Get Healthy, Give Healthy CRY 2015

ARE CHILDREN GETTING A HEALTHY START?

A study on early childhood in urban slums

Overview of the Study

– Nutritional status among children in the age group of 1 to 5 years

– Immunization status and Supplementation history

– ICDS service and its utilization by children

– Knowledge and practice of primary care giver about ICDS service provisions

Methodology

• Geographical Area: 15 slums across 5 metropolitans• Respondent : Primary caregiver for children between 1 to 6 years• Design: Household survey• Sample Size: 1260 parents• Tools: Questionnaire • Nutritional Assessment as per WHO guidelines• Data Analysis using statistical package(SPSS/STATA)

• Caregivers of Children under the age of 1 year not included

The Study Team

• The team comprising of 60 volunteers came from various disciplines. They were either college goers or young professionals who believe that ‘what we can do, we must do’ to bring about change in the lives of children

To quote one of the volunteers involved in the study

‘After the first few days, I felt so comfortable moving around in the community, there was an inner curiosity to see and know more of this unknown world that existed alongside ‘my world’. From being shocked, I gradually started wondering about how these children still managed to enjoy and stay happy’

Area and Respondent Profile

• Slums Covered in Bangalore: 5

• Sample Covered : 258

• Profile of Respondents:The respondents comprised of a mix of migrants from neighbouring states, locals and are primarily from the lower socio-economic group. They have varied religious and linguistic backgrounds. Most of them are employed in the unorganized sector and are daily wage earners.

Nutritional Status of Children

• Malnutrition in urban slums is far more than regular urban spaces on an average.* Data from Chennai and Kolkata is not included in the calculation of stunted..

Stunted Wasted Underweight0

10

20

30

40

50

60 55

28

45

The National Picture

CRY Survey (Urban Slums)*

40

17

33

NFHS 3 (Urban Areas)

Bangalore Chennai Delhi Kolkata Mumbai 0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

33.0%

62.6%

50.2% 49.0%41.3%

Prevalence of Underweight Children in Slums

• One in three children underweight in slums of Bangalore. *CRY Volunteers in Bangalore have been working on malnutrition in these areas since 2011

Stunting Wasting Underweight0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

52.1%

19.8%

33.0%

Malnutrition among children in Banga-lore slums

33.9

17

26.4

NFHS 3 (Karnataka Urban, <3 years)

• Birth of every fourth child is unregistered in Slums of Bangalore

Bangalore Chennai Delhi Kolkata Mumbai Total0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

74.2% 71.2%

86.8% 85.1%

67.9%77.4%

Birth Registration

Basic inputs- child health

Boys Girls0%

10%20%30%40%50%60%70%80%90%

78% 77%

Status of immunisation- Bangalore slums

* This is only for some form of vaccination

Vitamin A Supplementa-tion

Deworming IFA Tablets0%

10%

20%

30%

40%

50%

60%

43%52%

38%

Access to Vitamin A, Deworming and IFA tablets- Bangalore slums

Vitamin A Dose

Deworming Dose

IFA supplement

0 10 20 30 40 50 60 70 80

47

52

34

73

69

53

52

58

44

Health Services Provided to Children in Different Institutions

Enrolled in Private Preschool Enrolled in AWCs Enrolled in other institutions

Anganwadi-Enrolment & Services

ICDS Access and Coverage

• Enrolment in AWCs Bangalore stood at 47%.• 50% of parents were aware of the right age of AWC enrolment

47%

25%

23%

5%

Enrolled in AWCsNever Enrolled/ Dropped outEnrolled in Private PreschoolOther

Growth monitoring- National picture

Bangalore

Chennai

Delhi

Kolkata

Mumbai

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

66.1%

75.6%

59.2%

87.0%

73.3%

Percentage of Parents who reported growth monitoring by AWCs

Regularity of Growth Monitoring

66%

18%

16%

Growth Monitored Regu-larlyGrowth Monitored but irregularlyGrowth not monitored in last 6 months

Only two-thirds (66%) of the parents surveyed in Bangalore said that the AWC does regular growth-monitoring.

Growth Monitoring Feedback to parents

Around 74% of the parents in Bangalore reported that AWCs do not give regular and proactive feedback

26%

36%

37%Informed whenever measured

Informed only when asked by parents

Not regular/ never in-formed

Feedback to parents of malnourished children

• 89% of the parents were NOT INFORMED that their ward is underweight • Indicative of low parental engagement as well as outreach

Informed that the child is malnour-ished and needs treatment

Did not inform parents0%

10%20%30%40%50%60%70%80%90%

100%

11%

89%

AWCs –Other Service Indicators- Bangalore slums

Parents feel safe in sending their child to AWCs

Children like going to AWCs

Parents visited AWCs in the last 12 months

0%20%

40%60%

80%100%

120%

94%

88%

97%

Bangalore Chennai Delhi Kolkata Mumbai 0.0%

20.0%40.0%60.0%80.0%

100.0%79.0%

88.8%65.1%

77.5% 84.2%

Use of Toys and Recreational Material

Bangalore Chennai Delhi Kolkata Mumbai0%

10%20%30%40%50%60%70%80%90%

100%

73%

93%

76%

54%

74%

Use of Teaching Learning Material

Perceptions of Parents on Space and friendly environment in AWC/Preschools

Bangalore Chennai Delhi Kolkata Mumbai 0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

85.7%

96.9%

63.3%

71.1% 72.9%

85.7%

65.7%

82.2%

61.2%

98.1%

Recommendations

• Early Childhood Care and Development (ECCD) policy and programmes to be

contextualised to urban settings

• Entitlement for children (0-6 years) to be guaranteed by law

• Improving the information and knowledge of parents on ECCD

• National ECCE Policy 2013 to be strengthened

– States to expedite its implementation

• Basic Minimum Standards for ECCE across institutions

• Convergence between ICDS and Health services

Recommendations for ICDS

• Strengthening the service delivery of all 6 services of Anganwadi• Intervention to Improve the nutritional Status among 1- 6: Quality, Quantity

and regularity– Growth Monitoring process to be strengthened and broad based: Monitor

Height– Need for Improvement in early Identification and management cases of

malnutrition– Strengthening the component of Nutritional Counselling by AWW

• Improve community outreach and engagement by AWW to strengthen awareness

• Strengthen community ownership of ICDS to improve services• Realistic Assessment of the Anganwadi Workers workload and Capacities wrt

to expected outcome

Thank You