Accredited Social Health Activist Workers Research Articles

Assessment and Grading of Accredited Social Health Activist Workers Based on Simulation, Awareness, and Writing Skills in Urban and Rural Karnataka: A Comparative Study

Introduction: Accredited Social Health Activist (ASHA) workers and their activities are regarded as a critical component linking the community and health-care facilities. They are the cornerstone of the Indian public health-care system responsible for spreading awareness and recommending preventive measures in the community. This study aims to assess the awareness, writing skills, and practical-based performance of the ASHA workers in urban and rural Karnataka. Materials and Methods: A cross-sectional study was conducted among ASHA workers in rural and urban Mysore district. A multistage sampling technique was adopted for selecting the participants. The ASHA workers were asked to fill out a pretested semi-structured questionnaire. An unpaired t-test was used for inferential statistics. P < 0.05 was considered statistically significant. Results: The mean age of the workers in urban areas was 36.38 ± 5.877 years, while in rural, it was 41.53 ± 6.755 years. The overall average score for rural ASHA workers was more (70.49 ± 14.018) when compared to the urban ASHAs (65 ± 13.400). The average years of experience were 6.14 ± 1.44 years in urban and 10.5 ± 2.66 years in rural areas. The daily working hours ranged from 3 to 10 h in urban and 2 to 10 h among rural ASHA workers. Conclusion: The overall score of rural ASHA workers was higher when compared to urban ASHAs. Even though the grading and performance of the ASHA workers were good, their expertise in identifying and tackling life-threatening conditions remains inadequate. This can be improved with more vigilant and periodic training and monitoring along with periodic recruitment at regular intervals.

The impact of accredited social health activists in India on uptake of modern contraception: A nationally representative multilevel modelling study

ABSTRACT The government of India introduced the Accredited Social Health Activist (ASHA) programme in 2006 to connect marginalised communities to the health system. ASHAs are mandated to increase the uptake of modern contraception through the doorstep provision of services. There is currently no evidence on the impact of ASHAs on the uptake of contraception at the national level. This paper examines the impact of ASHAs on the uptake of modern contraception using nationally representative National and Family Health Survey data collected in 2019–21 in India. A multilevel logistic regression analysis was performed to determine the effect of contact with ASHAs on the uptake of modern contraception, controlling for regional variability and socio-demographic variables. The data provide strong evidence that ASHAs have succeeded in increasing modern contraceptive use. Women exposed to ASHAs had twice the odds of being current users of modern contraception compared to those with no contact, even after controlling for household and individual characteristics. However, only 28.1% of women nationally reported recent contact with ASHA workers. The ASHA programme should remain central to the strategy of the government of India and should be strengthened to achieve universal access to modern contraception and meet sustainable development goals by 2030.

Barriers and Enablers of Postnatal Care by Accredited Social Health Activist (ASHA) Workers: A Community-Based Qualitative Study From Tribal Gujarat.

Background The care provided to the mother and child from delivery to six weeks after is defined as postnatal care. The postnatal period is both a happy and critical phase for the mother and the newborn. However, the provision of high-quality care services is often ignored during this time. The objective of this study was to assess postnatal care services quality by Accredited Social Health Activist (ASHA) workers and associated factors such as newborn care in rural tribal areas of Gujarat, India. Methodology An ethnographic approach was adopted. Four primary health centers (PHCs) were selected purposively from Sankheda Block, Chhotaudepur, a tribal district in the eastern part of Gujarat. Information on obstacles and facilitators of postnatal care services was collected using in-depth interviews (IDIs) with a purposive sample of 22 ASHAs working in selected PHCs. Qualitative data were analyzed using thematic analysis. Results The median age of the ASHA workers was 39 years and ranged from 30 to 51 years (N = 22). Most ASHAs encountered logistical challenges when offering postnatal care services (e.g., they struggled to care for the mother and her babies because they were missing essential equipment, such as a thermometer and a salter-type baby weighing machine, or they had broken equipment). The two main issues facing ASHAs were incentives and timely payments. There were concerns about their safety and physical security during fieldwork. The majority of ASHA workers had good experiences during postnatal home visits, and they received support from other healthcare workers. There were many misconceptions and false assumptions in the community regarding breastfeeding, prelacteal feeding, family planning, and contraception methods. ASHAs wanted to become long-term government employees and believed they were entitled to sufficient training, assistance, recognition, and remuneration for the duties they performed. Conclusions Postnatal mothers receive considerably less attention than antenatal mothers because it mostly depends on ASHA workers and field staff. ASHA workers are doing their best regarding postnatal care. This study revealed some issues ASHAs face, including logistic issues, transportation issues, regular and timely payment issues, and local-level acceptance issues.

