GARDEN CITY
COLLEGE OF
NURSING
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Mrs. VEENA .J.V.1ST YEAR M.SC .NURSING
GARDEN CITY COLLEGE OF NURSING,
VIDYANAGAR, OLD MADRAS ROAD, BANGALORE -560 036
2. / NAME OF THE INSTITUTION / GARDEN CITY COLLEGE OF NURSING,VIDYANAGAR, OLD MADRAS ROAD, BANGALORE -560036
3. / COURSE OF THE STUDY AND SUBJECT / M.SC. NURSING 1ST YEAR
COMMUNITY HEALTH NURSING
4. / DATE OF ADMISION TO THE COURSE / 13-08-2012.
5. / TITLE OF THE TOPIC / A STUDY TO IDENTIFY THE KNOWLEDGE AND UTILIZATION OF INTEGRATED CHILD DEVELOPMENT SCHEME SERVICES AMONG WOMEN IN SELECTED VILLAGE AT BENGALURU,IN A VIEW TO DEVELOP A PAMPHLET.
6. / BRIEF RESUME OF THE INTENDED WORK
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9. / INTRODUCTION
‘Anything that is wasted effort represents wasted time. The best management of our time thus becomes linked inseparably with the best utilization of our efforts.’[1]
-TED .W . ENGSTROM
India Since independence, one of the greatest problems India is confronting with is malnutrition among under-5 children. As in other developing nations, malnourishment is a burden on considerable percentage of population, the most vulnerable being the youngest group of the society. About two-third of the under-five children of our country is malnourished. Among them, 5-8% is severely malnourished while rest falls in the group of mild or moderate malnutrition. So it can be said that malnutrition is one of the most widespread conditions affecting child health. The 'germ' of malnutrition 'infects' a fetus in the intra-uterine life due to lack of sufficient antenatal care on part of the mother. The condition deteriorates further when after birth the infant is deprived of exclusive breast feeding or initiation of weaning is delayed.
India is the home to the largest child population in the world. "The development of children is the first priority on the country’s development agenda, not because they are the most vulnerable, but because they are our supreme assets and also the future human resources of the country". In these words, our Tenth Five Year Plan (2002-07) underlines the fact that the future of India lies in the future of Indian children.[2]
Majority of children in India have underprivileged childhoods starting from birth. The infant mortality rate of Indian children is 47 and the under-five mortality rate is 93 and 25% of newborn children are underweight among other nutritional, immunization and educational deficiencies of children in India. Figures for India are substantially worse than the developing country average.[3]
The first six years of a child’s life are most crucial as the foundations for cognitive, social, emotional, physical, motor and psychological development are laid at this stage.As per the study in India, there are about 157.86 million children below six years of age, and many of them have inadequate access to health care, nutrition, sanitation, child care, early stimulation, etc. To ensure that all young children, even those from vulnerable sections of society have access to their basic rights.[4]
In order to get rid of all these problems Integrated Child Development Scheme or ICDS was launched in October 1975, as a program of the fifth five year plan of India in accordance to National Policy For Children, to address the problems of persistent hunger and malnutrition especially among children. Since its inception, it is one of the largest program for promotion of maternal and child health and nutrition. It also included awareness building among pregnant and lactating women on pre and post natal care of children as well as non-formal education and care of children in 03-06 years of age. Education, Health and Nutrition were integrated in one package for the first time in India. ICDS was started initially in 33 blocks in 1975 and the program has expanded rapidly since then and has currently reached 5,267 blocks covering all parts of India. According to the government, the program caters to 33.2 million children and 6.2 million pregnant and lactating women.[5]
Integrated Child Development Services (ICDS) is India's primary social welfare scheme to tackle malnutrition and health problems in children below 6 years of age and their mothers. The main beneficiaries of the program were aimed to be the girl child up to her adolescence, all children below 6 years of age, pregnant and lactating mothers. The gender promotion of the girl child by trying to bring her at par with the male child is a key component of the scheme.[6]
Over the years it has grown into one of the largest integrated family and community welfare schemes in the world. Given its effectiveness over the last few decades, Government of India has committed towards ensuring universal availability of the program. ICDS provides health, nutrition, immunization, preschool education, health and nutrition education, and referral services to young children and their mothers. ICDS also empowers mothers to take better care of their children.[7]
During the Eighth, Ninth and Tenth Five Year Plan periods, the outreach of ICDS services increased enormously, and several initiatives were taken to improve the quality of services, the goal being universalization with quality. Government of India increased the budgetary allocations for ICDS so that more projects could be started in unreached areas, and World Bank,(United Nations International Children's Emergency Fund) UNICEF, (Cooperative for American Relief Everywhere) CARE, (United States Agency For International Development) USAID and other international agencies provided support in many ways. Training of ICDS functionaries was strengthened under the Udisha Project, and Mobile Training Teams provided skills training at the field level. However, in spite of the expansion of ICDS, evaluation studies done by forces indicate that ICDS reaches out to only 30% of the children. Children from remote scattered hamlets and children living in new slum clusters are often out of the ambit of ICDS services.[8]
Malnutrition has decreased only marginally from 47% in 1998-99 to 46% in 2005-06, as was revealed in the National Family Health Survey III (2006). Clearly, new innovations are required to actually make a dent on the problem of malnutrition among children. The Supreme Court, in its order dated 29.04.2004, directed the Government of India to increase the number of (anganawadi centers) AWCs to cover 14 lakh habitations. Efforts are being made to universalize ICDS so that a functional AWC exists in every settlement and full coverage of children is ensured. Mini-Anganwadi Centers are already functioning in rural/ tribal projects with population between 150-300. States have to submit their special requirements for setting up AWCs in habitations with less than 150 populations, which have to be cleared by Government of India.[9]
During the Eleventh Five Year Plan (2007-2012), nutritionally backward states would be the focus of special attention, and micronutrient supplementation/ fortification would be used as a strategy to combat specific micronutrient deficiencies.[10]
The involvement of Panchayats, women’s self help groups (SHGs),Non Government Organizations (NGOs), corporate and business houses, and other civil society organizations usher in public-private partnership in the true spirit of the concept. In spite of the many lacunae in the functioning of the scheme, the achievements under ICDS are many. Notable among them is the progressive decline in infant and child mortality, and the spread of awareness about immunization, and health and nutrition education.[11]
Research reveals the true ground realities and field situation, and serves as a pointer to the path which needs to be taken to achieve desired results. This compilation covers the research studies on ICDS conducted during 1996-2008. A total of 456 beneficiaries comprised the sample, of whom 59 were lactating mothers, 56 were expectant mothers, 38 were children 0-6 months, 162 were children aged 6 months to 3 years, 141 were children aged 3-6 years, and there were 59 other persons. Data was collected through interviews and observations. It suggests that awareness on all ICDS services is not yet achieved to the level of satisfaction.[10]
NEED FOR STUDY
Nutrition is the cornerstone of socio-economic development. Nutrition plays a key role in physical, mental and emotional development of children and much emphasis has been given to provide good nutrition to growing populations especially in the formative years of life. Malnutrition is a silent emergency. Globally, more than one third of child deaths are attributable to under nutrition.
