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ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.4
,
No
.1
, Mar
c
h 201
5,
p
p
.
1
7
~
20
I
S
SN
: 225
2-8
8
0
6
17
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urn
a
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h
o
me
pa
ge
: h
ttp
://iaesjo
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r
na
l.com/
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e
x.ph
p
/
IJPHS
The Effi
cacy of The Int
e
grat
ed
Child Development Services in
Perspective to Nutritional Condi
tion and Growth Development
Jem
y
E
l
i
z
abet
h J
o
sep
h
1
, Shi
ju M
a
thew
2
1
Medical Science, JJT University
, Jhunjhunu, Rajasthan-333001, I
ndia
2
Departm
e
nt of
Medica
l L
a
b
Te
chnolog
y
,
Coll
e
g
e
of Appl
ied
Medic
a
l Sc
ien
ces,
Jazan Univ
ersit
y
Jazan, Kingdom
of Saudi Ar
abia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
Mar 20, 2014
Rev
i
sed
D
ec 20
, 20
14
Accepte
d
Ja
n 16, 2015
A survey
was conduct
e
d to assess the
nutritio
nal status of ch
ildren (0-6
y
e
ars) among 40
Anganwadis
in 4 districts of Kerala State r
e
gis
t
ered under
the ICDS
s
c
heme. A s
e
lf- prepar
ed s
t
ructured int
e
rview s
c
hedul
e
was
us
ed.
To get th
e qualitative
information of
the stud
y anthropometr
i
c measures
includ
e heigh
t
and weight wer
e
used
for assessing nutritional status of th
e
childr
e
n.
The s
t
e
p
wis
e
ana
l
y
s
is
of two vari
abl
e
s
h
e
ight fo
r ag
e and
weight fo
r
age was applicable on the b
a
sis of Wate
rlow’s
a
nd Gom
ez’ clas
s
i
fic
a
tion
.
To
exam
ine th
e re
la
tionship betw
ee
n nutrition
a
l st
at
us of the chi
l
d a
nd selec
t
ed
variab
le th
at
af
fects nutr
ition
a
l
status of ch
il
dren, Chi-squ
a
r
e
test w
a
s
emplo
y
ed. Based on Go
mez’ classifica
tion, out of 400 children, only
300
(75.0%) of
chi
l
d
ren received s
upplem
entar
y
n
u
trition
through
ICDS out of
which 250 (6
2.5%) ch
ildren
were
normal while 50 (1
2.5%) wer
e
underweight. Based on Waterlo
w
’s classi
ficatio
n out of 400 ch
ildren
,
on
ly
290 (72.5%) of
childr
e
n received supplem
entar
y
nutrition throug
h ICDS out
of these ch
ildren
200 (50 %) were normal while
90 (22.5%) were stunted.
I
t
can thus be con
c
luded
that majority
of ch
ildr
e
n
were normal w
ho received
supplem
entar
y
n
u
trition
through
ICDS.
Keyword:
Health
ICDS
Maln
u
t
rition
Nu
t
r
itio
n
Presc
h
oolers
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Jem
y
Elizabeth Jose
ph,
Ph.D. Researc
h
Sc
holar i
n
M
e
dical Science
,
JJT Un
iversity,
Jh
unjh
unu
, Rajasth
a
n-
333
001
, In
d
i
a.
Em
a
il: j
e
m
y
sh
i
j
u
@g
m
a
i
l
.co
m
1.
INTRODUCTION
I
n
d
i
a h
a
s
o
n
e
o
f
th
e
h
i
gh
est p
e
r
c
en
tag
e
s
o
f
th
e sev
e
r
e
m
a
ln
ou
r
i
sh
ed
ch
ild
r
e
n
’
s in
th
e
w
o
r
l
d
al
ong
with
Su
b-sah
a
ran
Africa
rei
g
on
[1
]-[3
]
. Maln
u
t
rition
is
“th
e
synd
rome th
at resu
lts fro
m
th
e in
teraction
bet
w
ee
n p
o
o
r
di
et
s and di
sea
s
e and l
eads t
o
m
o
st
of t
h
e ant
h
ro
p
o
m
e
t
r
i
c
defi
ci
t
s
ob
ser
v
ed am
ong chi
l
d
re
n i
n
t
h
e wo
rl
ds l
e
ss devel
ope
d
cou
n
t
r
i
e
s” [
4
]
.
