Impact on Public Health Nutrition Services Due to COVID-19 Pandemic in India: A Scoping Review of Primary Studies on Health and Social Security Determinants Affecting the First 1000 Days of Life
2. Research Question
- Access to health services for women and children including the following:
- Antenatal coverage;
- Childbirth (delivery services for pregnant women, type of delivery, pregnancy outcomes, and complications in pregnancies);
- Post-natal services and immunization;
- Access to community health services and community health extension workers.
- Care for women and children during pandemic including the following:
- Nutrition of pregnant and nursing mothers (P&NMs);
- Early initiation of breastfeeding, exclusive breastfeeding for the first six months of infant, continued breastfeeding for at least the first two years of life;
- Stress levels;
- Mental health, including depression, and social support.
- Household food security status (food availability, food accessibility, food choices, and food utilization);
- How did vulnerabilities of gender, social stigma, and unemployment exacerbate these indicators? What was the extent, coverage, type, and impact of social protection schemes for P&NMs and children under two years?
3.1. Theoretical Framework
3.3. Inclusion Criteria
4.1. Access to Health Services for Women and Children
4.1.1. Pre-Natal and Post-Natal Services
4.1.2. Immunization Services
4.2. Care for Women and Children
4.2.1. Nutrition of P&NMs and IYCF
4.2.2. Mental Health including Depression and Social Support
4.3. Household Food Security Outcomes
4.4. Social Protection Schemes for Women and Children
5.1. Synergies between the Socio-Economic Impact of the COVID-19 Pandemic in LMICs
5.2. Varied Impacts of Social and Food Security Policies
5.3. Role of Frontline Workers
5.4. Inconsistencies in Data
5.5. A New Opportunity for Researchers
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
|Research Question(s)||Evidence (March 2020–May 2022)||Findings|
|Author||Location||Year||Study Design||Population||Sample size||Intervention||Outcomes|
|Pre-natal and Post-natal Service Delivery||Singh et al.||District Sant Kabir Nagar, Uttar Pradesh||2020||Comparative analysis||Pregnant women||6 community health centers, 3 block-level primary health centers||Data from Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and Janani Suraksha Yojana and Pradhan||There was a 2.26% decline in institutional deliveries, and 41.84% availed free drop back post-institutional delivery. A free diet during the hospital stay was provided to 40.66% of women, and only 3.18% of women utilized free referral services. About 16,161 women benefitted from free routine investigations and 1278 underwent a free routine ultrasound. 20% decrease for all vaccines except for BCG.|
|Goyal et al.||Jodhpur||2020||Observation||Pregnant women||633||Single-center study||45.1% reduction in institutional deliveries, 44.7% of pregnancies with complications, 7.2% rise in high-risk pregnancy, two maternal mortalities, pre-eclampsia, nausea and vomiting, preterm labor, and depression.|
|Sinha et al.||Dakshinpuri, Delhi||2020||Randomization||P&NMs||199 mothers||Semi-structured questionnaires and IDIs||Of the women who delivered baby after lockdown, 84% had more than four ANC visits. Among women who delivered baby before lockdown 97% had more than four ANC visits. Over 100 (n = 103) women before lockdown received intrapartum care, while 90 (n = 96) women received intrapartum care after lockdown.|
|Ulaganeethi et al.||Puducherry||2021||Mixed methods||Pregnant women||150||Not available||62 women did not complete the ideal number of ANC visits and 61 developed health problems. Furthermore, 44 received teleconsultation, and 13 did not take IFA supplementation|
|Nguyen et al.||Uttar Pradesh||2021||RCT||Frontline workers and mothers||479 FLW, 587 mothers||Longitudinal survey, IDIs||4% of FLWs revealed giving VHND administrations, 29% directed home visits, 1% ANC administrations, and 5% growth monitoring of child. Likewise, FLWs expanded outreach exercises, such as conveyance of IFA (40%), oral rehydration arrangement and zinc (half), THRs (95%), or counselling administrations (80%) to households. Challenges faced by FLWs included having to walk significant distances (42%), nonavailability of transportation (29%), less participation from recipients (26%), absence of personal protective gear (PPE) (26%), apprehension about getting the infection while conveying food to recipients (25%), and uneasiness about wearing masks (20%).|
|Immunization Services||John et al.||Bihar (rural)||2020||Purposeful sampling||FLWs||30||In-depth interviews (IDI)||Women prefer product-oriented services (rations) rather than counselling. Immunization attendance was low.|
