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Background: Anganwadi was an initiative taken by the Indian government under the Integrated Child Development Services Scheme (ICDS). Anganwadi is a primary healthcare and education center in rural India, focusing on the health of pregnant women and nursing mothers along with child health care. The important services utilized by the Anganwadi child beneficiaries are - primary health checkup and immunization, supplementary nutrition, non-formal education for children in pre-school and referral services. Methods: A study was conducted among 849 Anganwadi child beneficiaries from the three districts of Telangana, i.e. Bhadradri Kothagudem, Nalgonda and Nizamabad, which have the highest number of Anganwadi centers in the state. Complete enumeration of the Anganwadi child beneficiaries was employed through interview method by using self-designed, structured questionnaire. Data was analyzed using SPSS version 23 and Chi-square test was applied to see whether the provision of supplementary nutrition and health related facilities have any association with the growth of the child beneficiaries in terms of height and weight of the child beneficiaries. The Chi-square test was also applied to see whether the pre-school educational facilities have any association with the children’s behaviour about regular attendance and their attitude towards reading and learning. Results: As regards social status, out of 849 children, about 41 Percent of them belong to Backward Community followed by Scheduled Tribe (29%), Scheduled Caste (20%) and about 10% of them belong to Other Community children. The distribution of Child Beneficiaries in sample Anganwadi Centers by religion reveals that Children belonging to Hindu religion was found to be the predominant one with 591 (69.61%) children followed by 161 (18.96%) who belonged to Muslim religion, 61 (7.18%) child beneficiaries who belonged to Christian religion and lastly 36 (4.24%) of them belonged to Sikh religion. The distribution of Child Beneficiaries in the sample Anganwadi Centers by type of family reveals that at the aggregate level, 261 (30.74%) of the Child Beneficiaries live in the joint families whereas 588 (69.25%) of them live in the nuclear families. Arriving at conclusion about the availability of Infrastructural facilities, 258 (91.16%) of the sample Anganwadi Workers have good infrastructural facilities in their Centers whereas 25 (8.83%) of the sample Anganwadi Workers do have the infrastructural facilities but in bad condition. With regard to the analysis of the Anganwadi Workers having any problem in maintaining the Anganwadi Centers, some of the Anganwadi Workers responded positively and others responded negatively. On the whole, this table shows that most, 175 (61.83%), of the Sample Anganwadi Workers do not face any kind of challenges in maintaining their Centers whereas 108 (38.16%) have expressed some kind of issues in maintaining their Centers. On our enquiry about whether parents of child beneficiaries were satisfied with overall services provided at centre, 835 Parents (98.35%) of the child beneficiaries were satisfied with the overall services provided by the Anganwadi Center whereas 14 (1.64%) Parents of the child beneficiaries were not satisfied with the overall services provided by the Anganwadi Center. Pattern of attendance by Beneficiaries in Anganwadi centers reveals that 719 beneficiaries i.e. almost 85% of the total beneficiaries had regular attendance in their respective Anganwadi Centers whereas mere 130 beneficiaries i.e. around 15% of the total beneficiaries had irregular attendance in their respective Anganwadi Centers. When adequate facilities with regard to immunization and regular checkup taking place, we enquired about health status of children. For which out of 849 child beneficiaries 756 (89.04%) of the beneficiaries do not have tendency of frequent illness and their health position was good whereas 93 (10.95%) of the beneficiaries do have tendency of frequent illness and are facing one or other health problem by the children. Conclusions: Material for preparing Pre-School Education should be provided by the centres since they are not available in all Anganwadi Centres. Integrated Child Development Services can provide free and compulsory education to all children and the government should give rules and weightage to ICDS regarding education for three to six children. Proper classroom, seating arrangements, toilet, playground and fencing should be taken as the first priority in each Anganwadi centres. The Centres should be set up in a suitable area with fewer disturbances. The Centre should introduce and provide books, teaching aids such as audio and visual aids, blackboard, toys, charts, etc. The children should be taught personal health and hygiene. Care is to be taken to avail clean drinking water.

