INTEGRATED CHILD DEVELOPMENT SERVICES

INTRODUCTION
Integrated Child Development Services (ICDS) Scheme Introduction

Children in the age group 0-6 years constitute around 158 million of the
population of India (2011 census). These Children are the future human
resource of the country. Ministry of Women and Child Development is
implementing various schemes for welfare, development and protection of
children.

Launched on 2nd October, 1975, the Integrated Child Development Services

(ICDS) Scheme is one of the flagship programs of the Government of India and
represents one of the world’s largest and unique programs for early childhood
care and development. It is the foremost symbol of country’s commitment to
its children and nursing mothers, as a response to the challenge of providing
pre-school non-formal education on one hand and breaking the vicious cycle of
malnutrition, morbidity, reduced learning capacity and mortality on the other.
The beneficiaries under the Scheme are children in the age group of 0-6 years,
pregnant women and lactating mothers. Objectives of the Scheme are:

1 to improve the nutritional and health status of children in the age-

group 0-6 years;
2 to lay the foundation for proper psychological, physical and social
development of the child;
3 to reduce the incidence of mortality, morbidity, malnutrition and school
dropout;
4 to achieve effective co-ordination of policy and implementation
amongst the various departments to promote child development; and
5 To enhance the capability of the mother to look after the normal health
and nutritional needs of the child through proper nutrition and health
education.

Services under ICDS:The ICDS Scheme offers a package of six services, viz.

1. Supplementary Nutrition
2. Pre-school non-formal education
3. Nutrition & health education
4. Immunization
5. Health check-up and
6. Referral services

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 The last three services are related to health and are provided by
Ministry/Department of Health and Family Welfare through NRHM & Health
system. The perception of providing a package of services is based primarily on
the consideration that the overall impact will be much larger if the different
services develop in an integrated manner as the efficacy of a particular service
depends upon the support it receives from the related services.

For better governance in the delivery of the Scheme, convergence is,

therefore, one of the key features of the ICDS Scheme. This convergence is in-
built in the Scheme which provides a platform in the form of Anganwadi
Centres for providing all services under the Scheme.

TARGET GROUP
The pre-school age is the most vulnerable and critical phase in the overall
development of an individual, so children up to 6 years form the target group. As
the child’s health and nutritional status is affected to a large extent by the
mother’s health status during pregnancy and lactation as well as by the attention
and care given by the mother during childhood, women in the reproductive age
(15-45 years) are also included in the program with special attention to the
nutritional and health needs of pregnant and lactating mothers. Even though the
minimum legal age of marriage for women is 18 years, incidence of teenage
pregnancy (below 18 years) is still quite significant in India (NFHS survey I, II and
III). For different services the target groups are: For Supplementary Nutrition,
Immunization, Health Check-ups and Referral services, the target group is children
below 6 years and pregnant and lactating mothers. For Pre-school education, the
target group is children of 3-6 years. For Nutrition and Health Education, the
target group is women of the age group 15-45 years. With development, ICDS
program has expanded its range of interventions to include components focused
on adolescent girls (11-18 years) (introduced in 2000) nutrition, health,
awareness, and skill development, as well as income-generation schemes for
women.

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The delivery of services to the beneficiaries is as follows:

Services Target Group Service provided by

Children below 6
years,
(i) Supplementary Anganwadi Worker and
Nutrition Anganwadi Helper [MWCD]
Pregnant & Lactating
Mothers (P&LM)
Children below 6
years,
ANM/MO
(ii) Immunization* Pregnant & Lactating
[Health system, MHFW]
Mothers (P&LM)

Children below 6
years,
ANM/MO/AWW
(iii) Health Check-up* Pregnant & Lactating [Health system, MHFW]
Mothers (P&LM)

Children below 6
years,
AWW/ANM/MO
(iv) Referral Services Pregnant & Lactating
[Health system, MHFW]
Mothers (P&LM)

(v) Pre-School AWW

Children 3-6 years
Education [MWCD]
AWW/ANM/MO
(vi) Nutrition & Health
Women (15-45 years) [Health system, MHFW &
Education
MWCD]

* AWW assists ANM in identifying the target group.

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SUPPLEMENTARY NUTRITION
It includes supplementary feeding (supplement to the daily diet of beneficiary to
be consumed at AWC) and growth monitoring; prevention against vitamin A
deficiency and control of nutritional anemia. To provide supplementary nutrition
all families in the community are surveyed to identify children below the age of 6
and pregnant & nursing mothers (up to six months of nursing). Supplementary
feeding support is provided for 300 days in a year. By providing supplementary
feeding, the Anganwadi attempts to bridge the protein energy gap between the
recommended dietary allowance and average dietary intake of children and
women. For growth monitoring, children below the age of 3 are weighed once a
month and children 3-6 years of age are weighed every quarter. Weight-for-age
growth cards are also maintained for all children below 6 years. This helps to
detect growth faltering and helps in assessing nutritional status of the child and if
the child is malnourished, the grade of malnutrition. If the malnutrition is mild
(Grades I and II), the mother is advised on the food and other health care
requirements of the child. For severely malnourished children, they are given
special supplementary feeding and referred to Health Sub-Centers, Primary
Health Centers as and when required. The nature and type of food under
supplementary nutrition program varies from state to state. It usually consists of
a hot meal, containing a varied combination of pulses, cereals, oil, vegetables and
sugar. Some states provide ready-to-eat meals containing some basic ingredients.
There is flexibility in selection of food items to respond to local needs.
Supplementary Nutrition Program (SNP) also provides a crucial opportunity to
counsel pregnant women enabling utilization of key services, i.e. antenatal care,
iron folic acid supplementation and improved care, adequate extra care from
family and rest during pregnancy. Special care is also taken to reach children
below the age of 2 years, and to encourage parents and siblings to either take
ration home or to bring them to the Anganwadi for supplementary feeding.

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Nutritional norms:
- 500 calories and 12-15 grams of protein to children in the age group 0-6 years
- 800 calories and 20-25 grams of protein to severely malnourished children
under 6 years of age
- 600 calories and 18-20 grams of protein to adolescent girls and pregnant and
lactating women.
PRE-SCHOOL EDUCATION (PSE)
Pre-School Education contributes to the universalization of primary education, by
providing to the child the necessary preparation for primary schooling and
offering substitute care to younger siblings, thus freeing the older ones –
especially girls – to attend school. Under this, child centered play way activities,
which is built on local culture and practices, using local support materials and
developed by Anganwadi workers through enrichment training are promoted. It is
considered the most joyous daily activity of the ICDS program, which is visibly
sustained for three hours a day. The activities which are undertaken as part of
PSE include story-telling, counting numbers, free conversations to speak freely
and apply their mind in order to organize small activities, painting, drawing,
threading and matching color related to fine muscle coordination and
development, reading simple words, writing alphabets words, distinguish objects,
recognize pictures etc. The constitution of the PSE kit may vary within a state/UT
keeping in view the specific local needs and resources. A suggestive list is as
follows: Flash cards for story telling; models on pictures/picture books of animals;
Fruits, vegetables, parts of the body, pictures/picture books; building blocks-
plastic or card board or wood; Stuffed toys, dolls for role play, colours, numbers,
alphabets, matching cards; Stacking rings/Shape Towers, balls, threading
boards/beads & wires, kitchen set, wheel toys; Dhapli/Small Drum and simple
puzzles, etc. though the list is not exhaustive. Under PSE, children are fully
prepared for entering Class I at the age of 6 years under the Sarva Shiksha
Abhiyan (SSA) and District Primary Education Program (DPEP). So there is strong
convergence between ICDS, SSA and DPEP.

