**2. Review of health management aspects of ICDS**

ICDS services are provided through a vast network of ICDS centres, better known as "Anganwadi". The term Anganwadi developed from the idea that a good early child care

Three Decades of the Integrated Child

were covered (Radhakrishna & Ravi. 2004).

Development Services Program in India: Progress and Problems 247

proportion of villages covered by ICDS activities in these region increased, on average from 28% to 43% between 1992 and 1998, compared with increases from 58% to 82% between 1992 and 1998 in the rich northern states of Gujarat, Haryana, Maharashtra and Punjab. The programme coverage is regressive relative to need, expenditure per child, and economic performance of the states. The states with the highest prevalence of stunted and underweight children, such as Bihar and Uttar Pradesh tend to have the lowest programme coverage. In 2001/2002, government expenditure per undernourished child in the 'rich' north states averaged 235 rupees, compared with 97 rupees in the 'poor' north states. Bihar (the poorest state) receives only Rs 25 per malnourished child, while Punjab (the richest state) receives Rs 334. Ironically, due to poor governance, Bihar spent only 76% of its ICDS allocation in 2003, compared with 98% of allocated ICDS funds spent by Punjab in the same year (Lokshin et al, 2005). The average resident in Bihar is at least four times poorer than the average person in Punjab. Bihar's government health expenditure per person in 2005 was 84 rupees, compared with 251 rupees in Punjab. Bihar's 2007 per capita income was 13663 rupees, compared with Punjab's 27,873 rupees (Berham & Ahuja, 2008). Based on wealth rankings, richer villages have a higher probability of being covered by the programme than poorer ones. For example, only half of the villages from the lowest two income deciles had the ICDS programme in place in 1998, while about 80 per cent of the richest villages in India

*Equity issues*: Program placement closely reflect equity issues, but extend to include analysis of persistent inequalities in maternal and child health outcomes based on income level., caste, gender or rural residence. A recent analysis of trends in infant undernutrition in India between 1992 and 2005 using the nationally representative family health survey (Subramanyam et al, 2010) revealed that the overall prevalence (%) of underweight was 49.14, 43.82 and 40.26 in 1992, 1998 and 2005 respectively. The corresponding prevalence (%) of stunting was 52.43, 50.65, and 44.73. Social disparities in undernutrition over these 14 years either widened or stayed the same. The absolute rates of undernutrition decreased for everyone regardless of their social status. The disparities by household wealth were greater than the disparities by maternal education. There were no disparities in undernutrition by caste, gender or rural residence. Maternal education is improving, with the female literacy parity index of youths increasing from 0.64 in 1991 to 0.81 in 2001, and projected to reach parity by 2015. The bulk of the increase was in the poor states. For example, in Bihar, the female literacy rate in 2001 was 34%, compared with male literacy rate of 60%. By providing bicycles for year 9 and 10 students, and providing school uniforms free of charge to women, Bihar increased its year 9 enrolment of girls in year 9 by 170,000 in 2007, compared with 2006 prior to the commencement of the scheme However, addressing income inequity, the most influential determinant of infant undernutrition in India, remains a major challenge. The proportion of people below the national poverty line estimated for 1990 was 37%. By the year 2004‐05, the poverty headcount ratio declined to 28%. The poorer and relatively populous states such as Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh had about 193.5 million of people below poverty line in 2004‐05 (64% of total people below poverty line) and are expected to have nearly 198 million people below poverty line in 2015 (71% of total people below poverty line (GI, 2010). Despite claims of rapid economic growth by Bihar and several other poor states, outmigration, poverty and inefficient health administration have not translated economic gains into significant improvements in maternal and child health. Public health facilities are typically allocated on the basis of population (Koenig *et al.,* 2000). However, the quality of services is likely to depend on the level of economic development in the region; owing to the difficulties of relocating skilled medical personnel in remote areas.

and development centre could be run with low cost local materials even when located in an 'Angan' or courtyard. The Anganwadi centre is operated by a modestly paid Anganwadi worker, assisted by an Anganwadi helper or *Sahayika*. The local Anganwadi is the cornerstone of the ICDS programme. The basic responsibility for implementing the programme rests with the State Government. The nodal department responsible for implementing ICDS at the state level is typically the Women and Child Development Department, or sometimes a related department (e.g. the Social Welfare Department). One Anganwadi worker is allotted to a population of 1000. However, this differs by state, with relatively affluent states having a better staff to child ratios. In order to provide supplementary nutrition, cooked food is provided to the children in the age group of 2-6 years, expectant and lactating mothers and adolescent girls. The Supplementary Nutrition Programme aims to provide up to 300 calories and 8-10 grams of protein to the children and 500 calories and 20-25 grams of protein to the lactating mothers, pregnant ladies and adolescent girls. Severely malnourished children are given double diet as compared to a normal child.

Of all childhood nutrition programmes in India, the ICDS is the only one with federal legislative backing. For example, in 2006, On 13 December 2006, India's Supreme Court stipulated that the Government of India shall sanction and operationalize a minimum of 14 lakh AWCs in a phased and even manner starting forthwith and ending December 2008. The ruling stated that, while maintaining the upper limit of one AWC per 1000 population, the minimum limit for opening of a new AWC is a population of 300 may be kept in view. All the State Governments and Union Territories were directed to fully implement the ICDS scheme by, inter-alia, allocating and spending at least Rs.2 per child per day for supplementary nutrition out of which the Central Government shall contribute Rs.1 per child per day; allocating and spending at least Rs.2.70 for every severely malnourished child per day for supplementary nutrition out of which the Central Government shall contribute Rs.1.35 per child per day; allocating and spending at least Rs.2.30 for every pregnant women, nursing mother/adolescent girl per day for supplementary nutrition out of which the Central Government shall contribute Rs.1.15. (Right to Food campaign, 2007) .

Tarozzi and Mahajan (2007) documented an increase in gender inequality in nutritional status in India over the 1990s, with the nutritional status of boys improving substantially more than that of girls. Gragnolati et. al (2005) attribute much of the child malnutrition in India to the high levels of exposure to infection and inappropriate infant and young child feeding and caring practices in the first two to three years of a child's life. A persistent decline in per capita calorie consumption in India over the last twenty years has been documented (Deaton and Dreze, 2008; Ray, 2007) The declining trend occurred across all income levels, and at a point when the nutritional measures for children are worsening.

*Program placement*: Coverage of ICDS is modest relative to need. In 2009, it benefitted 34 million children aged 0-6 years and 7 million pregnant and lactating mothers. Programme coverage is especially high in the southern region, the north-eastern region, and the nonpoor states of the northern region. Of the villages sampled by the NFHS, a third had an ICDS programme in place in 1992, and the figure had risen to more than half in 1998. The need for the ICDS program appears to be particularly high in the poor northern states of Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh, where the proportion of stunted and underweight children exceeded 50% in the 1992 and 1998 surveys. The

and development centre could be run with low cost local materials even when located in an 'Angan' or courtyard. The Anganwadi centre is operated by a modestly paid Anganwadi worker, assisted by an Anganwadi helper or *Sahayika*. The local Anganwadi is the cornerstone of the ICDS programme. The basic responsibility for implementing the programme rests with the State Government. The nodal department responsible for implementing ICDS at the state level is typically the Women and Child Development Department, or sometimes a related department (e.g. the Social Welfare Department). One Anganwadi worker is allotted to a population of 1000. However, this differs by state, with relatively affluent states having a better staff to child ratios. In order to provide supplementary nutrition, cooked food is provided to the children in the age group of 2-6 years, expectant and lactating mothers and adolescent girls. The Supplementary Nutrition Programme aims to provide up to 300 calories and 8-10 grams of protein to the children and 500 calories and 20-25 grams of protein to the lactating mothers, pregnant ladies and adolescent girls. Severely malnourished children are given double diet as compared to a normal child. Immunization services are provided to all children below six years of age, who are immunized against tuberculosis, diphtheria, whooping cough, tetanus, polio and

Of all childhood nutrition programmes in India, the ICDS is the only one with federal legislative backing. For example, in 2006, On 13 December 2006, India's Supreme Court stipulated that the Government of India shall sanction and operationalize a minimum of 14 lakh AWCs in a phased and even manner starting forthwith and ending December 2008. The ruling stated that, while maintaining the upper limit of one AWC per 1000 population, the minimum limit for opening of a new AWC is a population of 300 may be kept in view. All the State Governments and Union Territories were directed to fully implement the ICDS scheme by, inter-alia, allocating and spending at least Rs.2 per child per day for supplementary nutrition out of which the Central Government shall contribute Rs.1 per child per day; allocating and spending at least Rs.2.70 for every severely malnourished child per day for supplementary nutrition out of which the Central Government shall contribute Rs.1.35 per child per day; allocating and spending at least Rs.2.30 for every pregnant women, nursing mother/adolescent girl per day for supplementary nutrition out of which

the Central Government shall contribute Rs.1.15. (Right to Food campaign, 2007) .