Int
e
g
r
at
ed C
h
i
l
d
De
vel
o
p
m
ent
Servi
ce Schem
e
i
s
a
uni
que
pr
o
g
ram
m
e, whi
c
h e
n
c
o
m
p
asses t
h
e m
a
i
n
com
pone
nt
s o
f
hum
an res
o
ur
ce dev
e
l
o
pm
ent
,
nam
e
l
y
- h
eal
t
h
,
nut
rition and education. Th
e
National
Policy for children
adopted in
1974 has em
phasized
t
h
e need
to
accord
p
r
i
o
rity to
ch
ild
ren
,
in
t
h
e cou
n
t
ry's d
e
v
e
lop
m
en
tal effo
rt
s. Th
e
p
o
licy state
m
en
t fo
cu
ses o
n
p
r
ev
en
tiv
e and
p
r
o
m
o
tiv
e aspects o
f
ch
ild
h
ealth
an
d nutritio
n
for ex
pectant and
nursing m
o
ther
s.
It
ai
m
s
t
o
pr
ovi
d
e
adeq
uat
e
ser
v
i
ces for c
h
i
l
d
re
n b
o
t
h
be
fo
re a
nd aft
e
r bi
rt
h and t
h
ro
u
g
h
o
u
t
t
h
e peri
od
of g
r
o
w
t
h
t
o
en
su
r
e
t
h
ei
r
fu
ll ph
ysical, men
t
al an
d
social d
e
v
e
lop
m
en
t. Th
ere
are stu
d
i
es don
e
wh
ich
shows th
at th
ere is a
p
o
s
itive
i
m
p
act o
f
ICDS o
n
ch
ild
nu
t
r
itio
n
a
l statu
s
.
Sin
g
h
et al. (19
93) and
Ch
ian
i
et al. (1
99
4) h
a
v
e
fou
n
d
po
sitiv
e
im
pact
of
IC
DS
o
n
c
h
i
l
d
nut
ri
t
i
onal
st
at
us.
The
nat
i
o
ns
of
t
h
e
w
o
rl
d a
r
e
ran
k
e
d
acc
or
di
n
g
t
o
t
h
ei
r
achi
e
vem
e
nt
s i
n
ful
f
i
l
l
m
e
nt
of c
h
i
l
d
ri
g
h
t
s
an
d p
r
og
r
e
ss fo
r
wom
e
n.
A m
a
jori
t
y
of c
h
i
l
d
re
n l
i
ve i
n
im
pove
ri
she
d
econ
o
m
i
c, soci
al
and e
nvi
r
o
nm
ent
a
l
condi
t
i
on,
whi
c
h i
m
pedes t
h
ei
r
phy
si
cal
an
d
m
e
nt
al
devel
opm
ent
.
R
ecog
n
i
z
i
n
g t
h
e I
ndi
a g
o
v
e
r
nm
ent
has b
een g
r
eat
l
y
conce
r
ned a
b
o
u
t
safe
gua
rdi
n
g an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:2252
-88
06
IJP
H
S
V
o
l
.
4,
No
. 1,
M
a
rc
h 20
1
5
:
1
7
– 20
18
enha
nci
n
g t
h
e
devel
o
pm
ent
of chi
l
d
ren p
a
rt
i
c
ul
arl
y
those from
the
weake
r
sec
tion
s
of
so
ciety [
5
]-[
10
]
Em
p
h
a
sizin
g
on
th
e abov
e si
g
n
i
fican
ce
o
f
p
o
s
itiv
e im
p
act o
f
ICDS
o
n
ch
ild
ren
and
th
eir
n
u
t
ritio
n
a
l
statu
s
,
th
e p
r
esen
t p
a
p
e
r
w
a
s condu
cted
to
ev
aluate th
e n
u
t
ritio
n
a
l statu
s
o
f
ch
ild
ren
ag
ed
b
e
tween
0
-
3
years
regi
st
ere
d
i
n
g
ove
r
n
m
e
nt
spo
n
sore
d m
a
ternal and child care
An
g
anw
adi
ce
nters i
n
India.
