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research letter

Indian Pediatr 2012;49: 756-757

Antenatal and Perinatal Care in an ICDS Area: Progress Made in 19 Years


Munish Kumar Kakkar, Mukesh Kumar Gupta, Shallu Kakkar MS and A K Malhotra

Mahatma Gandhi University of Medical Sciences & Technology, Sitapura, Jaipur, Rajasthan, India.
Email: drmukeshgupta.pediatrics@gmail.com
 


ICDS program has made significant improvement in availability and utilization of antenatal and natal care including IFA supplementation, TT administration and delivery by trained personnel. However, postnatal care and promotion and initiation of breastfeeding within 2 hours of birth still remain deficit areas.

Key words: Integrated Child Development Services


The Integrated Child Development Services (ICDS) scheme was initiated in the year 1975 and later it became the largest Governmental programme for mother care and child development. The beneficiaries included children (0-6 yr), expectant & lactating mothers, and women aged 15-45 years. Facilities provided were supplementary nutrition, immunization, non-formal education of preschool children, functional literacy of the women, and essential health care and health surveillance [1]. We had studied the utilization and availability of antenatal and perinatal care in 1991 [2]. To evaluate the progress made in availability and change in utilization patterns of the services over a period of about 2 decades, we conducted this study during 2009-2010. We visited the same ICDS block (Chaksu, District Jaipur, Rajasthan) as in previous study and door to door survey of all lactating mothers was done using similar questionnaire [2]. Lactating woman was defined as one who had delivered a child (living or dead) within the last 12 months and was not pregnant again during the same period.

TABLE I	Comparison of the Data from 1991 and 2009-10 

    	
  1991 2009-10
N =136 (%) N=182, (%)
Age <18 yr 3 (2.2) 3 (1.7)
Age 18-35 yr 127 (93.4) 175 (96.2)
Age >35 yr 6 (4.4) 4 (2.2)
ANC received 99 (72.8) 178 (97.8)
First ANC
  First trimester  15 (11) 103 (56.6)
  Second trimester 54 (39.7) 64 (35.2)
  Third trimester 30 (22.1) 11 (6.0)
Number of ANCs
  1-3 times 84 (61.8) 124 (69.7)
  4-5 times 02 (1.5) 42 (23.6)
  6 times 13 (9.6) 12 (6.7)
Receipt of Tetanus Toxoid
  Two doses 90 (66.2) 178 (97.8)
  One dose 3(2.2) 0
  Not received 43 (31.6) 04 (2.2%)
Antenatal supplementation
  Regularly 46 (33.8) 140 (76.9)
  Irregularly 22 (16.2) 19 (10.4)
  Nil 136 (50) 23 (12.6)
Place of delivery
  Sub center   2 (1.5) 30 (16.5)
  PHC   4  (2.9) 12 (6.6)
  Private Hosp   16 (11.8) 26 (14.3)
Hosp   6 (4.4) 105 (57.7)
  Other   1(0.7) 0
Home 107 (78.6) 09 (4.9)  
Postnatal care*
  Untrained dai 0 0
  Trained dai 0 0
  ANM 3 (2.2) 02 (1.1)
  LHV 0 0
  Medical officer 12 (8.8) 117 (64.3)
  Other 1 (0.7) 0
  Total received care 16 (11.7) 119 (65.4)
Initiation of breastfeeding
  Within 6 hours 23 (17.2) 149(81.9)
  6-48 hours 74 (54.5) 21 (11.5 )
  >48 hours 39 (28.3) 05 (2.7)
Died 7 (3.8)
*0-10 days after birth

Table I shows the comparative data in year 1991 and 2009-2010. Overall, significant improvement in delivery and coverage of services in ICDS scheme were observed in terms of coverage of antenatal care (72.8% vs 97.8%), Tetanus Toxoid (TT) administration (68.4% vs 97.8%) and Iron Folic acid (IFA) supplementation (50% vs 87%) during pregnancy, institutional deliveries (4.4% vs 57.7%) and breastfeeding practices (initiation of breastfeeding within 6 hours of child birth, 17.25 vs 81.9%). However, early marriage and child birth were still a problem as 2.2% mothers were younger than 18 years in 1992 as well as 2010. The norm of having two children is not yet established as 29% mothers were having 3 or more children in year 2009-10, which also suggests inadequacy of birth control measures.

There are many other areas where improvement was suboptimal like first ANC visit in first trimester, >3 ANC visits, ANC as well as TT at all, and not receiving IFA supplementation. However, these data were better as compared to national figures reported by Government of India where 11.5% pregnant mother did not receive ANC and 26.5% did not receive TT [1] and also in the report from Rajasthan (2010) only 55% pregnant women received TT [3]. Postnatal care was a relatively weak area of ICDS project as only 65.4% mothers received postnatal care as compared to national data where 87% received PNC [3,4]. Postnatal home visits in initial 2 days after delivery has been shown to reduce neonatal mortality rate; hence, it is very important to improvise this [4]. There was increasing trend to have antenatal, natal and postnatal services from medical officers and home deliveries were significantly reduced from 78.6% in 1992 to 4.9% in 2010. However, the progress made in many areas were also due to additional efforts made as part of Janai Suraksha Yojna in National Rural Health Mission, which has its primary focus on institutional deliveries.

To conclude, ICDS program has made significant improvement in many areas but a lot need to be done for improvement in postnatal care, promotion and initiation of breastfeeding within 2 hours of birth.

Contribution: MKK, SK & MG conceptualized the study and drafted the manuscript; MKK, AKM &SK were involved in data collection and MKK, MG analyzed the data.

References

1. Three decades of ICDS: An Appraisal; National Institute of Public Cooperation and Child Development: Government of India, Ministry of Health and Family Welfare 2006. Available from: URL: http:// http://nipccd.nic.in/reports/eicds.pdf. Accessed May 15, 2012.

2. Kakkar M, Sharma U, Kabra A, Kakkar S. Availability of antenatal and perinatal care in an ICDS area. Indian Pediatr. 1995; 32: 597-9.

3. RCH II Outcomes: State Data Sheet, 2010 accessible from http://www.mohfw.nic.in/NRHM/PRC_RA_Reports/Rajasthan/Chittorgarh/State%20Fact%20Sheet.pdf. Accessed May 15, 2012.

4. National Rural Health Mission: Rajasthan State Report, Government of India 2009Available from: URL: http:// www.mohfw.nic.in/..l ./Rajasthan_Report. Accessed May 15, 2012.

5. Gogia S, Ramji S, Piyush G, Gera T, Shah D, Mathew JL, et al. Community Based Newborn Care: A Systematic Review and Meta-analysis of Evidence: UNICEF-PHFI Series on Newborn and Child Health, India. Indian Pediatr. 2011; 48:537-46.

 

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