milk in the ideal food for growth and development of infants. Ideally breastfeeding should be initiated within one hour of birth followed by frequent, on demanding feeding (WHO 2004). Despite being known to improve child survival, only 54.9% of children are exclusively breastfed in India. Breastfeeding was initiated within one hour in 41.6% of the children, which has almost doubled since the last round of NFHS – 3 (23.4%). Early initiation of breastfeeding, exclusive breastfeeding, initiation of complementary feeding after six months and appropriate Infant and Young Child Feeding (IYCF) practices are being promoted by the Ministry of health and family in collaboration with the Ministry of woman and child development. A recent initiative launched in August 2016, Mother Absolute Affection (MMA) Program, among mothers and includes awareness generation, community level interventions and health facility strengthening and monitoring.

Childhood under nutrition accounts for 45% of under – 5 mortality alone and remains a key public health challenge in India. There was hardly any difference in the proportion of children (<5 years of age) with wasting between NFHS – 3 and NFHS – 4, however, there was a reduction in prevalence of stunting by about 10% at the national level. Even after 35 years of the launch of the Integrated Child Development Services (ICDS) scheme, the problem of under nutrition still continue and the reduction in the prevalence is relatively unimpressive.

According to a study, the program gave more attention to food distribution rather than the quality of care. In addition, poor skills of the staff, scarcity of logistics and poor supervision have added to the problem. The Mid Day Meal Scheme (MDM) is another initiative that focuses on promotion of food security, nutrition and access to education for children. Nutrition Rehabilitation Centres (NRCs) have been set-up at facility level to provide medical and nutritional care to Severe Acute Malnourished (SAM) children under 5 years of age who have medical complications. Dietary diversification still remains the most appropriate way forward, though supplementation and fortification should also be considered potential solutions to fill nutritional gaps.

A detailed review of observational studies examined the mortality reduction with childhood vaccines. A total of 24 studies on measles vaccine were included, the authors reported that relative risk of mortality was reduced by 62-86%.

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INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) PROGRAMME

The ICDS programme is primarily a child welfare programme. It was started by the Government of India in 1975-1976. Before ICDS a number of child health and nutrition programmes were being operated by different departments but without proper coordination. In ICDS, for the first time an attempt has been made to combine (integrate) all the relevant services of health, nutrition and education and deliver them as a package to children and their mothers.

The programme’s main aim is to provide nutrition, health and educational services to children before and after birth and through the early childhood period so that their proper physical, mental and social development is ensured.

The specific objectives of ICDS are to:

1. Improve the nutritional and health status of children in the age group of 0 to 6 years and adolescents.
2. Lay the foundation for proper psychological, physical and social development of the child.
3. Reduce the incidence of mortality, morbidity, malnutrition and school drop outs.
4. Achieve effective coordination of policy and implementation amongst the various departments to promote child development.
5. Enhance the capability of the mother to look after the health and nutritional needs of the child through proper nutrition and health education.

The Components of the ICDS programme are:

1. Supplementary nutrition
2. Immunization
3. Periodic health check-ups, treatment of minor ailments and referral services.
4. Growth monitoring.
5. Non – formal preschool education.
6. Health / nutrition education to women.
7. Safe drinking water.

The focal point of the convergence (bringing together) of these services is the ‘Anganwadi’ (AW). The AW or preschool child centre is located within a village slum or tribal area. Each centre is managed by an Anganwadi worker (AWW) and a helper.

SUPPLEMENTARY NUTRITION:

All families in the community are surveyed to identify the poorest children below the age of six and expectant or nursing mothers. Three hundred days a year, supplementary food is prepared and distributed to them at the Anganwadi. The type of food from state to state but usually consists of a food item (That can easily prepared at the Anganwadi) containing cereals, pulses, oil and sugar. Some states provide a ready – to – eat snack containing the same basic ingredients.