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IMMUNIZATION
Immunization of infants protects children from six vaccine preventable diseases,
viz. Poliomyelitis, Diphtheria, Pertussis, Tetanus, Tuberculosis and Measles. These
diseases are major and preventable causes of child mortality, disability, morbidity
and related malnutrition. Pregnant women are immunized against Tetanus, which
reduces chances of maternal and neonatal mortality. The services of
immunization, health check-up and referral services are provided through the
public health infrastructure, i.e. Health Sub-Centre, Primary Health Centre and
Community Health Centre, as these are the joint responsibility of ICDS and the
Ministry of Health and Family Welfare. Immunization services are delivered by the
Ministry of Health and Family Welfare under its Reproductive Child Health (RCH)
Program. The AWW assists the health functionaries in coverage of the target
population for immunization. She helps in the organization of fixed day
immunization sessions. She maintains immunization records of ICDS beneficiaries
and follows up to ensure full coverage. The Iron and Vitamin "A" Supplementation
(IFA tablets) are provided to children and pregnant women under the
immunization program, which are also delivered under the RCH Program of the
Ministry of Health and Family Welfare. The frequency of various vaccine
deliveries under the immunization program is as follows:
- BCG - at birth Oral Polio - at birth, 6,10,14 weeks
- DPT - at 6,10, 14 weeks Hepatitis B - at 6,10,14 weeks
- Measles – at 9 week
-DPT+ Oral Polio - at 18 to 24 months
- DT - at 5 years
- Vitamin A - at 9,18,24,30 and 36 month
-Tetanus Toxoid - to Pregnant Women in different trimesters

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HEALTH CHECK-UP
It includes health care of children less than six years of age, antenatal care of
expectant mothers and postnatal care of nursing mothers. These services are
provided by the ANM, Medical Officers In-charge of Health Sub-Centres and
Primary Health Centres under the RCH programme of the Ministry of Health and
Family Welfare. Health services include regular health check-ups, recording of
weights, immunisation, management of malnutrition, treatment of diarrhoea,
deworming and distribution of simple medicines, etc. At the Anganwadi, children,
adolescent girls, pregnant women and nursing mothers are examined at regular
intervals by the Lady Health Visitor (LHV) and Auxiliary Nurse Midwife (ANM) who
diagnose minor ailments and distribute simple medicines. They provide a link
between the village and the Primary Health Care Sub-Centre.
REFERRAL SERVICES
During health check-ups and growth monitoring, sick or malnourished children,
who are in need of prompt medical attention, are referred to the Primary Health
Centre or its sub-centre by AWW. The AWW has also been oriented to detect
disabilities in young children. She enlists all such cases and refers them to the
ANM and Medical Officer in charge of the Primary Health Centre/ Sub-centre.
These cases referred by the AWW are to be attended by health functionaries on a
priority basis.
NUTRITION AND HEALTH EDUCATION (NHE)
NHE has the long-term goal of capacity building of women in the age group of 15-
45 years so that they can look after their own health, nutrition and development
needs as well as that of their children and families. The main objective of
education in nutrition is to help individual to establish food habits and practices
that are consistent with the nutritional needs of the body and adapted to the
cultural pattern and food resources of the area in which they live. NHE comprises
basic health, nutrition and development information related to childcare and
development, infant feeding practices, utilisation of health services, family
planning and environmental sanitation, maternal nutrition, ante-natal care,
prevention and management of diarrhoea, acute respiratory infections and other
common infections of children. NHE is delivered through inter-personal contact
and discussion and involves the following services/activities which are discussed
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at these meetings: Services for children - taking care and monitoring of child’s
growth, timely immunisation , knowledge about breast feeding, colostrum
feeding, treatment of diarrhoea/minor illness, not to provide home-made
medicine during illness, preparation of nutritious food/feeding practices,
importance of education of the child, about cleanliness and hygiene, preparation
of oral dehydration solution, care of severely malnourished children. Services for
Mother - About immunisation during pregnancy, about institutional delivery,
about feeding practices during pregnancy and lactating period, about correct
posture during pregnancy, correct posture during breast feeding, about self care
& health, about diseases illness, about nipple hygiene, purification of water to
mothers and adolescent girls, small family norms, etc.

ADOLESCENT GIRLS SCHEME

ICDS, with its opportunities for early childhood development, seeks to reduce
both socioeconomic and gender inequalities. For this a special intervention has
been devised for adolescent girls using the ICDS infrastructure – the Kishori Shakti
Yojana (KSY). This intervention focuses on school dropouts, girls in the age group
of 11-18 years, with a view to meet their needs of selfdevelopment, nutrition,
health, education, literacy, recreation and skill development. KSY is being
implemented in 6,118 ICDS projects. Under KSY, various programme options are
available to the states/UTs to selectively intervene for the development of the
adolescent girls on the basis of specific needs of the area. KSY also seeks
convergence with the schemes of the Health Department in order to improve the
nutritional and health status of the adolescent girls. Special emphasis is placed on
reducing nutritional anemia among this group. The scheme also attempts to
motivate and enhance the potential of adolescent girls as social animators. It
seeks to improve their capabilities in addressing nutrition and health issues
through centre based instructions, training camps and hands on learning as well
as sharing of experiences

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Funding Pattern

Prior to 2005-06, providing of supplementary nutrition was the

responsibility of the States and administrative cost was provided by the
Government of India as 100% central assistance. The nutrition costs were
meagre and coverage of the program in all villages/habitations was also limited
and not universal. Since many States were not providing adequate
supplementary nutrition in view of resource constraints, it was decided in 2005-
06 to support the States/UTs up to 50% of the financial norms or to support 50%
of expenditure incurred by them on supplementary nutrition, whichever is less.
Since 2009-10, Government of India has modified the sharing pattern of the
ICDS Scheme between the Centre and States. The sharing pattern of
supplementary nutrition in respect of North-Eastern States between Centre
and States has been changed from 50:50 to 90:10 ratios. In respect of other
States/UTs, the existing sharing pattern in respect of supplementary nutrition
is 50:50. The existing cost sharing ratio for other components is 90:10 except
the new components approved under Strengthening & Restructuring for which
it is 75:25 (90:10 for NER).