Tarozzi and Mahajan (2007) documented an increase in gender inequality in nutritional status in India over the 1990s, with the nutritional status of boys improving substantially more than that of girls. Gragnolati et. al (2005) attribute much of the child malnutrition in India to the high levels of exposure to infection and inappropriate infant and young child feeding and caring practices in the first two to three years of a child's life. A persistent decline in per capita calorie consumption in India over the last twenty years has been documented (Deaton and Dreze, 2008; Ray, 2007) The declining trend occurred across all income levels, and at a point when the nutritional measures for children are worsening. *Program placement*: Coverage of ICDS is modest relative to need. In 2009, it benefitted 34 million children aged 0-6 years and 7 million pregnant and lactating mothers. Programme coverage is especially high in the southern region, the north-eastern region, and the nonpoor states of the northern region. Of the villages sampled by the NFHS, a third had an ICDS programme in place in 1992, and the figure had risen to more than half in 1998. The need for the ICDS program appears to be particularly high in the poor northern states of Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh, where the proportion of stunted and underweight children exceeded 50% in the 1992 and 1998 surveys. The

measles.

proportion of villages covered by ICDS activities in these region increased, on average from 28% to 43% between 1992 and 1998, compared with increases from 58% to 82% between 1992 and 1998 in the rich northern states of Gujarat, Haryana, Maharashtra and Punjab. The programme coverage is regressive relative to need, expenditure per child, and economic performance of the states. The states with the highest prevalence of stunted and underweight children, such as Bihar and Uttar Pradesh tend to have the lowest programme coverage. In 2001/2002, government expenditure per undernourished child in the 'rich' north states averaged 235 rupees, compared with 97 rupees in the 'poor' north states. Bihar (the poorest state) receives only Rs 25 per malnourished child, while Punjab (the richest state) receives Rs 334. Ironically, due to poor governance, Bihar spent only 76% of its ICDS allocation in 2003, compared with 98% of allocated ICDS funds spent by Punjab in the same year (Lokshin et al, 2005). The average resident in Bihar is at least four times poorer than the average person in Punjab. Bihar's government health expenditure per person in 2005 was 84 rupees, compared with 251 rupees in Punjab. Bihar's 2007 per capita income was 13663 rupees, compared with Punjab's 27,873 rupees (Berham & Ahuja, 2008). Based on wealth rankings, richer villages have a higher probability of being covered by the programme than poorer ones. For example, only half of the villages from the lowest two income deciles had the ICDS programme in place in 1998, while about 80 per cent of the richest villages in India were covered (Radhakrishna & Ravi. 2004).

*Equity issues*: Program placement closely reflect equity issues, but extend to include analysis of persistent inequalities in maternal and child health outcomes based on income level., caste, gender or rural residence. A recent analysis of trends in infant undernutrition in India between 1992 and 2005 using the nationally representative family health survey (Subramanyam et al, 2010) revealed that the overall prevalence (%) of underweight was 49.14, 43.82 and 40.26 in 1992, 1998 and 2005 respectively. The corresponding prevalence (%) of stunting was 52.43, 50.65, and 44.73. Social disparities in undernutrition over these 14 years either widened or stayed the same. The absolute rates of undernutrition decreased for everyone regardless of their social status. The disparities by household wealth were greater than the disparities by maternal education. There were no disparities in undernutrition by caste, gender or rural residence. Maternal education is improving, with the female literacy parity index of youths increasing from 0.64 in 1991 to 0.81 in 2001, and projected to reach parity by 2015. The bulk of the increase was in the poor states. For example, in Bihar, the female literacy rate in 2001 was 34%, compared with male literacy rate of 60%. By providing bicycles for year 9 and 10 students, and providing school uniforms free of charge to women, Bihar increased its year 9 enrolment of girls in year 9 by 170,000 in 2007, compared with 2006 prior to the commencement of the scheme However, addressing income inequity, the most influential determinant of infant undernutrition in India, remains a major challenge. The proportion of people below the national poverty line estimated for 1990 was 37%. By the year 2004‐05, the poverty headcount ratio declined to 28%. The poorer and relatively populous states such as Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh had about 193.5 million of people below poverty line in 2004‐05 (64% of total people below poverty line) and are expected to have nearly 198 million people below poverty line in 2015 (71% of total people below poverty line (GI, 2010). Despite claims of rapid economic growth by Bihar and several other poor states, outmigration, poverty and inefficient health administration have not translated economic gains into significant improvements in maternal and child health. Public health facilities are typically allocated on the basis of population (Koenig *et al.,* 2000). However, the quality of services is likely to depend on the level of economic development in

Three Decades of the Integrated Child

Development Services Program in India: Progress and Problems 249

increased for Anganwadi workers to Rs 1500 (\$US36) per month and helpers to Rs 750 (\$US18) per month. In the public sector, the national minimum wage since 2009 is Rs 100 per day. On 4 May 2010, hundreds of Anganwadi workers from various parts of India staged a protest march in New Delhi demanding higher wages, job security and status of government servants with privileges of pension and allied retirement benefits. The wide inequity in remuneration between Anganwadi workers and the least paid Indian government employees is a major demotivating factor for the core human resource sector of the ICDS programme. There are also wide regional differences in salaries paid to Anganwadi, and this is a major source of perceived unfairness and demotivation for relatively lower paid staff. For example, in Puducherry, Anganwadi workers are paid Rs 12,000 per month workers and Anganwadi helpers paid Rs 6,000 monthly, compared with Rs 2000 monthly for Anganwadi workers and Rs 1200 monthly for helpers in Kamataka. Such perceived unfairness, coupled with other workforce-related encumbrances affecting Anganwadis, contribute to sub-optimal performance of this cadre of workers (Figure 1).

Fig. 1. Factors influencing health workers performance (Source; http://www.biomedcentral.com/content/pdf/1472-6963-11-34.pdf)

There are wide variations in the competence of Anganwadi workers, with some workers, particularly in the wealthier states having tertiary educational qualifications. It is in the most vulnerable states such as Bihar that qualified Anganwadi workers are in short supply. The distribution of Anganwadi workers is not fluid – being almost exclusively women, Anganwadi staff generally work in their areas of residence. Cultural encumbrances as well as lack of formal recognition of this cadre of workers are additional disincentives for mobility to underserved areas. Thus, areas with low female literacy are unlikely to have qualified Anganwadi workers. Such health workforce shortages explain why the ICDS

In India, the Panchayati Raj Act has placed emphasis on building local government, and devolving health activities to them.

However, a rapid rise in private providers of healthcare, with a subsequent increase in its utilisation can in turn influence the quality of care in public facilities (Peters *et al.,* 2002). According to Bhargava *et al.* (2005) the healthcare infrastructure in India has evolved gradually over time and comprises of public facilities, private providers and NGO's. Initially, healthcare was available mainly in urban areas via government facilities and from private practitioners offering services to those who can afford them. Urban settings are considered to be more attractive to medical personnel, thereby restricting the pool of medical practitioners prepared to work in rural areas. This increase in supply of urban doctors has improved the quality of medical services in urban areas.

Government health expenditure in India is relatively low compared to other countries in the region and has actually declined over the last two decades. According to Bhalotra (2007), while government health expenditure constituted 1.3% of the GDP in 1990, this had declined to 0.9% in 1999. Relative to other countries in the region, India devotes a smaller share of its income to health spending than, for example, Bangladesh (1.4%) or Sri Lanka (1.8%) (Deolalikar 2005), and it spends a disproportionate part of its health budget on (curative) hospital services which are less pro-poor than (preventive) public health expenditures (Peters *et al.* 2002).

Jalan and Ravallion (2003) found a significantly lower prevalence and duration of diarrhoea among children living in households with piped water. Health gains from piped-water tend to be lower for children with less well-educated women in the household. It is possible that education is acting as a proxy for knowledge about how to assure that water is safe to drink and how best to treat illness. The income effect on the child-health benefits from piped water is also found at given levels of education, though it is not as pronounced. This is consistent with a previous study by Rajna et al (1998) which used data from the 1992-1993 National Family and Health Survey in India to show that improvements in health services, maternal education and provision of safe drinking water have had a desirable impact on child survival in Uttar Pradesh.

*Health workforce*: The World Health Report 2008 and the 62nd World Health Assembly resolution strongly reaffirmed the principles of primary health care. These principles include equity, solidarity, social justice, universal access to services, multi-sectoral action, decentralization and community participation as the basis for strengthening health systems and optimising the quality of health services (WHO, 2008). Member states were urged to train and retain adequate numbers and mix of health workers able to work in a multidisciplinary context (GO, 2006). The ICDS was conceptualised as a primary health care initiative, but not enough has been done so far to develop and retain adequate health workforce in terms of quantity, quality and distribution. There are around 1.5 million women workers engaged in the Anganwadi projects across India. Although each ICDS is staffed by several Anganwadi and community health officers (most of whom are Anganwadi with several years' experience), and headed by a maternal and Child Development Officer, the front-line staff is the Anganwadi, local women proposed by an ICDS village and trained in health and nutrition for at least three months. The Anganwadi workers are not normally gazetted as government workers, but are rather paid as casual staff. Anganwadi workers are expected to have completed high school. Those with less than high school education are employed as Anganwadi helpers. In announcing the 2008-2009 Budget, Indian Finance Minister Chidambaram stated that minimum salaries would be

In India, the Panchayati Raj Act has placed emphasis on building local government, and

However, a rapid rise in private providers of healthcare, with a subsequent increase in its utilisation can in turn influence the quality of care in public facilities (Peters *et al.,* 2002). According to Bhargava *et al.* (2005) the healthcare infrastructure in India has evolved gradually over time and comprises of public facilities, private providers and NGO's. Initially, healthcare was available mainly in urban areas via government facilities and from private practitioners offering services to those who can afford them. Urban settings are considered to be more attractive to medical personnel, thereby restricting the pool of medical practitioners prepared to work in rural areas. This increase in supply of urban