In Andhra Pradesh, for example, a ready – to – eat (RTE) powder is made from wheat flour, defatted soya flour (flour of soyabean from which tat has been removed) milk powder and sugar. This powder is then used to prepare a supplement. For infants and very young children, the powder is mixed with clean drinking water and fed. This is why the powder is also called a ready – to – mix (RTM) powder.

Special care is taken to reach children below the age of three and to encourage parents and sibling to bring them to the Anganwadi for feeding. By providing about 300 calories a day to children under 6 years, the anganwadi attempts to bridge the calorie – gap i.e., deficit in calories that exists between the home diet they consume and what require for healthy living. Food consumption surveys have shown that on an average, an Indian preschool child eats food which supplies 800-900 calories while he / she requires 1240 calories per day. This means the gap is around 300 calories per day.Additionally, specific nutrients are supplied to take care of individual deficiencies vitamin A for blindness, iron and folic acid for anaemia and iodized salt in areas where iodine deficiency is present. Energy, and protein content of the supplementary food supplied to different target beneficiary groups is as follows-

supplementary food supplied

IMMUNIZATION SCHEDULE

Immunization plays a crucial role in preventing serious childhood diseases. These diseases includes tuberculosis (TB), diphtheria, whooping cough, poliomyelitis (polio) measles, tetanus and typhoid. Some of the diseases e.g. measles can result in severe malnutrition. They can also kill the young child. The recommended immunization schedule is given here.

For the Infant/young children

Health check-up, treatment of minor ailments and referral services:- 

At the Anganwadi, children, adolescent girls and pregnant and lactating mothers are examined and treated at regular intervals by the local health personnel, such as the Lady Health Visitor (LGV) and Auxiliary Nurse Midwife (ANM). The Lady Health visitor is also called the health Centre and Sub-centres. In addition, the Anganwadi medical kit. Children / women requiring special investigations and treatment are referred to doctors at the PHC or district hospital

GROWTH MONITORING

Monitoring in a simple layman’s terminology means keeping a regular track or check on something, like every week or every month. Keeping a regular track of the change in weight over a period of time (i.e. every month) can, therefore, be referred to as Growth Monitoring. From this, statement it might however appear that growth monitoring is only an assessment (i.e. weighing) tool but this is not true.

Growth monitoring is the regular measurements, recording and interpretation of a child’s growth change in order to counsel, act and follow up results. In other terms assessment (weight) and action (consequence of results) are linked by relevant interpretation in growth monitoring. These activities are best described by the term Growth Monitoring and promotion (GMP). The term promotion has been added because monitoring alone emphasizes assessment rather than action.

Growth Monitoring has been defined in many ways. The Integrated Child Development Services (ICDS) Programme defines growth monitoring as under:

Growth Monitoring is a regular measurement of growth which enables mothers to visualize growth or lack of it, and obtain specific relevant and practical guidance to ensure continued regular growth and health of children.

In most developing countries children suffer from malnutrition, which you know is associated with poverty, compounded by repeated infections (like diarrhea, measles) and illnesses. The resulting feature is – weight loss or lack of weight gain (i.e. growth faltering). Growth faltering, therefore, can best be detect at an early phase through growth monitoring and promotion.

The purpose of Growth Monitoring is to help identify the at – risk child, take action on the first sign of inadequate growth and integrate nutrition intervention (breast feeding, supplementary feeding etc.) with other health interventions (immunization, ORI) to restore health and proper growth of children. Growth Monitoring is a preventive and promotive strategy aimed at action before malnutrition strategy aimed at action before malnutrition occurs. By creating concern and demand for growth and enabling it to be visualized Growth Monitoring uses regular monitoring of growth to establish a regular, recurring, effective communication with each mother.

Infact it acts as a tool for health and nutrition education to mothers thus promoting optional health of the child.

