A coordinated approach to children's health in India: progress report after five years (1975-1980)
Lancet 1(8316): 109-111
1983
ISSN/ISBN: 0140-6736 PMID: 6129424 DOI: 10.1016/s0140-6736(83)91753-1Document Number: 426436
This article reports the evaluation of the 2nd phase of the integrated child development services scheme (ICDS), launched in India on October 2, 1975 as an experimental project in 29 rural and tribal blocks and 4 urban slums. Data were analyzed to determine the impact of the coordinated approach for delivery of health and nutrition services in 1976-1980, when the experimental project changed to a national program to cover a larger population, and the rate of change due to ICDS in a year, comparing the 1st and 4th years of the program. The study sample was drawn from 56 ICDS blocks, 23 projects established in 1975-1976, and 33 in 1978-1979. All selected villages have similar socioeconomic conditions, with most of the population living below the poverty line. The randomly selected samples studied were: A--27,726 preschool children (16,989 rural, 5553 tribal, and 5184 urban), in whom a baseline study was conducted before ICDS projects began in 1976; B--27,487 preschool children (10,078 rural, 8291 tribal, and 9118 urban) whose baseline study was conducted before their ICDS programs began in 1979; C--15,882 from the same blocks as sample A but different children (9266 rural, 3822 tribal, and 2794 urban) who were surveyed in 1979-1980, about 3 years after the implementation of ICDS; D--10,947 children (5291 rural, 3228 tribal, and 2428 urban) from projects established in 1979 were surveyed before the projects began in 1979 and again after 1 year of ICDS; and E--2532 children (1552 rural, 570 tribal, and 410 urban) were selected from 6 ICDS projects established in 1976 and surveyed in 1979 and in 1980. The percentage of children receiving BCG immunization fell slightly from 1976-1979 (samples A and B), but the proportion receiving tetanus (DPT) rose in that time. Poliomyelitis immunization was not included in the national schedule but in 1979, 9.2% of children received it through an ad hoc program. There was an increase in vitamin A administration between 1976-1979, but distribution of supplementary nutrition remained almost the same. Severe malnutrition (grades 3 and 4) decreased from 19.1% in 1976 to 15.1% in 1979. Both BCG and DPT coverage were greater in sample C than in sample B. Health check-up and distribution of vitamin A and supplementary nutrition were significantly lower in Sample B than in sample C. Severe malnutrition was reduced to 10.8% in the children receiving services from ICDS compared with 15.1% in the population receiving health and nutriton services from the Department of Health and Social Welfare. BCG and DPT immunization coverage increased by 108% and 622%, respectively between 1976 and 1979. Health check-up, distribution of vitamin A, and supplementary nutrition showed increases of 221%, 412%, and 120%, respectively. Grade 3 and 4 malnutrition declined by 43.5%.