1. To Study the Socio-Economic and Demographic characteristics of Child beneficiaries and Anganwadi Workers.

2. To examine the Supplementary Nutritional, Health Status and availability of Pre-School Educational facilities to Children at Sample Anganwadi centres.

3. To observe the Status of Immunization, Health Check-Up, and Referral Services for children at Anganwadi Centres.

Gulfshan and Senbagam, et al (2023)[1] A study to assess the effectiveness of hydrabadi mix ball on nutritional status among malnourished under five year children at selected anganwadi in barabanki, Uttar Pradesh. Introduction: Malnutrition is a major public health problem worldwide today, particularly in children under five years of age. Protein energy malnutrition is the most widely prevalent form of malnutrition in developing and underdeveloped nations. The nutritional status of children is an indication of the nutritional profile of the entire community. Preschool is a vulnerable period for the child, especially from the growth and development stand point. Aim: Assess the effectiveness of hydrabadi mix ball among malnourished under five year children. objectives: 1.To Assess the nutritional status among under five years children before giving hydrabadi mix ball in experimental and control group.2.To assess the nutritional status among malnourished under five years children after giving hydrabadi mix ball in experimental group and without giving hydrabadi mix ball in control group.3.To assess the effectiveness of hydrabadi mix ball on nutritional status among malnourished under five years children in experimental and control group.4.To determine the association between the pre-test level of hydrabadi mix ball on nutritional status among malnourished under five years children with selected demographic variables in experimental and control group.

Lall, G., et al (2023)[2] ICDS, a large public health programme, addresses the needs of children with ‘Anganwadi Workers (AWW)’ as frontline agents of delivery. This paper describes formative work done with AWWs, as part of ASPIRE to assess their understanding of Early Child Development (ECD) and acceptability of a novel ECD intervention. Framework analysis of their responses from FGDs led to identification of three themes:1) time use 2) understanding of ECD and 3) delivering messages using videos. The findings suggest that AWWs tight schedules, often leave them feeling overburdened with work. They are aware of factors that can aid as well as hinder child growth and development, but their understanding of play is limited to games played by older children. They expressed acceptability in using a video intervention, specifying features that would increase relevance for families. These have implications for ECD intervention development, training needs of AWWs as well as policymakers in the field.

Amir, A., et al (2023)[3] Background: As children have poor immunity, many children suffer from fever, cough, dysentery, stomach ache, worms and other gastrointestinal diseases. Major problems with health are stomach infections and diarrhea due to lack of personal hygiene. Methodology: Facility based cross sectional study to compare the status of personal hygiene among children attending Anganwadi centers in urban, rural and tribal areas of Udaipur district through two stage sampling technique. Result: 52.1% of total children (3-6years) had teeth or gum infection. 36.1%, 36.8% and 22.5% of total children (3-6 years) washes their hand after using toilet, before eating food and after wiping or blowing nose respectively. Conclusion: Poor status of personal hygiene is more in tribal and rural children than urban children.

Jaiswal, R., et al (2020)[4] About one-third (30.00%) of the population in the developing world is suffering from one or other form of malnutrition, despite marked advancements in medical sciences, improved economic status and higher hygienic awareness. Health and nutritional status of under-privileged children in these countries present even worst scenario. The present study is undertaken to assess nutritional status of Anganwadi children of Raipur (Chhattisgarh) using both conventional anthropometric indices and CIAF, considered better indicator of malnutrition besides enabling the identification of children with multiple anthropometric failures. For the purpose, 240 Anganwadi children (120 boys; 120 girls), selected cross-sectionally, were subjected to height and weight measurements, as per standard Anthropometric procedures. Z-score values of Weight-for-Height, Weight-forage and Height-for-age were determined by use of Ms-Excel 2010.Values falling in <-2SD range reflect undernutrition, according to WHO guidelines. SPSS version 16.0 was employed for analysing the data through ANOVA and Chi-square tests. Incidence of underweight, stunting & wasting was found to be 48.75%, 42.10% & 23.75%, respectively. CIAF value of 54.16%not only indicates malnutrition but also points out its greater prevalence. Sex-specific prevalence of underweight (55.83% boys; 41.67% girls), stunting (45.00% boys; 39.17%girls), wasting (25.84%boys;21.67% girls) and CIAF (72.5% boys;62.5% girls) was found to be higher among boys than those of girls. The study observed considerably high incidence of malnutrition among the Anganwadi children. WHO recommended interventional food policies & programs need to be implemented more vigorously to improve health and nutritional status of children.

