A mixed-methods study of child nutrition services in Rural Anganwadi settings of western Maharashtra

Child malnutrition continues to pose significant public health challenges in rural India, despite extensive policy interventions under the Integrated Child Development Services (ICDS). Anganwadi Centres (AWCs), as ICDS’s frontline units, offer essential services including supplementary nutrition, preschool education, and health referrals. This mixed-methods cross-sectional study explored both the nutritional status of children and community perceptions of AWC services in rural Western Maharashtra. Quantitative data were collected from 105 children aged 6–59 months across 11 functional AWCs using standard anthropometric indicators (Height-for-Age, Weight-for-Age, Weight-for-Height), analysed with WHO Anthro Plus and SPSS v29. A composite scoring system categorized nutritional outcomes. The qualitative insights were drawn from 40 purposively sampled stakeholders: Anganwadi Workers, Accredited Social Health Activists, parents, and village leaders via semi-structured interviews analysed thematically. The findings indicated that 82.9% of children were nutritionally normal, with 13.3% mildly and 3.8% moderately malnourished. Partial immunization, low birth weight, and suboptimal feeding emerged as key risk factors. Thematic analysis revealed four core concerns: perceived service value, operational constraints, limited community engagement, and governance gaps. Although AWCs are appreciated locally, their sustainability remains fragile. Strengthening ICDS demands real-time monitoring, enhanced training, participatory governance, and context-responsive reforms.