Journal of Dental Research and Review

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 5  |  Issue : 4  |  Page : 139--144

Implementing innovative and sustainable methods to tackle grassroot level problems at anganwadi centers in Virpapura Village, Karnataka (India)


Maurvi Shukla 
 Department of Public Health, Bharati Vidhyapeeth Dental College and Hospital, Sangli, Maharashtra, India

Correspondence Address:
Maurvi Shukla
B-19, Main Colony, P.O. Walchandnagar, Taluka Indapur, Pune - 413 114, Maharashtra
India

Abstract

Background: Anganwadi center is a part of the Integrated Child Development Services program, which was implemented by the government for reducing maternal and childhood malnutrition. However, the anganwadi centers lack few essential elements necessary for the progressive development of children. Aim: To identify the lack of facilities in the anganwadis and implement innovative and sustainable solutions to tackle grass-root level problems at anganwadi centers. Materials and Methods: A descriptive survey was carried out among 15 anganwadis of Kudur block in Karnataka for 30 days. A 10-item self-designed checklist was used for the survey. Virpapura's anganwadi was selected for the implementation of the program. Innovative and sustainable solutions were implemented for supplemental diet, hygienic practices, creative activities, and dental care. Results: The current study shows that, while all anganwadis served sufficient two meals to children, only 59.49% of children aged 2–6 years fell within normal body mass index category, and 73.3% anganwadis had moderate attendance. All anganwadis were made of pucca building; 46.6% of them were clean, 33.3% shared compound with a primary school, and 66.6% had sanitation facilities but was not put to use. Handwashing habit was absent in children, and there was poor dental knowledge among anganwadi workers. Occasionally, creative activities were conducted for the children. Conclusion: A sustainable solution to any problem can arise from the people themselves; all they need is encouragement and environment to step forward. Solutions to problems of rural India can be ingrained successfully with community participation.



How to cite this article:
Shukla M. Implementing innovative and sustainable methods to tackle grassroot level problems at anganwadi centers in Virpapura Village, Karnataka (India).J Dent Res Rev 2018;5:139-144


How to cite this URL:
Shukla M. Implementing innovative and sustainable methods to tackle grassroot level problems at anganwadi centers in Virpapura Village, Karnataka (India). J Dent Res Rev [serial online] 2018 [cited 2019 Jul 23 ];5:139-144
Available from: http://www.jdrr.org/text.asp?2018/5/4/139/250790


Full Text



 Introduction



The National Family Health Survey-III revealed that 40.4% of children below the age of 3 years are underweight in India. The Integrated Child Development Services (ICDS) program was implemented as the most important government intervention for reducing maternal and childhood malnutrition.[1]

The ICDS today covers 8.4 crore out of the total 16.54 crore children of age below 6 years in the country and 1.91 pregnant and lactating mothers through 7066 projects and 13.42 lakh anganwadi centers.[2]

Anganwadi workers (AWWs) have the responsibility to provide different services which include nutrition and health education, Non-Formal Pre-School Education, supplementary nutrition, growth monitoring and promotion, and family welfare services. They also coordinate in arranging immunization and health checkup camps. Their functions also include community survey and enlisting beneficiaries, primary health care and first aid, and referral services to the severely malnourished, sick, and at-risk children.[3]

There have been several studies conducted by dentists from different parts of India on anganwadi functioning and AWWs [Table 1]. While these studies focused on empowering AWWs with adequate knowledge on a particular subject, for example, oral health care, or to assess the prevalence of caries among children in anganwadis, there is a significant lack of interventions to curb the problems existing in anganwadis in terms of infrastructure, diet, and basic hygiene facilities or activities. This study focuses on those aspect of the anganwadis. The objective of this study was to identify the lack of facilities in the anganwadis and implement innovative and sustainable solutions for the grass-root level problems at the anganwadis to boost the holistic development of young children in Virpapura, Karnataka.{Table 1}

