Status of growth monitoring activities in selected ICDS projects of Rajasthan

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INDIAN PEDIATRICS VOLUME 33-NOVEMBER 1996
949
Brief Reports
Status of Growth Monitoring
Activities in Selected ICDS
Projects of Rajasthan
Umesh Kapil
N.Saxena
D. Nayar
N. Gnanasekaran
Growth Monitoring (GM) was devised
as a tool for assessing the growth and
development of a child, for detecting the
earliest changes in growth and to bring
about appropriate responses to ensure that
the growth continues uninterrupted(l).
However, various studies in the past have
shown that GM has not been able to bring
about the desired improvement in the
health and nutritional profile of the
beneficiaries(2-5).
In India, GM is conducted on a regular
basis in Integrated Child Development
Services (ICDS) scheme which covers
nearly 3908 administrative blocks
throughout the country(6). The present
study was conducted in selected ICDS
projects of Rajasthan to assess the
knowledge and practices about GM
amongst Anganwadi workers (AWWs) and
to assess the status of GM activities.
Methods
All the districts in the state of Rajasthan
with ICDS projects functional for more
From the Human Nutrition Unit and Computer
Facility, All India Institute of Medical Sciences.
New Delhi 110 029.
Reprint requests: Dr. Umesh Kapil, Associate
Professor, Human Nutrition Unit, All India Insti-
tute of Medical Sciences, New Delhi 110 029.
Received for publication: April 11,1996;
Accepted: May 31,1996
than 3 years duration were enlisted.
Keeping in view the operational feasibility,
five districts namely Jaipur, Ajmer,
Udaipur, Bharatpur and Bikaner were
selected. In each district, one ICDS project
with more than two years in operation was
selected again in view of the operational
feasibility (except Udaipur where two
projects were selected). A total of six
ICDS projects (2 rural and 4 urban) were
selected for the detailed study. In each
project, 20 Anganwadi Centers (AWCs)
which were within 20 km of the block
headquarters were further selected. The
study sample thus comprised of 120 AWCs
from 6 ICDS projects.
A pretested semi-structured
questionnaire was administered to 120
anganwadi workers (AWWs) to collect
information about their knowledge,
practices regarding GM and the status of
GM activities. Observations method was
used to assess the GM skills of AWWs.
The AWWs were asked to undertake GM
of 5 children present on the day of the
survey. They were also asked to interpret
the pre-filled growth charts with
ascending, descending and flattened
growth curves. Secondary data on growth
monitoring consisting of growth charts and
registers available at AWCs was also scru-
tinized to assess the status of GM activities
undertaken by AWW.
Results
The present study revealed that 88% of
the AWWs were educated upto primary
school level. Sixty seven per cent workers
had worked for more than 5 years in the
ICDS programme. Preplacement training
and subsequent in-service training was
received by 88.3% and 67.5% of AWW's
respectively. However, no special training
on GM was received by any of the AWW
studied.
Seventy five per cent AWCs had Salter