2.
R
E
SEARC
H M
ETHOD
A s
u
r
v
ey
-
bas
e
d st
udy
was c
o
n
d
u
ct
ed i
n
t
h
e m
ont
h o
f
Fe
br
uary
,
2
01
3
t
o
Ja
n
u
ary
,
2
0
1
4
, am
on
g
4
0
An
ga
nw
a
d
i
s
in
4
d
i
stricts o
f
Kerala State i.e., Th
iruv
ananth
apu
r
am
, Ko
l
l
a
m
, Path
an
amth
itta an
d
Ko
ttaya
m
regi
st
ere
d
u
n
d
e
r t
h
e
IC
DS
sc
hem
e
. For
t
h
e
st
udy
t
h
e
perm
i
ssi
on
has
been
t
a
ke
n
fr
om
t
h
e g
o
v
er
nm
ent
of
fi
ci
al
at Directorate
of Social
W
e
lfare, T
h
i
r
uva
nt
hap
u
r
am
(Gov
t
.
of
Keral
a
)
.
A
self prep
ared
stru
ctu
r
ed
interv
iew
sche
dule was
pre
p
are
d
and pretested in the field. In
the present study ant
h
ropom
et
ric measurem
ents
(height
an
d
weigh
t
) were used
fo
r assessin
g
nu
t
r
itio
n
a
l statu
s
o
f
th
e ch
ild
ren
.
Ch
ildren
were ex
am
in
ed
in
th
e
An
ga
nw
a
d
i
s
w
h
ere
t
h
ei
r
hei
g
ht
s a
n
d
wei
ght
s we
re t
a
ken
.
A c
o
m
p
l
e
t
e
assessm
ent
of
n
u
t
ri
t
i
onal
st
at
us
i
n
cl
ude
s
th
e co
llection
o
f
an
t
h
ro
po
m
e
tric d
a
ta.
A
stan
d
a
rd
m
easu
r
in
g tap
e
was u
s
ed
to m
easu
r
e
h
e
igh
t
. C
h
ild
ren
were
weighed usi
ng a standardized Salter’s
scale
to
t
h
e
nea
r
est
10
0
gram
s w
h
en at
t
e
n
d
i
n
g a
n
An
gan
wad
i
.
To
tal a
n
u
m
b
e
r
o
f
400ch
ild
r
e
n
w
e
re
tak
e
n
fo
r
t
h
e stu
d
y
as sam
p
le and
f
o
r
all
o
f
th
em
th
e su
pp
l
e
m
e
n
t
ar
y fo
od w
a
s
pr
o
v
ide
d
.
Wei
ght
f
o
r a
g
e a
n
d
heig
ht
fo
r a
g
e
were
calcula
ted
an
d ch
ildren
were classified in
to
d
i
fferen
t
g
r
ad
es
of m
a
lnutrition according to
Gom
ez’s and Waterlow’s cla
ssification [11]. Data of 400
childre
n we
re a
n
alyze
d
using t
h
e Statistical Package
for So
cial Sciences (SPSS)
version 20.0.
Classif
i
cat
i
on by
G
o
m
e
z
et
al.
Norm
al
>90% of standar
d
weight for
age
Gr
ade I
89%-
75% of stan
d
a
r
d
weight for
age
Gr
ade II
74%-
60%o
f
standa
r
d
weight for
age
Grade I
I
I
<60% of standar
d
weight for
age
Cla
ssifica
tio
n
by
Wa
terlo
w
Norm
al
>95% of height
for
age
M
ildly
i
m
paired
87.
5%-
95% of hei
ght for
age
M
oder
a
tely
i
m
paired
80%-
87.
