Adolescent girls' health, nutrition and wellbeing in rural eastern India: a descriptive, cross-sectional community-based study

Prevalence of Psychiatric Morbidity and Alcohol use Disorders Among Adolescent Indigenous Tribals from Three Indian States

Background

Among the Indian adolescents, the prevalence of psychiatric morbidity and alcohol use disorders (AUD) are 7.3% and 1.3%. However, no separate data are available for indigenous tribal populations. This study estimated the prevalence of psychiatric morbidity and AUD and associated socio-demographic factors among adolescents in the tribal communities in three widely varying states in India.

Methods

Using validated Indian versions of the MINI 6.0, MINI Kid 6.0, and ICD-10 criteria, we conducted a cross-sectional survey from January to May 2019 in three Indian sites: Valsad, Gujarat (western India); Nilgiris, Tamil Nadu (south India); and East Khasi Hills district of Meghalaya (north-east India) on 623 indigenous tribal adolescents.

Results

Aggregate prevalence of any psychiatric morbidity was 15.9% (95% CI: 13.1-19.0) (males: 13.6%, 95% CI: 10.0-18.1; females: 17.9%, 95% CI: 13.9-22.6), with site-wise statistically significant differences: Gujarat: 23.8% (95% CI: 18.1-30.2), Meghalaya: 17.1% (95% CI: 12.4-22.7), Tamil Nadu: 6.2% (95% CI: 3.2-10.5). The prevalence of diagnostic groups was mood disorders 6.4% (n = 40), neurotic- and stress-related disorders 9.1% (n = 57), phobic anxiety disorder 6.3% (n = 39), AUD 2.7% (n = 17), behavioral and emotional disorders 2.7% (n = 17), and obsessive-compulsive disorder 2.2% (n = 14). These differed across the sites.

Conclusion

The prevalence of psychiatric morbidity in adolescent tribals is approximately twice the national average. The most common psychiatric morbidities reported are mood (affective) disorders, neurotic- and stress-related disorders, phobic anxiety disorder, AUD, behavioral and emotional disorders, andobsessive-compulsive disorder.

Delivering PACE++ curriculum in community settings: Impact of TARA intervention on gender attitudes and dietary practices among adolescent girls in Bihar, India

Adolescence phase has high intrinsic and instrumental relevance. The Transformative Action for Rural Adolescents intervention delivered PACE++ curriculum with innovations to introduce a) health and nutrition sessions and b) delivery of the content in community settings of rural Bihar. This paper examines impact of the intervention showcasing establishment of intergenerational community connect for empowering and invigorating adolescent girls on gender attitude, empowerment and adolescent health and nutrition. The impact evaluation is based on a two-arm (intervention and comparison groups) cluster randomized controlled design with two rounds of representative cross-sectional surveys. The baseline and endline sample comprised of 2327 and 2033 adolescent girls (15-19 years), respectively. Descriptive statistical, difference-in-differences and propensity score matching methods are used to confirm the program impact. The DID and PSM analyses confirm high significance of impact on gender equity norms, diets and nutritional knowledge and understanding of employee related rights and responsibilities. School-going adolescent girls performed better than those who have discontinued formal education. The intervention showcases the importance of delivering the modified PACE curriculum in rural settings through leveraging community platforms. The findings call for greater policy attention on scaling up of similar initiatives for empowerment and social capital development of adolescent girls.

Is the burden of anaemia among Indian adolescent women increasing? Evidence from Indian Demographic and Health Surveys (2015-21)

