Assessment of Services at Anganwadi Centers Under the Integrated Child Development Services Scheme in Urban Jaipur: A Cross-Sectional Study

Assessment of Services at Anganwadi Centers Under the Integrated Child Development Services Scheme in Urban Jaipur: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Services at Anganwadi Centers Under the Integrated Child Development Services Scheme in Urban Jaipur: A Cross-Sectional Study Deepak Muraleedharan, Neethu E, Jayadevan R, B Balu, Suresh Kewalramani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6381852/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background ICDS scheme in India supports child health, nutrition, and maternal care through Anganwadi Centers, offering six core services. Urban overcrowding and resource constraints affect service quality. Irregular nutrition supply, inadequate immunization, and limited health education underscore need for evaluation and policy reforms. Objective To evaluate facilities and services of Anganwadis centers delivered under Integrated Child Development Service. Methods Cross-sectional study assessed 85 randomly selected Anganwadi Centers (AWCs) in urban Jaipur using structured interviews and direct observations. Data collection was conducted post-approval from relevant authorities. Statistical analysis was performed using Microsoft Excel. AWCs were selected through probability proportionate to size sampling. Inclusion criteria involved AWCs as per sampling technique, while exclusions were based on unavailability of Anganwadi Workers (AWWs). Results Study assessed 85 Anganwadi Centers (AWCs), revealing disparities in service delivery. 56% had adequate nutrition stock, 44% faced shortages. Education-focused activities were common, but parental awareness (35.3%) and staff training (29.4%) were lacking. Immunization (87%) and health check-ups (80%) were prevalent, yet referral for severe illness was low (40%). Growth monitoring (96%), growth retardation detection (27%) was limited. Community engagement was active (75%), though government scheme participation (57%) needed improvement. Chi-square test showed no significant association (p > 0.05) between nutrition stock and service quality, indicating other factors influence. Conclusions AWCs play a vital role in child health and development, yet service disparities persist. Nutrition stock shortages, limited parental awareness, and inadequate growth retardation detection highlight gaps. Despite strong immunization and health check-ups, urgent care referrals remain low. Anganwadi Centers Service Delivery Child Health Nutrition Assessment Public Health Policy INTRODUCTION The Integrated Child Development Services (ICDS) scheme is a flagship program in India aimed at improving the health, nutrition, and overall development of children under six years of age, as well as addressing the well-being of pregnant and lactating mothers. At the heart of this initiative are Anganwadi Centers (AWCs), which serve as the primary service delivery points for a range of essential interventions. According to ICDS guidelines, AWCs are mandated to provide six core services: supplementary nutrition, immunization, health check-ups, referral services, non-formal preschool education, and nutrition and health education. [ 1 ] These services play a critical role in reducing malnutrition, improving child survival rates, and fostering early cognitive and social development. [ 2 , 3 ] However, despite the well-defined framework, the quality, accessibility, and effectiveness of these services remain highly variable across different regions, particularly in urban areas where overcrowding and resource constraints pose significant challenges. [ 4 ] Studies indicate that AWCs often face challenges such as an irregular supply of supplementary nutrition, insufficient immunization coverage, inadequate growth monitoring, and limited outreach of health education programs. [ 5 , 6 ] Moreover, disparities in infrastructure, staffing, and community participation further hinder service delivery. [ 7 ] Evidence suggests that while ICDS has contributed significantly to child nutrition and health, gaps in implementation persist, necessitating continuous evaluation and systemic improvements. [ 8 , 9 ] This study aims to evaluate service delivery in urban AWCs in Jaipur under the ICDS scheme, identifying key challenges and potential areas for policy intervention. Strengthening these services is imperative for achieving the broader goals of maternal and child health improvement in India. MATERIALS AND METHODS This community-based, descriptive cross-sectional study was conducted in AWCs across urban Jaipur, Rajasthan. All AWCs in urban Jaipur formed the study universe. Data collection began after