As a vital input to provide the essential services of health check – up and referral services, each anganwadi center is provided every year with a medicine kit consisting of easy to use and dispensable medicines to remedy common ailments like cough and common cold, skin infections etc. If the ailment requires specialized treatment the case is referred to the nearest health system. They provide a link between the village and the Primary Health Centre and sub – centres.

THE ROLE OF KEY PROJECT STAFF CHILD DEVELOPMENT PROJECT OFFICER (CDPO)

• Provides link between ICDS and government administration. 
• Secures anganwadi premises. 
• Incharge of 4 Supervisors and 100 AWWs. 
• Identifies beneficiaries and ensures supply of food to centre and flow of health services. Monitors programme and reports to State Government. 

SUPERVISOR 

• Responsible for 20-25 anganwaris. 
• Acts as mentor to AWWs. 
• Assists in record keeping, organizing common unity visits, visits of health personnel. Provides on – the – the job training to AWWs. 

ANGANWADI WORKER (AWW) 

• Is multi – purpose agent of change 
• Selected from the community. 
• Provides direct link to children and mothers. 
• Assists CDPO in survey of community and beneficiaries. 
• Organizes non – formal education sessions. 
• Provides health and nutrition education to mother. 
• Assists PHC staff in providing health services. 
• Maintains records of immunization, feeding and pre- school attendance.
• Liaises with block administration local school, health staff and community. 
• Other community – based activities e.g. family planning.

A) ANGANWADI WORKER (AWW) 

AWW is usually a woman from the same village, slum or tribal area where the centre is located. She plays a pivoted role in the ICDS structure due to her close and continuous contact with the community. As the crucial link between the village population and the Government administration, she becomes a central figure in assessing and meeting the needs of the community. 

B) SUPERVISOR (MUKHYA SEVIKA) 

For every 20 to 25 anganwadis, one senior person invariably a lady is appointed to supervisor and guide the AWW in her day – to – day activities. She is called a Mukhya Sevika (MS) and is trained for three months at Home Science Colleges or Departments of Social Work in the universities. 

C) CHILD DEVELPOPMENT PROJECT OFFICER (CDPO) At the block level a senior officer, designated as CDPO, is appointed to oversee the programme. He / She is responsible for the implementation of the programme within the Block. CDPOs are given Special two months training in child development, accounting, and finance management and survey techniques.

CLINICAL SIGNS OF NUTRITIONAL DISORDERS 

1. Clinical signs are changes in the body which are indicative of nutritional deficiency / excess. 
2. Protein energy malnutrition 
3. Vitamin A deficiency 
4. Anaemia 
5. Goitre 
6. Fluorosis 
7. Vitamin C deficiency 
8. Rickets Essential fatty acid deficiency 
9. Vitamin B Complex deficiency

A. Protein Energy Malnutrition - Clinical forms of protein energy Malnutrition (PEM) are kwashiorkor, marasmus and marasmic - kwashiorkor.

a. Kwashiorkor 

It is more common among children of 1-3 years of age. The most important sign without which a diagnosis of kwashiorkor should not be made is presence of oedema (swelling of the body). The swelling is present mostly in the extremities particularly the lower extremities (legs and feet). The investigator can confirm the presence of oedema by applying pressure with the thumb over the skin just above the ankle or feet for a few seconds. It would leave a depression, when thumb is removed, the depression will disappear. In a normal child who does not have any oedema, no such depression would occur.

Children with kwashiorkor are always apathetic and often irritable showing no interest in their surroundings. Their skin and hair (flag signs) may show changes. Kwashiorkor may be associated with other deficiencies and infections. Let us now discuss clinical sign of marasmus.

b. Marasmus 

Marasmus is characterized by extreme wasting of muscle and subcutaneous fat. The child is very thin, with skin loosely hanging and appears to have nothing but skin and bones. The child has an old man’s face and is extremely weak with little strength even to cry. The body weight could be as low as 50% of standard weight for age. Hair will be thin and sparse. The child may be associated with diarrhea and other infections. 