Assessment of Awareness and Knowledge of Oral Potentially Malignant Disorders and Oral Cancer among Accredited Social Health Activist Workers from Randomly Selected Blocks of Thrissur District, Kerala, India: A Cross Sectional Study

Introduction: Oral and oropharyngeal cancers are prevalent in the head-and-neck region, with global rates decreasing. However, in India, they are rising due to a lack of knowledge about risk factors and symptoms. The Indian government launched the National Health Mission to provide accessible, affordable, and reliable primary health care. Accredited social health activist (ASHA) workers can link health services to rural people. This study aimed to evaluate the awareness level among these workers about potentially malignant oral disorders and oral cancer (OC). Materials and Methods: A predesigned semi-structured questionnaire-based descriptive cross-sectional study was conducted among 150 voluntary ASHA workers from randomly selected blocks of Thrissur district, Kerala, to collect the data. Results: Our study showed that the majority of ASHA workers (82.3%) were aware of the role of tobacco in OC. A substantial portion of workers (88.4%) expressed that early detection of OC is possible at its initial stage. Less than 10% (7.5%) of all the ASHA workers were educated by dentists, whereas almost three-quarters (75.5%) of ASHAs preferred primary health center health practitioners as primary representatives for early OC detection, despite their being poorly trained in the early diagnosis and detection of OC. Conclusion: India has made progress in controlling malignancies but still lags in reducing OC mortality rates. Spreading knowledge of contributory agents and early detection methods through ASHA workers could reduce the incidence and mortality of OC. Including more dentists in the public health system and training ASHA workers on early OC detection can play a major role in reducing its incidence.

Technology Empowerment of ASHA Workers Using E-Health Initiatives in Rural Rajasthan

Introduction: Electronic health (e-health) initiatives grant the tools and knowledge to improve health care, benefiting not only patients but also healthcare professionals and institutions. Objectives: To empower ASHA (Accredited Social Health Activist) technically in terms of using e-health initiatives and to assess feasibility and usefulness of such initiatives; to enhance digital health literacy and to observe the effect of training and skill development of grass root level healthcare workers engaged in primary care. Method: A prospective observational cohort study, in which ASHA’s were recruited in two selected villages of Rajasthan. They were trained to use a web-based application, developed for use on portable device (tablet) to screen, diagnose and provide health education on non-communicable diseases. In-depth interviews and group discussions were done with ASHAs to know their views about the tablet and application use. Results: There was 19.3%, 29.3% and 40% improvement in ASHAs’ ability to measure haemoglobin, blood sugar and blood pressure respectively and also an improvement of 86.5% in tablet and application operation was observed. This improvement in ability of ASHAs was highly significant for all above four parameters (p-value <0.001). ASHAs agreed that the app was useful and helped them connect to the people and explain things more properly. They reported the beneficiaries understood more clearly through pop- up videos which also proved beneficial in increasing compliance. Conclusion: Training ASHA worker in e-health technology is feasible and can assist in screening and management of non-communicable diseases.

Comprehending Knowledge, Practices, and Perceptions of Community Health Workers Regarding Adolescent Health Program: A Cross-Sectional Inquiry in Bellary District, Karnataka