Mhatre, P. J., et al (2023)[5] An impaired nutritional status in preschool children leaves significant impact on their overall childhood development. A community-based, cross-sectional study was conducted in Panvel, Maharashtra, over 15 months to assess the overall prevalence and patterns of undernutrition in preschool children using the composite index of anthropometric failure (CIAF). The sample size of 8542 was obtained from randomly selected 132 Anganwadis. Conventional indices (underweight, stunting, and wasting) and CIAF classification were used to assess the prevalence of undernutrition. Statistical analysis was performed using the SPSS version 27. About 50.6% of children were detected as “anthropometric failure” by CIAF method which is higher than conventional indices for underweight (32.9%), stunting (35.7%), and wasting (16.4%). The 13–25 months’ age group was most significantly affected (57%) as per the CIAF. Undernutrition prevalence was similar for both genders across all age groups. A comprehensive policy is needed to identify and treat all anthropometrical failure children with special emphasis on 13–25 months’ age group.

6(a) Sources of data

The present study was planned to evaluate the performance of Anganwadi Centers under ICDS in Telangana. The study has been conducted in sample districts from three regions of Telangana state of India by adopting two-stage stratified random sampling procedure. A list of Anganwadi centers covered by Women Development and Child Welfare Department, in urban as well as rural areas, was obtained from the Directorate, Department of Women Development and Child Welfare, Government of Telangana, Hyderabad.

As a first stage, one district from each of the three regions was selected on the basis of the highest number of AWCs are available. The districts selected were Nalgonda, Bhadradri-Kothagudem, and Khammam.

At the second stage, from each district 5% of the AWCs located in urban and rural areas were selected, and one child beneficiary from three different age groups was chosen as sample respondents.

6(b) Sample Design

Sample Design

Multistage Stratified Random Sampling Method

1st State:     Districts; Criteria - Highest number of AWCs - 3

2nd Stage:   Mandals; Criteria - Highest number of AWCs - 3

3rd Stage:   Villages; Criteria - Highest number of AWCs - 15

4th Stage:   Sample Respondents (AWWs) - 5% of AWCs in 3 districts - 283

Sample Respondents (AWBs) - 3 child beneficiaries from each AWC - 849

6(c) Period of study

Secondary data has been collected for a period of ten years i.e., ten calendar years from 2010 to 2020, while primary data has been collected from respondents for a period of one year i.e., 2021.

6(d) Statistical techniques chosen

Simple mathematical computations like ratios, percentages and growth rates are used to assess the data that had been collected; and also used Chi-Square Test for Hypotheses testing.

6(e) Limitations of the Study:

Our research study is confined only to selected sample districts. Secondary data is also collected and limited for a restricted period of time. Information collected through pre-structured schedule is purely based on memory of the respondents. Thus, the conclusions and results can be applied with caution for the policy purpose.

Socio-Economic Characteristics of Anganwadi Child Beneficiaries in Bhadradri Kothagudem, Nalgonda and Nizamabad Districts of Telangana:

This section is filled with the analysis related to the socio-economic status of the sample Anganwadi Child Beneficiaries among three sample districts. As already mentioned, the three sample districts are: Bhadradri Kothagudem, Nalgonda and Nizamabad.

Table 2: Socio-Economic Characteristics of Child Beneficiaries in the Study Area

Source: Field Study

*Figures in the bracket represent percentages.

Table 2 presents the socio-economic characteristics of Child beneficiaries under ICDS. Child beneficiaries are chosen purposively one from each Anganwadi Centre. Therefore, under each age group, there are 283 children. It means that the total number of children chosen is 849 and children under each age group constitutes as 33% equally under all three groups. It is clear from the data that majority (60%) of the sample child beneficiaries are boys and about 40% of them are Girl students.