Anaemia is a significant public health issue, particularly affecting women in India. However, little is known about the burden of anaemia among adolescent women in India over time. This study aimed to analyse the change in the prevalence of anaemia among adolescent women in India from 2015 to 2021 and identify the factors associated with anaemia in this population. This study used information on 116,117 and 109,400 adolescent women (aged 15-19) from the fourth and fifth round of National Family Health Survey, respectively. Bivariate statistics and multivariable logistic regression were employed to identify the statistically significant predictors of anaemia. The prevalence of anaemia among adolescent women in India increased from 54.2% (99% CI: 53.6-54.8) to 58.9% (99% CI: 58.3-59.5) over the study period (2015-16 to 2019-21). Among the 28 Indian states, 21 reported an increase in the prevalence of anaemia. However, the levels of increase varied across the states. While Assam, Chhattisgarh, and Tripura showed a substantial rise of 15 percentage points, the states of Punjab, Karnataka, Telangana, Bihar, and Madhya Pradesh recorded a marginal increase of less than 5 percentage points. Notably, Uttarakhand and Kerala exhibited a decline in anaemia prevalence during the study period. Additionally, the number of states with anaemia prevalence exceeding 60%, doubled from 5 in 2015-16 to 11 in 2019-21. Several factors were found associated with anaemia, including having more than one child (AOR: 1.33, 99% CI: 1.16-1.51), having no education (AOR: 1.25, 99% CI: 1.16-1.34), belonging to Scheduled Tribes (AOR: 1.47, 99% CI: 1.40-1.53), being in the lowest wealth quintile (AOR: 1.17, 99% CI: 1.12-1.23), year of survey (AOR: 1.26, 99% CI: 1.23-1.29), and being underweight (AOR: 1.10, 99% CI: 1.07-1.12). In conclusion, the rise in anaemia prevalence among adolescent women in India suggests the need for targeted interventions to mitigate the burden of anaemia and enhance the overall health of this population.

Menstrual Hygiene Practices in Indian Tribal Females: A Systematic Review and Meta-Analysis

India is native to many tribal communities: Bharia (Madhya Pradesh), Bihl (Rajasthan), Santhal (Bihar, Jharkhand), Bodo (Assam, West Bengal), and many more. They reside in isolated geographical regions, which poses challenges in reaching out to them. In addition, they still have firm beliefs and taboos regarding menstruation. Knowledge about menstrual health and hygiene is one of the most important aspects of tribal health. Therefore, it is important to synthesize the results of menstrual hygiene data from the Indian tribal population. We have calculated the pooled prevalence of sanitary pad use, dustbin disposal, and hygienic reuse of menstrual materials. Online databases, namely PubMed, Cochrane Central, CINAHL, Pan African Journals, EBSCO, and Google Scholar, were searched. After the removal of duplicates, a quality check, and screening of cross-references, 19 articles were selected for final review. Statistical analysis was done by Revman 5.4 and STATA 17.0. A p-value of <0.05 was considered statistically significant. PRISMA guidelines were followed. The protocol registration number was CRD42022331376. This is a non-funded article. The pooled prevalence of sanitary pad use in Indian tribal females was 2% (95% CI 1 to 3). The pooled prevalence of dustbin disposal of menstrual material was 1% (95% CI: 0.00 to 0.02). The pooled prevalence of hygienic reuse of menstrual materials was 1%. Sanitary menstrual hygiene practices are very less prevalent in Indian tribal females. Awareness programs and tribal health policies need to be accelerated for the promotion of menstrual hygiene. Also, literature on the use, disposal, and storage of menstrual adsorbents is scarce in Indian tribes. Health research in this area needs to be emphasized.

Mid-upper arm circumference (MUAC) measurement usage among children with disabilities: A systematic review

Background: Anthropometric measurements, including mid-upper arm circumference (MUAC), are used for monitoring and evaluating children's nutritional status. Evidence is limited on optimal nutritional assessment for children with disabilities, who are at high risk for malnutrition. Aim: This study describes MUAC use among children with disabilities. Methods: Four databases (Embase, Global Health, Medline, and CINHAL) were searched from January 1990 through September 2021 using a predefined search strategy. Of the 305 publications screened, 32 papers were included. Data included children 6 months to 18 years old with disabilities. Data including general study characteristics, methods for MUAC measurement, terminology, and measurement references were extracted into Excel. Due to heterogeneity of the data, a narrative synthesis was used. Results: Studies from 24 countries indicate that MUAC is being used as part of nutritional assessment, but MUAC measurement methods, references, and cutoffs were inconsistent. Sixteen (50%) reported MUAC as a mean ± standard deviation (SD), 11 (34%) reported ranges or percentiles, 6 (19%) reported z-scores, and 4 (13%) used other methods. Fourteen (45%) studies included both MUAC and weight-for-height but nonstandard reporting limited comparability of the indicators for identifying those at risk of malnutrition. Conclusion: Although its speed, simplicity, and ease of use afford MUAC great potential for assessing children with disabilities, more research is needed to understand its appropriateness, and how it performs at identifying nutritionally high-risk children in comparison to other measures. Without validated inclusive measures to identify malnutrition and monitor growth and health, millions of children could have severe consequences for their development.