Government health expenditure in India is relatively low compared to other countries in the region and has actually declined over the last two decades. According to Bhalotra (2007), while government health expenditure constituted 1.3% of the GDP in 1990, this had declined to 0.9% in 1999. Relative to other countries in the region, India devotes a smaller share of its income to health spending than, for example, Bangladesh (1.4%) or Sri Lanka (1.8%) (Deolalikar 2005), and it spends a disproportionate part of its health budget on (curative) hospital services which are less pro-poor than (preventive) public health expenditures

Jalan and Ravallion (2003) found a significantly lower prevalence and duration of diarrhoea among children living in households with piped water. Health gains from piped-water tend to be lower for children with less well-educated women in the household. It is possible that education is acting as a proxy for knowledge about how to assure that water is safe to drink and how best to treat illness. The income effect on the child-health benefits from piped water is also found at given levels of education, though it is not as pronounced. This is consistent with a previous study by Rajna et al (1998) which used data from the 1992-1993 National Family and Health Survey in India to show that improvements in health services, maternal education and provision of safe drinking water have had a desirable impact on

*Health workforce*: The World Health Report 2008 and the 62nd World Health Assembly resolution strongly reaffirmed the principles of primary health care. These principles include equity, solidarity, social justice, universal access to services, multi-sectoral action, decentralization and community participation as the basis for strengthening health systems and optimising the quality of health services (WHO, 2008). Member states were urged to train and retain adequate numbers and mix of health workers able to work in a multidisciplinary context (GO, 2006). The ICDS was conceptualised as a primary health care initiative, but not enough has been done so far to develop and retain adequate health workforce in terms of quantity, quality and distribution. There are around 1.5 million women workers engaged in the Anganwadi projects across India. Although each ICDS is staffed by several Anganwadi and community health officers (most of whom are Anganwadi with several years' experience), and headed by a maternal and Child Development Officer, the front-line staff is the Anganwadi, local women proposed by an ICDS village and trained in health and nutrition for at least three months. The Anganwadi workers are not normally gazetted as government workers, but are rather paid as casual staff. Anganwadi workers are expected to have completed high school. Those with less than high school education are employed as Anganwadi helpers. In announcing the 2008-2009 Budget, Indian Finance Minister Chidambaram stated that minimum salaries would be

doctors has improved the quality of medical services in urban areas.

devolving health activities to them.

(Peters *et al.* 2002).

child survival in Uttar Pradesh.

increased for Anganwadi workers to Rs 1500 (\$US36) per month and helpers to Rs 750 (\$US18) per month. In the public sector, the national minimum wage since 2009 is Rs 100 per day. On 4 May 2010, hundreds of Anganwadi workers from various parts of India staged a protest march in New Delhi demanding higher wages, job security and status of government servants with privileges of pension and allied retirement benefits. The wide inequity in remuneration between Anganwadi workers and the least paid Indian government employees is a major demotivating factor for the core human resource sector of the ICDS programme. There are also wide regional differences in salaries paid to Anganwadi, and this is a major source of perceived unfairness and demotivation for relatively lower paid staff. For example, in Puducherry, Anganwadi workers are paid Rs 12,000 per month workers and Anganwadi helpers paid Rs 6,000 monthly, compared with Rs 2000 monthly for Anganwadi workers and Rs 1200 monthly for helpers in Kamataka. Such perceived unfairness, coupled with other workforce-related encumbrances affecting Anganwadis, contribute to sub-optimal performance of this cadre of workers (Figure 1).

Fig. 1. Factors influencing health workers performance (Source; http://www.biomedcentral.com/content/pdf/1472-6963-11-34.pdf)

There are wide variations in the competence of Anganwadi workers, with some workers, particularly in the wealthier states having tertiary educational qualifications. It is in the most vulnerable states such as Bihar that qualified Anganwadi workers are in short supply. The distribution of Anganwadi workers is not fluid – being almost exclusively women, Anganwadi staff generally work in their areas of residence. Cultural encumbrances as well as lack of formal recognition of this cadre of workers are additional disincentives for mobility to underserved areas. Thus, areas with low female literacy are unlikely to have qualified Anganwadi workers. Such health workforce shortages explain why the ICDS

Three Decades of the Integrated Child

infection (Kameswararao, 2004).

Development Services Program in India: Progress and Problems 251

health spending actually fell from 1.12% in 1999 to 0.97% in 2005 (Berman & Ahuja, 2008). In terms of fulfilment of public health functions, a 2004 World bank evaluation found that although India's public health system has the capacity to carry out its public health functions, the system has major weaknesses in relation to persistently overlooking fundamental public health functions such as public health regulations and their enforcement; "deep management flaws", which hinder effective use of resources, including inadequate focus on evaluation; on assessing quality of services; on dissemination and use of information; and on openness to learning and innovation; "the central government functions too much in isolation and needs to work much more closely with other key actors, especially with sub-national governments, as well as with the private sector and with communities." (Das Gupta et al, 2004). Given inadequate funding and flawed management of the public health system, the platform on which the ICDS relies is weak. India's weak public health system partly explains the insignificant impact of the program on maternal and child health outcomes. Child malnutrition is mostly the result of high levels of exposure to infection and inappropriate infant and young child feeding and caring practices, and has its origins almost entirely during the first two to three years of life. The ICDS program, while successful in many ways, has not made a significant dent in child malnutrition. This is mostly due to the priority that the program has placed on food supplementation, targeting mostly children after the age of three when malnutrition has already set in. Compared to 1990, 10,000 fewer children in India died daily before reaching their fifth birthday in 2009. However, India still accounted for 21% of global under-five mortality in 2009. The infant mortality rate declined 40%, from 83.8% in 1990 to 50.3% in 2009, while the under-five mortality rate declined 45%, from 118 in 1990 to 65.6 in 2009 (UN, 2010). The slower decline in infant mortality rate reflects, in part the inappropriate strategy of the ICDS in focussing food supplementation on children aged 37 to 59 months, with less attention paid to encouraging breast feeding and providing adequate supplementary feeding to infants. *Maternal feeding and caring behaviour*: Maternal feeding and caring behaviour is mediated by sociocultural environments of households, including the impact of religion and parental education and wealth status. A 2005 study of 408 children aged 1 – 3 years enrolled in an ICDS program in north India found that 199 (48.7%) children were underweight and 79.2% of children had dietary calories intake below 80% of recommended dietary intake. Advice regarding breast feeding and/or complementary feeding was given by Anganwadi workers to only 179 (43.8%) women (Prinja et al, 2008). The ICDS program has not achieved any major success in improving behavioural outcomes such as timely initiation of breast feeding (16.7%) and complementary feeding (39.9%). Prevalence of exclusive breast feeding has remained low at 28.2%. Although other factors including socio-economic conditions, sociocultural beliefs and literacy status determine child feeding practices, the low proportion of women who reported to have been advised by the Anganwadi worker regarding breast feeding and complementary feeding reflects the deficiency of the program (Prinja et al, 2008). The percentage of pregnant women who had at least three antenatal care visits in 2008 was 51%, and only 47% of deliveries were attended by skilled birth attendants. Antenatal care attendance is a strong predictor of maternal caring behaviour (Halim et al, 2010). An important gap in maternal feeding practices is exclusive breastfeeding for the first four months of infancy. A 2003 study in urban and rural areas of Latur and Osmanabad districts of Maharashtra State revealed that exclusive breastfeeding for the first four months was undertaken by 40% of mothers. Such inadequacies predispose infants to malnutrition and

program may paradoxically result in negative maternal and child health outcomes in poorer and remote regions of India where female education is low. Consequently, many centres, particularly in the poorer states such as Orissa are staffed by Anganwadi helpers, and these staff lack the necessary qualifications for the level of in-service training they are regularly invited to attend (GO, 2006; Udani et al, 1990). It is unrealistic to expect a high school graduate with three months training to adequately perform some of the tasks entrusted to Anganwadi workers, such as pre-school and health education, maintenance of records of births and deaths, administration of pulse-polio drops, and provision of supplementary nutrition to pregnant and lactating mothers and children up to the age of six. Access to Anganwadi training is inequitable. As at January 2008, Andhra Pradesh, whose maternal and child health indicators are higher than the national average, had 66 accredited Anganwadi training centres, while Bihar had none and Sikkim had only one, despite these two states having high levels of infant malnutrition and inferior maternal health outcomes compared with national average. In relation to food provision, for example, many states provide pre-packaged food which the Anganwadi workers describe as unpalatable to enrolled children. As a result, some Anganwadi workers have had buy food for severely malnourished children from their paltry salaries – a source of significant job dissatisfaction. Since 2009, Anganwadi workers and helpers have been advocating that the food preparation and supply must be localised and the responsibility for food procurement and preparation must be given to women's organisation instead of contractors, as is the case in Kerala and Tamil Nadu (Radhakrishna & Ravi, 2004).