|Singh et al.||District Sant Kabir Nagar, Uttar Pradesh||2020||Comparative analysis||Pregnant women||6 community health centers, 3 block-level primary health centers||Data from Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), Janani Suraksha Yojana and Pradhan||There was a 2.26% decline in institutional deliveries, and 41.84% availed free drop back post-institutional delivery. A free eating regimen during medical clinic stay was given to 40.66% women, and just 3.18% women used free reference administrations. Around 16,161 women profited from free routine examinations, and 1278 went through a free routine ultrasound. There was 20% reduction for all immunization with the exception of BCG.|
|Nguyen et al.||Uttar Pradesh||2021||RCT||FLWs||479 FLW, 587 mothers||Longitudinal survey, IDIs||4% of FLWs revealed giving VHND administrations, 29% directed home visits, 1% ANC administrations, and 5% growth monitoring of child. Likewise, FLWs expanded outreach exercises, such as conveyance of IFA (40%), oral rehydration arrangement and zinc (half), THRs (95%), or counselling administrations (80%) to households.|
|Nutrition of P&NMs and IYCF||UNICEF and Population Council Institute||Bihar||2020||Survey||Households with a P&NMs and children under two years of age||794||Not available||(1) Half (48.2%, 95% CI: 44.8, 51.7) of households reported food shortages in the past month; this was higher among households with pregnant women, children under five, in rural, marginalized, economically weaker households, and those with lost income. (2) Half of females versus one-third of males reported shortages of food and reduced intake. (3) Three-fifths (59.2%, 95% CI: 55.8, 62.6) of households reported reduced food intake during lockdown; this was higher among rural, marginalized, and economically weaker households, and with those who lost income. (4) Nine-tenths of households compromised in consumption of vegetables or fresh foods. (5) A third (36.1%, 95% CI: 31.3, 40.8) of eligible households received take-home rations in the past month, and this was slightly higher among poor households. Three out of five (mean 2.9, 95% CI: 2.8, 3.1) suggested nutritional categories were consumed by pregnant women on the day preceding the study; most were drastically averse to eating dairy items and meat. (6) A third (29%, 95% CI: 22.2, 35.7) of families with a child 6–14 years admitted receiving cash in lieu of mid-day meals. (7) Receiving cash in lieu of a mid-day meal was similarly announced by qualified families in both rural and urban areas; be that as it may, a higher extent of males (35%) received cash than females (26%).|
|Azeez E P et al.||Delhi and Gurugram||2021||Qualitative||Female migrant workers dependent on government social security||19||Interviews||The closure of schools, anganwadis, parks, and other sporting offices adversely affected transient women and their families. This is not simply because they are denied of schooling, children did not get mid-day meals, and families had extra liability to deal with kids over the course of the day. Admittance to latrines became difficult during the lockdown, and women endured this. The absence of accessibility of necessities, such as cooking gas, and the rising cost of vegetables additionally influenced travelers who are, as of now, jobless. Abrupt changes in daily schedules and childcare were distressing for respondents. Most women resorted to staying in their single rooms all through the lockdown period with no or restricted methods for diversion and entertainment.|
|Husain et al.||Bihar rural||2021||Longitudinal Panel||Women and children||1148||Two-phase primary survey||Mean Dietary score (DS) of mothers decreased from 5.65 to 5.20; MDD declined by 11%; 92% households obtained free rations, and 81% benefitted from cash transfer.|
|Sahoo et al.||Pan-India||2020||Online cross-sectional survey||Women of reproductive age and FLWs||1636||Questionnaire on survey monkey||472 women of reproductive age agreed that COVID-19 can be passed onto the baby through breastfeeding, while 24% of health workers (n = 322) believed that breastfeeding can transmit COVID-19.|
|Food INSECURITY||Nguyen et al.||Uttar Pradesh||2021||RCT||Households with a P&NMs and children under two years of age||1849 (2019), 587 (2020)||Longitudinal survey||The HFI increased by 80%, 62% households’ were food insecure, coverage of PDS rations increased by 71%, and child feeding practices are of major concern, with only 19% of children achieving MDD ( ≥ 4 food groups). An extremely low proportion of children were eating meat (1%), eggs (1%), and vitamin-A rich fruits and vegetables (4%). One-third of the children consumed other fruits and vegetables, and nearly two-thirds consumed legumes and nuts in the 24 h before the survey. Quality of infant diet −12% (food insecure) and 28% (food secure).|