 Materials and Methods



A random sample of 15 anganwadis in the Kudur block of Karnataka were selected for the survey. The survey was carried out using a self-designed checklist for facility assessment in the anganwadis. The ten criteria chosen were classified as follows: four criteria about anganwadis (cleanliness, proximity to a primary school, sanitation, and infrastructure), five criteria about anganwadi children (body mass index [BMI], number of meals served per day, handwashing habit, attendance, and creative activities), and one criterion about AWW (knowledge of dental terms). The survey was conducted by personal visits to each anganwadi center within 15-km radius of Kudur. The assessment criteria and parameters are detailed in [Table 2]. The BMI for children aged 2–6 years in this study was recorded with respect to age and gender and expressed as percentile. This obtained BMI percentile for age and gender was plotted on growth chart developed by the Centres for Disease Control (CDC) 2000 standards.[15] Informed written consent was obtained before conducting the survey and implementing the program.{Table 2}

Statistical analysis

Descriptive analysis (number and percentage) was calculated.

 Results



Facility assessment in the anganwadis

The survey was completed in 15 anganwadis, and BMI was recorded for 116 children. The outcomes of the ten criteria are as follows:

Cleanliness

Only seven (about 46.6%) anganwadis could be regarded as clean.

Proximity to primary school

Only five (33.3%) anganwadi centers shared the campus with a primary school.

Sanitation facilities

Sanitation facilities were present in ten (66.6%) anganwadis, but none (0%) were in use. Open defecation was followed in each of the 15 anganwadis.

Infrastructure

All the anganwadis in the region were made up of cement and brick materials (pucca built). The rooms were well ventilated and had a single door for entry and exit of children. Only, three (20%) anganwadis lacked a playground for children.

Body mass index

BMI was recorded under the following categories:

About 36.20% of children fell in underweight category, 59.49% in normal, and 4.31% in overweight category.

Number of meals served per day

All the 15 anganwadis (100%) served two regular meals to the children, which included the breakfast (minor meal) and lunch (major meal). The major meal, that is, lunch comprised rice (maize) and sambhar (spiced lentils) and the minor meal comprised a variety of breakfast items such as milk, eggs, and pulses such as sprouted mung beans, groundnut, and jaggery on different days of the week.

Handwashing habit in children

None (0%) of the children in the anganwadis practiced handwashing before the meals.

Attendance

About 11 (73.3%) anganwadis had moderate (20%–60%) attendance and 4 (26.6%) had low attendance.

Creative activities

Occasionally, activities such as drawing, outdoor games, and group activities were conducted for the children in all the anganwadi centers.

Knowledge of dental health terms

Overall 100% (n = 15) of AWWs were never exposed to dental health treatments or dental health-related training. They were devoid of knowledge of basic dental health terms.

Implementation of the innovative and sustainable solutions

Four basic survey outcomes were targeted for which a local tangible and sustainable solution could be provided by involving the community and AWWs. This program was implemented in only one anganwadi at Virpapura.

Introduction of handwashing habit

A tippy tap water system[16] was introduced in the premises of the anganwadis [Figure 1]a.{Figure 1}

Materials used: 5-L unused oil can, roadside three wood sticks, and unused rope of variable length. The children would step on the stick lying on ground, which pulled the can downward and in this way, the water from the can was used for handwashing. A soap was tied parallel to the can. This intervention was instantly accepted in the anganwadis and children started with the habit of handwash before every meals. The handwashing habit was followed for 2 months by the children in the anganwadis.

Introduction of nutrition-rich food

Despite the regular anganwadi food supply, 54% of children were in the underweight category. To tackle this problem, a community meeting was setup to know the most easily available and cost-effective iron-rich ingredients available in kitchens of the houses in the village. After several trials, uriittu was made, as shown in [Figure 1]b. Uriittu consists of ragi (finger millet), groundnut, coconut, jaggery, and water [Table 3]. Women in the village were encouraged to make this food product and give it to their children. The children and their mothers started consuming uriittu for 3 months, and the activity was monitored during this study with the help of AWWs. The children were encouraged to carry uriittu in tiffin boxes.{Table 3}

Inculcating creative activities in daily routine

Several group activities such as memory games and drawing activities were introduced in the anganwadi centers. For example, to introduce English as a language, each item in the room was labeled in English, and children were asked to iterate the words loudly everyday when they entered the room.