5%o
f
heig
ht for
age
Sever
e
ly i
m
pair
ed
<80% of height
for
age
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Supplemen
tar
y
Nutri
t
ion
Maln
u
t
rition
is clearly lin
k
e
d to
in
ap
propriate feed
ing
p
r
actices rath
er
than
ju
st to
fo
od
av
ailab
ility
or
ho
use
hol
d f
o
o
d
sec
u
ri
t
y
. I
C
DS/
Anga
n
w
ad
is
cen
ters ar
e
su
ppo
sed
to
pro
v
i
d
e
supp
lemen
t
ar
y f
e
ed
ing an
d
inculcate good
fee
d
ing practi
ces
am
ong
m
o
thers. S
u
pplem
e
ntary
feedi
n
g s
hould
be i
n
troduce
d
at a
r
ound
6
m
ont
hs of a
g
e
i
n
ad
di
t
i
on t
o
cont
i
n
ue
d b
r
e
a
st
feedi
n
g
upt
o t
w
o y
ears
o
f
age.
Acc
o
r
d
i
ng t
o
IC
DS n
o
rm
s,
identified se
ve
rely
m
a
lnouris
hed c
h
ildre
n, t
hos
e placed
in Gra
d
e III and Gra
d
e IV
, shoul
d be
give
n special
su
pp
lem
e
n
t
ary feed
ing
wh
ich m
a
y b
e
th
erapeu
tic in
n
a
t
u
re
,
o
r
j
u
st
do
u
b
l
e
rat
i
ons
,
a
n
d
s
h
oul
d
al
s
o
be re
fer
r
ed
to
m
e
d
i
cal serv
ices. Ho
wev
e
r, sin
ce th
e nu
tritio
n
a
l st
atus of the ICDS children
was
rarely
recor
d
ed or
categ
orized in
d
i
fferen
t
grad
es as
p
e
r th
e gro
w
t
h
ch
art,
n
o
v
a
riatio
n in
t
h
e
qu
an
tity of fo
od
g
i
ven to th
ese
ch
ild
ren
was
ob
serv
ed
.
All the ch
ildren were p
r
ov
id
ed
with
th
e sam
e
q
u
an
tity o
f
food
. Tab
l
e
1
d
a
ta
sh
ows
that only75.0
% of c
h
ildre
n
had r
ecei
ved the supplem
e
ntary
nutrition through
ICDS a
n
d 25.0 %
of c
h
ildre
n
did not recei
ve supplem
e
nta
r
y nutrition.
W
illiam
s
(198
8) c
o
nducted
a study whic
h revealed t
h
at ICDS
pr
o
v
i
d
e
d
n
u
t
r
i
t
i
on su
p
p
l
e
m
e
nt
s co
nsi
s
t
i
n
g of
30
0 cal
o
r
i
e
s and
1
0
g
of
pr
ot
ei
ns f
o
r al
l
60-
7
2
m
ont
h ol
d
chi
l
d
re
n. T
h
e s
i
m
i
l
a
r wo
rk
ha
s been re
p
o
rt
e
d
by
Al
i
and Jah
a
n (
2
0
1
2
) a
nd
Swam
i
n
at
han (
1
9
9
0
)
on t
h
e i
m
pact
of IC
DS p
r
og
r
a
m
m
e;
fou
nd t
h
at
t
h
e
m
o
t
h
er
s of IC
DS ar
ea
s were better inform
ed of the
care during pre-natal
p
e
ri
o
d
, im
p
o
r
t
a
n
ce
o
f
supp
lemen
t
ary feed
ing
,
growth se
rvices to
ch
ild
ren
an
d to im
p
r
o
v
e
th
e cap
ab
i
lity o
f
m
o
th
ers to
m
eet th
e h
e
l
p
and
n
u
t
ritio
n
a
l
n
e
ed
s
o
f
th
eir
ch
il
d
r
en
t
h
ro
ugh
prop
er
nu
trition
ed
u
cation
[1
2
]-[16
].
Table 1. Perce
n
tage distri
buti
o
n
of
c
h
ildre
n who recei
ve
d/ did not
recei
ve
suppl
em
entary nutr
ition through
I
C
D
S
(N
=300
)
Supple
m
enta
ry nutrition through ICDS
Nu
m
b
e
r
Percentage
Received
300
75.0
Did not receive
100
25.0
T
o
tal 400
100.