|Kesar et al.||Pan-India||2020||Survey||Households with a P&NMs and children under two years of age||5000||Phone interviews||77% households consumed less food, 66% lost employment, and only 38.9% said they never went without food, with the rest often being hungry.|
|Social Protection||Karnataka Government||Karnataka||2020||Rapid assessment||P&NMs and children under two years of age||80 villages and cities across 20 districts,||Not available||Children between 0–6 years—of the 80 towns/regions, Anganwadi focuses in 10 regions have not yet given proportions/ rations to children between the ages of 0–6 years. In the leftover, some proportion has been given, but not the full amount. The required eggs and milk have not been given. None found any consideration being given to the promotion of additional nourishing and wellbeing requirements of youngsters who have been recognized as malnourished, which is a glaring exclusion. Pregnant and lactating women—some measure of rations is by and large given to 75% respondents in the region. Despite the provision, this is not enough.|
|Kumar Chatterjee||Chhattisgarh||2020||Not available||Households dependent on government social security||24,000||Not available||Families not having BPL cards and a stigma related to patients who had tested positive/quarantined at hospitals were issues. Health call centers were set up in Dantewada to connect with health workers and enable isolation.|
|Azeez E P et al.||Delhi and Gurugram||2021||Qualitative||19 women||Interviews||Interviews||Most of the women do not hold a ration card and the necessary local certification required for accessing social security. Proof of local identity is required to receive protection. Though there was some relaxation of these requirements, many received no such help. A couple of the members received support from neighborhood NGOs regarding proportion and food. A sensation of being disregarded by the public authority was unmistakable among the participants.|
|Ramani et al.||Dharavi slum, Mumbai||2022||Mixed||450 families, 49 community members||Survey and FGDs||Survey and FGDs||Bought food from government-financed stores (397, 84.8%), received it free from government-financed initiatives (275, 58.8%), received prepared food/proportion from ICDS or workplace (209, 44%), NGOs (160, 34%)|
|Nguyen et al.||Uttar Pradesh||2021||RCT||479 FLW, 587 mothers||Longitudinal survey||Longitudinal survey||30% reduction in home visits and THR. In April 2020, THRs 71.2%, hot cooked meal 0%, and dry rations 22.6%.|
|Mental Health||Jelly et al.||Dehradun, Haridwar, Nainital||2021||Cross-sectional||Pregnant women||333||Event-Revised (IES-R) scale and the Generalized Anxiety Disorder-7 (GAD-7) scale.||73.6% of the pregnant women reported a minimal psychological impact, with a mean IES-R score of 16.93 ± 11.23, whereas 69.4% of respondents had a minimal level of anxiety.|
|Tikka et al.||Delhi, Dehradun, Bhubaneshwar||2021||Cross-sectional||Pregnant women||750||Generalized Anxiety Disorder-7 scale (GAD-7)||11.1% experienced significant generalized anxiety, 24.7% had mild anxiety, and 11.1% showed moderate/severe anxiety.|
|Anandhi et al.||Tamil Nadu||2020||Case control and cross sectional||Antenatal and postpartum Women||300||DASS 21||Depression (64.0%) among COVID-19 positive cases was lesser (71.3%) than that of control group. Anxiety prevalence was more among cases 81 (54.0%) compared to the control group (52.0%). Prevalence of stress among cases 29 (19.3%) and controls 28 (18.7) were not much different.|
|Nanjundaswamy et al.||South India||2020||Cross-sectional (online) survey||Obstetricians||118||Survey monkey using Likert scale||Pregnant women had concerns about contracting the COVID-19 infection (39.83%), the safety of their infant (52.14%), concerns related to hospital visits (72.65%), methods of protection against COVID-19 (60.17%), and anxieties related to social media messages (40.68%).|
|Nilima et al.||Pan-India||2020||Cross-sectional||Women and children||1316||Online survey||90% mothers worried, and 50% experienced sleep cycle disruption.|
|Kumari et al.||India||2021||Qualitative||Antenatal and postpartum women||14 pregnant and 11 postpartum women||IDI and FGDs||Increased fear about contamination, including that the hospital is the epicenter of contamination, fear about new-born baby getting infected. Anxiety due to financial issues, anxiety due to changed lifestyle (diet, exercise, and nutrition), a lack of support, less/decreased interaction and involvement, self-motivation, and coping strategies were all concerns.|