Abstract Introduction Community health workers are crucial in improving health and bridging gaps between communities and health care services. They are integral to various national health initiatives to prevent diseases and enhance well-being. Providing health care services to adolescents is a pivotal responsibility for auxiliary nurse midwives (ANMs) and Accredited Social Health Activist (ASHA) workers. Objectives This study aims to evaluate the community health workers' comprehension, implementation practices, and viewpoints regarding the implementation of the Rashtriya Kishor Swasthya Karyakram (RKSK) program. Methodology The research was conducted across primary health centers in Hagaribommanahalli and Huvina Hadagali taluks. A two-stage sampling technique was utilized to gather data from 404 participants, who were administered a semi-structured questionnaire. Data analysis was performed using SPSS version 20 software. Results Out of the total community health workers, 336 (83.2%) were ASHA workers, while 68 (16.8%) were ANMs. The mean age of the community health workers was 38 ± 6 years, and 79% had received training in the RKSK program. Of the respondents, 60.9% demonstrated adequate knowledge, and 79.5% correctly executed the RKSK activities. In addition, 80.5% of the participants strongly concurred with statements reflecting their perception of the RKSK program. Conclusion The study findings indicate that community health workers possess a commendable understanding of the RKSK program. Furthermore, their effective implementation practices and positive perceptions regarding the RKSK program and its activities suggest a genuine commitment to supporting the RKSK program and other health-related endeavors targeting adolescents.

Knowledge and perception of Accredited Social Health Activists' about breastfeeding and complementary feeding practices: AQualitative study using Focus Group Discussion

Background: Accredited Social Health Activist (ASHA) workers bridge the gap between the health system to provide accessible, affordable, accountable, reliable, and effective primary healthcare. Aims and Objectives: To determine the views of ASHA workers about breastfeeding and complementary feeding. Materials and Methods: Focus Group Discussion (FGD) with ASHA workers in a rural Primary Health Centre was conducted to assess their knowledge and perception regarding breastfeeding and complementary feeding. It was a qualitative study conducted by using FGD. The study had been conducted in one block of one district of Maharashtra, which was selected purposively for the study. All ASHAs from the nearby nine villages belonging to Nere Primary Health Center were included as study participants. Statistical analysis: The interview transcribing method was used to analyze the data. Results:The ASHAworkers had good knowledge about the importance of breast milk and breastfeeding. Already, they were giving information to the pregnant ladies and lactating mothers in their villages. They had little knowledge about the Infant and Young Child Feeding practices, breastfeeding positions and suggested the conduction of training to learn effective breastfeeding techniques. Conclusions: All ASHA workers have good knowledge about the importance of breast milk, and they realized the importance of effective breastfeeding techniques. It is recommended to conduct lactation training for ASHAworkers, and pregnant and lactating women.

A Study to Assess the Effectiveness of Planned Teaching Program on Awareness Regarding Environmental Sanitation among the ASHA (Accredited Social Health Activist) Workers Working in Selected Rural Community Area

Background: Water, sanitation and waste management are important driving forces for community health in India. A clean environment, open defecation free areas, personal hygiene practices among the individuals, proper solid and liquid waste management, and availability of adequate safe drinking water determine the health of individuals as well as the community. Aim and Objective: A study was planned to assess awareness regarding environmental sanitation among the ASHA (Accredited Social Health Activist) workers working in selected rural community area. Material and method: A per-experimental pre-test post-test design was used to assess the effectiveness of planned teaching program on the awareness of 30 ASHA (Accredited Social Health Activist) Workers selected by non-probability convenient sampling. Result: The analysis and interpretation revealed that the effectiveness of planned teaching program as the post-test awareness score of the ASHA workers regarding environmental sanitation was significantly higher than the pre-test awareness score. Conclusion: Our result indicates that the planned teaching program was an effective tool for improving the awareness regarding environmental sanitation among ASHA (Accredited Social Health Activist) Workers.

What they know about their work, barriers, and challenges faced by the community health workers while performing their multiple roles: mixed method study in India

Background: Accredited social health activist (ASHA) forms the backbone of National Health Mission (NHM) as they are the important link between the community and the health system, her services become very crucial for the success of NHM. They are occupied by multiples roles, responsibilities and they are expected to perform at optimum level. Aim was to assess the knowledge and practice of ASHA workers regarding their work responsibilities and to explore the barriers and challenges faced by them while performing their multiple roles. Methods: An explanatory mixed-methods study was conducted among community health workers (ASHA) of having at least one years of experience at Uttarakhand, India with 150 ASHAs for quantitative and 14 for qualitative. Purposive sampling was employed for both the approaches. Results: Quantitative approach shown that almost 91% of ASHA are having the knowledge about the importance of colostrum milk followed by importance of Anganwadi center (83%), immunization (79%), general health (70%), and birth preparedness (69%). The core thematic areas in qualitative result represented as personal, psychological, economic, social and environmental factors. They showed a level of unhappiness and distress related to their work overload and incentives. Conclusions: In general, ASHAs are having adequate knowledge about their job responsibilities, there is more training needed about maintaining the records and documentation process. There is immediate need to overcome the barriers and challenges they are facing, which can hamper their performance level.