As regards social status, out of 849 children, about 41 Percent of them belong to Backward Community followed by Scheduled Tribe (29%), Scheduled Caste (20%) and about 10% of them belong to Other Community children.

The distribution of Child Beneficiaries in sample Anganwadi Centers by religion reveals that Children belonging to Hindu religion was found to be the predominant one with 591 (69.61%) children followed by 161 (18.96%) who belonged to Muslim religion, 61 (7.18%) child beneficiaries who belonged to Christian religion and lastly 36 (4.24%) of them belonged to Sikh religion.

The distribution of Child Beneficiaries in the sample Anganwadi Centers by type of family reveals that at the aggregate level, 261 (30.74%) of the Child Beneficiaries live in the joint families whereas 588 (69.25%) of them live in the nuclear families.

Table 3: Facilities available at Anganwadi Centers

Source: Field Study

*Figures in the bracket represent percentages.

At the outset, it is clear from the above that about 70 percent of Anganwadi Centers are being housing either in community halls or in Auditoriums and only about 30 percent of them are having their own buildings. During the field investigation most of the Centers had not seen boundary surrounding the Center. Due to inadequate space for displaying NFPSE posters or other posters related to nutrition and health education, for conducting recreational activities like outdoor activities. At some centers cases of theft of vessels and other stuffs are very common and many respondents have to face difficulties due to the unavailability of the locking facility on some Centers.

As regards the type of Anganwadi centre building construction in which they were located, it is clear that the number of Anganwadi Centers were with Cement structure is the highest (98%) while only about 2 percent Anganwadi Centers were housing in mud type of houses. Though we do not have detailed information about own building Centers, but on the whole whether they are working either in school buildings, auditoriums or community halls but housing in pukka houses which are safe for children who are getting educated in Anganwadi Centers.

With regards to Educational aids, about 70 Percent of these Anganwadi centers were well equipped with all types of educational aids through which children got educated in Anganwadi centers.

Social Health Activist plays a crucial role and it is clear that each Anganwadi worker has been in touch with Social Health Activist Workers and they meet frequently. What we observed that they are regularly having meetings and implementing program effectively.

Results related with the updating of records in Anganwadi centres shows that the records have been updated at Anganwadi centers to the extent of 80 Per cent. It is a positive sign to say that the activities of the program have been implemented regularly and reaching to the grass root level beneficiaries, but this is all with the hardship and hard work of Anganwadi Workers at Centers.

As regards the availability of Medical Kit in Anganwadi centres, 204 (72.08%) of the sample Anganwadi Workers do have the medicine kit in their Centers. This is most important one where in urgency with which health problems could be solved. Hence, not only 72 Percent Centers, all the Centers should have Medical Kit. Our results are almost similar of the study (3) by Prudhviraj et al (2022).

Whether these Centres are receiving funds from Government or not, the response is that 283 (100%) out of 283 sample Anganwadi Workers had only the source of government funds and no other source of funds available to them. If the Non-Governmental Organizations and Donors also contribute, these Centers can serve more number of beneficiaries.

Arriving at conclusion about the availability of Infrastructural facilities, 258 (91.16%) of the sample Anganwadi Workers have good infrastructural facilities in their Centers whereas 25 (8.83%) of the sample Anganwadi Workers do have the infrastructural facilities but in bad condition. These results are nearer to the study (4) Prudhviraj, K.,et al.,(2022).

With regard to the analysis of the Anganwadi Workers having any problem in maintaining the Anganwadi Centers, some of the Anganwadi Workers responded positively and others responded negatively. On the whole, this table shows that most, 175 (61.83%), of the Sample Anganwadi Workers do not face any kind of challenges in maintaining their Centers whereas 108 (38.16%) have expressed some kind of issues in maintaining their Centers.