The population norms for setting up of AWCs/Mini-AWCs

The revised population norms for setting up of AWCs and Mini-AWCs are
as under:

Population Norms under ICDS

For AWCs in Rural/Urban Projects

 1 AWc
 2 AWCs
 3 AWCs

Thereafter in multiples of 800 1 AWC

For Mini-AWC

 1 Mini-AWC

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 For Tribal/Riverine/Desert, Hilly and other difficult areas/ Projects

 1 AWC

For Mini-AWC

150-300 1 Mini-AWC

Anganwadi on Demand (AOD)

Where a settlement has at least 40 children under 6 years of age but no AWC

Revised Nutrition and Feeding Norms under Supplementary Nutrition

Component of ICDS (revised w.e.f 24 February 2009)

Provision of supplementary nutrition under the ICDS Scheme is

primarily made to bridge the gap between the Recommended Dietary
Allowance (RDA) and the Average Daily Intake (ADI) of children and pregnant
and lactating women. Under the revised Nutritional and Feeding norms which
have been made effective from February 2009, State Governments/UTs have
been requested to provide 300 days of supplementary food to the beneficiaries
in a year which would entail giving more than one meal to the children from 3-6
years who visit AWCs. This includes morning snacks in the form of
milk/banana/egg/seasonal fruits/micro-nutrient fortified food followed by a hot
cooked meal (HCM). For children below 3 years of age, pregnant and lactating
mothers, Take Home Rations (THRs) in the form of pre-mixes/ready-to-eat food
are provided. Besides, for severely underweight children in the age group of 6
months to 6 years, additional food items in the form of micronutrient fortified
food and/or energy dense food as THR is provided. These norms have also
been endorsed by the Supreme Court in order dated 22.04.2009. The extent of
nutritional supplements to different types of beneficiaries is indicated below:

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Revised Nutritional Norms in ICDS (since February, 2009)

Beneficiaries Calories Protein (g)

Children
500 12-15
(6 months to 72 months)
Severely malnourished Children
(SAM) 800 20-25
(6 months- 72 months)
Pregnant women and lactating
600 18-20
mothers

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Existing Monitoring System under ICDS Scheme:

Monitoring Mechanism

Ministry of Women and Child Development (MWCD) has the overall

responsibility of monitoring the ICDS Scheme. There exists a Central Level ICDS
Monitoring Unit in the Ministry which is responsible for collection and analysis
of the periodic work reports received from the States in the prescribed
formats. Records and registers at AWC level and monthly/ half yearly progress
reports at Block and Anganwadi levels have been prescribed. States/ UTs are
required to compile the information and send the State level consolidated
reports to MWCD on number of operational projects, AWCs, number of
beneficiaries of supplementary nutrition and pre-school education and
nutritional status of children. The information received in the prescribed
formats is compiled, processed and analysed at the Central level on quarterly
basis. The progress and shortfalls indicated in the reports on ICDS are reviewed
by the Ministry with the State Governments regularly by review meetings and
field visits.

Wheat Based Nutrition Program (WBNP)

Under the Wheat Based Nutrition Program (WBNP), food grains viz.,
wheat, rice and other coarse grains are allocated at Below Poverty Line (BPL)
rates to the States/UTs through the Department of Food & Public Distribution
(D/o Food & Public Distribution), for preparation of supplementary food in
ICDS. The Ministry is responsible for processing and approval of the proposals
from the States/UTs for allocation of food grains in coordination with the D/o
F& PD. During 2014-15, allocation of 9,70,653 MTs of wheat; 7,10,406 MTs of
rice and 12,075 MTs of maize was made to 31 States/UTs. An allocation of
4,74,782 MTs of Wheat, 4,40,534 MTs of Rice, 11,036 MTs of Maize and 9418
MTs of Ragi has been made to 30 States/UTs for the 1st and 2nd quarter of
2015-16.

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Supplementary Nutrition (under the Integrated Child Development Services
Scheme) Rules, 2015 under NFSA, 2013

National Food Security Act (NFSA) was promulgated by the Government

of India vide Gazette Notification dated 10.09.2013. In view of this,
Supplementary Nutrition Program (SNP), which is one of six services under
ICDS has been made as an entitlement under the NFSA. Sections 4,5,6 & 7 of
the NFSA pertain to ICDS and IGMSY schemes of the Ministry. As per clause 22
(3) of the said Act, the Central Government shall provide food grains in respect
of the entitlements, under Section 4,5 & 6 to the State Governments, at prices
specified in Schedule I of the Act.

Section 39 of the NFSA provides that the Central Government may in

consultation with the State Governments and by notification make rules to
carry out the provisions of this Act. Accordingly, the Supplementary Nutrition
(under the Integrated Child Development Services Scheme) Rules, 2015 were
notified in the Gazette of India on 01.06.2015 in consultation with State
Governments and other stake holders.

Welfare Measures for the AWWs and AWHs

Enhanced Honoraria

Honorarium of AWWs has been enhanced by Rs.1500/- per month on the

last honorarium drawn by them and that of AWHs and AWWs of “Mini-
Anganwadi Centres” by Rs. 750/- per month on the last honorarium drawn by
them with effect from 1st April, 2011. The honorarium to AWWs of Mini-AWCs is
further enhanced by Rs. 750/- per month, on the last honorarium drawn by
them w.e.f. 04.07.2013.

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Anganwadi Karyakartri Bima Yojana (AKBY)

The ICDS Scheme envisages Anganwadi Workers (AWWs) and Anganwadi

Helpers (AWHs) as honorary workers who are paid a monthly honorarium.
AKBY under the LIC’s Social Security Scheme is one of the welfare measures
extended to the grassroots functionaries of the ICDS Scheme. The Government
of India has introduced the Anganwadi Karyakatri Bima Yojana with effect from
1.4.2004. The premium under the scheme is Rs. 280/- per annum per member
out of which Rs.100/- is paid by LIC from Social Security Fund, Rs.100/- by the
Government of India and Rs. 80/- by the Anganwadi Worker/Helper (insured
member). The premium of Rs. 80/- payable by these workers have been waived
off until 31.3.2017. The salient features of this Bima Yojana are as under: -

 Natural death Rs. 30,000

 Accidental benefit Death/ Total permanent disability Rs. 75,000
 Partial permanent disability Rs. 37,500

Female Critical Illness (FCI) Benefits

An amount of Rs. 20,000/- is payable on the diagnosis of invasive cancers

(malignant tumour) manifest in the organs (i) Breast, (ii)Cervix Uteri, (iii)
Corpus Uteri, (iv) Ovaries, (v) Fallopian Tubes, (vi) Vina/Vulva (subject to proof
of affliction satisfactory to Corporation). A malignant tumour characterized by
uncontrolled growth and spread of malignant cells and invasion of tissue that
originates in one of the above anatomical sites is covered under the Scheme.

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Shiksha Sahayog through Anganwadi Karyakartri Bima Yojana(AKBY-LIC)

A free add-on scholarship benefit is available for the children of

Anganwadi Workers covered under the AKBY Scheme. Scholarship of Rs. 300/-
per quarter for students in 9th to 12th standard (including ITI courses) is
provided. Scholarship is limited to two children per family. With the waiver of
Rs. 80/- as premium payable towards critical illness by the Anganwadi Workers
(AWWs) and Helpers (AWHs) w.e.f. 1.4.2007, all AWWs and AWHs are covered
for all the benefits under the Scheme. During the financial year 2015-16 (upto
31.06.2015), the following number of claims were settled and scholarships paid
by LIC:

Critical illness Scholarships

Natural Accidental claim settle up settled up to
to 31.06.2015 31.06.2015
Amoun Amoun Amoun Amoun
Intimat Settl t Intimat Settl t Numb t Numb t
ed ed Disburs ed ed Disburs er Disburs er Disburs
ed ed ed ed
636000 185916
212 212 8 8 600000 0 0 29712
0 00

Introduction Of ‘WHO’ Growth Standard In ICDS

The World Health Organization (WHO) based on the results of an intensive

study initiated in 1997 in six countries including India has developed new
International Standards for assessing the physical growth, nutritional status
and motor development of children from birth to 5 years age. The Ministry of
Women and Child Development and Ministry of Health have adopted the New
WHO Child Growth Standard in India on 15th of August, 2008 for monitoring
the Growth of Children through ICDS and NRHM.