A comparative study of knowledge of accredited social health activist (ASHA) workers regarding child health services working in rural and urban areas of a block of Haryana

National Rural Health Mission (NRHM) has created a cadre of trained female community health activists called Accredited Social Health Activist (ASHA) to strengthen the health care system and to mobilize community towards increased utilization of existing health services. The contribution of the Accredited Social Health ActivistASHA) to the achievement of the country’s targets for new-born & child health services is critical. The present study was planned with objective to assess & compare the level of knowledge of ASHA workers regarding child health services working in rural and urban areas of a block of Haryana. The present cross-sectional, community-based study was conducted in block Barwala, district Hisar of Haryana. The assessment of knowledge of ASHA workers was done on the basis of scoring. Appropriate statistical tests like percentages and chi-square (χ2) test were applied. Regarding child health services majority of ASHA workers had good knowledge, assessed by score gained by them and none of them was having poor knowledge about child health services. However, in rural area score gained was better than urban area & the observed difference was found to be statistically significant. Majority of ASHA workers either working in rural or urban areas, were having inadequate knowledge about identification of danger signs during diarrhoea & acute respiratory infection in a child and danger signs of new born. They had adequate knowledge regarding cord stump care; breast Feeding practices; routine Immunization; Vitamin A supplement and home based post natal care (HBPNC) visits. Inadequate knowledge of ASHA workers regarding new born care should be taken into consideration. Supportive supervision should be done in their working area.

Knowledge of Accredited Social Health Activist (ASHA) Workers Regarding Maternal Health Services: A Comparative Study between Rural and Urban Areas of a Block of Haryana

Introduction: All people, everywhere, deserve the right care, right in their community. In any community,maternal mortality ratio strongly reflects the overall effectiveness of health systems. To increase utilization of existing health services, Accredited Social Health Activist (ASHA) is the key component of the National Rural Health Mission. The present study was planned with objective-to assess & compare the level of knowledge of ASHA workers regarding maternal health services in between rural and urban areas of a block of Haryana. Method: The present cross-sectional, community-based study was conducted in block Barwala, district Hisar of Haryana. The assessment of knowledge of ASHA workers was done on the basis of scoring. Appropriate statistical tests like percentages and chi-square (χ2) test were applied. Result: Regarding maternal health services majority of ASHA workers had good knowledge, assessed by score gained by them and none of them was having poor knowledge about maternal health services. However in rural area score gained was better than urban area & the observed difference was found to be statistically significant. Knowledge of identification & treatment of anaemia and identification of danger signs during pregnancy were inadequate among ASHA workers of both areas. Conclusion: Knowledge of ASHA workers was inadequate as far as anaemia and danger signs during pregnancy were concerned. Frequent and regular refresher training should be organized in their working area.

A STUDY ON THE KNOWLEDGE PRACTICE GAP OF ASHAS ABOUT HER WORK PROFILE FROM NORTHERN INDIA

Objective: The objective of the study was to study the knowledge practice gap of Accredited Social Health Activist (ASHAs) about her work profile from northern India. Methods: The study was carried out between June 2021 and November 2021. The study comprised all 97 local ASHA employees, who were all questioned using a self-made semi-structured questionnaire. Results: Data were collected from 94 ASHA workers. 91 (96.8%) of ASHA workers completed 8th standard or more of schooling. 92 (97.87%) of ASHA workers completed training before working as ASHA. Almost all the study subjects had knowledge about immunization activities, accompanying delivery cases, and participation in family planning activities. Very few ASHAs knew that active participation in village health planning, providing counseling to the residents on various health issues and addressing adolescence health issues with residents of the village were part of her work profile. Drug kit stock register, format for individual birth preparedness plans, format for first examination of the new born, and home visit form for high risk baby were relatively deficient with respect to their maintenance and completeness. Conclusion: ASHAs do offer a variety of services and have the ability to contribute to the provision of primary healthcare, but they must still put their knowledge to use when offering services and/or advise to negotiate access to healthcare for underprivileged women and children.