obtaining approvals from the Women and Child Development department and ICDS in charge, Institutional Research Review Board (RRB) and Ethics Committee. Data was collected from January 2023 to August 2024, followed by three months for data compilation and analysis. Sample size was determined using a 95% confidence level, 10% absolute allowable error, and assumed a 50% variability in service delivery. Sample size was reduced to 85 by applying finite population correction. AWCs were selected using a probability proportionate to size sampling technique, as urban Jaipur is divided into four administrative blocks: Jaipur 1 (18 AWCs), Jaipur 2 (22 AWCs), Jaipur 3 (23 AWCs), and Sanganer City (22 AWCs). The final sample size was 85 AWCs,. Inclusion criteria included all AWCs in urban Jaipur in working condition, while exclusion criteria involved AWCs where Anganwadi Workers (AWWs) were unavailable after two visits or on long-term leave. Good Service Delivery includes well-functioning AWCs with regular NHED sessions, immunization, and health check-ups. Poor Service Delivery includes AWCs with inconsistent or inadequate services. Data collection was carried out through direct observation and structured interviews with AWWs, using pre-tested questionnaire and check list to assess services. Statistical analysis was performed using Microsoft Excel and SPSS vr 26, with qualitative data expressed as percentages and proportions. RESULTS The assessment of 85 Anganwadi Centers (AWCs) revealed significant variations in service delivery. Notably, 56% of centers had adequate nutrition stock, while 44% faced shortages, highlighting supply disparities. Education-focused activities like songs and rhymes (82.4%), literacy (70.6%), and health awareness (76.5%) were widely implemented, whereas parental awareness (35.3%) and staff training (29.4%) were less emphasized. Book availability varied, with Kilkaria (92%) being most common and Sabla (26%) least available. Only 40% of AWCs conducted weekly Nutrition, Health, and Education (NHED) sessions, while 3% never held them, indicating gaps in outreach. Most AWCs participated in immunization sessions (87%), but the frequency varied. 80% of AWCs conducted regular health check-ups, benefiting children (87%) and pregnant women (53%), while 7% lacked check-ups entirely. Although 80% referred individuals to healthcare facilities, but only 40% referred severe illness cases, suggesting gaps in urgent care awareness. Non-formal education for adolescent girls was offered in 72% of centers, though only 27% conducted dedicated classes. Growth monitoring was well-established, with 96% having growth charts and 93% conducting monthly assessments, but only 27% identified growth retardation, pointing to detection gaps. Community engagement efforts included monthly meetings (45%), health campaigns (75%), and IEC material usage (89%), reflecting strong outreach. However, participation in government schemes (57%) showed room for improvement.(Table 1 ) Table 1 Distribution of various service delivery in AWCs Various service delivery Number of AWCs Percentage Adequate monthly stock supply of Supplementary nutrition 48 56% Non-Formal Education Basic Literacy Activities 60 71% Numeracy/Counting Activities 55 65% Storytelling Sessions 50 59% Educational Games and Play 45 53% Drawing and Art Activities 40 47% Songs and Rhymes 70 82% Parental Awareness and Involvement 30 35% Early Childhood Curriculum Training 25 29% Awareness on Health and Hygiene 65 76% Availability of book in AWC Kilkaria 78 92% Sabla 22 26% Umang 69 81% Tarang 69 81% Indradhanush 54 64% Other books 30 35% Frequency of NHED Sessions Twice a Week 12.75 17% Weekly 30 40% Fortnightly 9.75 13% Monthly 9 12% Occasionally (Irregular) 5.25 7% Never 2 3% Frequency of Immunization Sessions in AWCs − 1 time per month 30 40% − 2 times per month 25 33% − 3 times or more per month 10 13% Health Check-up Parameter Regular health check-ups conducted 60 80% Irregular health check-ups conducted 10 13% No health check-ups conducted 5 7% Presence of medical staff 45 60% Availability of basic medicines 55 73% Health check-ups for pregnant women 40 53% Health check-ups for children 65 87% Referral Services Referral to Health Facilities 60 80% Referral for Malnutrition Cases 50 67% Referral for Pregnant Women 55 73% Referral for Severe Illnesses 30 40% Good Service Delivery includes well-functioning AWCs with regular NHED sessions, immunization, and health check-ups. Poor Service Delivery includes AWCs with inconsistent or inadequate services. Among AWCs with sufficient stock (56%), 67% provided good service, while 33% had poor service. For those with insufficient stock (44%), 81% had good service, and 19% had poor service. A chi-square test showed no significant association (p > 0.05), indicating that nutrition stock availability does not significantly impact service delivery quality.