BRIEF REPORTS
INDIAN PEDIATRICS VOLUME 33-NOVEMBER 1996
950
type weighing scales. In 9% of the AWCs,
weighing scales were not in working
condition. About 7% AWCs did not have
any weighing scales. Growth charts for
conducting GM activities were available
at 83.3% of AWCs.
It was found that 38.3% AWWs
mentioned that GM is undertaken to only
identify malnourished children. Almost
90% of the AWWs were not aware of the
correct sequence of steps required for
conducting GM. More than half (54.2%) of
the workers did not know about the type of
intervention measures to be taken on
findings of GM. About 33% of the AWWs
conducted GM at AWC. Eighty nine per
cent of the AWWs mentioned that they had
"adequate time" for conducting GM
despite other responsibilities.
It was observed that nearly 75% of
AWWs were not able to use the Salter
weighing scales correctly. Only 10% of the
AWWs followed the practice of plotting the
weights immediately after weighment.
Nearly half of the AWWs plotted weights
incorrectly on the growth charts. The skills
of the AWWs regarding assessment of GM
is depicted in Table I.
The growth chart of each child
registered was scrutinized and it was found
TAB LE I-Distribution of AWWs According to
Their Skills in GM as Observed by the
Research Team (n=120).
Skills in GM AWWs
No. %
1. Correct use of tools 31 25.8
2. Correct plotting on growth charts 59 49.2
3. Correct interpretation of
(i) Ascending growth curve 78 65.0
(ii) Descending growth curve 76 63.3
(iii) Flattened growth curve 51 42.5
that the weights of only 60% children were
being recorded regularly (i.e., 4 or more
weight recordings for children less than 3
years and 1 or more weight recording for
children more than 3 years during the last 6
months). About 40% of the severely
malno urish e d ch ildren were not bein g
weighed regularly. However, no significant
difference (p <0.05) was documented
between the growth faltering amongst
children weighed regularly or irregularly
(Table II).
Discussion
GM is useful measure which can
significantly contribute to the promotion of
child health and nutrition. GM brings
about two way communications between
the parents and the health worker. GM can
serve as a focal point for offering multiple
services for child and family welfare and
increase community participation. Growth
data if collected appropriately can be used
at various levels such as sector, project,
state and even national level to guage
change in nutritional status and to evaluate
impact of development programmes on
childhood under-nutrition.
The success of GM activities, however,
depends on proper knowledge, objective
TABLE II- Distribution of Children According to
Change in their Growth Status During
Previous Six Months and Regularity of
Plotting Weights as per the Growth
Charts (n=1358).
Change in No. of children
growth status Regular Irregular Total
Improvement 335 (37.2) 169 (36.9) 504
Deterioration 439 (48.8) 239 (52.2) 678
No Change 126 (14.0) 50 (10.9) 176
Total 900 458
* Figures in parentheses denote percentages.

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INDIAN PEDIATRICS VOLUME 33-NOVEMBER 1996
951
and practical training of AWWs,
availability and maintenance of adequate
tools, resources for follow-up action and
most importantly, community
participation(7,8).
In the present study education, training
status and experience of most of the
AWWs was adequate. However, most of
the AWWs still considered GM to be a
regular weighment exercise aimed at
detection of malnutrition. Many AWWs
were not aware about the follow-up actions
required to be taken on findings of GM,
apart from providing extra supplementary
nutrition. These findings are consistent
with earlier studies(7,9).
The availability and maintenance of
tools for GM, i.e., weighing scales and
growth charts were adequate in the present
study. However, incorrect use of the tools
was common. Earlier studies have also
documented inaccuracies in weighing and
charting of weights by AWWs(10,ll).
It was also seen that the interpretation
of all kinds of growth curves was generally
poor. More than half of the AWWs could
not interpret a flattened growth curve
which meant that inadequate weight gain
was not being recognized as a danger
signal(ll). Mother's (of the children
surveyed) understanding about GM was
also inadequate. This indicated that as the
AWWs themselves could not comprehend
the growth curves adequately, they could
not make the growth trajectory of the child
visible to the mother. Thus, Nutrition and
Health Education (NHE) and other follow-
up action on GM including the mother's
participation in improving the growth
status were given low priority. The present
study supports the findings of the earlier
reports(l,5,10,ll).
In the present study, GM activities in
the study areas were by and large being
limited to be weighment of children who
attended the AWCs. The findings indicate
that there is a need for reinforcement of the
importance of growth monitoring activities
of all children in the community. During
the training courses of the AWWs, special
emphasis should be given on correct age
assessment, regular weight recording,
plotting of weight on growth charts,
interpretation of growth curves, NHE and
follow up action.
Acknowledgment
Financial assistance received from the
Department of Women and Child
Development, Ministry of Human
Resource Development, Government of
India, in form of Grant-in-aid for the
project is duly acknowledged.
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