Graduation Year


Document Type




Degree Granting Department

Global Health

Major Professor

Norbert Wagner, M.D., Ph.D.

Co-Major Professor

Boo Kwa, Ph.D.


Diarrhea, Acute respiratory infections, Nutrition, Anganwadi, Preschool


This cross-sectional, community-based study was designed to compare the health outcomes of 2 - 5 year-old children in different types of preschools. The Integrated Child Development Services (ICDS), run by the government of India, created a system of preschools, called anganwadis, to combat malnutrition, provide health education for mothers, and preschool for children 2 - 6 years old in 1975. Many children attend their local anganwadis, while others attend private schools, and others do not attend school at all. A pre-tested questionnaire was used to interview 125 urban and 130 rural mothers regarding their knowledge, attitudes, and practices about acute diarrheal disease (ADD), acute respiratory infections (ARI), and nutrition (practice only) as they pertained to their 2 - 5 year-old child. Two-week and four-week health recalls were obtained to determine which children had experienced diarrhea or ARIs during those time periods.

Anthropometric measurements of the children (weight, height, upper-arm circumference) were collected whenever possible. The study was carried out in an urban slum rural villages surrounding in and surrounding Bangalore, India. Data was collected from March through May of 2009. Through data analysis, KAP and child health scores were calculated to compare four preschool types: anganwadis receiving health check-ups from a medical college, anganwadis not receiving the medical check- ups, other (non-anganwadi) preschools and children not attending preschool. Analyses were performed to identify gaps in KAP, determine the impact of KAP on nutritional status, determine the impact of KAP on ADD and ARI, and determine if preschool type influences KAP scores. Children not attending preschool of any type are at higher risk of ADD, ARI, and being underweight. These children have mothers with the lowest attitude scores.

Mothers of children in other preschools have the highest percentage of good knowledge and practice scores. Children who attend other preschools also have the lowest prevalence of underweight. This information can be useful in designing interventions for specific populations.