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Impact of enhanced nutrition program on child growth and diet in India

The Indian Integrated Child Development Services (ICDS) provides supplemental food to children 6‐36 months. Evaluations have shown mixed effects on child nutrition. This study assessed the impact of program enhancements of local production of supplemental food, micronutrient supplementation, and improved program monitoring. Data came from 30 villages; half received the enhanced program. Multilevel linear regression was used to examine differences in changes in growth and nutrient intake between the enhanced and usual program groups. Children in enhanced program initially aged 12‐18 mo and 32‐36 mo gained, respectively 0.72 SD (p=0.02) and 0.63 unit SD (p=0.03) greater height‐for‐age. Similar results were observed for weight‐for‐age. Weight‐for‐height changes differed by almost 1 SD (p=0.01) among children who were initially 19‐25 mo. Significant differences were observed for energy intake among boys who were initially 12‐18 mo (137.45 kcal, p=0.03) with the enhanced program. A similar pattern was observed for protein and iron intake, but was explained by differences in energy intake. Older children benefited most from the enhanced program. Results from a parallel qualitative study support the plausibility of observed outcomes. The ICDS program would be more effective in improving child nutrition if it included these enhancements. Funded by UNICEF.