Evaluation of trained Accredited Social Health Activist (ASHA) workers regarding their knowledge, attitude and practices about child health

Introduction: In India, with the introduction of Accredited Social Health Activist (ASHA) workers under the National Rural Health Mission (NRHM) from 2005 to 2006, utilization of healthcare services at the peripheral level has improved. This study was conducted with the purpose of evaluating knowledge, attitudes and practices of ASHA workers in relation to child health. Methods: A cross-sectional study was conducted at Palghar Taluka in the Thane district of Maharashtra for a period of 3 months from January 2011 to March 2011, inclusive, with the study participants all being trained ASHA workers working in the various primary health centres of Palghar Taluka. A total of 150 ASHA workers were working in the area, of which four workers were untrained and thus excluded from the study. The study was conducted by the authors after receiving permission from the medical officer in charge of the primary health centres. Each of the ASHA workers was then contacted individually by the authors and had the study explained to them, after which they were interviewed face to face. Informed consent was taken from each of the study participants. A pre-tested semi-structured questionnaire was designed for ASHA workers regarding child health after thoroughly studying the ASHA Training Module 2, which was then translated into their local language (ie Marathi). Results: A total of 70 (47.9%) workers were from the under 25 years age group; 67 (45.9%) had received less than a secondary level education. A total of 67.1% of ASHA workers were not aware of the correct preventive measures for vitamin A deficiency. Twenty-nine (19.9%) of the ASHAs did not feel the need for referral for a child with diarrhoea who is unable to drink or breast feed. Similarly, in acute respiratory tract infections, 35 (23.9%) of ASHAs did not know to refer a child with fast breathing. Fifty-nine ASHAs (50.4%) considered a baby crying for more than 3 hours following immunization not worth referring to a first referral unit. The oral contraceptive pill was the most frequently advised temporary contraceptive measure for females in the reproductive age group (15-45 years). Conclusion: Despite the training given to ASHAs, lacunae still exists in their knowledge regarding various aspects of child health morbidity. Monthly meetings can be used as a platform for the reinforcement of various aspects of child health. Periodical refresher training should be conducted for all of the recruited ASHA workers. In the future training sessions, more emphasis should be given to high risk cases requiring prompt referral.