A common Mother & Child Protection Card (MCPC) to be used under both
ICDS & NRHM program has been sent to all States/UTs with a letter under joint
15
signatures of both the Secretaries of WCD & Health. It is currently under roll
out by the States/UTs.

Implications

- Change in current estimates

- increase in total of normal weight children

- increase in severely underweight children

- increase in underweight children (mild/moderate and severe)in age

group of 0-6 months.

 The requirement of funds for SNP; Centre and State contribution would
be almost double.
 The Anganwadi Worker with the help of New Growth Chart would be
able to assess correctly severely underweight children and number of
such children would increase in each Anganwadi Centres. The number of
normal children would also increase in all the Anganwadi Centres.
 The new charts would now help us in comparing growth of our children
within projects, districts, states & also other countries.

According to the recent review under the Secretary, WCD, and the
information provided by the States, the new WHO Growth Chart has been
implemented in 6666 ICDS Projects and 12,71,889 Anganwadis.

The joint MCPC card has been completed in 6621 Projects and 10,12,153
Anganwadi centres. The States have been impressed upon to ensure
compliance of the roll out of New WHO Growth Chart & MCPC card.

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 Role and responsibilities of Anganwadi workers.

The Integrated Child Development Service Scheme (ICDS) is one of the initiatives
taken up by the Central Government, which provides a package of six services viz.,
supplementary nutrition, immunization, health checkups, referral services,
nutrition and health education for mothers/pregnant women, nursing mothers
and to adolescent girls (kishoris) through anganwadi workers. The responsibilities
of anganwadi workers are ever increasing these days. They have certain
prescribed responsibilities other than the above mentioned services in the
anganwadi. The present study has been undertaken with the objective of
assessing the role and responsibilities of anganwadi workers in Mysore district.
The universe of the study is Mysore District. The tool used for the study is
questionnaire. Among 235, around 122 anganwadi workers representing grama
panchayats of each taluk have been covered under the study. The results found
that anganwadi workers are very active in rendering their services to the
beneficiaries. Key words: Initiatives, Supplementary Nutrition, Adolescent girls,
Anganwadi.

Introduction
ICDS is the world’s largest community based outreach programme which offers a
package of health, nutrition and education services to the children below six years
and pregnant and nursing mothers. The Integrated Child Development Services
scheme (ICDS) was started in Karnataka on 2nd October 1975 with a pilot project
at T. Narasipura in Mysore
District with just 100 Anganwadi Centres. Since then, the programme has
expanded to all the revenue taluks in the State. The welfare of pregnant women,
nursing mothers, adolescent girls and children below 6 years has acquired a prime
place in the programme. The programme is
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a package of six services viz., supplementary nutrition, immunization, health
check-up, referral services, and nutrition and health education for mothers /
pregnant mothers, nursing mothers and to adolescent girls (kishoris).
An Anganwadi is the focal point for the delivery of ICDS services to children and
mothers. An Anganwadi normally covers a population of 1000 in both rural and
urban areas and 700 in tribal areas. Services at Anganwadi center (AWC) are
delivered by an Anganwadi

Worker (AWW) who is a part-time honorary worker. She is a woman of same

locality,chosen by the people, having educational qualification of middle school or
Matric or higher.
She is assisted by a helper who is also a local woman and is paid honorarium.
Being the functional unit of ICDS programme which involves different groups of
beneficiaries, the
AWW has to conduct various types of job responsibilities. Not only she has to
reach to variety of beneficiary groups, she has to provide them with different
services which include nutrition and health education, Non- Formal Pre School
Education (NEPSE), Supplementary nutrition, growth monitoring and promotion
and family welfare services. She also coordinates in arranging immunization
camps, health check-up camps. Her functions also include community survey and
enlisting beneficiaries, primary health care and first aid, referral services to
severely malnourished, sick and at risk children, enlisting community support for
Anganwadi functions, organizing women’s groups and Mahila Mandals, school
enrolment of children and maintenance of records and registers (Sunder Lal
1997).
Each anganwadi workers receives less than Rs. 3,500/- per month which is very
low remuneration, but the responsibilities of these workers are very extensive.
Yet, they have been found to be among the most dedicated and committed of
public servants who have developed grass root contacts and are able to identify
particular individuals and groups in any community, easily.
The anganwadi worker is the most important functionary of the ICDS scheme. The

18
anganwadi worker is a community based front line worker of the ICDS
programme. She plays a crucial role in promoting child growth and development.
She is also an agent of social change, mobilizing community support for better
care of young children (Kant et al. 1984).
The partnership at community level, between frontline workers of different
sectors and community groups, can make the vision a reality. The Anganwadi
Worker is the community - based voluntary frontline workers of the ICDS
Programme. Selected from the community, she assumes the pivotal role due to
her close and continuous contact with the beneficiaries. The Anganwadi Worker
monitors the growth of children, organizes supplementary feeding, helps in
organizing immunization sessions, distributes vitamin A, iron and folic acid
supplements, treats minor ailments and refers cases to medical facilities
(ICDS report, 1995).

Objectives of ICDS
1. To improve the nutritional and health status of children in the age-group 0-6
years.
2. To lay the foundation for proper psychological, physical and social
development of the child;
3. To reduce the incidence of mortality, morbidity, malnutrition and school
dropout;
4. To achieve effective co-ordination of policy and implementation amongst the
various departments to promote child development; and
5. To enhance the capability of the mother to look after the normal health and
nutritional needs of the child through proper nutrition and health education.

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The Administrative Structure
- The Anganwadi Worker and Anganwadi Helper at the Anganwadi (Village) level.
- The Anganwadi Supervisor at the Sector level The Child Development Project
Officer (CDPO) at the Project level.
- The District Programme Officer (DPO) at the District level.
- Directorate of Child Development Department of Women and Child
Development, State Govt.
- Department of Women and Child Development, Govt. of India.
- Ministry of Human Resource Development, Government of India Role and
responsibilities of Anganwadi Workers.

The role and responsibilities of AWWs and Helpers envisaged under

the ICDS Scheme is as under:-
1. To elicit community support and participation in running the programme.
2. To weigh each child every month, record the weight graphically on the growth
card, use referral card for referring cases of mothers/children to the sub-
centres/PHC etc., and maintain child cards for children below 6 years and produce
these cards before visiting medical and para-medical personnel.
3. To carry out a quick survey of all the families, especially mothers and children in
those families in their respective area of work once in a year.
4. To organise non-formal pre-school activities in the anganwadi of children in
the age group 3-6 years of age and to help in designing and making of toys and
play equipment ofindigenous origin for use in anganwadi.
5. To organise supplementary nutrition feeding for children (0-6 years) and
expectant and nursing mothers by planning the menu based on locally available
food and local recipes.

20
 6. To provide health and nutrition education and counseling on breastfeeding/
Infant &young feeding practices to mothers. Anganwadi Workers, being close to
the local community, can motivate married women to adopt family planning/birth
control measures
7. AWWs shall share the information relating to births that took place during the
month with the Panchayat Secretary/Gram Sabha Sewak/ANM whoever has been
notified as
Registrar/Sub Registrar of Births & Deaths in her village.
8. To make home visits for educating parents to enable mothers to plan an
effective role in the child's growth and development with special emphasis on
new born child.
9. To maintain files and records as prescribed.
10. To assist the PHC staff in the implementation of health component of the
programme viz. immunisation, health check-up, ante natal and post natal check
etc.