(Table 2 ) Table 2 Association between distribution of nutrition and service delivery Nutrition Stock Good Service Delivery Poor Service Delivery Total P value Sufficient (56%) 32 16 48 X2 = 1.530,df = 1, P value = 0.216 Insufficient (44%) 30 7 37 Total 62 23 85 DISCUSSION The current study reveals key findings about the functioning and services of Anganwadi Centers (AWCs), which align and contrast with previous research. In terms of supplementary nutrition supply, 56% of AWCs in this study had adequate nutrition, similar to Sharma et al., where 60% of AWCs had consistent supplies, highlighting persistent issues with stock management. [ 10 ] Educational resources were also unevenly distributed, with basic materials like Kilkaria books present in most centers (92%), but specialized resources such as Sabla books were rare (26%), reflecting trends in other studies. [ 11 ] Non-formal education, crucial for preschool attendance, was significant, with 29.5 children enrolled per center in this study, which aligns with findings from Patel et al. and Verma et al. [ 12 , 13 ] Regarding health services, 87% of AWCs conducted immunization sessions, consistent with Reddy et al., but 13% of centers lacked regular health check-ups, indicating gaps similar to findings from Goswami et al. [ 14 , 15 ] Lastly, 78% of AWCs were housed in permanent structures, comparable to studies by Banerjee et al. and Verma et al., though infrastructure improvements, especially sanitation, are needed. [ 13 , 16 ] CONCLUSION Assessment of 85 Anganwadi Centers revealed nutrition shortages (44%), a strong focus on education (82.4%), but gaps in parental awareness (35.3%) and staff training (29.4%). While health services (80%) and immunization (87%) were prevalent, growth monitoring (96%) lacked early detection (27%). Community engagement (45%) needs strengthening. RECOMMENDATIONS Community engagement should be increased to raise awareness of ICDS benefits and encourage greater participation from local populations. Policy reforms are also necessary, including better incentives for AWWs, recruitment of additional staff, and periodic evaluations of the ICDS scheme. Capacity-building initiatives for Anganwadi Workers (AWWs) through regular training programs are essential to improve their skills in early childhood care, nutrition, and health education. Declarations Ethical Clearance: The study commenced after obtaining approval from the institutional ethical committee and assured that the data would remain anonymous, and confidentiality would be maintained throughout the study process. Data availability Only the anonymized dataset was used for analysis and made available with the manuscript. Data is provided as a supplementary information file. Ethics approval and consent to participate The study was performed in accordance with the ethical standards of the Institutional Ethics Committee of Sawai Man Singh Medical College, Jaipur. Obtained approvals from the Women and Child Development department and ICDS in charge, Institutional Research Review Board (RRB) and Ethics Committee. Informed consent was taken for collecting data from AWWs Competing interests: The authors declare no competing interests . Funding - No Consent to publish: not applicable Consent to participate: not applicable AUTHOR CONTRIBUTIONS D.M, S.K and N.E conceptualised the study. D.M,S.K and J.D designed the methodology and applied statistical analyses. D.M, N.E and B.B conducted data collection and wrote the main manuscript D.M, and B.B provided supervision. All authors reviewed the final manuscript. ACKNOWLEDGEMENTS I sincerely thank my mentors, colleagues, Anganwadi Workers, and ICDS authorities for their support and contributions to this study. Data availability: YES (Dr Deepak Muraleedharan, [email protected] ; 9950282252) Code availability: not applicable References Ministry of Women and Child Development, Government of India. Integrated Child Development Services (ICDS) Scheme – Programme Guidelines. New Delhi: MWCD; 2017. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-51. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369(9555):60-70. Gupta A, Suri S, Dhingra M, Rai P, Sondhi M. Challenges in Implementation of ICDS: A Study from Urban Slums in North India. J Family Med Prim Care. 2021;10(4):1672-1678. Sharma R, Gupta M, Aggarwal AK. Assessment of Anganwadi Services under ICDS in Urban Slums of North India. Indian J Community Med. 2020;45(2):123-128. Patel A, Pusdekar Y, Badhoniya N, Borkar J, Agho KE, Dibley MJ. Anganwadi Services and Their Impact on Child Health Outcomes in India. J Public Health Res. 2021;10(3):456-462. Nair MK, George B, Johnson J. Growth monitoring practices in Anganwadi Centres under ICDS scheme. Indian Pediatr. 