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|Health and Social Security Provision||Government Body||Efforts during COVID-19 Pandemic|
|Integrated Child Development Scheme||Ministry of Women and Child Development, Government of India||On 30 March 2020, the Ministry instructed AWWs to provide a single instalment of food grains or meals to mothers, infants, and adolescent girls to the extent possible, and to continue door-to-door service delivery if needed.|
|Uttarakhand State Government||Promised life insurance worth 4 lakh INR to 68,000 health workers under ICDS (Hindustan Times, 2020) including Anganwadi workers, Anganwadi assistants, and employees of the Garhwal Mandal Vikas Nigam and Kumaon Mandal Vikas Nigam.|
|Madhya Pradesh Government||Promised health insurance coverage of INR50 lakhs to frontline workers (FLWs).|
|Public Distribution System||Central Government||Cash transfers of INR500 were initiated by the central government under Pradhan Mantri Jan Dhan Yojana (PMJDY) (Sridhar, 2021). Additionally, all families under the public distribution system were allocated a free 1 kg of pulses for three months (Economic Times, 2020). Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) for NFSA beneficiaries and Atma Nirbhar Bharat Package (ANB) for Migrants/Stranded Migrants.|
|Bihar state Government||Community kitchens and relief camps were initiated in government schools to provide food and shelter.|
|Delhi State Government||Temporary ration cards were developed to provide e-coupons, wheat, and rice without charge to all poor communities.|
|Uttar Pradesh Government||Started dry ration distribution only in October 2020. While the government promised Rs 50 L relief to health workers, in January 2020 only 16% (12) out of the total 72 Anganwadi workers who died on COVID duty had received insurance support from the government (The Print, 2022).|
|Domains||Target Group||Key Indicators|
|Pre-natal and post-natal service delivery||P&NMs||TT1/TT2/Booster, ANC check-ups (at least 4), institutional deliveries, type of delivery, place of delivery, village health and nutrition days (VHND), cash transfers under the Pradhan Mantri Matru Vandana Yojana Scheme (PMMVY), Janani Suraksha Yojana (JSY)|
|Immunization services for children under two years||Children under two years of age||Six vaccine preventable diseases covered under ICDS, namely poliomyelitis, diphtheria, pertussis, tetanus, tuberculosis, and measles|
|Nutrition of P&NMs||P&NMs||IFA (≥100 days), deworming, calcium (360 tablets), THR, counseling for the diet of mother and child|
|IYCF practices||P&NMs, Children under two years of age||Early initiation of breastfeeding, exclusive breastfeeding for the first six months, continued breastfeeding for at least first two years of life, diet diversity, adequate quantity and quality of food, child growth monitoring, oral rehydration solution|
|Food insecurity of households||Household of a P&NM with children under two years of age||Food insecurity, relation of HFI to diet of mother and child, PDS system, social protection under Pradhan Mantri Garib Kalyan Yojana|
|Mental health of pregnant mother||P&NMs||Direct pathways, namely stress, anxiety, panic, and depression due to disruption of antenatal and post-natal services, immunization challenges for the infant, fear of testing positive for COVID-19|
|Indirect pathways, namely stress, anxiety, panic, and depression due to domestic abuse, food insecurity, loss of employment, social interaction, and perceived social support|
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Khandelwal, S.; Mehra, M.; Singh, A. Impact on Public Health Nutrition Services Due to COVID-19 Pandemic in India: A Scoping Review of Primary Studies on Health and Social Security Determinants Affecting the First 1000 Days of Life. Int. J. Environ. Res. Public Health 2022, 19, 13973. https://doi.org/10.3390/ijerph192113973
Khandelwal S, Mehra M, Singh A. Impact on Public Health Nutrition Services Due to COVID-19 Pandemic in India: A Scoping Review of Primary Studies on Health and Social Security Determinants Affecting the First 1000 Days of Life. International Journal of Environmental Research and Public Health. 2022; 19(21):13973. https://doi.org/10.3390/ijerph192113973Chicago/Turabian Style
Khandelwal, Shweta, Mahima Mehra, and Ayushi Singh. 2022. "Impact on Public Health Nutrition Services Due to COVID-19 Pandemic in India: A Scoping Review of Primary Studies on Health and Social Security Determinants Affecting the First 1000 Days of Life" International Journal of Environmental Research and Public Health 19, no. 21: 13973. https://doi.org/10.3390/ijerph192113973