11. To assist ANM in the administration of IFA and Vitamin A by keeping stock of
the two medicines in the Centre without maintaining stock register as it would
add to her administrative work which would affect her main functions under the
Scheme.
12. To share information collected under ICDS Scheme with the ANM. However,
ANM will not solely rely upon the information obtained from the records of
AWW.
13. To bring to the notice of the Supervisors/ CDPO any development in the
village this requires their attention and intervention, particularly in regard to the
work of the coordinating arrangements with different departments.
14. To maintain liaison with other institutions (Mahila Mandals) and involve lady
school workers and girls of the primary/middle schools in the village which have
relevance to her functions.

21
 15. To guide Accredited Social Health Activists (ASHA) engaged under National
Rural Health Mission in the delivery of health care services and maintenance of
records under the ICDS Scheme. 16. To assist in implementation of Kishori Shakti
Yojana (KSY) and motivate and educate the adolescent girls and their parents and
community in general by organizing social awareness programmes/ campaigns
etc.
17. AWW would also assist in implementation of Nutrition Programme for
Adolescent Girls (NPAG) as per the guidelines of the Scheme and maintain such
record as prescribed under the NPAG.
18. Anganwadi Worker can function as depot holder for RCH Kit/ contraceptives
and disposable delivery kits. However, actual distribution of delivery kits or
administration of drugs, other than OTC (Over the Counter) drugs would actually
be carried out by the ANM or ASHA as decided by the Ministry of Health & Family
Welfare.
19. To identify the disability among children during her home visits and refer the
case immediately to the nearest PHC or District Disability Rehabilitation Centre.
20. To support in organizing Pulse Polio Immunization (PPI) drives.
21. To inform the ANM in case of emergency cases like diarrhoea, cholera etc.

22
 ICDS Project Report

[1 nov.2017- 15 nov.2017]

Activities held in Anganwadi

23
Basic information of Anganwadi
ICDS project in Anganwadi was held between-
1st November 2017 to 15th November 2017
Anganwadi no. – 184.
Address - Todakar mandap tarun mandal, near choundeshwari hall,
Mangalwar Peth, Kolhapur.
Anganwadi worker [AWW] - Mrs. Sampada Madan Salokhe.
Anganwadi helper – Mrs. Rama Kulkarni.
Total children’s covered under Anganwadi from age group 0-6yrs. – 85
Children’s between 0-3 yrs. age group -25
Pregnant women’s – 4
Nursing mothers – 4
Adolescent girls – 51
Malnourished children’s -2

24
Services provided by ICDS in Anganwadi-
1. Immunization – every 2nd Tuesday of month.
2. Referral services- growth monitoring in every month.
3. Health check-up- every 6 month, Deworming – every six month, Program
for pregnant women’s- once in month’ Program for adolescent girls – once
in month
4. Supplementary nutrition- for 0-6 yrs. children’s, adolescent girls, pregnant
women’s.
5. Non-formal pre-school education [different activities, teaching poems,
alphabets etc.]
6. Nutrition and health education.

Daily routine of ICDS anganwadi no. 184 in Kolhapur.

25
26
1]IMMUNIZATION
ICDS aims for the better health of the children. The reason is they have given
certain services. Immunisation or vaccination is also one of the services by ICDS
protection of children of age group 0-10 yrs. Is important objective of the ICDS. It
is strictly made a point to observe that all the children’s coming to anganwadi and
also in the surrounding areas get vaccinated according to schedule. Along with
this the pulse polio programs are also carried out. Care is taken not to leave any
children unvaccinated. There are many serves which are done in home to home to
make it point that no child is leave unvaccinated.
Immunisation of the pregnant women and infants project children from
6 vaccine preventable disease like poliomyelitis, diphtheria, pertussis, tetanus,
tuberculosis, and measles.
Vaccination have reduce the no. of infection from vaccine preventable
diseases by more than 90%. Immunisation protects us from serious diseases and
also prevents the spread of these diseases to others.

27
28
29
Immunization schedule

Sr. Immunization Age No. Prevention against

no of disease
dose

1 BCG 0-6weeks 1 Tuberculosis

2 D.P.T. 6-10weeks 3 Diphtheria,
pertussis, tetanus

3 O.P.V. 6,10,14weeks 3 Polio

4 Measles 9-12months 1 Measles
5 D.P.T. booster 16-18months 1 Diphtheria,
pertussis, tetanus

6 O.P.V. booster 16-18months 1 Polio

7 D.T. booster 5-6 yrs. 1 Diphtheria, tetanus
8 T.T. Pregnant 2 Tetanus
mother

Observation:-
1. 15 children’s were given Vitamin A dose.
2. 5 children’s were given D.T. dose.
3. 5 children’s from age 1 ½ to 2 years were given D.P.T. booster.
4. 5 children’s were given measles.
5. 4 babies were given DPT 1st dose and 2 babies were given 3rd DPT dose.
6. 4 pregnant women’s were given tetanus vaccine.

30
2] Growth monitoring
Growth monitoring is a very important factor for child’s physical
development. Growth monitoring may consist of routine measurement of height
weight body fat etc. growth monitoring is very important for detection of health
problems or nutritional problems in growing children.
In India there is an alarming rate of child mortality due to malnutrition.
More over in a malnourished child, development of mile stones is delayed.
Developmental delays are mainly observed in areas like vision and five motors,
language and comprehension and personal, social development.
The objective of growth monitoring is to prevent illness, health,
malnutrition, provide medical care and professional, social support.

31
Importance of growth monitoring
Growth monitoring is a very important factor in a human being life.
Poor growth in early life has a negative impact on development and cognitive
morbidity are as rapid and excessive growth is associated with a higher
prevalence of obesity and cardiovascular diseases.
Growth assessment is the single most useful for defining health and
nutritional status at both the individual and population level. This is because
disturbances in health and nutrition, regardless of their etiology almost always
effect growth.
Growth monitoring strives to improve nutrition, reduce the risk of
inadequate nutrition, educate care givers and produce early detection.
Red – undernourished.
Yellow– towards undernourished.
Green – good.
Moreover every six months the head circumference and mid arm circumference is
also measured.
Health check -up is done after every 6 months by doctors by CPR government
hospital.
Similarly check-up is also done for pregnant and lactating women.
Categories by Anganwadi workers for growth monitoring-
- Each child is the age group age 0-3 must be weighed at least every month
and plotted in the WHO new growth register.
- If the growth trajectory is in the green zone and above the AWW must
appreciate the mother and advice, her to maintain feeding practices.
- The mother must be consulted to increase the frequency of feeding during
and after illness, so that child recovers early and gets back its normal
weight soon.
- Proper counselling of care giver by AWW is very important so that they
follow appropriate practices to ensure proper health of their children.

32
Observation-
Growth chart of some students-
Name Age Height[cm] Weight Head
[yrs.] [kg] circumfe-
rence[cm]
1. Arya Jadhav. 2½ 84 11 48
2. Sarthak Surywanshi. 2½ 87 11.5 47.5
3. Om Mali. 3 95 12 49
4. Shakti Zipa. 2½ 88 10 48
5. Amey chavan. 3½ 91 11 49
6. Ketaki Zirmire. 2½ 88.5 10 47.5
7. Gayatri Patil. 5 104 16 50
8. Shriraj Mulik. 2½ 87 11 48
9. Shravani Patil. 5 105 15 50
10. Arush Rode. 2 85 10 47.5
The given table show the growth chart of 10 children. This growth chart represent
the age, height and weight, head circumference of the children of the Anganwadi.