2019;56(8):633-639. Singh A, Jain S, Bhanot A. Effectiveness of ICDS in Improving Nutritional Status of Children: A Systematic Review. J Nutr Health Sci. 2022;9(1):45-58. Khandekar S, Sharma P, Wadhwa S. Impact of Anganwadi Centers on Maternal and Child Health in Urban India. J Public Health Policy. 2023;44(2):198-215. Sharma R, Gupta M, Aggarwal AK. Assessment of Anganwadi Services under ICDS in Urban Slums of North India. Indian J Community Med. 2022;47(2):123-128. Gupta A, Suri S, Dhingra M, Rai P, Sondhi M. Challenges in Implementation of ICDS: A Study from Urban Slums in North India. J Family Med Prim Care. 2021;10(4):1672-1678. Patel A, Pusdekar Y, Badhoniya N, Borkar J, Agho KE, Dibley MJ. Anganwadi Services and Their Impact on Child Health Outcomes in India. J Public Health Res. 2021;10(3):456-462. Verma P, Singh S, Bhanot A. Evaluation of Infrastructure and Service Delivery at Anganwadi Centers in India. J Nutr Health Sci. 2021;9(1):45-58. Reddy P, Kumar R, Sharma S. Immunization Coverage and Challenges in Anganwadi Centers: A Multi-Center Study. Indian Pediatr. 2019;56(8):633-639. Goswami S, Mehta N, Chatterjee K. Healthcare Service Utilization in Anganwadi Centers: A Cross-Sectional Study. J Public Health Policy. 2020;44(2):198-215. Banerjee R, Das S, Mishra P. Infrastructure Gaps in ICDS: An Evaluation of AWCs in Urban India. J Dev Policy Rev. 2019;18(4):215-230. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6381852","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494828838,"identity":"c64a4d1b-0eb0-4956-8fc6-4e7311021f24","order_by":0,"name":"Deepak Muraleedharan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDCCA2wMDAkGNXJg9gOitTyoOGYMZicQq4XxwRnmxAYQhygtfLfbUjcktrGlzw87/BBoi52cbgMBLZJ3jh27kdgmk7vxdpoBUEuysdkBAloMbqS3AbWw5W6cnQDSciBxG5FamNMNZ6d/IFZL2rEbCWeYE+Slc4i0BeiXtBsJFccMN0jnFBxIMCDCL8AQM7v5w6BGXn52+uYPHyrs5AhqYZCAuRCs0oCQcmQt8g3EqB4Fo2AUjIIRCQAOUU+DWNXftgAAAABJRU5ErkJggg==","orcid":"","institution":"Sawai ManSingh Medical College and Hospital","correspondingAuthor":true,"prefix":"","firstName":"Deepak","middleName":"","lastName":"Muraleedharan","suffix":""},{"id":494828839,"identity":"6306735e-db29-45c3-9a2a-9f41ac19454a","order_by":1,"name":"Neethu E","email":"","orcid":"","institution":"Sawai ManSingh Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Neethu","middleName":"","lastName":"E","suffix":""},{"id":494828840,"identity":"b09a4a88-c5c7-4acd-a3be-303847676aa8","order_by":2,"name":"Jayadevan R","email":"","orcid":"","institution":"Sawai ManSingh Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jayadevan","middleName":"","lastName":"R","suffix":""},{"id":494828842,"identity":"1ab11f62-1be1-4e42-955a-6c6a81946a7e","order_by":3,"name":"B Balu","email":"","orcid":"","institution":"Sawai ManSingh Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"B","middleName":"","lastName":"Balu","suffix":""},{"id":494828845,"identity":"15b4a3a5-78ce-40d6-8f55-dc538c4cffc5","order_by":4,"name":"Suresh Kewalramani","email":"","orcid":"","institution":"Sawai ManSingh Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Suresh","middleName":"","lastName":"Kewalramani","suffix":""}],"badges":[],"createdAt":"2025-04-05 11:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6381852/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6381852/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96244726,"identity":"8b4bdf97-3340-4660-9f1a-b1ede947f5e3","added_by":"auto","created_at":"2025-11-19 07:19:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":559611,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6381852/v1/27266fdc-83f1-4308-882b-56073ea26c34.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Services at Anganwadi Centers Under the Integrated Child Development Services Scheme in Urban Jaipur: A Cross-Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe Integrated Child Development Services (ICDS) scheme is a flagship program in India aimed at improving the health, nutrition, and overall development of children under six years of age, as well as addressing the well-being of pregnant and lactating mothers. At the heart of this initiative are Anganwadi Centers (AWCs), which serve as the primary service delivery points for a range of essential interventions. According to ICDS guidelines, AWCs are mandated to provide six core services: supplementary nutrition, immunization, health check-ups, referral services, non-formal preschool education, and nutrition and health education.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e These services play a critical role in reducing malnutrition, improving child survival rates, and fostering early cognitive and social development.