Improving symptom assessment and management in the community through capacity building of primary palliative care: A study protocol of exploratory research

Aim: To determine the effectiveness of capacity building program on palliative care (PC) in enhancing the capacity of the primary health care workers in need assessment and symptom management of cancer patients. Background: In India, less than one percent of people living with cancer have access to palliative care since most are from low- and middle-income groups. Accredited social health activist (ASHA) and primary health care workers are grassroots workers who are the first contact with family members and are seldom aware of PC in India. It is essential to train them to give practical and efficient care to needy people. Design: A quasi-experimental design with follow-up will be conducted using an evaluative approach. Methods: The study population consists of 1440 Primary Health Care Workers (staff nurses, ANMs, and ASHA workers) of three taluks of Udupi District, Karnataka State, India. Training on PC will be provided for ASHA workers for one day and ANM/Staff nurses for three days. After their training, they are expected to demonstrate the gain in knowledge & skill in providing PC for cancer patients by identifying and implementing PC services using a mobile app at the primary healthcare level. Discussion: Palliative home care can give comfort and reduce patients' financial burden, and this training may help to improve the quality of life of needy patients. Impact: If this palliative care training program succeeds, it can be integrated into the healthcare continuum, making it an essential component of primary healthcare delivery to achieve universal health coverage. Moreover, home-based PC supports patients who want to die at home even though it reduces hospital stay costs. Trial registration: CTRI/2020/04/024792.

EVALUATION OF KNOWLEDGE, AWARENESS AND IMPLEMENTATION GAP OF HOMEBASED NEWBORN CARE AMONG ASHA WORKERS AND MOTHERS IN RURAL AREAS OF AMRITSAR, PUNJAB

Background: India contributes to 17.5% of the world's population, nearly 20% of the total live births, in spite of signicant steps that have been taken to reduce child and neonatal mortality, yet accounts for 26% of global neonate deaths. India has witnessed a signicant reduction in the number of neonatal deaths - from 1.35 million in 1990, to around 0.76 million in 2012. In an attempt to address the issue of high neonatal mortality, Government of India issued Home Based Newborn Care (HBNC) guidelines in 2011; and Accredited Social Health Activist (ASHA) workers were mobilized for providing maternal and immediate newborn care. Methods: This cross-sectional study was conducted in the rural areas of Amritsar District. The duration of study was 1 year (January 2020 to December 2020) and data was collected using a predesigned pretested semi-structured questionnaire. Total 400 subjects were recruited in the study in which 200 ASHA workers and 200 mothers were included.20-30 ASHA workers who had completed their NRHM training were selected from each block randomly. 20-30 mothers from each block of Amritsar were selected randomly. Results: In this cross-sectional study, 90% ASHA workers had knowledge on weighing, temperature measurement (78%), feeding frequency (63%), handwashing (2%) and Kangaroo Mother Care (KMC) positioning (12%) . Majority of ASHAs had knowledge about danger signs like bleeding stump (95%) ,distended abdomen (75%), fever (69.5%), chest indrawing (61.5%) and lethargy (35%).The study concluded that 54% of ASHA workers provided average quality and 46% ASHAs provided good quality care of newborn care. Out of 200 mothers, 74.5% mothers were aware of frequency of feeding, initiation of breastfeeding (32%), proper positioning of breastfeeding and attachment (21%), urine and stool frequency (44%), danger signs for which they should seek help (41%), temperature assessment (59%) and Kangaroo Mother Care positioning (2%). Conclusion: Present study concluded that majority of newborns get all the age-appropriate home visits but very less mothers had knowledge and awareness about HBNC provision.