*Strategic approach to addressing undernutrition*: A 2008 study of reasons for poor performance of health workers entailed interviews of Anganwadi and mothers in rural Wardha, Sewagram. Mothers of children enrolled in ICDS programs in this region lamented the poor quality of supplementary food. They reported that *Khichari*, a preparation of rice and dal (pulses), a common supplementary food, contained very little oil and dal component.  Although, there was variety in the supplementary food available, such as use of sprouted grains and green peas, they were less frequently prepared. Anganwadi, on their part listed the 12 most common reasons for the limited success of ICDS: 1) poor cooperation from villagers; 2) poor understanding of parents; 3) mothers do not follow medical advice; 4) mothers are busy with farm work; 5) Irregular and poor health check-up service; 6) mothers do not follow dietary advices; 7) poor personal hygiene of families; 8) poverty; 9) poor environmental sanitation; 10) poor child care practices; 11) poor support from authorities, and 12) various social problems. This survey also revealed that most of the workload of Anganwadi workers is taken up in paperwork and attendance at workshops, which significantly reduce the time devoted to their core ICDS duties (Dongre et al, 2008). Although the ICDS is the most well-known of India's national dedicated maternal and child health nutrition and education program, there are at least two other national and 10 regional nutrition and education programs in India, including National Mid-day Meal Scheme, the National Rural Health Mission, Comprehensive Rural Health Project, Integrated Nutrition and Health Program and the Public Distribution System. These programs appear to compete rather than collaborate with one another in the achievement of optimal maternal and child health outcomes (Tarozzi, 2002; Mann et al, 2010). India's public health system, on which all maternal and child health programs rely is poorly funded and poorly functioning. From an expenditure perspective, government spending on health per capita increased from Rs 202 to Rs 257 between 2000 and 2005. Adjusting for inflation, this increase is modest – Rs 215 in 2005. However, as percentage of GDP, India's government

program may paradoxically result in negative maternal and child health outcomes in poorer and remote regions of India where female education is low. Consequently, many centres, particularly in the poorer states such as Orissa are staffed by Anganwadi helpers, and these staff lack the necessary qualifications for the level of in-service training they are regularly invited to attend (GO, 2006; Udani et al, 1990). It is unrealistic to expect a high school graduate with three months training to adequately perform some of the tasks entrusted to Anganwadi workers, such as pre-school and health education, maintenance of records of births and deaths, administration of pulse-polio drops, and provision of supplementary nutrition to pregnant and lactating mothers and children up to the age of six. Access to Anganwadi training is inequitable. As at January 2008, Andhra Pradesh, whose maternal and child health indicators are higher than the national average, had 66 accredited Anganwadi training centres, while Bihar had none and Sikkim had only one, despite these two states having high levels of infant malnutrition and inferior maternal health outcomes compared with national average. In relation to food provision, for example, many states provide pre-packaged food which the Anganwadi workers describe as unpalatable to enrolled children. As a result, some Anganwadi workers have had buy food for severely malnourished children from their paltry salaries – a source of significant job dissatisfaction. Since 2009, Anganwadi workers and helpers have been advocating that the food preparation and supply must be localised and the responsibility for food procurement and preparation must be given to women's organisation instead of contractors, as is the case in Kerala and

*Strategic approach to addressing undernutrition*: A 2008 study of reasons for poor performance of health workers entailed interviews of Anganwadi and mothers in rural Wardha, Sewagram. Mothers of children enrolled in ICDS programs in this region lamented the poor quality of supplementary food. They reported that *Khichari*, a preparation of rice and dal (pulses), a common supplementary food, contained very little oil and dal component.  Although, there was variety in the supplementary food available, such as use of sprouted grains and green peas, they were less frequently prepared. Anganwadi, on their part listed the 12 most common reasons for the limited success of ICDS: 1) poor cooperation from villagers; 2) poor understanding of parents; 3) mothers do not follow medical advice; 4) mothers are busy with farm work; 5) Irregular and poor health check-up service; 6) mothers do not follow dietary advices; 7) poor personal hygiene of families; 8) poverty; 9) poor environmental sanitation; 10) poor child care practices; 11) poor support from authorities, and 12) various social problems. This survey also revealed that most of the workload of Anganwadi workers is taken up in paperwork and attendance at workshops, which significantly reduce the time devoted to their core ICDS duties (Dongre et al, 2008). Although the ICDS is the most well-known of India's national dedicated maternal and child health nutrition and education program, there are at least two other national and 10 regional nutrition and education programs in India, including National Mid-day Meal Scheme, the National Rural Health Mission, Comprehensive Rural Health Project, Integrated Nutrition and Health Program and the Public Distribution System. These programs appear to compete rather than collaborate with one another in the achievement of optimal maternal and child health outcomes (Tarozzi, 2002; Mann et al, 2010). India's public health system, on which all maternal and child health programs rely is poorly funded and poorly functioning. From an expenditure perspective, government spending on health per capita increased from Rs 202 to Rs 257 between 2000 and 2005. Adjusting for inflation, this increase is modest – Rs 215 in 2005. However, as percentage of GDP, India's government

Tamil Nadu (Radhakrishna & Ravi, 2004).

health spending actually fell from 1.12% in 1999 to 0.97% in 2005 (Berman & Ahuja, 2008). In terms of fulfilment of public health functions, a 2004 World bank evaluation found that although India's public health system has the capacity to carry out its public health functions, the system has major weaknesses in relation to persistently overlooking fundamental public health functions such as public health regulations and their enforcement; "deep management flaws", which hinder effective use of resources, including inadequate focus on evaluation; on assessing quality of services; on dissemination and use of information; and on openness to learning and innovation; "the central government functions too much in isolation and needs to work much more closely with other key actors, especially with sub-national governments, as well as with the private sector and with communities." (Das Gupta et al, 2004). Given inadequate funding and flawed management of the public health system, the platform on which the ICDS relies is weak. India's weak public health system partly explains the insignificant impact of the program on maternal and child health outcomes. Child malnutrition is mostly the result of high levels of exposure to infection and inappropriate infant and young child feeding and caring practices, and has its origins almost entirely during the first two to three years of life. The ICDS program, while successful in many ways, has not made a significant dent in child malnutrition. This is mostly due to the priority that the program has placed on food supplementation, targeting mostly children after the age of three when malnutrition has already set in. Compared to 1990, 10,000 fewer children in India died daily before reaching their fifth birthday in 2009. However, India still accounted for 21% of global under-five mortality in 2009. The infant mortality rate declined 40%, from 83.8% in 1990 to 50.3% in 2009, while the under-five mortality rate declined 45%, from 118 in 1990 to 65.6 in 2009 (UN, 2010). The slower decline in infant mortality rate reflects, in part the inappropriate strategy of the ICDS in focussing food supplementation on children aged 37 to 59 months, with less attention paid to encouraging breast feeding and providing adequate supplementary feeding to infants. *Maternal feeding and caring behaviour*: Maternal feeding and caring behaviour is mediated by

sociocultural environments of households, including the impact of religion and parental education and wealth status. A 2005 study of 408 children aged 1 – 3 years enrolled in an ICDS program in north India found that 199 (48.7%) children were underweight and 79.2% of children had dietary calories intake below 80% of recommended dietary intake. Advice regarding breast feeding and/or complementary feeding was given by Anganwadi workers to only 179 (43.8%) women (Prinja et al, 2008). The ICDS program has not achieved any major success in improving behavioural outcomes such as timely initiation of breast feeding (16.7%) and complementary feeding (39.9%). Prevalence of exclusive breast feeding has remained low at 28.2%. Although other factors including socio-economic conditions, sociocultural beliefs and literacy status determine child feeding practices, the low proportion of women who reported to have been advised by the Anganwadi worker regarding breast feeding and complementary feeding reflects the deficiency of the program (Prinja et al, 2008). The percentage of pregnant women who had at least three antenatal care visits in 2008 was 51%, and only 47% of deliveries were attended by skilled birth attendants. Antenatal care attendance is a strong predictor of maternal caring behaviour (Halim et al, 2010). An important gap in maternal feeding practices is exclusive breastfeeding for the first four months of infancy. A 2003 study in urban and rural areas of Latur and Osmanabad districts of Maharashtra State revealed that exclusive breastfeeding for the first four months was undertaken by 40% of mothers. Such inadequacies predispose infants to malnutrition and infection (Kameswararao, 2004).

Three Decades of the Integrated Child

(Vijayaraghavan et al, 1984)

Development Services Program in India: Progress and Problems 253

was of the order of 20%. To test whether large doses of vitamin A supplements prevented keratomalacia, a case-control analysis was done, with patients with severe protein-energy malnutrition being used as controls. The high odds ratio clearly indicated that keratomalacia was more likely to occur in children not receiving supplements

Fig. 2. Global Vitamin A deficiency prevalence (Source: WHO, 2009b).

*ICDS infrastructure:* The infrastructure for ICDS clinics is sub-optimal to facilitate achievement of its objectives. Although total budgetary allocation for the ICDS scheme increased from Rs. 529300.00 Lakh in 2007/2008 to Rs. 670500.00 Lakh in 2009/2010, this budget translates to less than 2 rupees per enrolled child and mother per day, and there is very little to show for such funding increases in the area of infrastructure. For example, a report of unannounced visits by the Karnataka State Commission for Protection of Child Rights to ICDS centres in 13 districts between July 2009 and July 2010 revealed cramped Anganwadi centres with no toilets for children, stale bread passed on as 'hot meals', drab walls without any charts as characteristic findings. Commission chairperson Nina Naik stated that there is an urgent need for "revisiting and redesigning the current ICDS programme in the interest of children". Low attendance was also found to be rampant, with just 20-25% of the enrolled children in the 3-6 year bracket going to ICDS centres. "Community seemed to have no confidence in the service and retain children at home or admit the 5-6 year olds into private pre-school services," observed the report. Similarly, a 2009 study of 65 ICDS centres in 10 districts of Madhya Pradesh found that, of the 65 centres studied only 24 (37%) have suitable buildings. Only 72% of the studied centres had their own Salter children weighing machine, only 66% of the centres had adult weighing machines, and only 58% had growth registers (Samvad, 2009). A major contributor to poor ICDS infrastructure is corruption. For example, a recent Times of India report stated that, in the state of Assam, although the government allots Rs 175000 for each ICDS building, the

state spends only Rs 30,000 in each of the buildings in reality (Times of India, 2011).

