Student Dissertation

Agency : Knowledge and Practice; National Health Mission; Infant Mortality Rate; Home based new born care; Accredited Social Health Activist.

Objective : • To assess the Knowledge of ASHA regarding HBNC. • To assess the Practices of ASHA in providing HBNC. • To study various factors influencing the effective provision of HBNC services.

Background : Reducing infant and child mortality is one of the foremost goals of National Health Mission (NHM). The country as a whole has made significant progress in reducing Infant Mortality Rates (IMR). However it is now clear that a high proportion of the burden of infant deaths is related to new born deaths, and further gains in reducing IMR are likely only through a focused effort at implementing evidence based cost effective interventions that affect neonatal health outcomes. There is sufficient evidence to demonstrate that despite the increasing number of institutional deliveries, a substantial proportion of neonatal deaths occur in the home. Thus the provision of HBNC is critical. For effective promotion of Home-based newborn care (HBNC), NHM offers several platforms which include the presence of trained Accredited Social Health Activists (ASHA) in every village. The Government of India (GoI) released HBNC guidelines in 2011 to increase access to newborn care through ASHAs. The guidelines expect ASHAs to make home visits to promote essential newborn care, identify illness, and refer infants if required. ASHAs receive an incentive for conducting such visits. This study was conducted to assess Knowledge and practices of ASHAs in provision of HBNC services.

Methodology : A Descriptive cross sectional study was conducted in a Block (Bahadurpur) of a High Priority District (Allahabad). 3 Clusters were randomly selected from the block. 146 out of 150 ASHAs who have undergone HBNC training / Module6-7 training, were interviewed with the help of an interview schedule. Filled interview schedule were checked for completeness and correctness and data was entered in MS Excel for analysis.

Findings : Most of the ASHAs carry weighing machine and thermometer during home visit but leave other important items like medicine, dressing materials etc. Talking of advices given to the mothers it was appreciable to know that most of the ASHAs gave advices on Breast Feeding (97.3 percent), Care of cord (77.3 percent) and Hand Washing (51.4 percent) practices but less than half of the ASHAs advice mother regarding vaccination (41.8 percent), maintenance of temperature (41.8 percent) & birth registration (2.7 percent) of new born. Most of the ASHAs (95.9 percent) had knowledge regarding early initiation of Breast Feeding. Just around one fifth of ASHAs (18.5 percent) talk about feeding of colostrum to the new born. Just little more than half of the ASHAs (55.5 percent) advice regarding Kangaroo Mother Care. During home visits, apart from weight and temperature, rest other signs of the new born were examined by half or less than half of the ASHAs only. Lack of adequate supplies of HBNC checklists (just 65.8 percent supplied) and delayed payments of incentives to ASHAs also affected the provision of HBNC services. The study found that although the knowledge level is good the implementation of HBNC services by ASHA has a lot of scope for improvement. Ensuring refresher training, supply of checklist to all ASHAs, regular supportive supervision and on time payment of incentives can make provision of HBNC effective and thus help achieving the goal of reduction of neonatal mortality.