Impact of Covid-19 Pandemic on the Accredited Social Health Activists: An Exploratory Study in Rangareddy District of Telangana, India

The whole world is immensely dealing with the COVID-19 which was originated from the Wuhan city in the end of 2019. All the countries have been in a devastating state by the sudden outbreak which led to many deaths from the deadly infection. Many low- and middle-income countries are being suffering due to the poor healthcare infrastructure and a smaller number of healthcare workers. India is one of them. Due to the insufficient number of healthcare workers, the workload on the existing numbers has increased to a double-fold, especially on the grass-root workers. Accredited Social Health Activist (ASHA), an initiative of the National Rural Health Mission in India is involved in the implementation of the primary health care facility at the grassroot level. The effective implementation of the health care policy depends on the performance of the ASHA workers. The present study aims to identify the challenges and barriers faced by the ASHA workers while delivering their services during the pandemic times and provide policy suggestions for strengthening of the grass-root level health care workers for facing any kind of future health emergencies.

Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study

Purpose: To develop and validate the questionnaire and to translate it to the local vernacular language, Kannada. To assess the level of awareness and knowledge about common eye conditions among the ASHA workers in the rural communities of Udupi district. Materials & Methods: A cross-sectional observational study was conducted on32 ASHA (Accredited Social Health Care Activists) workers of age ranging from 32-48 years (SD + 3 years) from January 2019 to April 2019. This study was presented and approved by the Institutional Research Board, (Manipal College of Health Professions) and written consents were taken from the subjects. A validated questionnaire was used in this process. Beforehand this questionnaire was developed from the conclusion of a structured focus group discussion comprised of vision science experts. The phase and content validation proceeded. This validated questionnaire was used to elicit the responses from the ASHA workers of Udupi district, India. This structured questionnaire consisted of questions from refractive errors, cataract, diabetic retinopathy, glaucoma, pink eye or madras eye, common stye and retinopathy of prematurity. Responses were analysed by calculating the percentage. Having heard of the eye disease in question was defined as ‘‘awareness’’ and having some understanding of the eye disease was defined as ‘‘knowledge’’. Results: A total of 32 ASHA workers from Udupi district were included in the study with the mean age of 40±5 years. The awareness about myopia was 100% (32), hyperopia 87.50% (28), presbyopia 28.12% (9), cataract 96.87% (31), diabetic retinopathy 100% (32), glaucoma 71.87% (23), pink eye or madras eye 71.87% (23), common stye 18.75% (6) and retinopathy of prematurity 40.62% (13). Conclusion: The results indicate that the study population had a high level of awareness about eye diseases, but their knowledge of the diseases was still limited. Very less awareness about common style, presbyopia, and retinopathy of prematurity. ASHA workers require a lot more awareness and knowledge about common eye diseases which can be improved by conducting health care programs and giving them training.

Assessment of knowledge of ASHA workers regarding MCH services and practices followed by mothers - A field study.

Accredited social health activist (ASHA) workers act as a "bridge" between rural people and health service outlets and play a central role in achieving national health and population policy goals. According to the National Family Health Survey (NFHS) V (2019-2021) data, infant mortality rate (IMR) is still high in rural areas (32.4 per 1000 live births) in Punjab, compared to urban areas (20.1). Maternal mortality ratio (MMR) is also high (129 per lakh), according to sample registration system (SRS) 2016-2018 data. In this descriptive, cross-sectional study conducted at RHTC, Bhadson, we assessed the knowledge of ASHA workers regarding maternal and child health (MCH) services and their provision by them to their beneficiaries (mothers with children aged 0-6 months). Out of the total 196 ASHA workers, 72 were selected randomly to assess their knowledge, while 100 beneficiary mothers were interviewed face to face to assess the services provided by the ASHA workers. Almost 65.2% of ASHA workers were above 35 years of age. Majority of the ASHA workers (40/72) replied that average weight gain in pregnancy is 10 kg. Very few, that is, 17 (23.6%), ASHA workers knew that breastfeeding should be started within the first hour after delivery of the baby. Counseling regarding nutrition, birth preparedness, institutional delivery, and birth registration was given by ASHA workers to 75%-85% of mothers. There was statistically significant improvement in the practices by mothers with the counseling given by ASHA workers regarding pre-lacteal feed, utilization of family planning methods, and delaying early bathing. The study concludes that ASHA workers have good knowledge regarding various aspects of antenatal period, but when it comes to postnatal period and care of the newborn, there are some lacunae. These aspects of newborn care need to be reinforced into the refresher trainings of the ASHA workers.