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We conducted a Chi Square Test to know whether Null Hypothesis is Rejected or Accepted. Null Hypothesis is “There is no association between the availability of infrastructure facilities and problems in maintaining Anganwadi centres”

Results are as follows:

Chi-Square = 16.924, df = 1:

Computed value = 16.924 which is higher than table value of 3.841. Hence Null Hypothesis is rejected.

Therefore, there is a significant relationship between the availability of infrastructural facilities and problems maintaining Anganwadi workers.

Table 5: Opinion on availability of SNP and Health and Nutrition

Source: Field Study

*Figures in the bracket represent percentages.

Results in above table reveal information about the availability of supplementary nutrition, health and nutrition education service, satisfaction about the growth in height and weight of children, etc., The response for the opinion about whether Adequate Supplementary Nutrition is there or not, 768 (90.45%) out of 849 Anganwadi Beneficiaries responded positively and 81 (9.54%) of them were responded negatively.

And also it is clear in our opinion survey about the adequate availability of health and nutrition education service, at the aggregate level, the highest number of sample beneficiaries 774 (91.16%) out of 849 have the satisfactory opinion about adequate availability of the health and nutrition education service provided in the Anganwadi center followed by 75 (8.83%) of them having unsatisfactory opinion about adequate availability of the health and nutrition education service provided at their Anganwadi center.

Though the majority of parents (94%) is satisfied with the growth in weight and height of children, it is necessary that we also give importance to the views of minority respondents. Thus, it is suggested that the need for evaluating and monitoring the feeding practices at home and educating mother to give proper breakfast, inclusion of milk, balanced meal and diet plans in future. Mere monitoring of the child beneficiaries by the AWCs is not sufficient to bring improvement in child’s growth and development. Improvement with attitudinal change in health and nutrition habits of the mothers and children shall positively and constructively improve their nutritional status.

On our enquiry about whether parents of child beneficiaries were satisfied with overall services provided at centre, 835 Parents (98.35%) of the child beneficiaries were satisfied with the overall services provided by the Anganwadi Center whereas 14 (1.64%) Parents of the child beneficiaries were not satisfied with the overall services provided by the Anganwadi Center.

We conducted a Chi Square Test to know whether Null Hypothesis is Rejected or Accepted.

Null Hypothesis is “There is no association between the problems faced by Anganwadi worker and their level of satisfaction with their nature of work and work load”

Results are as follows:

Chi-Square = 134.966, df = 1,

Computed value = 134.966 which is higher than table value of 3.841.

Null Hypothesis is rejected.

Therefore, there is a significant relationship between Provision of Supplementary Nutrition and Health related facilities on growth of the child beneficiaries in terms of height and weight of child beneficiaries.

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Table 6: Opinion on availability of Pre education Facilities

Source: Field Study

*Figures in the bracket represent percentages.

Information furnished in this table is related to availability of Pre-School educational facilities. As regards whether the daily pre-school education activities are taking place or not, the aggregate responses revealed that around 97% of the beneficiaries agreed to the daily pre-school activities being taking place in the Anganwadi Centers whereas 3% of the beneficiaries did not agree to the daily pre-school activities being taking place in the Anganwadi Centers.

With regard to the usage of educational material is up to the mark or not, at the aggregate level, out of 849 sample Anganwadi beneficiaries, 817 (96.23%) of the beneficiaries are happy with the usage of educational material whereas 32 (3.76%) of the beneficiaries are not happy with the usage of educational material on a regular basis.

As regards the change in the children behaviour after attending centre, at the aggregate level, out of 849 sample Anganwadi beneficiaries, parents of 835 (98.35%) of the beneficiaries are happy, whereas parents of 14 (1.64%) of the beneficiaries are unhappy.

Pattern of attendance by Beneficiaries in Anganwadi centers reveals that 719 beneficiaries i.e. almost 85% of the total beneficiaries had regular attendance in their respective Anganwadi Centers whereas mere 130 beneficiaries i.e. around 15% of the total beneficiaries had irregular attendance in their respective Anganwadi Centers.

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We conducted a Chi Square Test to know whether Null Hypothesis is Rejected or Accepted.

