High Coverage and Utilization of Fortified Take-Home Rations among Children 6–35 Months of Age Provided through the Integrated Child Development Services Program: Findings from a Cross-Sectional Survey in Telangana, India

Abstract

The Integrated Child Development Services (ICDS) in the State of Telangana, India, freely provides a fortified complementary food product, Bal Amrutham, as a take-home ration to children 6–35 months of age. In order to understand the potential for impact of any intervention, it is essential to assess coverage and utilization of the program and to address the barriers to its coverage and utilization. A two-stage, stratified cross-sectional cluster survey was conducted to estimate the coverage and utilization of Bal Amrutham and to identify their barriers and drivers. In randomly selected catchment areas of ICDS centers, children under 36 months of age were randomly selected. A questionnaire, constructed from different validated and standard modules and designed to collect coverage data on nutrition programs, was administered to caregivers. A total of 1,077 children were enrolled in the survey. The coverage of the fortified take-home ration was found to be high among the target population. Nearly all caregivers (93.7%) had heard of Bal Amrutham and 86.8% had already received the product for the target child. Among the children surveyed, 57.2% consumed the product regularly. The ICDS program’s services were not found to be a barrier to product coverage. In fact, the ICDS program was found to be widely available, accessible, accepted, and utilized by the population in both urban and rural catchment areas, as well as among poor and non-poor households. However, two barriers to optimal coverage were found: the irregular supply of the product to the beneficiaries and the intra-household sharing of the product. Although sharing was common, the product was estimated to provide the target children with significant proportions of the daily requirements of macro- and micronutrients. Bal Amrutham is widely available, accepted, and consumed among the target population in the catchment areas of ICDS centers. The coverage of the product could be further increased by improving the supply chain.

Progress of children with severe acute malnutrition in the malnutrition treatment centre rehabilitation program: evidence from a prospective study in Jharkhand, India

“…That distribution of THR amount was inadequate for the children to realize growth benefits. Previous studies on ICDS have attributed poor coverage of take-home ration to low demand for the product due to poor ration quality; distribution to non-eligible households; and insufficient stocks at AWCs [ 27 , 28 ]. Intra-household sharing of ration targeted at the children remains a challenge for food based programs.…”

Marketing and infant and young child feeding in rapidly evolving food environments

“…The use of fortified infant foods has been included in strategies to improve child nutrition after age 6 months since they can improve the intake of iron, zinc, and other nutrients often lacking in diets of young children (Campos Ponce, Polman, Wieringa, & Doak, ; Leyvraz et al, ; Lutter et al, ; Plessow, Arora, Brunner, & Wieser, ; Wieser et al, ; WHO, ). They have been shown to lead to enhanced growth (Diana et al, ; Ten Year Strategy to Reduce Vitamin and Mineral Deficiencies Maternal Infant and Young Child Working Group Formulation Subgroup, ) and improved iron status (Faber, Kvalsvig, Lombard, & Benadé, ; Lutter, ).…”

Scaling‐up interventions to improve infant and young child feeding in India: What will it take?

“…There remains a high interstate variability in the implementation and reach of the CFS (India-MoWCD, 2015). Irregular supply and sharing of the product remain to be the barriers to achieving full coverage and use of the CFS (Leyvraz et al, 2016). Given the mandate to universalize the CFS, economic and operational costs, and programmatic gaps in the ICDS, it is imperative to examine the contribution of the food supplementation to the complementary feeding practices in the context of India and its use at the household level.…”