child health problems services immunization, nutritional supplementation, growth monitoring icds
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ICDS Integrated Child Development Services immunization nutritional supplementation growth monitoring services
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https://mimer.edu.in/02-pdf/e-content/08-PSM/ICDS.pdf
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Child Health Problems, Services, Immunization, Nutritional Supplementation, Growth Monitoring & ICDS
1. Overview of Child Health Problems in India
Children under 6 years face several overlapping health threats:
- Malnutrition - underweight, stunting, wasting, micronutrient deficiencies (iron, vitamin A, iodine)
- Vaccine-preventable diseases (VPDs) - polio, diphtheria, pertussis, tetanus, measles, tuberculosis, hepatitis B
- Infections - diarrheal diseases, acute respiratory infections (ARI), malaria
- Developmental deficits - delayed motor, cognitive, and social milestones
- Anemia - highly prevalent in children and adolescent girls
- Vitamin A deficiency - leading cause of preventable blindness
- High infant mortality rate (IMR ~34/1000 live births) and under-5 mortality rate (~40/1000)
2. Integrated Child Development Services (ICDS)
Background
ICDS is India's flagship, centrally-sponsored scheme launched on 2 October 1975 under the National Policy for Children. It is one of the largest integrated early childhood programmes in the world, covering children 0-6 years, pregnant women, lactating mothers, and adolescent girls. It has since been renamed Anganwadi Services under the POSHAN Abhiyan framework.
- Implemented through Anganwadi Centres (AWCs) - one AWC per 400-800 population in rural/urban areas, 300-800 in tribal areas
- Staffed by the Anganwadi Worker (AWW), supervised by Mukhya Sevika, with overall block-level management by the Child Development Project Officer (CDPO)
- Each ICDS project has approximately 100 Anganwadis
Objectives
According to Park's Textbook of Preventive and Social Medicine:
- Improve nutritional and health status of children aged 0-6 years
- Lay foundations for proper psychological, physical, and social development
- Reduce mortality, morbidity, malnutrition, and school dropout
- Achieve effective coordination of policy across departments working for child development
- Enhance the capability of the mother regarding nutritional needs of the child through proper nutrition and health education
3. Six Core Services under ICDS
| Service | Beneficiary |
|---|---|
| 1. Supplementary Nutrition | Children 0-6 yr, pregnant & lactating mothers |
| 2. Immunization | Children 0-6 yr, pregnant women (TT) |
| 3. Health Check-up | All beneficiaries |
| 4. Referral Services | Children, women requiring higher care |
| 5. Pre-school Non-formal Education (NFE) | Children 3-6 yr |
| 6. Nutrition & Health Education | Women 15-45 yr, adolescent girls |
Note: Services 1, 5, and 6 are provided by the ICDS department. Services 2, 3, and 4 are delivered through the Public Health Infrastructure (Ministry of Health and Family Welfare).
4. Supplementary Nutrition
Supplementary nutrition is provided for 300 days per year through AWCs.
Calorie and Protein Norms
| Beneficiary | Energy | Protein | Financial Norm |
|---|---|---|---|
| Child 6-72 months (normal) | 500 kcal | 12-15 g | Rs 8/child/day |
| Severely malnourished child 6-72 months | 800 kcal | 20-25 g | Rs 12/child/day |
| Pregnant/nursing woman | 600 kcal | 18-20 g | Rs 9.50/day |
Key Features
- State govts/UTs are mandated to provide more than one meal to children at AWCs: a morning snack (milk/banana/egg/seasonal fruit/micronutrient-fortified food) + a hot cooked meal
- Children below 3 years and pregnant/lactating mothers receive take-home ration (THR)
- Locally available foods are preferred (low-cost intervention, BCC strategy)
- For adolescent girls (10-19 yr): 6 kg food grain per month
5. Immunization under ICDS
Immunization services are provided by the Health Department (not the ICDS directly) and protect children from Vaccine-Preventable Diseases (VPDs):
| Vaccine | Disease Protected |
|---|---|
| BCG | Tuberculosis |
| OPV / IPV | Poliomyelitis |
| DPT | Diphtheria, Pertussis, Tetanus |
| Hepatitis B | Hepatitis B |
| Hib | Haemophilus influenzae type b |
| Measles/MR/MMR | Measles, Rubella |
| TT (for pregnant women) | Tetanus (reduces maternal & neonatal mortality) |
- Adolescent girls also receive immunization, deworming, prophylaxis for anemia, IDD, and vitamin deficiency under the Kishori Shakti Yojana scheme
- RBSK (Rashtriya Bal Swasthya Karyakram) - dedicated teams (Medical Officers, ANM, Pharmacist) - 3-4 teams per block - conduct health check-ups including immunization at the community level
6. Growth Monitoring
Growth monitoring is an integral component of supplementary nutrition under ICDS, as a nutrition surveillance activity.