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHowever, despite the well-defined framework, the quality, accessibility, and effectiveness of these services remain highly variable across different regions, particularly in urban areas where overcrowding and resource constraints pose significant challenges.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e Studies indicate that AWCs often face challenges such as an irregular supply of supplementary nutrition, insufficient immunization coverage, inadequate growth monitoring, and limited outreach of health education programs.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e Moreover, disparities in infrastructure, staffing, and community participation further hinder service delivery.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e Evidence suggests that while ICDS has contributed significantly to child nutrition and health, gaps in implementation persist, necessitating continuous evaluation and systemic improvements.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis study aims to evaluate service delivery in urban AWCs in Jaipur under the ICDS scheme, identifying key challenges and potential areas for policy intervention. Strengthening these services is imperative for achieving the broader goals of maternal and child health improvement in India.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis community-based, descriptive cross-sectional study was conducted in AWCs across urban Jaipur, Rajasthan. All AWCs in urban Jaipur formed the study universe. Data collection began after obtaining approvals from the Women and Child Development department and ICDS in charge, Institutional Research Review Board (RRB) and Ethics Committee. Data was collected from January 2023 to August 2024, followed by three months for data compilation and analysis. Sample size was determined using a 95% confidence level, 10% absolute allowable error, and assumed a 50% variability in service delivery. Sample size was reduced to 85 by applying finite population correction. AWCs were selected using a probability proportionate to size sampling technique, as urban Jaipur is divided into four administrative blocks: Jaipur 1 (18 AWCs), Jaipur 2 (22 AWCs), Jaipur 3 (23 AWCs), and Sanganer City (22 AWCs). The final sample size was 85 AWCs,. Inclusion criteria included all AWCs in urban Jaipur in working condition, while exclusion criteria involved AWCs where Anganwadi Workers (AWWs) were unavailable after two visits or on long-term leave. Good Service Delivery includes well-functioning AWCs with regular NHED sessions, immunization, and health check-ups. Poor Service Delivery includes AWCs with inconsistent or inadequate services. Data collection was carried out through direct observation and structured interviews with AWWs, using pre-tested questionnaire and check list to assess services. Statistical analysis was performed using Microsoft Excel and SPSS vr 26, with qualitative data expressed as percentages and proportions.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe assessment of 85 Anganwadi Centers (AWCs) revealed significant variations in service delivery. Notably, 56% of centers had adequate nutrition stock, while 44% faced shortages, highlighting supply disparities. Education-focused activities like songs and rhymes (82.4%), literacy (70.6%), and health awareness (76.5%) were widely implemented, whereas parental awareness (35.3%) and staff training (29.4%) were less emphasized. Book availability varied, with Kilkaria (92%) being most common and Sabla (26%) least available. Only 40% of AWCs conducted weekly Nutrition, Health, and Education (NHED) sessions, while 3% never held them, indicating gaps in outreach. Most AWCs participated in immunization sessions (87%), but the frequency varied. 80% of AWCs conducted regular health check-ups, benefiting children (87%) and pregnant women (53%), while 7% lacked check-ups entirely. Although 80% referred individuals to healthcare facilities, but only 40% referred severe illness cases, suggesting gaps in urgent care awareness. Non-formal education for adolescent girls was offered in 72% of centers, though only 27% conducted dedicated classes. Growth monitoring was well-established, with 96% having growth charts and 93% conducting monthly assessments, but only 27% identified growth retardation, pointing to detection gaps. Community engagement efforts included monthly meetings (45%), health campaigns (75%), and IEC material usage (89%), reflecting strong outreach. However, participation in government schemes (57%) showed room for improvement.