Impact of fortified food distributed through Anganwadi centers in the prevention of anemia among children in Andhra Pradesh.

Abstract

Anemia remains a significant public health problem among young children in India despite long-standing supplementary nutrition interventions under the Integrated Child Development Services (ICDS). Balamrutham, a fortified food provided through Anganwadi Centers, aims to improve nutritional and biochemical outcomes; however, evidence of its effectiveness under routine program conditions is limited. This study assessed the burden of anemia and iron deficiency among children attending AWCs and examined the association between Balamrutham consumption and anemia-related biochemical parameters. A community-based cross-sectional mixed-methods study was conducted among 230 children aged 1-6 years attending 23 AWCs in rural Andhra Pradesh. Sociodemographic, feeding, and dietary information were collected using a structured questionnaire. Anthropometric and biochemical assessment, including hemoglobin, serum ferritin, and serum iron was performed. Quantitative data were analyzed using descriptive statistics and logistic regression analysis. Qualitative data on barriers to Balamrutham consumption were collected through in-depth interviews and analyzed thematically. Among 230 children, 51 (22.2%) were consuming Balamrutham. The overall prevalence of anemia was 85.1%, with moderate anemia most common (57.8%). Low serum ferritin and low serum iron were observed in 47.0% and 44.8% of participants, respectively. Balamrutham consumption was not significantly associated with hemoglobin, serum ferritin, or serum iron levels. On multivariable logistic regression, younger age (1-3 years) and infrequent non-vegetarian food intake were independently associated with low ferritin levels. Thematic analysis identified five key barriers to Balamrutham utilization: perceived adverse effects, poor child acceptability, parental misconceptions, logistical constraints, and intra-household sharing. Despite the availability of fortified supplementary nutrition, inconsistent and inadequate consumption limited its measurable biochemical impact. Enhancing awareness, adherence, and implementation is key to improving ICDS nutrition outcomes.