Let us now discuss clinical signs of marasmic kwashiorkor:

c. Marasmic kwashiorkor 

Sometimes a child may suffer from clinical signs of both marasmus and kwashiorkor, this child may be having marasmic kwashiorkor. Marasmus with associated oedmea is called as marasmic kwashiorkor. The child therefore would be emaciated and will also have oedema. 

Let us go to clinical signs of vitamin A deficiency.

B. Vitamin A deficiency - Deficiency of vitamin ‘A’ leads to changes in eyes (ocular signs). The ocular lesions – also known as xerophthalmia – can be of milder nature, such as night blindness, changes in the white of the eye like conjunctival xerosis or Bitot’s spots. The severe lesions of eye affect the black of the eye (cornea). These are corneal xerosis, corneal ulcer of keratomalacia, which results in permanent loss of vision. Let us review these manifestations.

a. Night blindness Night blindness is the earliest symptom of vitamin ‘A’ deficiency in preschool children. The affected child cannot see properly at dusk. Often, an attentive mother can recognize the child’s inability to see the plate of food or toys in ill-li room.

b. Conjunctival Xerosis Conjunctival Xerosis is recognized by dryness of the conjunctiva, which also becomes thick and wrinkled. It appears rough instead of being smooth and glistening. The dryness becomes more obvious when the conjunctiva is exposed to air for 10-15 seconds by keeping eyelids drawn back.

c. Bitot’s Spots These are dirty white, foamy and raised spots on the surface of the conjunctiva, generally seen on the outer side of the cornea. Bitot spot may appear as a single spot or as several small spots, which may later unite to form a large triangular patch with base towards cornea. Bitot’s spots will be stained black when the children use ‘Kajal’. The Bitot’s sots may appear in only one eye or both eyes.

d. Corneal Xerosis This is manifestation of severe Vitamin ‘A’ deficiency, in which the cornea loses its normal smooth and glistening appearance and becomes dry and rough. Due to inability to see bright light, the child tends to keep the eyes closed and, hence, the condition may be missed during the clinical examination, if not observant.

e. Corneal ulcer Corneal xerosis, if not treated promptly, leads to uncertain of the cornea. Initially, the ulcer may be shallow, and if it becomes deep, it may lead to perforation resulting in prolapse of contents of the eyeball.

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METHODOLOGY

Growth monitoring and promotion of children from birth to five years is one of the important components of the ICDS programme. Weight-for-age is used as an indicator for detecting early growth faltering, assessing nutritional status of children and  taking appropriate measures on the first signs showing inadequate growth or no weight gain or loss of weight, for preventing and reducing the undernutrition. Growth monitoring is done with the help of growth chart developed on the basis of growth standards of children It is in this context that the practice of growth monitoring acquires significance. Fortunately, the onset of malnutrition, anaemia and most of the diseases can be detected if the growth is monitored regularly.

This observational study was conducted from January 2019 to April 2019 in the Anganwadi Centre of old Bhopal city. It includes the children from the age of 06-24 months. It covers the complementary feeding, Growth monitoring and Immunization. The subjects (mother/ children)  was selected attending the Anganwadi Centre. Detailed data was collected of all the subjects including the demography ie. Age and sex, weight, height, Immunization, dietary habits, health issues, Sanitization etc. In addition the data regarding their family background was also collected.

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INCLUSION CRITERIA: The children were enrolled in the study from the age of  06-24 months. It was divided in two groups.

Group I - 6-12 months

Group II - 13-24 months

A study group was made of 50 infants / young children in each group. Nutrition knowledge was assessed by a questionnaire specifically designed for the study. The questionnaire helped to test  the  knowledge of mothers regarding their infant/young children nutrition, food composition, misconception about  food.   This helped to collect all the data regarding the children about their breast feeding duration, food habits, growth and development of body, Immunization etc. The questionnaire was designed in a multiple choice format. It contains 20 questions in a very simple and familiar language, which can be easily understood by the mother of children so that the required data can be obtained to complete the survey.

