A Cross-Sectional Study of Knowledge and Practices of Asha Towards Maternal Health Care in Rural Field Practice Area of PHC Kalyanpur, Bihar

Background: ASHAs are essential to the success of NHM in India since they are the ones who are on the front lines. In order to provide maternal health services to the community, it is vital to ascertain whether they possess the requisite abilities and procedures. In order to make any necessary adjustments, it is crucial to discuss these worries and learn how people feel about the training component. A research to assess the abilities and strategies employed by ASHAs working in the catchment area was studied in the rural field practice area of the Darbhanga Medical College at PHC Kalyanpur, Samastipur, Bihar, to evaluate ASHA knowledge and practices, as well as the gaps between them, regarding maternal health care during pregnancy and postpartum. Methods: This community-based cross-sectional survey was conducted in the rural field practice area of PHC Kalyanpur from January 2021 to December 2022. All 340 mothers and the 68 ASHAs that were chosen were personally contacted. All of the participants were first briefed on the study’s objectives and asked for consent after being briefed on their part in the study. A semi-structured questionnaire that had been pre-tested was used to conduct one-on-one interviews to assess knowledge of each ASHA. Through one-on-one interviews with chosen beneficiary women, the practices of ASHA regarding the delivery of maternal health services were evaluated. Results: 28% of the participating ASHAs have finished eighth grade, while 61% of them were qualified more than tenth grade and 11% of them were graduate. 44% had experience of at least 15 years and 9% of the participants had fewer than ten years of experience. 75% of ASHA support early registration of expectant mothers at a nearby PHC before the third month of pregnancy. 14.70% of the ASHAs were aware of three danger signs of pregnancy namely swelling of legs, convulsions, high blood pressure and none of them knew how high blood pressure impacts the growth of the foetus. The majority of ASHA staff 60.30% advocated for a routine checkup within two weeks of delivery, whereas the remaining 39.70% either were unaware of it. Conclusion: The majority of ASHA staff, according to the aforementioned survey, has average expertise, which requires continuous revision and updating. ASHA employees were highly knowledgeable about prenatal care, with the exception of anaemia throughout pregnancy. They guided well about the public sector’s prenatal, antenatal, and intranatal care services. The vast majority of women were utterly pleased with the antenatal services offered by ASHA. In order for the ASHAs to obtain the necessary knowledge and skills with the most recent improvements, they should be undergoing on-the-job training.      【背景】印度国家健康任务（National Health Mission，NHM）的成功离不开认证社会健康宣传员（Accredited Social Health Activist，ASHAs），因其作为一线工作者承担核心职责。为向社区提供孕产妇健康服务，需明确他们是否具备所需的技能与操作规范。同时，探讨现存顾虑并了解相关方对培训环节的看法，对做出必要调整至关重要。本研究在比哈尔邦萨马斯蒂普尔县卡利安普尔初级卫生保健中心（Primary Health Centre，PHC）的德尔班加医学院农村实习区域开展，旨在评估辖区内ASHAs在妊娠期及产后孕产妇保健方面的知识、实践情况及两者间的差距，以了解其工作能力与策略。 【方法】本研究于2021年1月至2022年12月在卡利安普尔初级卫生保健中心的农村实习区域开展，为基于社区的横断面调查。研究共纳入340名产妇与68名入选的ASHAs，均进行了当面联系。所有参与者首先被告知研究目的，并在了解自身在研究中的参与要求后签署知情同意书。研究采用经预试验的半结构化问卷，通过一对一访谈评估每名ASHA的知识储备；同时通过对入选受益妇女的一对一访谈，评价ASHAs在孕产妇健康服务提供工作中的实际操作情况。 【结果】参与研究的ASHAs中，28%完成了八年级教育，61%拥有十年级以上学历，11%为大学本科毕业。44%的ASHAs拥有至少15年的工作经验，9%的参与者工作年限不足10年。75%的ASHAs会协助孕妇在妊娠第三个月前到附近的初级卫生保健中心完成早期建档。仅14.70%的ASHAs知晓妊娠期的3种危险征兆，即腿部肿胀、抽搐与高血压，但无人知晓高血压会对胎儿生长发育造成何种影响。60.30%的ASHAs倡导产妇在分娩后两周内进行常规检查，剩余39.70%的人员对此并不知情。 【结论】本次调查显示，大部分ASHAs的专业知识处于中等水平，亟需持续的修订与更新。除妊娠期贫血相关知识外，ASHAs对产前保健的掌握程度较高，且能够清晰指导群众使用公立部门提供的产前、孕期检查及产时保健服务。绝大多数受益妇女对ASHAs提供的孕期保健服务表示极为满意。为使ASHAs能够紧跟最新进展掌握必要的知识与技能，应为其提供在职培训。