Protocol
- Children < 3 years - weighed once a month
- Children 3-6 years - weighed quarterly
- Height/length is also recorded at periodic intervals alongside weight
What is Monitored
- Weight-for-age (to detect underweight)
- Height-for-age (to detect stunting)
- Weight-for-height (to detect wasting)
- Motor developmental milestones
- Watch over milestones, detect growth faltering early
Standards Used
Since 2008, the Government of India adopted the WHO Child Growth Standards (New WHO Child Growth Standard) for both ICDS and NRHM. These standards were developed through an intensive multi-country study (6 developing countries from 1997) and measure:
- Physical growth
- Nutritional status
- Motor development in children from birth to 5 years
Technology Support
The ICDS-CAS (Common Application Software) under POSHAN Abhiyan enables:
- Electronic growth monitoring and tracking
- Timely interventions
- Data-driven decision-making at the AWC level
7. Health Check-up Services
Health check-ups under ICDS include:
- Recording weight and height at periodic intervals
- Watching over developmental milestones
- Confirmation of immunization status
- General check-up for disease detection
- Treatment of common illnesses (diarrhea, ARI)
- Deworming
- Prophylaxis against vitamin A deficiency and anemia
- Referral of serious cases to higher facilities
8. Service Delivery by Beneficiary Group
| Beneficiary | Services Provided |
|---|---|
| Pregnant women | Health check-up, TT immunization, Supplementary nutrition, Nutrition & health education |
| Nursing mothers | Health check-up, Supplementary nutrition, Nutrition & health education |
| Other women (15-45 yr) | Nutrition and health education only |
| Children < 3 years | Supplementary nutrition, Immunization, Health check-up, Referral services |
| Children 3-6 years | Supplementary nutrition, Immunization, Health check-up, Referral services, Non-formal pre-school education |
| Adolescent girls (11-18 yr) | Supplementary nutrition, Nutrition & health education |
9. POSHAN Abhiyan (2018 Onwards)
ICDS was strengthened under POSHAN Abhiyan (National Nutrition Mission) with the goal of making India malnutrition-free by 2022. Key additions:
- Revised cost norms for supplementary nutrition (increased allocations, September 2017)
- Enhanced incentives for frontline workers (AWW)
- Technology-enabled growth monitoring via ICDS-CAS
- Convergence with other nutrition schemes
10. Impact and Challenges
Impact:
- Contributed significantly to reduction in child mortality, malnutrition, and school dropouts
- Universal Immunization Programme, ORT, and ICDS together have had considerable impact on child survival and extreme malnutrition
- Cost-effective: $10-22 per child per year
Challenges:
- Inconsistent quality and quantity of service delivery across states
- Operational gaps despite widespread coverage
- Continued high burden of stunting and underweight in many states
- Anemia in children and adolescent girls remains a persistent problem
Sources:
- Park's Textbook of Preventive and Social Medicine - ICDS Programme, Child Health sections
- ICDS Programme - MIMER Medical College
- Wikipedia - ICDS
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