(Table\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of various service delivery in AWCs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVarious service delivery\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of AWCs\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAdequate monthly stock supply of Supplementary nutrition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e\u003cb\u003eNon-Formal Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBasic Literacy Activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumeracy/Counting Activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStorytelling Sessions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducational Games and Play\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDrawing and Art Activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSongs and Rhymes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParental Awareness and Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly Childhood Curriculum Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAwareness on Health and Hygiene\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eAvailability of book in AWC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKilkaria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSabla\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUmang\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTarang\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndradhanush\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther books\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eFrequency of NHED Sessions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwice a Week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeekly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFortnightly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMonthly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOccasionally (Irregular)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFrequency of Immunization Sessions in AWCs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;1 time per month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;2 times per month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;3 times or more per month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eHealth Check-up Parameter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegular health check-ups conducted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIrregular health check-ups conducted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo health check-ups conducted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresence of medical staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAvailability of basic medicines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth check-ups for pregnant women\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth check-ups for children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eReferral Services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReferral to Health Facilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReferral for Malnutrition Cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReferral for Pregnant Women\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReferral for Severe Illnesses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eGood Service Delivery includes well-functioning AWCs with regular NHED sessions, immunization, and health check-ups. Poor Service Delivery includes AWCs with inconsistent or inadequate services.\u003c/p\u003e\u003cp\u003eAmong AWCs with sufficient stock (56%), 67% provided good service, while 33% had poor service. For those with insufficient stock (44%), 81% had good service, and 19% had poor service. A chi-square test showed no significant association (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that nutrition stock availability does not significantly impact service delivery quality.(Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between distribution of nutrition and service delivery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition Stock\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood Service Delivery\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePoor Service Delivery\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSufficient (56%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX2\u0026thinsp;=\u0026thinsp;1.530,df\u0026thinsp;=\u0026thinsp;1, P value\u0026thinsp;=\u0026thinsp;0.216\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInsufficient (44%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe current study reveals key findings about the functioning and services of Anganwadi Centers (AWCs), which align and contrast with previous research. In terms of supplementary nutrition supply, 56% of AWCs in this study had adequate nutrition, similar to Sharma et al., where 60% of AWCs had consistent supplies, highlighting persistent issues with stock management.