In World Health Organization (WHO), India Representative Nata Menabde, however, says that given the size of the population, absolute numbers will always be high in case of India. This should not overshadow the fact that the country has made significant progress in health field.[13]
The UNICEF report, released in New York, says almost 19,000 children less than five years of age die every day across the world. India tops the list of countries for 2011, with the highest number of such deaths at 16.55 lakh. As per the report, even as overall child mortality in the world has gone down, under-five deaths are increasingly concentrated in sub-Saharan Africa and South Asia. In 2011, 82 percent of under-five deaths occurred in these two regions, up from 68 percent in 1990.In 2011, about half of global under-five deaths occurred in just five countries: India, Nigeria, the Democratic Republic of the Congo, Pakistan and China. Though on the top of list in terms of absolute numbers, in terms of child mortality rate, India ranks 49th with 61 deaths per thousand children in 2011.[14]
According to the Indian census in 2001, the child population (0-6 years) was 15.9% of the total population. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub- Saharan Africa. The 3rd National Family Health Survey findings showed that 45% of less than 3 year old children were malnourished.4 If this continues; India would be raising a generation which is debilitated and unable to contribute effectively to the productivity of the country.[15]
Karnataka State is located in southern part of India and spreads across 191,791 sq.km. It has 30 districts and 176 taluks. Inter district disparities were observed in terms of coverage of beneficiaries of (Supplementary Nutrition Program) SNP program among children. Share of the beneficiaries in the age group 0-6 years ranged from 0.78 to 0.37. Districts such as Chickmagalur, Bangalore-rural, Kolar, Hassan and Tumkur occupied first five positions in terms of coverage of children in the age group of 0-6 years. Raichur, Bellary, Bijapur, Gulbarga and Koppal occupied last five positions. Variation with respect to the share of beneficiaries among the pregnant and lactating women was also quite high and ranged from 0.88 to 0.39.[16]
As per study in January 2012 there is a close on the heels of the damning hunger and malnutrition (HUNGaMA) report, which found 42 per cent children below age five across India underweight and 59 per cent children stunted, comes another report on the state of nutrition among children in Karnataka state.[17]
Over 1.2 million children in the state in the age group of 0-6 years are malnourished and underweight, says a government report submitted to the Karnataka High Court on January 19. The report was filed in response to a public interest petition being heard by the court. And it also gave a report that there are 2,689: number of malnourished children who died in Raichur district of Karnataka between April 2009 and August 2011. 4,531: number of children suffering from severe malnutrition, 2.1 million: number of mildly malnourished children in Karnataka, 1.13 million: number of moderately malnourished children, 71,605: number of severely malnourished children.[18]
A descriptive study was done in udupi to identify the knowledge and utilization of ICDS services Out of 225 women 49.3% had average knowledge and 46.7% with poor knowledge regarding ICDS. Among pregnant women there was 74.1% utilization of supplementary nutrition and 7.4% utilization of immunization. Among lactating mothers there was 76.2% utilization of supplementary nutrition, 4.8% utilization of health education. Mothers having children revealed that, there was 71.1% utilization of supplementary nutrition, 58.3% utilization of health checkup, 69.3% utilization of non-formal preschool education, 26.7% full and 50.5% partial utilization of immunization services. The main reason for not utilizing ICDS services were due to household work (43%), distance from anganwadi (40%) and due to lack of awareness (13%).Hence concluded that accurate information and encouragement from health personnel will further help to improve the knowledge and utilization of ICDS services.[19]
Integrated Child Development Scheme in Karnataka began as one of the pilot projects in the taluk of T. Narasipura in Mysore district. Since then there has been rapid expansion of the ICDS program in the past two decades. The number of projects increased to 24 by 1979-80 and was spread to 20 districts. Between 1980-81 and 1989-90, 113 projects were added (more than quadrupled). The years 1982-83 and 1989-90 saw rapid expansion when 29 and 28 projects were sanctioned respectively. In the next five years, 47 more projects were added to the existing ones. At present there are 185 projects functioning in 175 taluks in 27 districts of Karnataka, out of which 166 are Rural, 10 Urban and 9 Tribal projects and all projects belong to the central sector. This study indicates that there is a rapid increase in number of projects under ICDS which demands for periodic awareness in the people.[20]