*Micronutrient deficiencies – Iron and vitamin A*: According to the World Health Organization's 2009 Global health risks' report (WHO, 2009), iron deficiency anaemia accounted for 400,000 deaths and 1.5% of the global Disability Adjusted Life Years in 2004. This cost is disproportional borne by developing nations as 60% of the morbidity and 95% of the mortality related to iron deficiency are derived from the poorest nations of the world. Despite increased national and international awareness and recent governmental intervention programs, the prevalence of anaemia among Indian women has remained higher than 45% since 1990, and anaemia trends remain strongly correlated with iron deficiency. A 2007 Indian government "12 by 12 initiative", aimed at ensuring that all Indian adolescents have 12g/dL haemoglobin by 2012, listed the main causes of anaemia in India as low dietary intake, poor availability of iron, chronic blood loss due to hookworm infestation, and malaria (MOHFW, 2006). Although serum iron monitoring is not a major duty of Anganwadi workers, they can contribute to screening for iron deficiency indirectly through growth monitoring, which is a core duty. Unfortunately, it has been been reduced to routine of weight recording, with less than 3% of mothers in one ICDS-related study having knowledge of nutritional status of their child in terms of the growth chart (Prinja et al, 2008). Despite mothers stating that lack of nutritious food is the prime reason for their infants' undernutrition, the food provided by many Anganwadi centres is not palatable and most enrolled pupils do not eat adequately. In India as at 2008, 60.8 million children are chronically undernourished, representing 48% of all undernourished children aged less than 5 years globally. Almost all these undernourished children suffer from iron deficiency anaemia (Pada, 2010). In India, anaemia is the second most common cause of maternal death, accounting for 20% of total maternal deaths. Multiple studies show that at least 45% of all Indian women are anaemic, based on WHO criteria. Most anaemic mothers are malnourished, and are more likely to deliver malnourished babies (WHO, 2008). The main underlying cause of vitamin A deficiency as a public health problem is a diet that is chronically insufficient in vitamin A that can lead to lower body stores and fail to meet physiologic needs (e.g. support tissue growth, normal metabolism, resistance to infection). Deficiency of sufficient duration or severity can lead to disorders such as xerophthalmia (xeros = dryness; -ophthalmia = pertaining to the eye), the leading cause of preventable childhood blindness, anaemia, and weakened host resistance to infection, which can increase the severity of infectious diseases such as measles and risk of death. Good plant sources of vitamin A include spinach, carrots and oranges. Based on biochemical measurement, vitamin A deficiency is a public health problem in India, with over 5% of children affected [Figure 2] (WHO, 2009b). Although biochemical retinol measurements are not part of Anganwadi workers duties, they could be easily trained in detecting vitamin A deficiency using characteristic eye signs of vitamin A deficiency, such as bitot spots - superficial, irregularly-shaped, foamy grey or white patches that appear on the conjunctiva, the membrane that covers most of the eyeball. More importantly, the foodstuffs supplied at ICDS centres need to be prepared such that they are nutritious, balanced and palatable. Given the high incidence of nutritional blindness in India, provision vitamin A supplements may be included in the duties of Anganwadi staff. In a longitudinal study designed to assess the impact of a massive-dose vitamin A programme on the incidence of keratomalacia, 50 000 preschool children in 450 slum areas in India's Hyderabad city were given 200 000 IU of vitamin A once every 6 months. During the study period, the incidence of keratomalacia in areas covered by the programme decreased by about 80%, while in control areas the reduction

*Micronutrient deficiencies – Iron and vitamin A*: According to the World Health Organization's 2009 Global health risks' report (WHO, 2009), iron deficiency anaemia accounted for 400,000 deaths and 1.5% of the global Disability Adjusted Life Years in 2004. This cost is disproportional borne by developing nations as 60% of the morbidity and 95% of the mortality related to iron deficiency are derived from the poorest nations of the world. Despite increased national and international awareness and recent governmental intervention programs, the prevalence of anaemia among Indian women has remained higher than 45% since 1990, and anaemia trends remain strongly correlated with iron deficiency. A 2007 Indian government "12 by 12 initiative", aimed at ensuring that all Indian adolescents have 12g/dL haemoglobin by 2012, listed the main causes of anaemia in India as low dietary intake, poor availability of iron, chronic blood loss due to hookworm infestation, and malaria (MOHFW, 2006). Although serum iron monitoring is not a major duty of Anganwadi workers, they can contribute to screening for iron deficiency indirectly through growth monitoring, which is a core duty. Unfortunately, it has been been reduced to routine of weight recording, with less than 3% of mothers in one ICDS-related study having knowledge of nutritional status of their child in terms of the growth chart (Prinja et al, 2008). Despite mothers stating that lack of nutritious food is the prime reason for their infants' undernutrition, the food provided by many Anganwadi centres is not palatable and most enrolled pupils do not eat adequately. In India as at 2008, 60.8 million children are chronically undernourished, representing 48% of all undernourished children aged less than 5 years globally. Almost all these undernourished children suffer from iron deficiency anaemia (Pada, 2010). In India, anaemia is the second most common cause of maternal death, accounting for 20% of total maternal deaths. Multiple studies show that at least 45% of all Indian women are anaemic, based on WHO criteria. Most anaemic mothers are malnourished, and are more likely to deliver malnourished babies (WHO, 2008). The main underlying cause of vitamin A deficiency as a public health problem is a diet that is chronically insufficient in vitamin A that can lead to lower body stores and fail to meet physiologic needs (e.g. support tissue growth, normal metabolism, resistance to infection). Deficiency of sufficient duration or severity can lead to disorders such as xerophthalmia (xeros = dryness; -ophthalmia = pertaining to the eye), the leading cause of preventable childhood blindness, anaemia, and weakened host resistance to infection, which can increase the severity of infectious diseases such as measles and risk of death. Good plant sources of vitamin A include spinach, carrots and oranges. Based on biochemical measurement, vitamin A deficiency is a public health problem in India, with over 5% of children affected [Figure 2] (WHO, 2009b). Although biochemical retinol measurements are not part of Anganwadi workers duties, they could be easily trained in detecting vitamin A deficiency using characteristic eye signs of vitamin A deficiency, such as bitot spots - superficial, irregularly-shaped, foamy grey or white patches that appear on the conjunctiva, the membrane that covers most of the eyeball. More importantly, the foodstuffs supplied at ICDS centres need to be prepared such that they are nutritious, balanced and palatable. Given the high incidence of nutritional blindness in India, provision vitamin A supplements may be included in the duties of Anganwadi staff. In a longitudinal study designed to assess the impact of a massive-dose vitamin A programme on the incidence of keratomalacia, 50 000 preschool children in 450 slum areas in India's Hyderabad city were given 200 000 IU of vitamin A once every 6 months. During the study period, the incidence of keratomalacia in areas covered by the programme decreased by about 80%, while in control areas the reduction was of the order of 20%. To test whether large doses of vitamin A supplements prevented keratomalacia, a case-control analysis was done, with patients with severe protein-energy malnutrition being used as controls. The high odds ratio clearly indicated that keratomalacia was more likely to occur in children not receiving supplements (Vijayaraghavan et al, 1984)

Fig. 2. Global Vitamin A deficiency prevalence (Source: WHO, 2009b).

*ICDS infrastructure:* The infrastructure for ICDS clinics is sub-optimal to facilitate achievement of its objectives. Although total budgetary allocation for the ICDS scheme increased from Rs. 529300.00 Lakh in 2007/2008 to Rs. 670500.00 Lakh in 2009/2010, this budget translates to less than 2 rupees per enrolled child and mother per day, and there is very little to show for such funding increases in the area of infrastructure. For example, a report of unannounced visits by the Karnataka State Commission for Protection of Child Rights to ICDS centres in 13 districts between July 2009 and July 2010 revealed cramped Anganwadi centres with no toilets for children, stale bread passed on as 'hot meals', drab walls without any charts as characteristic findings. Commission chairperson Nina Naik stated that there is an urgent need for "revisiting and redesigning the current ICDS programme in the interest of children". Low attendance was also found to be rampant, with just 20-25% of the enrolled children in the 3-6 year bracket going to ICDS centres. "Community seemed to have no confidence in the service and retain children at home or admit the 5-6 year olds into private pre-school services," observed the report. Similarly, a 2009 study of 65 ICDS centres in 10 districts of Madhya Pradesh found that, of the 65 centres studied only 24 (37%) have suitable buildings. Only 72% of the studied centres had their own Salter children weighing machine, only 66% of the centres had adult weighing machines, and only 58% had growth registers (Samvad, 2009). A major contributor to poor ICDS infrastructure is corruption. For example, a recent Times of India report stated that, in the state of Assam, although the government allots Rs 175000 for each ICDS building, the state spends only Rs 30,000 in each of the buildings in reality (Times of India, 2011).

