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      Utilization of ICDS program by adolescent girls and implementation barriers in Urban Rishikesh, India

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          Abstract

          Context:

          Adolescent girls are at higher risk of mortality and morbidity due to childbirth. Government of India therefore initiated Adolescent girls’ scheme since year 2000. However, since its inception program received various setbacks.

          Aims:

          This study was carried out to assess the utilization of ICDS program for adolescent girls through Anganwadi centers (AWC) and implementation barrier from providers point of view. Also study assessed gaps in knowledge, attitude, and practice of anemia.

          Settings and Design:

          Mixed-method sequential explanatory approach was adopted. Quantitative data was collected by community-based cross-sectional survey in Urban Rishikesh, Uttarakhand. This was followed by in-depth interview of Anganwadi worker (AWW).

          Methods and Materials:

          Twenty adolescent girls from each of 20 clusters were selected by cluster sampling. Data was collected by structured validated questionnaire using Epicollect 5. AWWs were interviewed with help of interview guide.

          Statistical Analysis:

          Variables were described as proportion and mean. The interview transcript was analyzed using content analysis.

          Results:

          Out of 400 adolescent girls, 10% were school dropouts and 59% were undernourished. Seven percent had ever visited AWC in last year. The main reason for nonutilization was unawareness. 38% had knowledge regarding symptoms of anemia. AWW faces problems due to nonavailability of iron tablet, untrained for health education sessions, and service not meeting demand of beneficiaries.

          Conclusions:

          Poor utilization of ICDS services by adolescent girls due to unawareness. There is gap in knowledge regarding anemia among adolescent girls. Adolescent girls’ scheme is not as per felt need of beneficiary and poorly implemented.

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          Most cited references17

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          Prevalence of Anemia Among Adolescent Girls in a Rural Area of Tamil Nadu, India

          Background: Anemia accounts for a majority of the nutritional problem across the globe. The prevalence of anemia is inordinately higher among developing nations, because of low socioeconomic status and indigent access to the healthcare services. Adolescent period is signalized by marked physical activity and rapid growth spurt; therefore they need additional nutritional supplements and are at utmost risk of developing nutritional anemia. This study was carried out to find out the prevalence of anemia among adolescent girls. Materials and Methods: This study was a cross-sectional study conducted among 255 adolescent girls. After getting informed consent from the subjects, the information regarding age, sociodemographic status, menstrual history, and short clinical details were recorded. Blood samples were collected and analyzed using automated hematology analyser. Results and Discussion: Overall prevalence of anemia was found to be 48.63% (n = 124). The majority of the anemic girls (55.64%, n = 69) were having mild degree of anemia. Among 255 girls, 188 (73.73%) were from the early adolescent age group (10–14 years). Prevalence of anemia (52.24%) was high among the late adolescents and those belonging to low socioeconomic class. Conclusion: There is a significant relationship between anemia and socioeconomic status, dietary modification, nutritional supplementation, and helminth control; in addition, compliance with consumption of iron and folic acid tablets will prevent anemia to a great extent among adolescent girls.
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            Adolescent girls' Anaemia Control Programme, Gujarat, India.

            In June 2000, Adolescent Anaemia Control Programme was initiated as a pilot programme in Vadodara district of Gujarat covering over 69000 girls in over 426 schools. Programme strategy was to provide once weekly fixed day (Wednesday) supervised iron folic acid (IFA) supplements to all adolescent girls in Grade 8-12. Currently, programme covers 10 lakh schoolgirls and 2.6 lakh out of school girls with a compliance rate of over 90 per cent as reported by education department. This study was undertaken to institutionalize once a week IFA supplementation in the schools for adolescent girls with built in compliance monitoring in one district and scale up the programme from its learning to all the districts as feasible.
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              Adolescent girls’ health, nutrition and wellbeing in rural eastern India: a descriptive, cross-sectional community-based study

              Background India is home to 243 million adolescents. Two million (9%) of them belong to Scheduled Tribes living in underserved, rural areas. Few studies have examined the health of tribal adolescents. We conducted a cross-sectional survey to assess the health, nutrition and wellbeing of adolescent girls in rural Jharkhand, eastern India, a state where 26% of the population is from Scheduled Tribes. We aimed to identify priorities for community interventions to serve adolescents and their families. Methods Between June 2016 and January 2017, interviewers visited all households in 50 purposively sampled villages of West Singhbhum district, Jharkhand. They aimed to interview all girls aged 10–19. Interviewers conducted face-to-face interviews with girls to administer a survey about physical and mental health, disability, nutrition, sexual and reproductive health, gender norms, decision-making, education and violence. Interviewers also measured girls’ height, weight, and Mid-Upper Arm Circumference. Results Interviewers collected data from 3324 (82%) of an estimated 4068 girls residing in the study area. Their mean age was 14.3 (SD 2.9). 82% were from Scheduled Tribes. 89% of younger girls aged 10–14 and 46% of older girls aged 15–19 were in school or college. Girls dropped out of school because they were required for household work (37%) or work on the family farm or business (22%). Over a third reported symptoms of anaemia in the past month, but less than a fifth had a blood test. The prevalence of thinness (<−2SD median BMI for age and sex) was 14% for younger girls and 6% for older girls. 45% of girls were stunted (<−2SD median height for age and sex). 40% reported emotional violence in the past year, 14% physical violence, and 0.7% sexual violence. 12% had problems associated with depression or anxiety. 30% aged 15–19 had heard of contraception. Among married girls and their husbands, only 10% had ever used methods to prevent or delay pregnancy. Conclusions Our study identified several priorities to improve adolescent girls’ health, nutrition and wellbeing in largely tribal areas of Jharkhand: reducing violence, early marriage and undernutrition, as well as improving mental health, knowledge about contraception and school retention. Electronic supplementary material The online version of this article (10.1186/s12889-019-7053-1) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                J Family Med Prim Care
                J Family Med Prim Care
                JFMPC
                Journal of Family Medicine and Primary Care
                Wolters Kluwer - Medknow (India )
                2249-4863
                2278-7135
                November 2019
                15 November 2019
                : 8
                : 11
                : 3584-3590
                Affiliations
                [1 ] Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
                Author notes
                Address for correspondence: Dr. Meenakshi P. Khapre, Department of Community and Family Medicine, AIIMS, Rishikesh - 249 203, Uttarakhand, India. E-mail: drmeenaxi15@ 123456ymail.com
                Article
                JFMPC-8-3584
                10.4103/jfmpc.jfmpc_713_19
                6881966
                31803657
                4d39f9b4-9f05-4c51-a8ce-66a5524e3615
                Copyright: © 2019 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 29 August 2019
                : 17 September 2019
                : 16 October 2019
                Categories
                Original Article

                adolescent girls,anemia,integrated child development service schemes,mixed method

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