0
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
An
Eva
l
ua
tion
o
n
Th
e Effica
c
y o
f
Th
e
In
teg
r
a
t
ed
C
h
ild
Develo
pmen
t
S
e
rvi
ces in
.... (Jemy Eliza
b
e
t
h
Jo
sep
h
)
19
Table 2 s
h
ows
that based
on Gom
ez’ classifica
tion, out of 25.0%
child
re
n who di
d not recei
ve
sup
p
l
e
m
e
nt
ary
nut
ri
t
i
on,
m
a
jori
t
y
15
.0
%
of t
h
ei
r c
h
i
l
d
re
n
w
a
s u
nde
r
w
ei
g
h
t
.
O
n
t
h
e
ot
her
han
d
,
o
u
t
of
7
5
.
0
%
childre
n, who
receive
d s
u
ppl
e
m
e
ntary nu
tri
tion m
a
jority 62.5 %
of c
h
ildren,
were
ha
ving norm
al weight
for
age.
To
e
x
am
ine
t
h
e rel
a
t
i
o
n
s
hi
p
bet
w
een
nut
ri
t
i
onal
st
at
us (wei
ght
) of
chi
l
d
ren
a
n
d
t
hose
w
h
o rec
e
i
v
ed
su
pp
lem
e
n
t
ary
nu
tritio
n, nu
ll
h
ypo
th
esis was form
u
l
at
e
d
, t
h
at is, ch
i
l
d
r
en
who receiv
ed supp
lemen
t
ary
nut
ri
t
i
on ha
d
n
o
ef
fect
on
n
u
t
ri
t
i
onal
st
at
us
(wei
g
h
t
)
. To
exam
i
n
e t
h
e hy
pot
he
si
s chi
-
s
qua
re t
e
st
was
used
.
Calculated val
u
e of
χ
2
w
a
s 46.7
and
tab
l
e valu
e of
χ
2
at
5% l
e
vel
of si
g
n
i
f
i
cance an
d 1
de
gree
of f
r
ee
do
m
was
3.5. Calculate
d
val
u
e was
greater tha
n
table value. So
nu
ll h
ypo
th
esis
was rej
ected, th
at is, ch
ildren
,
who
receive
d suppl
e
m
e
ntary nutrition, ha
d
better nut
ritional
stat
us (wei
ght
).
Table 2. Perce
n
tage distri
buti
o
n
of health
sta
t
us
(wei
ght) of
childre
n acc
ording
to
Childre
n who receive/ did
not
receive
supplem
e
ntary nut
rition t
h
rough
ICDS
(Gom
ez’ classification
weight for age
)
N=
400
Supple
m
enta
ry nutrition Health
status of childr
e
nth
r
ough I
C
DS
Health status of
children
Norm
al Under
w
eight
T
o
tal
No. %
No.
%
No. %
Received 250
62.5
50 12.5
300
75.0
Did not receive
40
10.0 60 15.0
100
25.0
T
o
tal 290
72.
5
110
27.
5
400
100.
0
χ
2
=4
6.7 at d.f
1; P< 0.05
Table 3. Perce
n
tage distri
buti
o
n
of health
sta
t
us
(wei
ght) of
childre
n acc
ording
to
Childre
n who receive/ did
not
receive
supplem
e
ntary nut
rition t
h
rough
ICDS
(W
ate
rflow’s classification
wei
ght
for a
g
e) N=
400
Supple
m
enta
ry nutrition
Health status of
children
thr
ough I
C
DS
Health status of
children
Nor
m
al
Stunted
Total
No.
% No. %
No.
%
Received 200
50
90
22.5 290 72.5
Did not receive
80
20 30
7.5
110
27.5
T
o
tal
280
70.
0
120
30.
0
400
100.
0
χ
2
=2
.0
1 at d.f
1; P> 0.05
Table 3 indicates that based
on
W
a
terl
ow’s c
l
assification out of 27.5
% chi
l
dre
n
who
did
not recei
ve
su
pp
lem
e
n
t
ary n
u
t
rition
,
7.5
% ch
ild
ren
were stu
n
t
ed
. Ou
t
o
f
72
.5
% ch
i
l
d
r
en
wh
o
receiv
ed
su
pp
lem
e
n
t
ary
nut
ri
t
i
on, m
a
jo
ri
t
y
50 %
o
f
t
h
e c
h
i
l
d
re
n
w
e
re o
f
no
rm
al
hei
g
ht
f
o
r t
h
ei
r age
.