Three Decades of the Integrated Child

Fig. 3. Pyramid of effective capacity building

**3. Conclusion**

Development Services Program in India: Progress and Problems 255

The ICDS has not met its objectives, three decades on, due in part to poor health management. A systems capacity building approach is proposed to improve the health and development of mothers and children in India. This approach entails a revitalised India's public health, rather than the ICDS, as a major facilitator of maternal and child health improvements. Issues that need to be addressed include; (1) Revitalising India's public health system, and providing adequate funding to make it more responsive to the needs of the whole population, instead of the over-reliance of vertical programmes such as ICDS; (2) Introducing sustainable poverty reduction programmes, particularly in areas with high maternal and child malnutrition. Improvement in maternal education is also very important in reducing maternal and child health. Remarkably, such improvements are already underway; (3) Expanding the depth and breadth of the training curriculum of Anganwadi workers and professionalising the cadre within India's public service. These workers require adequate remuneration commensurate with their job description, over and above the minimum wage in India's public sector; (4) Devolving the supply of ICDS food from pilfering contractors to local women groups. Employment of dieticians to facilitate adequate quantity (at least 500 calories per meal) and quality (i.e. rich in all food classes) of the meals served at Anganwadi centres. Home visits should be introduced, particularly for malnourished children, to work with the mothers of such children in the provision of nutritious meals at their respective homes; (5) Streamlining the wide array of existing maternal and child health programs, most of which have not demonstrated evidence of effectiveness, to assure quality implementation; (6) Targeting children from 1-3 years, as most of the malnutrition in children develop from this period, and most long term consequences of malnutrition may be minimised if this cohort of children are properly

#### *Inadequate systems capacity building input into ICDS*

Capacity building is any action that improves the effectiveness of individuals, organizations, networks, or systems—including organizational and financial stability, program service delivery, program quality, and growth. Capacity building is a long-term process that improves the ability of an individual, group, organization, or ecosystem to create positive change and perform better to improve public health results (MSH, 2010). A number of activities which have taken place under the banner of organisational capacity building in relation to the ICDS program have focussed on erecting buildings and providing training programs to Anganwadi workers.

A systems capacity building approach to improving the ICDS looks beyond training, and even the ICDS itself, into structural factors which may impact on child health and development. The starting point for improving child health and development is the Indian nubile female. Poorly nourished women are more likely to give birth to underweight infants, a major risk factor for both child as well as maternal morbidity and mortality (Kelly et al, 1996).A recent maternal nutrition study in Pune found that 33% of Indian women have a BMI less than 17, implying significant underweight, compared with 14% of men (Chorghade et al, 2006). Improving maternal nutrition in India would entail addressing cultural, socio-economic and, knowledgebased and attitudinal impediments, a task beyond the scope of ICDS, but within the scope of India's public health system. Effective systems capacity building comprises optimal interaction of nine components [Box 1 and Figure 3] (Potter & Brough, 2004):

Box 1. Nine component elements of systems capacity building applicable to improving the effectiveness of ICDS programme

Fig. 3. Pyramid of effective capacity building


[39] Ahmad M, Rajapaksha A U, Lim JE, et al. Biochar as a sorbent for contaminant management in soil and water: A review. Chemosphere. 2014;**99**:19-33. DOI: 10.1016/j. chemosphere.2013.10.071

**73**

Section 2

Bioremediation with

Biochar

Section 2


**Meet the editors**

Sabyasachi Maiti is an M. Pharm, Ph D from Jadavpur University, Kolkata, India. Currently, he is working as Professor at the Department of Pharmaceutics, Gupta College of Technological Sciences, Asansol under Maulana Abul Kalam Azad University of Technology, Kolkata, India. He is working on biomaterials and their derivatives in designing controlled release drug delivery

systems. He has authored and co-authored more than 50 research publications and 20 book chapters. He has guided one doctoral and more than 20 Master's thesis. He has also served as a reviewer for various journals of international repute. He has received grants for organizing seminars as well as for research projects from national funding agencies. He is a life member of IPA, Indian Chemical Society and APTI.

Dr. Kalyan Kumar Sen is an M.Pharm, PhD from Jadavpur University, Kolkata, India. He has twenty-nine years work experience in the field of pharmacy. He is presently working as Principal, Gupta College of Technological Sciences, Asansol, India. He is life member of professional bodies like the Association of Pharmaceutical Teachers of India (APTI), Indian Society for Tech-

nical Education (ISTE) and Indian Science Congress Association. He has successfully guided more than forty postgraduate students and two PhD students. He has several publications in international and national peer reviewed journals. He has edited one book published by CRC Press, UK and contributed several book chapters. His area of research interest is design of nanoparticulate drug delivery and vaccine delivery system.


**5.2 Raila village**

424 Remote Sensing – Applications

density of change pattern elements, in addition to the edges of Kibera informal settlement, several changes occurred in the eastern part of Kibera. These are mainly due to larger new buildings constructions or complete rooftops renovations. Additional socio-economic data or bigger events information (like flooding) would be welcomed to associate the rate of more intensive rooftops renovations at some of Kibera villages and compared to the other

With external data, for example land cover for a reference point in time, a fairly reliable "from-to" change statistics could be extracted. However in rather homogenous land use areas like Kibera informal settlement is, where most of the land use is residential (section 5.1.1) and where urbanisation direction limits are well known due to formal residential settlement boundaries, such information would not additionally characterize the change pattern. On the example of Raila village change detection in section 5.2.2 we comment some difficulties observed related to detection of change in slum-like areas in a more

Fig. 11. Identified changes between years 2006 and 2009 (Erdas Imagine). Change pattern enclose changes due to new buildings construction, buildings disappearance and larger

Total surface of Kibera was calculated as a sum of housing areas of all 12 villages throughout whole Kibera from vector results obtained with object-based classification. All the vectorized structures have been computed using ArcGIS software and we assumed that

Sum of the residential areas show that total residential area of Kibera is around 1.646,883 m2, which is 358,706 m2 more than total surface from year 1993 given by Sartori et al. (2002), where residential area was 1.333,834 m2. We can see that informal settlement population density has increased from year 1993. Since Kibera is surrounded by well-defined residential boundaries and its drastical expansion therefore was not possible, we can assume that the increase of residential area can attribute to denser housing inside the informal settlements through years.

parts of the settlements.

rooftop renovations.

**5.1.3 Kibera population estimation in 2009**

all the structures are used for habitat purposes.

detail.

### **5.2.1 Detailed land cover map of Raila village 2009**

We made a detailed classification focused on residential housing only on image subset covering the area of Raila village. The main idea was to automatically obtain polygon shapes of each individual residential object or settlement. Although on VHR image individual objects in general can be distinguished, due to the complexity and variety of dense roof surface there was impossible to extract the shape of every individual residential object or each group of objects (settlements). Roofs and their elements themselves present heterogeneity, resulting in distinct spectral variation within areas of homogeneous land cover. Class "buildings\_bright" were possible to detect since they had a very distinct morphological pattern that was contrasted by surrounding (built-up) land cover. Segments of class "buildings\_brown" were sometimes integrated with their surroundings (soil) so they could not be readily distinguished. Some urban elements (like rooftops) are a combination of many different surface materials; this produced a spectral response that was difficult to interpret with routine procedures.

Automatic shape detection of each individual residential object would enable good total population estimation. Two approaches to get classified vector shapes closer to individual buildings were considered:

Finally, focused to residential build-up objects in Raila area four major object classes were modelled and mapped (Fig. 12).

Object-Based Image Analysis of VHR Satellite Imagery for

**5.2.3 Raila village population estimation in 2009**

terms of typical size of houses in the Raila village (Fig. 14).

2009 for Raila village, Kibera.

Population Estimation in Informal Settlement Kibera-Nairobi, Kenya 427

QB2006-03-27 QB2008-08-10 GE2009-07-25

Change pattern from years 2006-2008. Change pattern from years 2008-2009.

Urban growth pattern through years 2006, 2008 and 2009 for Raila village. Dark red corresponds to 2006-2008 and light red to 2008-2009 period. Fig. 13. Results of change detecion for urban growth pattern through years 2006, 2008 and

great and consequently buildings disappearance is more difficult to detect. Same applies if new building has dark colour rooftop covers (for example, often used blue colour plates). Main change missing occurrences therefore apply to the just described situations, making difficulties for automatic approaches. To some extent this problem was solved so that the threshold for negative changes was reduced during transformation categorisation step.

According to the total residential area in Raila village obtained from object based classification (section 5.1.1, Table 3), population estimation was calculated based on different density per area parameters (Table 6). Additionaly we illustrate this information also in

Fig. 12. Detailed object based classification results for residential areas in Raila village.

#### **5.2.2 Raila village urban growth**

Multi-level contextual change detection approach was applied to Raila village to highlight the extent of major urbanisation processes that can take action even in a short time span. As expected the development on southern border of the village is well recognised (Fig. 13) and different time sequences analysed outlined where and when the growth has taken place.