EXCLUSION CRITERIA The age of children present in the Anganwadi Centre was upto 6 years.  Children of the age more than 24 months and less than 6 months were not considered for the study.

INVESTIGATIONS: This observational study was conducted from January 2019 to April 2019 in the Anganwadi Centre of old Bhopal, Ibrahimpura ward-18.The timing for research in the Anganwadi Centre was taken from 9 Am to 1:00 Pm. The selection for the group of population was done by Random sampling method. Mothers of children aged 06-12 months and 13-24 months were invited to take part in the study at Anganwadi Centre. During the study, the infants / young children were  monitored at the time of enrollment, the mothers were interviewed to obtain background  information regarding food intake and feeding practices (i.e. whether breast fed and / or formula fed etc.) It was checked that how long exclusively breastfed and age of giving of solid food to their young children. The infants and young children were weighed and length was measured at the time of enrollment and checked at Anganwadi Centre whether it is accurate according to the age or not .Salter Scales and Digital Weighing Scale is necessary to monitor the weight of babies above six months of age .Followed the new growth chart prescribed by the World Health Organization (WHO) for growth monitoring. Record of Immunization of children was checked at Anganwadi Centre whether properly followed by their parents or not. Sanitary habits of their  parents towards their children’s diet  was also checked with the help of questionnaire .The  representation of data was done in  the form of  tables, charts, pictures, and diagrams.

Anganwadi Project Study

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RESULTS

The following results were obtained in this prospective study which was conducted from January, 2019 to April, 2019 in the Anganwadi Centre of old Bhopal, Ibrahimpura (ward – 18). A total of 100 children were evaluated during the study and it was found that percentage of exclusive breastfeeding till 6 months was 25% and percentage of starting complementary feeding at 6 months of age was 46%. Some more things were also find out which is being discussed here in this section.

A. GENDER: In this study there were 55 males (55%) and 45 females (45%)

Gender distribution of children

Above is the gender distribution of children in total 100 children

B. AGE DISTRIBUTION: The children included in this study were in the age range from 06 months to 24 months. They were classified into two groups 06 – 12 months (Group I) and 13-24 months (Group II).

c) Etiological Evaluation For etiological evaluation four most important factors i.e. Breastfeeding, Complementary feeding, Growth Monitoring and Immunization were taken into consideration. Weight, Height, Sex, dietary habits were also evaluated. 

i) Dietary Pattern Among 100 children, there were 22% vegetarians and 28% Non – Vegetarians in Group II. In Total 100 children there were 43% vegetarians and 57% Non – Vegetarians.

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DISCUSSIONS

The aforementioned results were contrasted with various other studies and pertinent literature and following inferences could be drawn in this prospective study On the basis of present observational study which was conducted from January 2019 to April 2019 at Anganwadi centre (ward-18),  Ibrahimpura, Bhopal. 100 mothers was randomly selected at Anganwadi centre and enquired through Questionnaire and it was found that only 26% infants are exclusively breastfed for six months. In this study it was found that the practice of continued breast feeding for children of 4 months was 18% and the rate of continued breastfeeding for children aged 5 months was 56% and the rate of breastfeeding of 6 months old children was 26%. Complementary foods should be introduced to children at 6 months of age, but in this study it was found that the month of starting feeding complementary foods for 6 months old children was 46%, while 36% mothers started giving complementary foods to their children from the age of 5 months and some mothers started giving complementary foods to their children from the age of 4 months. In this study it was also  found that many mothers lacked information on feeding practices for their young children, and that they largely believed that as long as a child was not hungry, he or she was getting adequate nutritional intake. If children who are breastfed feel fuller longer, then their mothers may feel less urgency in introducing more and more varied complementary foods. House hold income may also be a factor. Since breastfeeding is sometimes seen as low cost alternative, it may be that the poorer families are engaging in continued breastfeeding, and are therefore also less likely to have high levels of dietary diversity due to low  income. It was also seen in this study that that education level of mothers is not high some of them are illiterate, 27% mothers were higher secondary passed whether 43% were high school passed and remaining 30% were below these levels. This also play a very important role in the health of their children.