T
o
e
x
a
m
i
n
e t
h
e rel
a
t
i
ons
hi
p
betwee
n nutritional status (height)
of chi
l
dre
n
and supplem
e
ntary
nutrition receive
by childre
n, nul
l
hypothesis wa
s
form
ulated, that
is, s
u
pple
mentary nutrition
receive
d
by childre
n
has
no effect on their
nut
ri
t
i
onal
st
at
us
(hei
ght
). F
o
r t
e
st
i
n
g
t
h
e
hy
pot
hesi
s c
h
i
-
s
q
uare
t
e
st
was
u
s
e. C
a
l
c
ul
at
ed
val
u
e
o
f
χ
2
wa
s
2.
0
1
and t
a
bl
e
val
u
e
of
χ
2
at 5
%
lev
e
l o
f
sign
ifican
ce was
3
.
2
1
. Calcu
l
ated
v
a
lu
e was less th
an
tab
l
e v
a
lu
e so
nu
ll
hypothesis
was accepted, that
is, supplem
e
nt
ary nutrition re
ceive by c
h
ildren
has
no effec
t
on their nutritional
status (height).
4.
DIS
C
USSI
ON
Ade
q
uate food and
good
fee
d
ing practices
are esse
ntial for t
h
e norm
al growt
h
of a y
o
ung child.
St
udi
es
co
n
duc
t
e
d
by
Al
haji
et
al.
(2
002
)
sh
ow
th
at
150
m
ill
io
n
(2
6.6%)
wer
e
u
n
d
e
r
w
ei
gh
t, w
h
ile 18
2 mil
lio
n
(3
2.
5%
)
were
st
unt
e
d
al
l
ove
r t
h
e
w
o
rl
d.
M
o
re
t
h
a
n
hal
f
o
f
t
h
e
w
o
rl
d’
s
u
nde
r
n
o
u
ri
s
h
e
d
peo
p
l
e
l
i
v
e
i
n
In
di
a.
Mish
r
a
et al.
(1
999
)
in
th
eir
stu
d
y
fo
und
th
at ab
ou
t 5
4
% ch
i
l
d
r
en
w
e
r
e
u
nder
w
ei
g
h
t
,
5
2
%
w
e
r
e
stun
ted, w
h
ile
17
% we
re was
t
ed. The
St
u
d
y
do
ne by
Tam
a
nna
et al.
(2
010) sho
w
s th
at the n
u
t
rition
a
l statu
s
of ch
ildren
d
i
d
not
va
ry
fr
om
no
rm
al
t
o
3
rd
degree m
a
l
nou
ri
shm
e
nt
. Nearl
y
45.
8% we
re no
rm
al
, 1.8% were
ove
r n
o
u
r
i
s
h
e
d
and 2.
2% we
re
3
rd
de
g
r
ee m
a
lno
u
r
i
s
he
d. S
o
,
we ne
ed t
o
gi
v
e
hi
g
h
est
p
r
iority to
ch
ild
h
e
alth
and
nu
tritio
n
i
f
w
e
ho
p
e
f
o
r
a
b
r
i
g
h
t
er
f
u
t
u
r
e
o
f
o
u
r
coun
tr
y. Th
e h
e
i
g
h
t
fo
r ag
e in
d
e
x
sho
w
s abo
u
t
229 (
7
6
.
4
%
)
o
f
child
r
e
n
receive
d suppl
e
m
entary nutri
tion through ICDS. Out of
t
h
ese children
148 (49.4 %
)
were norm
a
l
while 81
(2
7 %)
were st
unt
e
d
. T
h
e ext
e
nt
of se
ve
re u
nde
r-
n
u
t
r
i
t
i
on
was hi
ghe
r i
n
Ut
t
a
r Pra
d
es
h
and R
a
jast
ha
n
whi
l
e
severe
u
n
d
er
-n
ut
ri
t
i
on
o
f
a c
h
ro
ni
c nat
u
re
w
a
s hi
g
h
e
r
i
n
O
r
i
ssa. F
u
rt
he
r
o
p
erat
i
o
nal
re
se
arch i
s
nee
d
e
d
t
o
fi
n
d
o
u
t
th
e reason
s for th
e sub
s
titu
tio
n
of th
e sup
p
l
em
en
tary
foo
d
fo
r
b
r
eakfast o
r
lun
c
h
,
t
h
e
ex
act calo
r
ic co
n
t
en
t
of
Anga
n
w
ad
i
f
o
o
d
gi
ve
n t
o
t
h
e chi
l
d
ren
.