Method incorporates spatial neighbourhood dependence to control the false change information (i.e. inherent changes due to locally based variability in data). As a result it gives a change pattern of positive and negative changes in imagery spectral space. Positive changes correspond to an increase in digital number values at the same location and negative changes to a decrease in spectral values. Method was developed for middle resolution imagery, but its application to Kibera informal settlement data proved this concept to be efficient on VHR imagery as well. In general, majority of objects transformations regardless of their size (small patches to entire buildings) was identified. The results were evaluated with visual control or before-after imagery comparison. Although quantitative assessment was not possible as more detailed independent data were not available, we estimate that more than 90% of changes associated to buildings appearance and disappearance are captured.

Hence, detailed inspection of identified changes outlined several difficulties related to detect change in slum-like areas. First of them is preservation of shape. Because of the use of multilevel information the objects edges may be shrinked to some degree, causing that change is not recognised at entire object extent but only at part of it. Second, the level of change recognition (detection rate) is different in positive and negative spectral space. New materials (i.e. metal plates) used to cover houses have very strong reflection, so difference from low reflecting brown soil to new buildings with bright cover is obvious and unproblematic. In contrast, for example from rusty rooftops to bare soil this difference is not

Fig. 12. Detailed object based classification results for residential areas in Raila village.

Multi-level contextual change detection approach was applied to Raila village to highlight the extent of major urbanisation processes that can take action even in a short time span. As expected the development on southern border of the village is well recognised (Fig. 13) and different time sequences analysed outlined where and when the growth has taken place.

Method incorporates spatial neighbourhood dependence to control the false change information (i.e. inherent changes due to locally based variability in data). As a result it gives a change pattern of positive and negative changes in imagery spectral space. Positive changes correspond to an increase in digital number values at the same location and negative changes to a decrease in spectral values. Method was developed for middle resolution imagery, but its application to Kibera informal settlement data proved this concept to be efficient on VHR imagery as well. In general, majority of objects transformations regardless of their size (small patches to entire buildings) was identified. The results were evaluated with visual control or before-after imagery comparison. Although quantitative assessment was not possible as more detailed independent data were not available, we estimate that more than 90% of changes associated to buildings

Hence, detailed inspection of identified changes outlined several difficulties related to detect change in slum-like areas. First of them is preservation of shape. Because of the use of multilevel information the objects edges may be shrinked to some degree, causing that change is not recognised at entire object extent but only at part of it. Second, the level of change recognition (detection rate) is different in positive and negative spectral space. New materials (i.e. metal plates) used to cover houses have very strong reflection, so difference from low reflecting brown soil to new buildings with bright cover is obvious and unproblematic. In contrast, for example from rusty rooftops to bare soil this difference is not

**5.2.2 Raila village urban growth**

appearance and disappearance are captured.

Change pattern from years 2006-2008. Change pattern from years 2008-2009.

Urban growth pattern through years 2006, 2008 and 2009 for Raila village. Dark red corresponds to 2006-2008 and light red to 2008-2009 period.

Fig. 13. Results of change detecion for urban growth pattern through years 2006, 2008 and 2009 for Raila village, Kibera.

great and consequently buildings disappearance is more difficult to detect. Same applies if new building has dark colour rooftop covers (for example, often used blue colour plates). Main change missing occurrences therefore apply to the just described situations, making difficulties for automatic approaches. To some extent this problem was solved so that the threshold for negative changes was reduced during transformation categorisation step.

#### **5.2.3 Raila village population estimation in 2009**

According to the total residential area in Raila village obtained from object based classification (section 5.1.1, Table 3), population estimation was calculated based on different density per area parameters (Table 6). Additionaly we illustrate this information also in terms of typical size of houses in the Raila village (Fig. 14).

Object-Based Image Analysis of VHR Satellite Imagery for

low processing costs.

information is aimed.

as sub-object attributes could be explored and used.

Population Estimation in Informal Settlement Kibera-Nairobi, Kenya 429

and were not under detailed examination of this study. Informal settlements represent a particular housing and living conditions which is from a humanitarian point of view in most cases below acceptable standards (UN-HABITAT, 2004; MKP, 2011; Sartory et al. 2002). Due to informal character and low governmental management services in the past, reliable and accurate data about informal settlements and their population is rarely available. On the other side there is a strong need to transform informal into formal settlements and to gain more control about the actual urbanisation progress. Thus, obtaining spatially and temporally accurate information is a first step to establish proper actions in terms of local or regional planning. For these tasks, conventional data sources, such as maps, statistics or even GIS data are usually obsolete, not available, not as accurate as needed or do not hold the information needed (MKP, 2011; Sartory et al. 2002). The case study presented demonstrates how informal settlements can be approached from VHR satellite image data. Using an object based approach of image analysis detailed land cover/use within informal settlements can be obtained to facilitate GIS-based management tasks and population modelling. The application of automatic, even if simple pixel-based, change detection proved to support real-time observation of informal settlement areas whenever appropriate VHR satellite data are available with relatively

Merits of object-based image analysis in dense informal settlements analysis with VHR remote sensing data have been confirmed in several studies (section 2). However some drawbacks still resist. In case of residential land cover/use map derivation main unsolved difficulty is automatic detection and separation of individual houses. Although small differences in heights of rooftops create visually well distinguished boundaries of objects, the heterogeneity of rooftop material and its small scale changeability often overrule the value of neighbourhood houses boundaries relationship. Current limit of object based analysis is also that still requires substantial post-classification routines and check-over that can be done mainly manually through visual control. What characterise this procedure as time demanding whenever geometrically and semantically correct

Change detection applied revealed great potential for long-term monitoring and informal settlements urbanisation growth analysis. Hence more research is needed to provide sufficient detection rate of spectrally lower magnitude changes that are typical for informal settlements specifics and its reflectance intensity representation on satellite imagery. Due to rooftop material used bright (metal) materials are unproblematic to distinguish from soils, however dark rooftop materials (blue, brown colour) are spectrally closer to bare, unpaved (brown) or vegetated (green) soils. Here object based approaches would prove better option

Valuable population estimation can be made with a relatively low cost if residential area if accurately estimated from high-resolution images, although some considerations exist. Area based population estimation model can be used for the informal settlements in other images of similar resolution knowing the number of people living per surface unit. Zhang (2002) exposed some problems of selection of the scales of remote sensing imagery, reduction of influence of plant cover on remote sensing data, stability of the correlation between population and remote sensing indicator variables and correction of building count. In this research we met all mentioned problems in order to accurately estimate

Table 6. Density of people living in Raila village according to different sources and total residential area obtained from object-based classification of GeoEye 2009-07-25 image.

Fig. 14. Density of people according to different sources per typical size of houses in Raila village.

In Table 6 we presented also the density on 32 m2 unit since this size of house was measured to be a most typical and frequent (medium range size) housing unit in Raila village. It was also observed that size of small buildings is approximately 16 m2, while large buildings reach on average 65 m2. Fig. 14 summarise in addition the above relationship.

When perfoming such population estimation it is assumed that all of the build-up area is used for dwelling, which is not allways true as houses may be also used for other activities. For the possible calibration of the above population densities field survey sampling would be required. Nevertheless, Table 6 clearly outlines how population estimation based on critera of simple density per area based modelling can propose up to 4-times higher (different) population estimation.


3.4 Impact of wine chemical composition on sensory profile of red wine treated with extractive free and ethanol impregnated cork powder and application doses

The sensory scores provided by the expert panel for aroma (Figure 6), taste and tactile/textural descriptors (Figure 7) and the chemical composition of wines, concerning the abundance of headspace aroma compounds and phenolic compounds, respectively, were subjected to multiple factor analysis. From the variable map, it can be concluded that for the first and second factors, both groups of variables contribute almost equally (53 and 46%, and 36 and 64% for the sensory and chemical data for the first and second factors, respectively) (Figure 6b).

T0

> Intensity

240

Hue Limpidity Oxidised (visual)

Fruity Floral Vegetable

Phenolic Oxidised (aroma)

Bitterness

Acidity Astringency

Body Balance Persistence

1Consonance

< 0.05).

p < 0.05.

Table 6. Mean scores of each attribute after sensory analysis of volatile phenol-free

ethanol extractive free cork after air removal and ethanol

(CKFI75250

 and

CKFI75500).

 (T0) and volatile

impregnation

 (CKNI and CKFI) and cork powders with a particle size below 75 μm at two application

phenol-spiked

 (TF) red wine after treatment with natural cork and

dichloromethane

 doses (250 and 500 g/hL)

 and

 analysis results

—no variance observed for most panellists.

Multiple factorial analysis of aroma sensory and chemical data: (a) representation of wine samples and clouds; (b) representation of groups (tables) of variables and (c) distribution of variables. VP-free (T0) and VPspiked (TF) red wines and after treatment with natural cork and dichloromethane and ethanol extractive free cork after air removal and ethanol impregnation (CKNI and CKFI) and cork powders with a particle size below 75 μm at two application doses (250 and 500 g/hL, CKFI75250 and CKFI75500, respectively). Centroid (¡); sensory data (Δ); chemical data (◊). AcEt, ethylacetate; Ac3 MetBut, 3-methylbutan-1-ol acetate; 3-MetButol, 3-methylbutan-1-ol; EtOct, ethyl octanoate; EtDec, ethyl decanoate; DiEtSuc, diethyl succinate; PhEt, 2-phenylethanol; 4-EG, 4-ethylguaiacol; 4-EP, 4-ethylphenol; OctAc, octanoic acid; DecAc, decanoic acid; DodAc, dodecanoic acid.