Knowledge of dental care terms

AWWs were introduced to basic dental health-care terms such as parts of the mouth, tooth brushing technique, ways to manage dental emergencies, discouragement of oral habits, and ways to maintain oral health. Videos were used to health educate the workers.

 Discussion



This is the first of its kind study in Kudur block. The current study suggests that all anganwadis were made of pucca building, with 46.6% found to be clean, 33.3% shared campus with a primary school bounded by compound wall, 20% lacked a playground, and 66.6% anganwadis had sanitation facilities. A similar study conducted near Bengaluru[18] suggests that about 47.6% of anganwadis had a compound wall, 61.9% of anganwadis were found clean, and 57.1% of centers had sanitation facilities.

The BMI recorded in the current study with CDC method for children aged 2–6 years had the following results: about 36.20% of children fell in the underweight, 59.49% in the normal, and 4.31% in the overweight categories. Another study based on the same method to calculate BMI had the following results: 5% underweight, 79% normal, 9% under the risk for overweight, and 6% overweight. While this study was carried out in anganwandis of Belgaum city,[19] the current study focuses on BMI obtained in a rural village of South Karnataka.

Anganwadis in Kudur block were seen to provide sufficient food to the anganwadi-going children, which included two meals a day. A similar study carried out in Dharwad of Karnataka[20] focused on the supplementary food provided by the ICDS to beneficiaries and the level of knowledge present in AWWs, stakeholders, and beneficiaries about food, health, and anganwadi activities.

While the current study focuses on inculcating handwashing habit in the anganwadi children with the tippy tap system, a model was constructed in the premises of anganwadi centers as a replacement of tap water; a similar study was also carried out in the rural area of Assam. The study was conducted to understand the factors influencing handwashing habit in a rural community.[21] It targeted young mothers of children <5 years of age. The study stressed on the importance of health education program in a rural community, especially for mothers.

Similar to the present study, where urrittu was prepared to meet the nutritional needs of the children, in a study carried out in Tilonia, Rajasthan, under the project name “Amrit Churna,"[22] the women in the village were involved in the preparation of a nutritional supplement to combat iron deficiency. The ingredients majorly included wheat, black gram, groundnut, sesame seeds, and jaggery. The project was targeted toward pregnant women and lactating mothers with the goal of alleviating iron deficiency in women and girls.

The anganwadi-going children of Virpapura were engaged in creative activities for their better development; a similar study carried out in anganwadis of rural Punjab stressed the importance of introducing preschool activities in children under the ICDS. The study concluded with a need of focus on training the AWWs with suitable skills for imparting preschool education in anganwadi children.[23]

While the current study initiated the introduction of dental care terms and simple methods to prevent dental problems in an anganwadi setup with the help of pictorial presentations and demonstrations, a similar study was carried out in Chhattisgarh where AWWs were trained to become oral health guides.[4] The study concluded an increase in dental knowledge among AWWs post educational training.

Limitations

Within the limitation of time and finance, the innovative and sustainable model was implemented in only one out of the 15 villages and despite the several problem areas, solutions were undertaken for four problems only. These activities were carried out for 2 months under the investigator's supervision and later on, the respective AWWs were asked to continue it. Postimplementation survey was not conducted to find out if there was any change in the BMI, handwashing habits, creative activities, and improvement in the dental knowledge of the children.

 Conclusion



A sustainable solution to any problem can arise from the people themselves; all they need is encouragement and environment to step forward. Solutions for the problems of rural India can be ingrained successfully with community participation.

Acknowledgment

The author wishes to acknowledge the scholarship offered by SBI Foundation Youth for India and DHAN Foundation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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