Null Hypothesis is “There is no association between the Pre-School Educational facilities on children behaviour about regular attendance towards reading and learning”

Results are as follows: Chi-Square = 72.779, df = 1,

Computed value = 72.779 which is higher than table value of 3.841.

Null Hypothesis is rejected

Therefore, there is a significant relationship between Pre-School Educational facilities on children behavior about regular attendance, attitude towards reading and learning.

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Table 7: Opinion on availability of immunization and health checkups

Source: Field Study

*Figures in the bracket represent percentages.

Table 7 reveals information about the availability of immunization and health checkup facilities at Anganwadi centres. When we asked the opinion on above aspect, about 801 (94.34%) out of 849 of the sample beneficiaries have responded positively about the adequate availability of immunization and health checkup facility at the Anganwadi Centers whereas 48 (5.65%) out of 849 of them have a negative opinion about the adequate availability of immunization and health checkup facility at the Anganwadi Centers.

On our enquiry about whether there are regular health checkups or not, it is observed that at the aggregate level, out of 849 sample beneficiaries, 786 (92.57%) of the beneficiaries answered in a positive way and 63 (7.42%) of the beneficiaries answered in a negative way.

On our enquiry whether there are adequate referral services available or not, it is observed that at the aggregate level, out of 849 sample beneficiaries, 792 (93.28%) of the beneficiaries agreed with the adequate availability of the referral services and 57 (6.71%) of the beneficiaries did not agree with the adequate availability of the referral services.

When adequate facilities with regard to immunization and regular checkup taking place, we enquired about health status of children. For which out of 849 child beneficiaries 756 (89.04%) of the beneficiaries do not have tendency of frequent illness and their health position was good whereas 93 (10.95%) of the beneficiaries do have tendency of frequent illness and are facing one or other health problem by the children.

We conducted a Chi Square Test to know whether Null Hypothesis is Rejected or Accepted.

Null Hypothesis is “There is no relationship between regular immunization, health check-up and referral services on child beneficiaries health.”

Chi-Square = 24990.878, df = 4,

Computed value = 24990.878 which is higher than table value of 9.488.

Null Hypothesis is rejected

Therefore, there is a significant relationship between regular immunization, health check-up and referral services on child beneficiaries health.

We conducted a Chi Square Test to know whether Null Hypothesis is Rejected or Accepted. Null Hypothesis is “There is no association between the availability of infrastructure facilities and problems in maintaining Anganwadi centres” Results are as follows: Chi-Square = 16.924, df = 1: Computed value = 16.924 which is higher than table value of 3.841. Hence Null Hypothesis is rejected. Therefore, there is a significant relationship between the availability of infrastructural facilities and problems maintaining Anganwadi workers. We conducted a Chi Square Test to know whether Null Hypothesis is Rejected or Accepted. Null Hypothesis is “There is no association between the problems faced by Anganwadi worker and their level of satisfaction with their nature of work and work load” Results are as follows: Chi-Square = 134.966, df = 1, Computed value = 134.966 which is higher than table value of 3.841. Null Hypothesis is rejected. Therefore, there is a significant relationship between Provision of Supplementary Nutrition and Health related facilities on growth of the child beneficiaries in terms of height and weight of child beneficiaries. We conducted a Chi Square Test to know whether Null Hypothesis is Rejected or Accepted. Null Hypothesis is “There is no association between the Pre-School Educational facilities on children behaviour about regular attendance towards reading and learning” Results are as follows: Chi-Square = 72.779, df = 1, Computed value = 72.779 which is higher than table value of 3.841. Null Hypothesis is rejected Therefore, there is a significant relationship between Pre-School Educational facilities on children behavior about regular attendance, attitude towards reading and learning. We conducted a Chi Square Test to know whether Null Hypothesis is Rejected or Accepted. Null Hypothesis is “There is no relationship between regular immunization, health check-up and referral services on child beneficiaries health.” Chi-Square = 24990.878, df = 4, Computed value = 24990.878 which is higher than table value of 9.488. Null Hypothesis is rejected Therefore, there is a significant relationship between regular immunization, health check-up and referral services on child beneficiaries health.

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