The phenolic negative attribute and the 4-EP and 4-EG headspace abundance were positively correlated with F1, showing that the reduction of the headspace abundance of 4-EP and 4-EG caused by CKNI, CKFI, CKFI75250 and CKFI75500 was important for the decrease of this wine defect. The fruity and floral positive attributes were negatively correlated with F1, showing that the decrease of the headspace abundance of these VPs was important for their perception. However, the abundance of the other headspace aroma compounds was also important for their perception, as they also present negative F1 score. These results are in accordance with previous works that verified that the absence of wine aroma defects, including VPs, was more important for the final wine aroma profile, where that negative off-odorants exert a strong aroma suppression impact on fruity aroma [20, 21, 24, 61, 66].

composition of wines [67]. By the phenolic composition of treated wines, the headspace abundance of 4-EP and 4-EG was also used for MFA, because is actually known that the aroma can interact with the perceived bitterness and astringency of foods, where wines are included [24, 67]. The first factor was important to describe the sensory and VP headspace abundance variables (Figure 7b). In the case of the chemical variables, only the second factor was important for its description. The correlation maps of observations and variables (Figure 7c) show that the persistence, body and balance attributes were correlated with F1 in the negative direction. However, acidity, bitterness and astringency attributes were correlated with F1 in the positive direction, and there was also a positive correlation between VP headspace abundance with this factor. The correlation of bitterness and astringency, unpleasant wine sensory attributes, with the headspace abundance of VPs, responsible for the negative phenolic aroma, can be explained by the relationship between several aroma compounds with the bitterness and astringency of foods, shown also for wine [24, 68]. The significant decrease observed in some phenolic compounds

Multiple factorial analysis of taste and tactile/textural sensory data, phenolic compound chemical data and volatile phenol headspace abundance: (a) representation of wine samples and clouds; (b) representation of groups (tables) of variables and (c) distribution of variables. VP-free (T0) and VP-spiked (TF) red wines and after treatment with natural cork, dichloromethane and ethanol extractive free after air removal and ethanol impregnation (CKNI and CKFI) and cork powders with a particle size below 75 μm at two application doses (250 and 500 g/hL, CKFI75250 and CKFI75500, respectively). Centroid (¡); sensory data (Δ); chemical data (◊); VP headspace abundance (●). TotPhe, total phenols; FlavPhe, flavonoid phenols; t-CaftAc, transcaftaric acid; CoutAc, coutaric acid; Del-3-Glc, delphinidin-3-O-glucoside, Cya-3-Glc, cyanidin-3-Oglucoside, Peo-3-AcGlc, peonidin-3-O-(6-O-acetyl)-glucoside; VPs, volatile phenols; 4-EP, 4-ethylphenol; 4-

Air Depleted and Solvent Impregnated Cork Powder as a New Natural and Sustainable Wine…

DOI: http://dx.doi.org/10.5772/intechopen.85691

Figure 7.

EG, 4-ethylguaiacol.

243

The phenolic composition of wines although changed significantly, especially after application of the CKFI75 at the two levels, the decrease was not high; nevertheless, significant differences were observed for bitterness, astringency, balance and persistence by sensory analysis, parameters usually linked to the phenolic

Air Depleted and Solvent Impregnated Cork Powder as a New Natural and Sustainable Wine… DOI: http://dx.doi.org/10.5772/intechopen.85691

#### Figure 7.

The phenolic negative attribute and the 4-EP and 4-EG headspace abundance were positively correlated with F1, showing that the reduction of the headspace abundance of 4-EP and 4-EG caused by CKNI, CKFI, CKFI75250 and CKFI75500 was important for the decrease of this wine defect. The fruity and floral positive attributes were negatively correlated with F1, showing that the decrease of the headspace abundance of these VPs was important for their perception. However, the abundance of the other headspace aroma compounds was also important for their perception, as they also present negative F1 score. These results are in accordance with previous works that verified that the absence of wine aroma defects, including VPs, was more important for the final wine aroma profile, where that negative off-odorants exert a strong aroma suppression impact on fruity aroma

Multiple factorial analysis of aroma sensory and chemical data: (a) representation of wine samples and clouds; (b) representation of groups (tables) of variables and (c) distribution of variables. VP-free (T0) and VPspiked (TF) red wines and after treatment with natural cork and dichloromethane and ethanol extractive free cork after air removal and ethanol impregnation (CKNI and CKFI) and cork powders with a particle size below 75 μm at two application doses (250 and 500 g/hL, CKFI75250 and CKFI75500, respectively). Centroid (¡); sensory data (Δ); chemical data (◊). AcEt, ethylacetate; Ac3 MetBut, 3-methylbutan-1-ol acetate; 3-MetButol, 3-methylbutan-1-ol; EtOct, ethyl octanoate; EtDec, ethyl decanoate; DiEtSuc, diethyl succinate; PhEt, 2-phenylethanol; 4-EG, 4-ethylguaiacol; 4-EP, 4-ethylphenol; OctAc, octanoic acid; DecAc,

The phenolic composition of wines although changed significantly, especially after application of the CKFI75 at the two levels, the decrease was not high; nevertheless, significant differences were observed for bitterness, astringency, balance and persistence by sensory analysis, parameters usually linked to the phenolic

[20, 21, 24, 61, 66].

242

decanoic acid; DodAc, dodecanoic acid.

Advances in Grape and Wine Biotechnology

Figure 6.

Multiple factorial analysis of taste and tactile/textural sensory data, phenolic compound chemical data and volatile phenol headspace abundance: (a) representation of wine samples and clouds; (b) representation of groups (tables) of variables and (c) distribution of variables. VP-free (T0) and VP-spiked (TF) red wines and after treatment with natural cork, dichloromethane and ethanol extractive free after air removal and ethanol impregnation (CKNI and CKFI) and cork powders with a particle size below 75 μm at two application doses (250 and 500 g/hL, CKFI75250 and CKFI75500, respectively). Centroid (¡); sensory data (Δ); chemical data (◊); VP headspace abundance (●). TotPhe, total phenols; FlavPhe, flavonoid phenols; t-CaftAc, transcaftaric acid; CoutAc, coutaric acid; Del-3-Glc, delphinidin-3-O-glucoside, Cya-3-Glc, cyanidin-3-Oglucoside, Peo-3-AcGlc, peonidin-3-O-(6-O-acetyl)-glucoside; VPs, volatile phenols; 4-EP, 4-ethylphenol; 4- EG, 4-ethylguaiacol.

composition of wines [67]. By the phenolic composition of treated wines, the headspace abundance of 4-EP and 4-EG was also used for MFA, because is actually known that the aroma can interact with the perceived bitterness and astringency of foods, where wines are included [24, 67]. The first factor was important to describe the sensory and VP headspace abundance variables (Figure 7b). In the case of the chemical variables, only the second factor was important for its description. The correlation maps of observations and variables (Figure 7c) show that the persistence, body and balance attributes were correlated with F1 in the negative direction. However, acidity, bitterness and astringency attributes were correlated with F1 in the positive direction, and there was also a positive correlation between VP headspace abundance with this factor. The correlation of bitterness and astringency, unpleasant wine sensory attributes, with the headspace abundance of VPs, responsible for the negative phenolic aroma, can be explained by the relationship between several aroma compounds with the bitterness and astringency of foods, shown also for wine [24, 68]. The significant decrease observed in some phenolic compounds

after application of ethanol impregnated cork-powders does not seem to be responsible for the change in the taste/tactile descriptors observed after wine treatment.

The results obtained from MFA supported the results from sensory analysis of the wines obtained after treatment with the different ethanol impregnated cork powders at the applied doses, highlighting the efficiency of extractive free corkpowders, especially cork powder with a lower particle size at 250 g/hL application dose (CKFI75250), for decreasing the levels of 4-EP and 4-EG in wines and for recovery of fruity and floral aroma attributes. A decrease in phenolic, bitterness and astringency attributes was also observed. The results obtained for visual (colour), aroma, taste and tactile/textural descriptors determined by the expert panel, validated by the wine chemical composition after treatment with ethanol impregnated cork powders show that the wine treated with CKFI75250 resulted in a significant increase in the sensory quality compared to TF, although not identical to T0 wine. This is explained by the efficient removal of VPs and no negative impact on the wine phenolic composition and a lower impact on the headspace aroma compounds when compared to CKFI75500.


**4. Conclusions**

This research provides a scientific basis and confirms the value of mulching as a sustainable although time-consuming agricultural method to improve soil organic carbon sequestration. Long-term effects of mulching have to be tracked to identify whether SOC improvement reaches a steady state related to the saturation of SOC pools. Future studies are also needed to quantify associated economic benefits and agricultural sustainability related to carbon-transformation processes.

**Author Contributions:** Conceptualization, V.P., A.P., E.H. and D.M.; methodology, V.P., A.P. and E.H.; investigation, E.H., D.M., I.H. and A.C.; resources, V.P., D.M., V.K. and K.B.; data curation, V.P., D.M. and V.K.; writing—original draft preparation, D.M.; writing—review and editing, A.P. and V.P.; visualization, D.M. and V.P.; supervision, A.P., V.P. and E.H.; project administration, A.P. and V.P.; and funding acquisition, A.P. and V.P. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by PRIMA program supported by the European Union, grant number 2041 (LENSES—leaning and action alliances for nexus environments in an uncertain future) (Call 2020 Section 1 Nexus IA).

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** Not applicable.

**Conflicts of Interest:** The authors declare no conflict of interest.