According to the survey of NFHS-4 which was held on 2015-16, breast milk is the ideal food for growth and development of infants. Ideally, breastfeeding should be initiated within one hour of birth followed by frequents, on demand feeding (WHO-2004). Despite being known to improve child survival, only 54.9% of children are exclusively breastfed in India. According to the survey of International Breastfeeding Journal 2018, which was accepted on 23 July 2018 and published on 29 August, In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. On the basis of study carried out in KIMS Hubli Hospital included a total 112 lactating mothers having children less than 1 year. Majority of the mothers (76.7%) studied belong to age group 21-30 years,  63.4% of infants received exclusive breastfeeding. 60.7% of the infants received breast milk on demand basis and 39.3% thought that breastfeeding should be given at scheduled time.

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SUMMARY

In present study evaluated 100 children in the Anganwadi Centre of old Bhopal. Two groups were made and each group contains 50 children. Group I is having children from the age of 6 months – 12 months and Group II is having children from the age of 13 months – 24 months. All the children were weighed and length was measured and cheeked whether it is according to the WHO Growth Chart or not. Then through a Questionnaire consist of 20 easy and genuine questions which was asked to their mothers to find out their breastfeeding duration, dietary habits, Hygiene & Sanitation, Immunization, Growth Monitoring etc. Out of the total 100 children 26% children were exclusively breastfed till six months, 45% mothers include other milk like Cow milk, buffalo milk or formula milk along with the breastfeeding, 45% mothers started giving complementary foods from the age of six months, 36% mothers were giving complementary foods 6 times a day, 32% mothers included sprouted pulse in the diet of their child, 41% mothers gave their children seasonal fruits and vegetable daily in the diet of their children, 76% mothers prepare the food for their children along with the food of other family members by modifying it, 89% mothers always washed their hands with soap before cooking and at the time of serving of food to their children, 92% mothers washed the fruits and salads before giving to their children, 48% mothers prepared the food for their children to increase the iron content in iron utensils, 68% mothers started giving non – vegetarian foods from the age of 8 – 10 months, 28% mothers are having the misconception that this food item should not be given to their children, 37% mothers know that their child is having food allergy, 65% mothers registered their child from the age of birth to 6 months, 4% children are having physical or mental health issues, 89% mothers done the vaccination of their children on proper time schedule, 74% mothers gave their children polio drops and vitamin A medicine on time, Only 10% mothers came to Anganwadi Centre on monthly basis for Growth Monitoring of their child, 87% mothers accept that the food provided by Anganwadi Centre improved the health of their children, 83% mothers are satisfied with all the services provided by Anganwadi Centre.

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CONCLUSION

In present study some more awareness is required to improve the health of the children. There is a need to remove the misconception of mothers about the foods and dietary habits and patterns. Mothers should be more encouraged to follow the proper time schedule for vaccination and for growth monitoring of their children. These steps will help a lot to improve the health status of the children of lower income group. This survey was conducted to cover all the  points like exclusive breastfeeding up to six months, appropriate complementary feeding, maintenance of proper hygiene, immunization etc in the Anganwadi Centre of old Bhopal. It helped us to understand whether the WHO guidelines being followed or not.

Human growth is very fast in formative years, particularly from birth to five years. Health and medical experts therefore plead for particular care in infancy and early childhood. The growth of the children is monitored by AWWs and the respective supervisors making use of growth charts, which in lay terms means an illustrative bird’s eye view of each individual child that instantly shows whether the child is normal or suffering from malnutrition.

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