Growth monitoring is also used in all setting to assess the response to

intervention. It is necessary to monitor the growth of especially low birth weight
babies and premature babies.
Growth chart is used as a comparison to other children of the same age group
and to document a pattern for growth for an individual child. Growth chart are
often referred to when there are other indication of possible health problem.
Measurement includes length, weight, mid arm circumference and head
circumference. Along with child’s growth child’s genetic, environment, physical
activity and any health issues that can influence a child’s measurement is also
considered.

Weight formula for 1-6 years= 2y+8

33
Height formula-
Age At birth 3months 9months 1year 2years
Height 50 cm. 60 cm. 70 cm. 75 cm. 90 cm.

Measurement of head circumference-

This is important part of routine baby care. During an examination a change from
expected normal head growth may alert of possible problem.
e.g. head circumference more than normal or increasing faster than normal
indicates hydrocephalous. And a very small size or very slow growth of head size
is known as microcephalus which may be a sign that the brain is not developed
properly.
Normal head circumference-
Age At birth 3months 6months 1year 2year
HC [cm] 34 40 43 45 47

34
Growth charts:-
The growth chart or “the road to health chart” is visible display of child’s
physical growth and development. Is designed primarily for longitudinal follow up
[growth monitoring] of a child, so that changes over time can be interpreted.
The growth chart being used in ICDS Anganwadi in India show 3 different lines -
red –undernourished
- yellow - towards undernourished.
- green – good.
Uses of growth chart:-
- For growth monitoring.
- For diagnostic tools.
- For planning & policy making.
- Educational tool.
- Tool for action.
- Evaluation.
- Tool for teaching – e.g. importance of adequate feeding.

35
Observation-
In anganwadi where project held there are 2 child’s suffering from delayed mile
stones namely –
1] Master. Rajveer Ranjit Jamdar.
3yrs. delayed mile stones since beginning.
2] and Miss Shravani Patil
5yrs. delayed speech.

36
3] In growth monitoring 2 children’s found undernourished. At birth these 2
child’s were low birth weight child.

3] Health check-up
This includes health care of children. Less than 6 yrs. Of age, antenatal care of
expectant mothers and post natal care of nursing mothers.
The various health services provided to children by anganwadi workers and
primary health centre staff.
It include:-
Regular general health check-up.
Recording of weight, ht.

37
Immunisation.
Management of malnutrition.
Treatment of diarrhoea.
De-worming.
Prophylaxis against vit. A deficiency and anaemia.
Distribution of simple medicines etc.
PHC and its subordinate’s health infrastructure carry out immunisation of
infant and expectant mothers as per the national immunisation schedule.
The anganwadi worker assists the health functionaries in coverage of the
target population for immunisation.

38
4]Supplementary nutrition

Malnutrition is serious problem in India. In order to reduce micronutrient

deficiencies relating the iron, iodine, vit. A etc. and reduction of chronic energy
deficiencies the government has introduced supplementary nutrition. The ICDS
has introduced certain supplementary programs in order to improve health and
nutritional status, psychological, physical and social development of the child.

39
Objectives:-
- To the incidence of morbidity, mortality, malnutrition and school dropout.
- To enhance the capacity of the mother to look after the health and
nutritional needs of the child through proper nutrition and health
education.
Supplementary nutrition is one of the top six services provided by the
ICDS at the anganwadi. The supplementary nutrition is given to children below
6 yrs. And pregnant and nursing mothers and expectant mothers from the low
income group. The type of food is depends upon the local availability of food,
type of beneficiary, location of project etc. the is to supplement nutritional
intake by about 200 calories and 8-10 bm. Proteins for children below 1 yr.
about 300 calories and 15 gm. Proteins for children between 1-6 yrs. And
about 500 calories and 25 gm. of Proteins for pregnant women and nursing
mothers and adolescent girls. Supplementary nutrition is given in 300 days a
year. Adequate funds for supplementary nutrition is provided in state plan
under Minimum need program. Children are weighted every month.
Nutritional education and health education is given to mothers. By providing
supplementary feeding anganwadi attempts a bridge intake of children gap
between the national recommended average intake of children and in women
in low income

40
41
Mid-day meal program
ICDS also include the mid-day meal program. This comes under ministry of
education of national school health committee. The government of India pays
40 % of expenditure and 60% is born by the state government. The mid-day
meal at anganwadi consisted of puffed rice and khichadi, groundnut chikki and
upma. This is serves alternatively. This food is high in calories and good
amount of protein. We can also say it as energy giving food. Hence we can also
say that, mid-day meal is an essential part of supplementary nutrition. This
comes under ministry of education on the recommendation of national school
health committee. Government of India started a scheme for providing mid-
day meal to children from 15th august 1995.
The meal is usually prepared from special food such as bal-ahar, soya fortified
bread, Indian multipurpose food, skim milk powder, and wheat.
The children’s studying in corporation schools are given mid-day meals. The
meals are based on combination of cereals, pulses, and leafy vegetables. Eggs
are given once a week. Such diet would increase the amount of vitamins and
minerals. And results in weight gain and clearance of deficiency symptoms.
Energy food or ready to eat food supplements based on cereals, oil seeds,
pulses, unrefined sugar and vitamins. Has been developed at CFTRI under the
name ‘energy food’ which is produced in collaboration with state govt. for
school feeding and for social welfare program. In energy food ingredients are
roasted for enhancement of flavour, to inactivate anti-nutritional factors and
to improve the protein digestibility.
Mid-day school meal model menu-
Foodstuff gm./day/child
Cereals and millets 75
Pulses 30
Oils and fats 8
Leafy vegetables 30
Non-leafy vegetables 30

42
43
 Special nutrition program [ SNP] :-

It was started to provide food to children of age group 1-6 living in tribal areas
and urban slums. It was started in year 1970-1971 by department of social
welfare of govt. of India and was implemented by state govt.
The food items supplies under program include:-
- Fresh milk gifted by care
- Enriched bread supplied by modern bakeries.
- Supplementary food such as bal-ahar, food like corn, soya milk, wheat flour,
skim milk powder supplied by CARE.
- Supplement of multivitamin tablets, vit. A, vit. C capsules folic acid and iron
tablets.
- 300 cal. And 10 gm. Proteins for pre-school children and about 500cal. And
25 gm. Protein to expectant and nursing mothers for 300 days a year. At
the present the SNP is operated as a part of minimum need program in the
various states. The nutrition component of ICDS program is funded by
states union territories from the SNP budget.

Objectives-
- To improve the nutritional and health status of children in age group of 0-6
yrs.
- To reduce incidence of morbidity and mortality.