Centres of Excellence for Adolescent Health and Development: A Case Study from Uttar Pradesh, India

Adolescents and young adult comprise a significant proportion of India's population. Although, this group of the population faces serious challenges to their health and well-being. To promote their health and well-being, Centre of Excellence (CoE) at King George's Medical University, Lucknow, India, serves as an advanced care facility for 10-24-year-old adolescents and young adult women. This paper reports the socio-demographic characteristics of, and health services availed to adolescents and young adults who are visiting the CoE in Lucknow, India. A total of 6038 beneficiaries received clinical services during June 2018-March 2022. Out of total clinical services, 38.37% counselling and 37.53% referral services were utilised. Menstruation (46.29%), sexual and reproductive (28.19%), nutrition (5.91%), and mental health (1.67%) related problems were highly reported. The age of beneficiaries is classified into three categories, i.e., 10-14, 15-19, and 20-24 years. Prevalence of overweight was highest among adolescents aged 20-24 years compared to other age groups. Other than nutrition, late-adolescent girls (15-19) faced more health problems than their counterparts. The percentage of beneficiaries decreased significantly during and post the COVID-19 period (<0.001). Therefore, age-specific programs are currently needed, and interventions need to be designed accordingly.

Prevalence of mental health problems among rural adolescents in India: A systematic review and meta-analysis

Adolescent mental health problems have been recognised as a major issue in low-income countries including India. Through a meta-analytic approach, the present review delineate the overall prevalence of each of the most discussed mental health problems among rural adolescents in India, comprising depression, anxiety disorders, generalised anxiety disorder, panic disorder, separation anxiety, social anxiety disorder, suicidality, hyperactivity, emotional problems, conduct problems and peer problems. The review also presents the potential determinants of such mental health problems. Using PRISMA guidelines, a total of thirty-five studies were finalized from databases such as PubMed, Science Direct, JSTOR, Web of Science, Google Scholar and ProQuest. From the findings, it is observed that male and female adolescents does not differ significantly in the prevalence of most mental health problems. However, social anxiety was found to be more prevalent among females when compared to males. In meta-regression, factors like tools used (screening tools vs diagnostic interviews), sample size, setting (school-based vs community-based), sampling technique and year of publication were found to influence the prevalence rates of certain mental health problems, reported in the studies. Major determinants influencing the prevalence of mental health problems in rural adolescents were age, socio-economic status, academic and family environment. Individual factors such as social media usage, physical activity, and substance use also contribute to mental health problems. As India accounts for one-fifth of the world's adolescent population, the findings of this review can have global implications.

Comparative Study of Physiological Indicators of Cardiovascular Fitness such as Heart Rate Variability, Harvard Step Test, Ankle-brachial Index, and Body mass Index in Rural and Urban Adolescent Girls

Objectives:

Health is defined as a state of complete physical, mental, and social well-being.

Materials and Methods:

Humans have settled in both urban and rural areas, which might have influenced people and their physiology in different ways.

Results:

Cardiovascular fitness as a marker of proper functioning of the whole body is associated with many health-related outcomes, with poor fitness leading to development of cardiovascular diseases (CVD).

Conclusion:

This study aimed to perform a comparative study of the physiological parameters’ indicative of cardiovascular fitness in urban and rural adolescent girls.

A study on child sexual abuse reported by urban indian college students

Background and Objectives

The prevalence of child sexual abuse (CSA) in India is 18-50% depending on the population studied. To devise strategies for prevention of CSA at the primary care level, we studied the prevalence of CSA amongst college students aged 17-25 years.

Methods

A group of medical students and their friends were sent, an anonymous questionnaire validated by experts via WhatsApp. The questionnaire assessed demography, occurrence of prior CSA and details of the sexual abuse.

