Effectiveness of the Training Course of ASHA on Infant Feeding Practices
at a Rural Teaching Hospital:
A Cross Sectional Study
Sushama S. Thakre, Subhash B. Thakre, Amol D.Thakre, Samir H. Golawar, Suresh M. More, Arun Y. Humne
1. Associate Professor, Preventive and Social Medicine, Indira
Gandhi Government Medical College, Nagpur, India.
2. Associate Professor, Preventive and Social Medicine,
Government Medical College, Nagpur, India.
3. Assistant Professor, J.N. Medical College, Wardha, India.
4. Assistant Professor and IMNCI/BPNI trainer,
Preventive and Social Medicine, Government Medical
College, Nagpur, India.
5. Statistician Cum Lecturer, Preventive and Social Medicine,
Government Medical College, Nagpur, India.
6. Professor and Head, Preventive and Social Medicine,
Government Medical College, Nagpur, India.
Introduction: Accredited Social Health Activists (ASHA) is the key functionaries for the effective implementation of maternal and child health care services at the grass root level in India. Method: The effectiveness of this training programme was assessed by conducting a pre-test and post-test assessments. The correct responses to the test items in the questionnaire were given one mark, with a maximum of 20 marks. Results: The training on the knowledge, attitude and practices of breast feeding was found to be effective. The difference in the pre and the post test score of the participants was found to be statistically significant (p<0.05). Conclusion: The ASHA workers and their supervisors gained the knowledge and skills on breastfeeding and complementary feeding after the training.
cite this article :
Sushama S. Thakre, Subhash B. Thakre, Amol D.Thakre, Samir H. Golawar, Suresh M. More, Arun Y. Humne. EFFECTIVENESS OF THE TRAINING COURSE OF ASHA ON INFANT FEEDING PRACTICES
AT A RURAL TEACHING HOSPITAL:
A CROSS SECTIONAL STUDY. Journal of Clinical and Diagnostic Research [serial online] 2012 August [cited: 2014 Dec 22 ]; 6:1038-1040. Available from http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=August&volume=6&issue=6&page=1038-1040&id=2284
Introduction The ASHA workers are undergoing a series of training episodes to acquire the necessary knowledge, skills and the confidence for performing their spelled out roles. They can educate and support new mothers on the early establishment of breastfeeding, the feeding of colostrum and the recognition of breast feeding problems (1). Evidence has suggested that the early breastfeeding (2), and the exclusive breastfeeding (3) rates in Maharashtra ranged from 52%-53% (4). ASHA work includes health and nutrition education on various aspects of the health of a mother and her child. Therefore, it is important for the ASHA workers to have adequate scientific knowledge about infant breastfeeding (5). The objective of the present study was to assess the knowledge (scientific and latest) and the attitude of the ASHA workers with regards to infant feeding, to identify the gaps in their knowledge and also to assess the effectiveness of the training course of ASHA on infant feeding practices.
Material and Methods
A community based, cross sectional study was undertaken at the Rural Health Training Centre, Saoner, District Nagpur, India during January to March 2011. 94 ASHA workers and 5 supervisors from the Saoner taluka, Nagpur district were the participants. The institutional ethics clearance and the participants’ informed consent were sought before the start of the study. A pre-designed, pretested and structured schedule was used for the data collection. A pretested questionnaire was administered to the participants for the data collection. The questionnaire consisted of 20 multiple-choice questions which covered issues on the entire IYCF (infant and young child feeding). After the pretest, the sessions on breast feeding, complementary feeding, and breast feeding attachment and positioning were under taken. The effectiveness of the training programme was assessed by conducting a post-test assessment by using the same questionnaire after the training programme. The correct responses to the test items in the questionnaire were given one mark, with a maximum of 20 marks. We divided the participants on the basis of their pre- and post-test scores into ‘very good score’ (if the participant secured ≥18), ‘good score’ (15-17) ‘average’ (12-14) and ‘below average’ score (≤11). The pre- and post-answer sets were evaluated, marked, and compared. Statistical analysis: The data were analyzed by using the Statistical Package for Social Science (SPSS), version 10 and the categorical data were analyzed by using Mc Nemar’s test.
A total of 99 ASHA supervisors and ASHA workers were enrolled in the study. The demographic characteristics revealed that 100% of the ASHA workers were literate; however, a majority were only 10th and 12th standard passed and only 5% were graduates. Almost all had one year of experience in health and social services. (Table/Fig 1) reveals the comparative score of the participants before and after the training on the breast feeding knowledge, attitude and practices. Earlier, the special training scores were as follows: very good 3(3.03%), good 65(65.66%), average 28(28.28%) and below average 3(3.03%). Immediately after the special training, 64 (64.45%) participants got very good scores, 31 (31.31%) got good scores and 4 (4.04%) got average scores (Table/Fig 2). This difference was found to be statistically significant (P=0.001). There were no below average scores in the post-test. The mean pretest score was 15.11 ± 1.89, which had risen significantly (P=0.001) post-test to a mean of 17.30 ± 1.59.
The ASHA workers are the key functionaries for the effective implementation of maternal and child health care services at the grass root level in India. They are formally trained for basic health care, predominantly for mothers and their children. The ASHA workers are the key functionaries who mobilize mothers and other stake holders of the community. They counsel women on breast-feeding and complementary feeding (1). The nutritional counseling of mothers of children who are aged 0–2 years is effective for a positive behavioural modification and it should be actively incorporated and emphasized. The children need to be fed more and this can be achieved by the counseling of mothers by ASHA, AWWs, auxiliary nurse-midwives, or supervisors. Social mobilization and community participation are critical for the success of any public health programme (6),(7). In the present study, all the ASHA workers had an accurate knowledge on the fact that breastfeeding had to be started as early as possible, immediately after the child’s birth. Similar findings have been reported among other health care personnel (8),(9). 94.44% of the workers had proper knowledge on the fact that pre-lacteal feeds needn’t be given. 55.55% of the ASHA workers knew that breastfeeding had to be given on-demand and similar findings have been reported by other workers also (9),(10). The results also suggested that the training on infant and young child feeding practices had significantly (P=0.001) improved the theoretical as well as the practical knowledge on breastfeeding in the trainees. These findings were similar to those of another study; however, that study was conducted for the supervisors of AWWs (11).In our study, ‘take action’ cards and simple key messages were used for the teaching sessions and they probably helped in a better transfer of knowledge.
The ASHA workers and their supervisors gained the knowledge and skills on breastfeeding and complementary feeding after the training.
The development of ideas and the mode of their presentation in this work owe much to Dr. Archana Patel, M.D. Paediatrics, Professor and Head, IGGMC, Nagpur from whom I have learned and continue to learn a great deal. Her kin interest, constructive criticism and constant encouragement were the prime factors that made my task easy and enabled me to complete this work successfully. With great pleasure, I acknowledge my gratitude to respected Dr. Arun Humane, Professor and Head, Department of community medicine, Government Medical College, Nagpur for his encouragement. My special thanks to all the staff members of rural health Training Centre, Saoner. I take this opportunity to thank all study participants for their support. Abbreviatioiations ASHA: Accredited Social Health Activist AWW: Anganwadi Worker IYCF: Infant and young Child feeding Practices NFHS: National Family Health survey
Taksande A, Tiwari S, Kuthe A. The knowledge and the attitudes of the anganwadi supervisor workers on infant (breastfeeding and complementary) feeding in the Gondia district. Indian J Community Med. 2009 July; 34(3): 249.