Take home ration [THR]:-

The ICDS offers the package of services to address. The development needs of
children under the 6 yrs. Of age including nursing and pregnant women’s and
adolescent girls under this program. Children’s under 6 yrs. Are entitled to
500kcal. And 12-15 gm. Proteins. Undernourished children’s are granted to avail

44
800kcal. And 22-25 gm. Proteins regularly while pregnant and lactating mothers
are entitled 600kcal. And 18-20 gm. Proteins. The supplementary nutrition shall
be distributed in form of micronutrient fortified food and energy dense food as
take home ration [THR].
THR is given to lactating mothers, children’s from 6 months to 3yrs. As they
do not attend the anganwadi centres daily basis. The severely
malnourished children between the age 3-6 yrs. Are also given THR.
The govt. of India has fixed the per beneficiary cost, calories and protein
norm to be maintain across the state. The per head ration cost is Rs. 7 for
pregnant and lactating mother and Rs. 6 for normal child under 3 yrs. And
Rs. 9 for severely malnourished child. While implementing the guideline
following aspects should be taken into consideration:-
- Coverage of children in difficult circumstances. Special measures must be
taken to ensure that children of migrants left behind, disable children, who
may not have any adult to bring them in to the net of ICDS and given the
supplementary nutrition.
- Wheat transport and delivery- a fair and transparent tender procedure
should be followed in selection of transport agents. Local conditions should
be taken in account. A rout chart should be prepared so that the delivery is
made on a fixed date every month.
- Storage-
Since wheat should not be store for more than month, the average quantity
required for month should be worked out.
- Expenditure monitoring-
The outmost transparency, financially discipline and prudence should be
maintained in all transaction dealing with govt. money at all.

45
5] NON-FORMAL PRE-SCHOOL EDUCATION (PSE)

Pre-School Education contributes to the universalisation of primary education, by

providing to the child the necessary preparation for primary schooling and
offering substitute care to younger siblings, thus freeing the older ones –
especially girls – to attend school. Under this, child centred play way activities,
which is built on local culture and practices, using local support materials and
developed by Anganwadi workers through enrichment training are promoted. It is
considered the most joyous daily activity of the ICDS programme, which is visibly
sustained for three hours a day. The activities which are undertaken as part of
PSE include story-telling, counting numbers, free conversations to speak freely
and apply their mind in order to organise small activities, painting, drawing,
threading and matching colour related to fine muscle coordination and
development, reading simple words, writing alphabets words, distinguish objects,
recognise pictures etc.

The constitution of the PSE kit may vary within a state/UT keeping in view the
specific local needs and resources. A suggestive list is as follows: Flash cards for
story telling; models on pictures/picture books of animals; Fruits, vegetables,
parts of the body, pictures/picture books; building blocks- plastic or card board or
wood; Stuffed toys, dolls for role play, colours, numbers, alphabets, matching
cards; Stacking rings/Shape Towers, balls, threading boards/beads & wires,
kitchen set, wheel toys; Dhapli/Small Drum and simple puzzles, etc. though the
list is not exhaustive. Under PSE, children are fully prepared for entering Class I at
the age of 6 years under the Sarva Shiksha Abhiyan (SSA) and District Primary
Education Programme (DPEP). So there is strong convergence between ICDS, SSA
and DPEP.

46
Games and playing activities are conducted for students.

Introduction:-
Children between the ages 3-6 years are imparted non formal pre-school
education in anganwadi in each village with about 1000 population. The objective
is to provide opportunities to develop desirable attitude, values and behaviour
pattern among the children. Locally produced inexpensive toys and material are
used in organising play and creative activity.

Games and playing activities for children are helpful in following ways:-
- To socialize the children.
- For physical exercise.
- To encourage them to play outdoor games.
- To find out their interests and skills.
- To improve their skills.
- To incorporate a sporty nature in them.
- To help to learn them for taking decisions independently.
- To enhance their mind power.
- To keep them healthy.
- Helps to learn them to work in group.

47
48
6] NUTRITION AND HEALTH EDUCATION
Personal hygiene
Hygiene is as set of practise performed for the prevention of health. It is after
referred to as cleanliness and original meaning goes much beyond that to include
all circumstances and practises, lifestyle issues, premises, and commodities that
engender a safe and healthy environment.
Personal hygiene is the first step to good health. Elementary cleanliness is
common knowledge. Neglect causes, problems that you may not even be aware
of. By improving standards of hygiene we can control these conditions. Every
external part of body demands a basic amount of attention on a regular basis.
Some of the personal hygiene habits that were suggested are:-
1. Having bath daily to keep it free of disease causing germs.
2. Brushing your teeth twice to keep our teeth and gums healthy.
3. Washing hands after using the toilet to stop spread of germ.
4. Washing hands before eating food to prevent germs from entering our
body.
5. Covering the nose and mouth while sneezing to prevent spread of germ.
6. Cutting your nails regularly.

49
 Importance of personal hygiene
Maintain personal hygiene is necessary for many reasons, personal, social, health,
psychological or simply as way of life. Keeping a good standard of hygiene helps
to prevent development and spread of infections, illness and bad odors.
Poor hygiene can lead to poor health. Conditions such as head lice, scabies etc.
should be treated immediately to prevent further infection and spread to others.
Hand washing cannot be emphasized enough as this simple action can prevent a
plethora of illness and disorders. Many people ‘forget’ to wash their hands after
using the toilet or before handling food which can cause a great deal of illness and
even death.

50
Maintain hygiene practise helps to reduce the risk of ill health and improve
quality of life.

Nutritional, Health, and Social awareness for

Adolescence Girls
Introduction:
According to WHO, Individual between 10 And 19 yrs. are considered as
adolescent, the period of transition from childhood to adulthood is called
adolescence with accelerated physical, biochemical and emotional
development. There are many physical and mental charges which result
due to influence of hormones. It is during to this period that the final
growth spurt occurs with increase in height and weight.

51
 Growth velocity is maximum for boys between 12 – 15 years and for
girls 10 – 13 years. They attain their adult status between 18 – 20yrs.
but bone mass continuous to increased demand for energy, protein,
vitamins and minerals.
Nutritional Programs for Adolescents
One Of the Objectives of World bank assisted ICDS 111 project is to
empower adolescence girls through increased awareness to take better
care of their personal and household and nutrition issues.
To motivate group and sustain their interest in project activities apart
from health and nutrition education. A special program for adolescence
girls to motivate them for self-recording of weight periodically is to be
introduced. A weight card is given for proposes.
Further iron and folic acid supplementation and De- worming once 6
months is done. They are persuaded to take handful to protein rich
locally available food like groundnuts or Bengal grams daily in addition
to their routine food.
Rajiv Gandhi scheme called ‘Sabla’ for empowerment of adolescence
girls. This scheme is aimed to enhance nutritional and economic status
of adolescence girls. Adolescence girls are given supplementary food
consisting 600 kcal and 18-20gms of protein for 300 days. For school
girls in the age group 11-14 and all other aged 15-18 as ‘take home
ration’. The cost of scheme is shared by central and state government.
The out of the school girls the age group of 11-14 years attending
anaganwadi and the girls in the age group of 15-18 will be provided
with supplementary nutrition in the form of ‘Take from Ration’.
Nutrition Component needs to be including in the curriculum to
improve nutritional status of adolescence, Parents, Teachers, and peers
group need to be role models in their life style behaviour.
The Nutritional concerns of adolescence have largely been neglected
they constitute one of the most vulnerable group who have not received
the attention they deserved. Only in turn can give birth to healthy
child.
52
 About 35-40m girls have come into anaganwadi. We suggest them to
take adequate diet which should be rich in protein and high energy and
supplemented by vitamins and minerals particularly Iron and calcium.
As we adolescence is a critical period of growth and development so
good nutrition is essential. During adolescence, the need for most
nutrient including energy, protein, vitamins and minerals increase.
Therefore it is important to make food choices carefully.
NAPG i.e. nutritional programme for adolescent girls was approved by
government in this aanganwadi should weight all adolescence girls
times in year. The aanganwadi should provide appropriate nutrition
education to beneficiaries and their families.
For the first time in India during 1991 – 1992, a special intervention
was devised for adolescence girls using the ICDS infrastructure. The
intervention focuses on school drop outs, girls in age group of 11-18
years to meet the need of self-development, nutrition, education,
literacy and recreational skill formation.
KSV i.e. kishor shakti yojana a special intervention has been devised
for the adolescents girls using the ICDS infrastructure.
Many sectors schemes pertaining to education, health and family
welfare, rural development, water and sanitation are being
implemented under the kishorin Shakti Yojana. The adolescent girls
are given a supplementary nutrition food with 600 calories and 18 to 20
gm. protein.
The Main Objectives of KYS are:
1. To Improve Nutritional status of the girls in the age group of 11 to 18
years.
2.To provide the requirement literacy and numeracy skills through the
non – formal stream of education. To stimulate a desire for more social
exposure and knowledge and help to improve their decision making
capabilities.
3. To train and equip the adolescents girls to improve / upgrade home
based and vocational skills.
53
4. To give a better understanding of environment related social issues
and their impact on their lives.
5. To encourage adolescent girls to initiate various activities to be
productive and useful members of society.
The adolescent girls were in the age group in 11 – 18 a highly
nutritious meals was suggested to them which include bhakari/ paratha
along with dal or veg /pohe/upma. Egg omelette for breakfast. Along
with the breakfast they are advised to have bhakari/ chapatti green
leafy veg. Dal sprouted. Along with this they must have curd. For
evening they must have fruit and puffed rice. Dinner same as lunch and
bedtime they should have one glass of milk.
As we know that the girl in the group required a high calories diet
with extra protein they should also be given fresh fruit and green leafy
vegetables, Milk is must for this age group. They must have chikki and
ragi laddo or cress garden seed ladoo which contain jiggery and
nutrition. Hence a good nutrition status of adolescent girls will prove to
be good nutritional status of future mother which will in turn led to the
birth of health children thus preventing the birth of undernourished
child.