Results

About 574 students participated in the study. The majority of respondents were female (380, 66.2%). About 467 (81.2%) of participants were from South India. Of the 380 women and 194 men who consented to participate in the study, 218 (57.3%) and 65 (33.5%), respectively, said that they had been sexually abused in the past (p < 0.00001). The event commonly occurred at 12-14 years (22.6%), but about 53% of victims were <12 years of age. The perpetrator was usually male (93.2%), less than 30 years of age (54%) and a stranger (42.7%). The most common form of CSA from 348 instances in 283 respondents was some form of "bad touch or caresses" (56.6%). About 25.8% of those abused did not speak to anyone about the event. Only 249 respondents (43%) were counselled regarding CSA by their parents.

Conclusions

The prevalence of CSA amongst South Indian college students is 49.3%. The victims were mainly girls <12 years of age and the perpetrators were mainly male (93.2%). Primary Care Physicians can play a greater role in the early detection and prevention of CSA.

Association between exposure to social media and knowledge of sexual and reproductive health among adolescent girls: evidence from the UDAYA survey in Bihar and Uttar Pradesh, India

Background

Poor sexual and reproductive health (SRH) outcomes amongst adolescent girls in India have been associated with inadequate knowledge of SRH. Evidence suggests that social media can promote health-seeking behaviors. Our objective in this study was to determine the association between exposure to social media and SRH knowledge among adolescent girls in Bihar and Uttar Pradesh, India.

Methods

A cross-sectional study was conducted with 10,425 adolescent girls from the UDAYA survey (wave-2, 2018–19). Girls’ exposure to social media was the key predictor, and SRH knowledge of sexual intercourse and pregnancy, contraceptive methods, and HIV/AIDS were outcomes of interest. Multivariable logistic regression models were performed to assess the association between exposure to social media and knowledge of SRH among adolescent girls.

Results

Of the study participants (n = 10,425), 28.0% (n = 3,160) had exposure to social media. Overall, 8.7%, 11.4%, and 6.6% of respondents had sufficient knowledge of sexual intercourse and pregnancy, contraceptive methods, and HIV/AIDS, respectively. Exposure to social media was associated with increased odds of knowledge of sexual intercourse and pregnancy (Odds ratio [OR]: 1.38; 95% confidence interval [CI]: 1.18, 1.61), contraceptive methods (OR: 1.46; 95% CI: 1.27, 1.67), and HIV/AIDS (OR: 2.18; 95% CI: 1.84, 2.58).

Conclusions

Our study shows the potency of exposure to social media in influencing SRH knowledge, which exclusively benefits female adolescents who are educated, residing in urban areas, and from wealthier families. Digital media-focused interventions inclusive of socio-cultural contexts (e.g., strategic investment in education and creating economic opportunities) are crucial to optimize social media's impact on SRH knowledge enhancements.

A substantial body of research shows that adolescent girls in India lack adequate sexual and reproductive health (SRH) knowledge. Evidently, this puts them at several health risks associated with early pregnancies, preventable gynecological morbidities such as irregular menstrual patterns, and urethral discharge, among several others. Perpetuated social stigma and lack of agency impede adolescents especially from marginalized communities from accessing accurate, sufficient, and timely SRH information from their immediate household members and healthcare providers at local service points. This adversely affects their health-seeking behaviors and ultimately results in avertable poor reproductive health outcomes. A growing body of literature highlights social media platforms (i.e., Facebook, Instagram, Twitter, etc.) as preferred modalities to gain SRH information among adolescents. Against this backdrop, we assessed the intricate association between social media exposure and SRH knowledge (across three dimensions: sexual intercourse and pregnancy, contraceptive methods, and HIV/AIDS) among adolescent girls in Bihar and Uttar Pradesh, India. We tested for association between several socio-demographic factors and SRH knowledge. Findings indicate that adolescents who were exposed to social media platforms were likely to have more SRH knowledge compared to those who were not. Socio-demographic factors like place of residence, for example residing in urban areas, higher levels of education and high wealth index acted as facilitators of social media exposure as well as SRH knowledge.

Perceptions of and challenges faced by primary healthcare workers about preconception services in rural India: A qualitative study using focus group discussion

Background

Providing preconception care through healthcare workers at the primary health care level is a crucial intervention to reduce adverse pregnancy outcomes, consequently reducing neonatal mortality. Despite the availability of evidence, this window of opportunity remains unaddressed in many countries, including India. The public health care system is primarily accessed by rural and tribal Indian population. It is essential to know the frontline healthcare workers perception about preconception care. The study aimed to identify barriers and suggestions for framing appropriate strategies for implementing preconception care through primary health centers.