Gar
g
et al.
(1997) in
Ghazia
b
ad,
Bhandari
et al.
(
199
3)
in Raj
a
sth
a
n,
fo
u
nd t
h
at
pre
v
al
ence
of m
a
lnut
ri
t
i
on i
n
c
h
i
l
d
re
n bel
o
w t
h
e age of five y
ears was
high
er in
sp
ite of the fact
t
h
at
t
h
ese po
p
u
l
a
t
i
on w
a
s be
i
ng ser
v
e
d
by
IC
DS
[1
7]
. A
l
i
m
i
t
a
t
i
on of t
h
i
s
st
udy
wa
s not
acc
ou
nt
i
n
g
for t
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:2252
-88
06
IJP
H
S
V
o
l
.
4,
No
. 1,
M
a
rc
h 20
1
5
:
1
7
– 20
20
registere
d
Anga
n
w
ad
is
chi
l
d
re
n wh
o di
d
n
o
t
at
t
e
nd
t
h
e
A
n
g
anw
a
d
i
s
centers, but
for
whom
supplem
enta
ry food
was
pr
o
v
i
d
e
d
.
Thi
s
c
oul
d
hav
e
o
p
ene
d
a
n
ot
h
e
r
di
m
e
nsi
on f
o
r
t
h
e st
udy
[
1
8]
-[
2
1
]
.
5.
CO
NCL
USI
O
N
To
prev
en
t
o
r
m
i
n
i
mize th
e p
r
o
b
l
em
o
f
maln
u
t
ritio
n
,
variou
s nu
trition
in
terv
en
tio
n p
r
o
g
ramm
es
have
been introduce
d
,
from
tim
e
to
tim
e
, in India.
Although the
IC
DS program
has bee
n
succes
sful i
n
im
pro
v
i
n
g t
h
e nut
ri
t
i
onal
st
at
us o
f
chi
l
d
re
n
(0
-6 y
ears
)
, f
u
r
t
her i
m
provem
e
nt
s can be m
a
de i
n
t
h
e fu
nct
i
oni
n
g
o
f
t
h
e pro
g
ram
.
Ch
an
g
e
s
need
to
b
e
m
a
d
e
in
th
e
u
n
d
e
rstan
d
i
n
g
and
utilizat
io
n
of the serv
ices. The stu
d
y
sh
ow
s t
h
e h
i
gh
ex
ten
t
o
f
un
d
e
rn
ou
r
i
sh
m
e
n
t
and
less than
satisf
actor
y p
e
rf
or
m
a
n
ce o
f
I
C
D
S
, abou
t 250
(6
2.
5%
)
c
h
i
l
d
r
e
n was n
o
rm
al
whi
l
e
o
n
l
y
5
0
(1
2.
5%
) we
re un
der
w
ei
g
h
t
wh
o ha
d rec
e
i
v
e
s
u
p
p
l
e
m
e
nt
ary
nut
ri
t
i
on t
h
r
o
u
g
h
IC
DS.
ACKNOWLE
DGE
M
ENT
Th
e au
tho
r
t
h
an
k
t
h
e ch
ild
ren an
d
t
h
eir m
o
th
ers
wh
o
h
a
v
e
willin
g
l
y p
a
rti
c
ip
ated
in
t
h
is
stu
d
y
an
d
a
special thanks
to the Directorate of
Soci
al
W
e
l
f
are,
Go
v
e
rnm
e
nt
of Ke
ral
a
, Keral
a
(
I
ndi
a
)
f
o
r
gra
n
t
i
ng t
h
e
p
e
r
m
issio
n
for
co
ndu
ctin
g th
e stud
y.
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len
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