54
55
56
 Activities conducted in
Anganwadi about nutrition
and health education by us.

Diarrhoea awareness.
Diarrhoea is the passage of stools with increased frequency. It is due to bowel
infection due to viruses/ bacterial, drugs, foods or disease. Acute diarrhoea is a
major cause of morbidity and mortality in infants and young children in India.
Dysentery is diarrhoea with visible blood and associated with fever and tenesmus.

57
Poor food hygiene and improperly handled food can cause infectious diarrhoea.
Food intolerance or allergy can also lead to diarrhoea. Most of the diarrhoeal
episodes are due to viruses -Rota viruses.
Dietary management in Diarrhoea- Encouraging to breastfeeding, better food
hygiene, improvement of nutritional status of children and food environmental
sanitation are important during managing diarrhoea in children.
Fluid – coconut water, butter milk, rice kanji with salt, lemon-sugar -salt beverage,
light tea may be given in unlimited quantity with teaspoon or from small drips
from a tumbler to avoid dehydration.
ORS WITH HOME MADE SOLUTION – For one glass of boiled cooled water one
pinch of salt and one tsp. sugar can be added to prepare ORS at home.
ORS SOLUTION- If diarrhoea is prolonged and dehydration becomes evident, to
rehydrated child orally by administering a solution with composition approved by
the WHO is recommended.
Glucose- 20 g/L
Sodium chloride -3.5 g/L
Sodium carbonate – 3.5g/L
Tri-sodium citrate-2.9g/L
Potassium chloride -1.5g/L
It is administered in small sips to prevent rapid passage of stools due to
hyperactive gastro-colic reflex. Usually one year old infant needs 1000 ml of ORS
in 24 hrs.
Foods allowed – riced based solutions, potato, millet, maize, buttermilk, mashed
bananas, apple etc.

58
59
 We conduct awareness lecture for parents on diarrhoea and its primary
treatment in our anganwadi where our project implanted. We distribute some
written guidelines related to diarrhoea to mothers.

60
Dental carries-
Tooth decay can be caused by caries. Tooth decay can be seen children with
nutritional deficiency. Vitamin A is necessary for enamel and Vitamin C is essential
for dentine. Calcium, phosphorus, and vitamin D are necessary for calcification as
well as fluorine decreases susceptibility of caries. Sticky and sugary things along
with fermentable carbohydrates can make caries faster in the mouth.

Pica –
Some kids are fond of eating non-nutrient substances like plaster, charcoal, wool,
clay, ashes, paint and earth usually at the age of 1-2 years, this is known as pica.
Children with pica are having risk of lead poisoning, iron deficiency anemia and
parasitic infections. . Pica can be treated with combination of education and
guidance, family counselling and behavior modification.

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 Importance of Breastfeeding /Lactation

Baby’s first food is mother’s milk. Nutrition word derived from ‘nutricus’ meaning
of is suckling from breast. Breast milk is natural and nutritious food for infant.
Hence, successful breast feeding is very important for child’s physical and mental
growth.
There are many misunderstandings are present in the community today. Hence ,
to clear this misunderstanding and explaining importance of breast feeding , I
arranged small lecture to the expecting mothers and infant’s mother.
In this lecture, I explained them why breast feeding is important and what is itrole
in child’s growth.
The infant should be put to breast within half an hour after normal delivery and
within four hours after caesarian section. Suckling reflex is most active at birth.
Colostrum- After delivery, during the first two to three days, thick, yellowish fluid
is secreted from the mammary gland. This fluid is called as colostrum. This fluid is
rich in protein as well as rich in multivitamins as well as antibodies which are very
important for child’s immunity. I explained them that colostrum is the first
immunization of infant and it plays very important role in antiviral and
antibacterial activity and protects baby. It also helps in enhancement of
development and maturation of baby’s gastrointestinal tract.
Transition of milk- After colostrum, breast milk is increases in quantity and
changes in appearance and composition. This occurs during next two weeks. This
phase is called transition milk. Immunoglobulin and protein content decreases
while fat and sugar content increases which are now essential for baby for further
growth and development.
Breast milk contents water as well as fat, protein, vitamins, minerals and lactose
sugar which satisfied the baby’s thirst as well as hunger.
I also explained expecting mother that breast feeding is not only beneficial to the
infant but also to the mother. It creates emotional bond between the mother and
baby. The main advantage of the breast feeding it is cheap, easily available and
nutritious food to the baby at any time, it required. I also explained them why
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breast feeding is good than bottle feeding. Breast milk is sterile, hence it reduces
contamination and gastrointestinal problems in the baby’s. It also reduces ear
infections and respiratory tract infections. Breastmilk also reduces the allergic
reactions because human milk protein do not cause allergies. Breast feeding can
be continued during illness of infant, like diarrhea and after vaccination. And the
most important thing about breast feeding is, those babies who breast feed are
less likely develop obesity, hypertension, diabetes mellitus, Atherosclerosis in
later life.
I also explained the advantages of breast feeding to the mother. In it, I told them
that breast feeding’s importance in postpartum bleeding and delays the
menstrual cycle as well as it acts as birth control tool. One more advantage of
breast milk is, it is convenient to administer for mother at any place and any time
and provides mother a sense of calm and satisfaction. Frequent suckling,
complete emptying of breast, correct positioning and supportive care are
important factors in successful lactation.

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Sample diet plan for nursing mothers

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 References:-

- www.mpwcd.nic.in/sc-ic-icds website
- Internet
- Book of dietetics by B.Srilakshmi.
- Park’s textbook of preventive and social medicines.
- Book of nutrition science by B.Srilakshmi.

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