Methods

The authors conducted a qualitative study using focus group discussions (FGDs) with 45 healthcare workers in four FGDs (8-14 participants in each), in four blocks of Nashik district. The transcribed discussions were analyzed in MAXQDA software using the Socio-Ecological Model as an initial coding guide, including four levels of factors (individual, interpersonal, community, and institutional) that influenced an individual's behavior to use preconception care services.

Results

Healthcare workers had some knowledge about preconception care, limited to adolescent health and family planning services. The interpersonal factors included heavy workload, stress, lack of support and co-operation, and paucity of appreciation, and motivation. The perceived community factors included poverty, migration, poor knowledge of preconception care, lack of felt need for preconception services, the influence of older women in the household decision, low male involvement, myths and misconceptions regarding preconception services. The identified institutional factors were lack of human resources, specialized services, logistics, and challenges in delivering adolescent health and family planning programs. Healthcare workers suggested the need for program-specific guidelines, training and capacity building of human resources, an un-interrupted supply of logistics, and a unique community awareness drive supporting preconception care services.

Conclusion

Multi-level factors of the Socio-Ecological Model influencing the preconception care services should be considered for framing strategies in the implementation of comprehensive preconception care as a part of a continuum of care for life cycle phases of women.

Prevalence and determinants of undernutrition among adolescents in India: A protocol for systematic review and meta-analysis

BACKGROUND

Undernutrition is one of the serious health problems among adolescents in India where 253 million adolescents are in the age group of 10-19 years. Since adolescents represent the next generation of adults, it is important to understand the nutritional status of adolescents. Even though several studies have been carried out in different states in India on adolescent undernutrition (stunting, wasting /underweight), there is no study or review that estimated the national pooled prevalence of adolescent undernutrition and its determinants. Therefore, this review aims to determine the pooled prevalence and determinants of undernutrition (stunting, underweight/wasting) among Indian adolescents.

METHODS

A systematic review of eligible articles will be conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A comprehensive searching of the literature will be made in Pub Med, EMBASE, SCOPUS, Google, Google Scholar, and Cochrane databases. The quality of the articles included in the review will be evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies in meta-analyses. The pooled prevalence and odds ratio of the associated risk factors or determinants with their 95% confidence interval will be computed using STATA version 16 software. The existence of heterogeneity among studies will be assessed by computing p-values of Higgins's I2 test statistics and Cochran's Q-statistics based on chi-square with a 5% level of significance among reported prevalence. Sensitivity analysis and subgroup analysis will be conducted based on study quality to investigate the possible sources of heterogeneity. Publication bias will be assessed through visual examination of funnel plots and objectively by Egger's regression test. This review protocol has been registered at PROSPERO (CRD42021286814).

DISCUSSION

By collecting and summarizing information on adolescent undernutrition can be a step towards a better understanding of the prevalence of nutritional status of Indian adolescents and how the associated factors influence the prevalence of undernutrition. This review will provide directions for further research and healthcare practitioners. This summarized finding at the national level will provide impetus to build nutritional strategies and proper healthcare services to fight against undernutrition among the most ignored population.

Cross-Sectional Analysis of Nutritional Status, Knowledge and Uptake of Nutritional Services Among Adolescent Girls in Western India

Purpose

Malnutrition status of adolescent girls remains a major public health problem in India. The present study assessed nutritional status, associated factors contributing to malnutrition and their access to health-care services in Dev Bhumi Dwarka district of Gujarat situated in western part of India.

Materials and Methods

The study was carried out using descriptive cross-sectional design. A total of 1252 adolescent girls from all four blocks of Dev Bhumi Dwarka district were interviewed by field investigators. The data were collected on socio-demographic characteristics, physical activities, diet, and anthropometry. The WHO classification for body mass index (BMI) was used to assess underweight, overweight, and obesity among adolescent girls. Chi-square analyses were performed to identify significant determinants of under-nutrition.