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e Educational resources were also unevenly distributed, with basic materials like Kilkaria books present in most centers (92%), but specialized resources such as Sabla books were rare (26%), reflecting trends in other studies.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e Non-formal education, crucial for preschool attendance, was significant, with 29.5 children enrolled per center in this study, which aligns with findings from Patel et al. and Verma et al.\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eRegarding health services, 87% of AWCs conducted immunization sessions, consistent with Reddy et al., but 13% of centers lacked regular health check-ups, indicating gaps similar to findings from Goswami et al.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e Lastly, 78% of AWCs were housed in permanent structures, comparable to studies by Banerjee et al. and Verma et al., though infrastructure improvements, especially sanitation, are needed.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eAssessment of 85 Anganwadi Centers revealed nutrition shortages (44%), a strong focus on education (82.4%), but gaps in parental awareness (35.3%) and staff training (29.4%). While health services (80%) and immunization (87%) were prevalent, growth monitoring (96%) lacked early detection (27%). Community engagement (45%) needs strengthening.\u003c/p\u003e"},{"header":"RECOMMENDATIONS","content":"\u003cp\u003eCommunity engagement should be increased to raise awareness of ICDS benefits and encourage greater participation from local populations. Policy reforms are also necessary, including better incentives for AWWs, recruitment of additional staff, and periodic evaluations of the ICDS scheme. Capacity-building initiatives for Anganwadi Workers (AWWs) through regular training programs are essential to improve their skills in early childhood care, nutrition, and health education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Clearance:\u003c/strong\u003e The study commenced after obtaining approval from the institutional ethical committee and assured that the data would remain anonymous, and confidentiality would be maintained throughout the study process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly the anonymized dataset was used for analysis and made available with the manuscript. Data is provided as a supplementary information file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was performed in accordance with the ethical standards of the Institutional Ethics Committee of Sawai Man Singh Medical College, Jaipur. Obtained approvals from the Women and Child Development department and ICDS in charge, Institutional Research Review Board (RRB) and Ethics Committee. Informed consent was taken for collecting data from AWWs\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding\u003c/strong\u003e- No\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD.M, S.K and N.E conceptualised the study. D.M,S.K and J.D designed the methodology and applied statistical analyses. D.M, N.E and B.B conducted data collection and wrote the main manuscript D.M, \u0026nbsp;and B.B provided supervision. All authors reviewed the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI sincerely thank my mentors, colleagues, Anganwadi Workers, and ICDS authorities for their support and contributions to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eYES (Dr Deepak Muraleedharan, [email protected]; 9950282252)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMinistry of Women and Child Development, Government of India. Integrated Child Development Services (ICDS) Scheme \u0026ndash; Programme Guidelines. New Delhi: MWCD; 2017.\u003c/li\u003e\n\u003cli\u003eBlack RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-51.\u003c/li\u003e\n\u003cli\u003eGrantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369(9555):60-70.\u003c/li\u003e\n\u003cli\u003eGupta A, Suri S, Dhingra M, Rai P, Sondhi M. Challenges in Implementation of ICDS: A Study from Urban Slums in North India. J Family Med Prim Care. 2021;10(4):1672-1678.\u003c/li\u003e\n\u003cli\u003eSharma R, Gupta M, Aggarwal AK. Assessment of Anganwadi Services under ICDS in Urban Slums of North India. Indian J Community Med. 2020;45(2):123-128.\u003c/li\u003e\n\u003cli\u003ePatel A, Pusdekar Y, Badhoniya N, Borkar J, Agho KE, Dibley MJ. Anganwadi Services and Their Impact on Child Health Outcomes in India. J Public Health Res. 2021;10(3):456-462.\u003c/li\u003e\n\u003cli\u003eNair MK, George B, Johnson J. Growth monitoring practices in Anganwadi Centres under ICDS scheme. Indian Pediatr. 2019;56(8):633-639.