Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India.
Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India.
Front Public Health. 2022 Jul 1;10:874104. doi: 10.3389/fpubh.2022.874104. eCollection 2022.
Integrated Child Developmental Services (ICDS) is the most extensive government-run health program for children with its foot spread across the complete Indian Territory. ICDS Scheme, has been provided for 40 years and has been successful in some ways. The program in reducing the undernourishment among children over the past decade has been modest and slow in India than what has been reached in other countries with comparable socio-economic measure. Therefore, this study aims to identify the district level clustering of the utilization of ICDS services in India, and the present research also tried to relate it with socio-economic and demographic factors.
The data from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015-16 in India is used to carry out the analysis. We classified the country in 640 districts and employed geospatial techniques like Moran's I, univariate and bivariate local indicators of spatial association (LISA), and spatial error regression.
The non-utilization under ICDS scheme varied between 93% in West Siang district of Arunachal Pradesh and around 7% in the Kandhamal district of Odisha in 2015-16 in India. The univariate LISA results suggest striking geographic clustering of utilization of ICDS services among children in India (Moran's I: 0.612). On another hand, there were regions with substantially low-low clustering of non-utilization of ICDS services in southeast India, including districts in Andhra Pradesh, Chhattisgarh, Southern Madhya Pradesh, Odisha, Telangana, and West Bengal. The findings also suggest that the proportion of the rural population (-0.190), and poor households (-0.132) in the district were significantly and negatively related while the proportion of uneducated women (0.450) was positively related to the non-utilization of ICDS services within the district.
This is the first-ever study that examined the complex interplay of the rural population, female illiteracy, poverty, SC/ST population, and Hindu population with non-utilization of ICDS services among children in the district in India. The study highlights the inter-district geographical disparities in the non-utilization of ICDS services. Further, it confirms that underprivileged districts in terms of the rural population and poor households are also disadvantageous in the utilization of ICDS services.
综合儿童发育服务（ICDS）是印度最广泛的政府运营的儿童健康计划，其服务范围遍布整个印度领土。该计划已经实施了 40 年，在某些方面取得了成功。在过去十年中，该计划在减少儿童营养不良方面的进展在印度较为缓慢，与其他具有类似社会经济措施的国家相比进展较为缓慢。因此，本研究旨在确定印度 ICDS 服务利用的地区层面聚类，并试图将其与社会经济和人口统计因素联系起来。
本研究使用了 2015-16 年在印度进行的第四次全国家庭健康调查（NFHS-4）的数据进行分析。我们将该国分为 640 个区，并采用了空间技术，如 Moran's I、单变量和双变量空间局部空间关联（LISA）以及空间误差回归。
在 2015-16 年，印度 ICDS 计划的非利用率在西桑江（Arunachal Pradesh）的 West Siang 区高达 93%，而在奥里萨邦（Odisha）的坎德哈马尔（Kandhamal）区则低至 7%。单变量 LISA 结果表明，印度儿童 ICDS 服务利用存在显著的地理聚类（Moran's I：0.612）。另一方面，在印度东南部地区，包括安得拉邦、恰蒂斯加尔邦、南中央邦、奥里萨邦、特伦甘纳邦和西孟加拉邦的一些地区，ICDS 服务的低利用率存在显著的低低聚类。研究结果还表明，该地区农村人口比例（-0.190）和贫困家庭比例（-0.132）与 ICDS 服务的非利用率呈显著负相关，而未受过教育的女性比例（0.450）与 ICDS 服务的非利用率呈正相关。
这是首次研究印度各地区农村人口、女性文盲、贫困、SC/ST 人口以及 ICDS 服务在该地区的儿童利用情况之间复杂的相互作用。该研究强调了 ICDS 服务非利用率的地区间地理差异。此外，它证实了在农村人口和贫困家庭方面处于不利地位的贫困地区在利用 ICDS 服务方面也处于不利地位。