Results

Mean age of the study population was 13.82±2.31. Of the total, around 34% of the adolescent girls were out-of-school. The prevalence of underweight (<-2SD) was 19.6%, 8.9% were overweight, and 2.6% were obese. The mean BMI was 19.77±2.42 kg/m², and height was 149.15 (2.23m²). In terms of knowledge, almost 79.6% were unaware of iron-deficiency anaemia, about 70% were not aware of haemoglobin test, and 44% did not know the benefit of using sanitary napkins. In addition, uptake of nutritional and health services was limited. The study found a statistically significant association of age (p = 0.00), the number of family members (p = 0.016), knowledge (p = 0.05), and use of toilet (0.041) with low-BMI.

Conclusion

Existing nutritional interventions need to focus on nutrition, health and hygiene education. It also reinforces a need for implementation research to understand barriers in uptake of health and nutrition services.

Comparing Reproductive Health Awareness, Nutrition, and Hygiene among Early and Late Adolescents from Marginalized Populations of India: A Community-Based Cross-Sectional Survey

Adolescence (10–19 years) is marked by many physiological changes and is vulnerable to health and nutritional problems. Adolescence, particularly, early adolescence is inadequately addressed in our national surveys. The present study aimed to assess the reproductive health awareness, nutrition, and hygiene of marginalized adolescent girls and boys and compare them among early and late adolescents. Our cross-sectional study was a part of a community-based project across India’s five zones, namely North, East, West, Central, and South. Unadjusted and adjusted logistic regression was performed to compare awareness about HIV/AIDS, or Sexually Transmitted Infections (STI), consumption of Iron Folic Acid (IFA) tablets and three meals in a day, safe menstrual hygiene practices, history of anemia, and open defecation practice among early and late adolescents. Data were reported as unadjusted and adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Among early adolescents, around 58% of girls and boys did not consume IFA tablets, and 28% of girls and 24% of boys defecated in the open. Compared to late adolescents, early adolescent girls had lower odds of awareness about HIV/AIDS (aOR (95% CI): 0.50 (0.47–0.54)) and open defecation (aOR (95% CI): 0.90 (0.83–0.98)) and higher odds of hand hygiene after defecation (aOR (95% CI): 1.52 (1.37–1.68)) and safe menstrual practices (aOR (95% CI): 1.42 (1.23–1.64)). There is a dire need to start public health interventions from early adolescence for long-term benefits throughout adolescence.

Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial

BACKGROUND

Improving the health and development of adolescents aged 10-19 years is a global health priority. One in five adolescents globally live in India. The Rashtriya Kishor Swasthya Karyakram (RKSK), India's national adolescent health strategy, recommends supporting community-based peer educators to conduct group meetings with boys and girls. Groups aim to give adolescents a space to discuss the social and health issues affecting them and build their capacity to become active community members and leaders. There have been no evaluations of the community component of RKSK to date. In this protocol, we describe the evaluation of the Jharkhand Initiative for Adolescent Health (JIAH), a community intervention aligned with RKSK and designed to improve school attendance, dietary diversity and mental health among adolescent girls aged 10-19 years in rural Jharkhand, eastern India.

METHODS

The JIAH intervention is delivered by a community youth team consisting of yuva saathis (friends of youth), youth leadership facilitators and livelihood promoters. Teams conduct (a) peer-led Participatory Learning and Action meetings with girls and boys, mobilising adolescents, parents, health workers, teachers and the wider community to make changes for adolescent health and development; (b) group-based youth leadership activities to build adolescents' confidence and resilience; and (c) livelihood promotion with adolescents and their families to provide training and practical skills. We are evaluating the JIAH intervention through a parallel-group, two-arm, superiority, cluster-randomised controlled trial. The unit of randomisation is a geographic cluster of ~1000 people. A total of 38 clusters covering an estimated population of 40,676 have been randomised to control or intervention arms. Nineteen intervention clusters have adolescent groups, youth leadership activities and livelihood promotion. Nineteen control clusters receive livelihood promotion only. Study participants are adolescent girls aged 10-19 years, married or unmarried, in or out of school, living in the study area. Intervention activities are open to all adolescent boys and girls, regardless of their participation in surveys. We will collect data through baseline and endline surveys. Primary trial outcomes are school attendance, dietary diversity and internalising and externalising mental health problems. Secondary outcomes include access to school-related entitlements, emotional or physical violence, self-efficacy and resilience.

TRIAL REGISTRATION

ISRCTN17206016. Registered on 27 June 2018.

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

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.