Assessment of knowledge, attitude, practice (KAP) regarding directly observed therapy (DOT) in tuberculosis among ASHA workers from tribal subpopulation zone of Rajasthan.

A high level of community awareness and positive perception towards tuberculosis and its management is crucial for the successful outcome of any control measure. In India the Accredited Social Health Activist (ASHA) plays a key role in providing awareness and counselling on healthcare issues and management, particularly in remote areas. The tribal population is vulnerable to such infectious diseases due to resource limitations and remote locations. We assessed the knowledge, attitude, and practice (KAP) regarding directly observed therapy (DOT) among ASHA workers in the tribal belt of the Sirohi district of Rajasthan state. This cross-sectional study was conducted among ASHA workers of Sirohi district from January 2021 to June 2021. A predesigned and structured questionnaire was used to gather information on knowledge, attitude, and practices regarding the management of tuberculosis and DOT. A total of 95 ASHAs participated in the study with a mean age of 35.82 years. Good knowledge (Mean score = 6.2947 ± 1.08052) was observed regarding tuberculosis and DOT. 81% (n = 74) have good knowledge regarding DOT whereas most have a poor attitude and only 47% have adequate practice. A 55% of ASHAs did not adhere even a single TB patient in the last three years. In our study, knowledge gaps were identified which may result in substandard patient care. The structured refresher training towards DOT and also training to work in tribal areas will further improve the KAP of ASHAs. It might be needed to provide a module or curriculum regarding awareness among ASHAs for strengthening follow-up system for tuberculosis patients among the tribal population.

Duties, responsibilities, and challenges of community health workers: Evidence from a health block of northern indian province

Introduction: Accredited Social Health Activist (ASHA) worker is a significant frontline health worker that acts as a link between community and health services and helps delivering quality health services to vulnerable section of the society. The present study was conducted with an objective to explore the duties and responsibilities of the ASHA worker along with obstacles faced by them while discharging their duties. Methods: It was a cross-sectional study including 150 ASHA workers of a health block in Himachal Pradesh. Data were collected using a semi-structured questionnaire consisting of six subsections dedicated to different dimensions related to ASHA workers. Results: Majority of ASHAs stated that their job had a positive effect on their social relationships, confidence as well as their physical and mental health. About two-thirds workers failed to fulfill targets due to many activities running simultaneously. About 43.3% felt mental stress during the job and 20.7% workers experienced harassment by hospital staff. About 40% stated that they had received unsatisfactory training. Toilet facility was available for only 59.3% workers and safe drinking water for 64.7% ASHAs. Only 4.7% of ASHAs were satisfied with their monthly income. Conclusion: While ASHAs are working with dedication in the field, still they are experiencing many problems associated with their personal life, community norms, terrain of the workplace, transportation, and organizational issues. The study recommends few amendments as ASHAs being an integral part of Indian health system must be given their due consideration so that the vision of universal health coverage and sustained development can be attained effectively.

Depression, anxiety, stress among ASHA workers, in selected primary health centres in Southern Bengaluru

Background: The COVID-19 pandemic was caused by a novel corona virus first discovered in Wuhan, December 2019. The healthcare system in India was quickly overwhelmed as tens of thousands of people with flu-like symptoms swarmed the hospitals.Methods: The present community based cross-sectional study was conducted among the accredited social health activist (ASHA) workers working under the selected primary health centres from August 2020 to November 2020. Primary health centres were selected by using simple random sampling technique. Three primary health centres were selected from the southern region of Bengaluru. The data was collected, compiled and entered into a Microsoft excel worksheet and analyzed using statistical package for social sciences (SPSS) software v.22.0. Descriptive statistics and suitable tests of significance like Chi-square test were applied as required.Results: A total of 78 ASHA workers participated in the present study. Majority of them belonged to the age group of 33-44 years. The mean age of the participants was 34 (+1.390) years. The present study showed that, 56.5% of the study participants experienced depression, anxiety or stress during the time of COVID-19 pandemic. Around 65% of the ASHA and Anganwadi workers were aware of the personal prophylactic measures to be used to prevent COVID-19 disease according to the present study.Conclusions: A significant proportion (56.5%) of the ASHA workers experienced depression, anxiety and stress during this pandemic. Measures should be undertaken to address the same.