\u003c/li\u003e\n\u003cli\u003eSingh A, Jain S, Bhanot A. Effectiveness of ICDS in Improving Nutritional Status of Children: A Systematic Review. J Nutr Health Sci. 2022;9(1):45-58.\u003c/li\u003e\n\u003cli\u003eKhandekar S, Sharma P, Wadhwa S. Impact of Anganwadi Centers on Maternal and Child Health in Urban India. J Public Health Policy. 2023;44(2):198-215.\u003c/li\u003e\n\u003cli\u003eSharma R, Gupta M, Aggarwal AK. Assessment of Anganwadi Services under ICDS in Urban Slums of North India. Indian J Community Med. 2022;47(2):123-128.\u003c/li\u003e\n\u003cli\u003eGupta A, Suri S, Dhingra M, Rai P, Sondhi M. Challenges in Implementation of ICDS: A Study from Urban Slums in North India. J Family Med Prim Care. 2021;10(4):1672-1678.\u003c/li\u003e\n\u003cli\u003ePatel A, Pusdekar Y, Badhoniya N, Borkar J, Agho KE, Dibley MJ. Anganwadi Services and Their Impact on Child Health Outcomes in India. J Public Health Res. 2021;10(3):456-462.\u003c/li\u003e\n\u003cli\u003eVerma P, Singh S, Bhanot A. Evaluation of Infrastructure and Service Delivery at Anganwadi Centers in India. J Nutr Health Sci. 2021;9(1):45-58.\u003c/li\u003e\n\u003cli\u003eReddy P, Kumar R, Sharma S. Immunization Coverage and Challenges in Anganwadi Centers: A Multi-Center Study. Indian Pediatr. 2019;56(8):633-639.\u003c/li\u003e\n\u003cli\u003eGoswami S, Mehta N, Chatterjee K. Healthcare Service Utilization in Anganwadi Centers: A Cross-Sectional Study. J Public Health Policy. 2020;44(2):198-215.\u003c/li\u003e\n\u003cli\u003eBanerjee R, Das S, Mishra P. Infrastructure Gaps in ICDS: An Evaluation of AWCs in Urban India. J Dev Policy Rev. 2019;18(4):215-230.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anganwadi Centers, Service Delivery, Child Health, Nutrition Assessment, Public Health Policy","lastPublishedDoi":"10.21203/rs.3.rs-6381852/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6381852/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eICDS scheme in India supports child health, nutrition, and maternal care through Anganwadi Centers, offering six core services. Urban overcrowding and resource constraints affect service quality. Irregular nutrition supply, inadequate immunization, and limited health education underscore need for evaluation and policy reforms.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate facilities and services of Anganwadis centers delivered under Integrated Child Development Service.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eCross-sectional study assessed 85 randomly selected Anganwadi Centers (AWCs) in urban Jaipur using structured interviews and direct observations. Data collection was conducted post-approval from relevant authorities. Statistical analysis was performed using Microsoft Excel. AWCs were selected through probability proportionate to size sampling. Inclusion criteria involved AWCs as per sampling technique, while exclusions were based on unavailability of Anganwadi Workers (AWWs).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eStudy assessed 85 Anganwadi Centers (AWCs), revealing disparities in service delivery. 56% had adequate nutrition stock, 44% faced shortages. Education-focused activities were common, but parental awareness (35.3%) and staff training (29.4%) were lacking. Immunization (87%) and health check-ups (80%) were prevalent, yet referral for severe illness was low (40%). Growth monitoring (96%), growth retardation detection (27%) was limited. Community engagement was active (75%), though government scheme participation (57%) needed improvement. Chi-square test showed no significant association (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between nutrition stock and service quality, indicating other factors influence.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eAWCs play a vital role in child health and development, yet service disparities persist. Nutrition stock shortages, limited parental awareness, and inadequate growth retardation detection highlight gaps. Despite strong immunization and health check-ups, urgent care referrals remain low.\u003c/p\u003e","manuscriptTitle":"Assessment of Services at Anganwadi Centers Under the Integrated Child Development Services Scheme in Urban Jaipur: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-05 10:56:12","doi":"10.21203/rs.3.rs-6381852/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f3295e1-75a7-43e2-a142-8f430defe06e","owner":[],"postedDate":"August 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-14T15:23:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-05 10:56:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6381852","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6381852","identity":"rs-6381852","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}