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.
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).
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).
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.
"Missing emergency symptoms, even after having collected information about them, is a surprisingly common and dangerous tendency among CHWs . Rafiki with the help of the rules used to define these symptoms and the reasoner, can make sure that this information is not missed. "
[Show abstract][Hide abstract] ABSTRACT: Community Health Workers (CHWs) act as liaisons between health-care providers and patients in underserved or un-served areas. However, the lack of information sharing and training support impedes the effectiveness of CHWs and their ability to correctly diagnose patients. In this paper, we propose and describe a system for mobile and wearable computing devices called Rafiki which assists CHWs in decision making and facilitates collaboration among them. Rafiki can infer possible diseases and treatments by representing the diseases, their symp-toms, and patient context in OWL ontologies and by reasoning over this model. The use of semantic representation of data makes it easier to share knowledge related to disease, symptom, diagnosis guidelines, and patient demography, between various personnel involved in health-care (e.g., CHWs, patients, health-care providers). We describe the Rafiki system with the help of a motivating community health-care scenario and present an Android prototype for smart phones and Google Glass.
10th IEEE International Conference on Collaborative Computing: Networking, Applications and Worksharing (CollaborateCom 2014), Miami, Florida (USA); 10/2014
[Show abstract][Hide abstract] ABSTRACT: Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.
The Lancet Oncology 04/2014; 15(5):489-538. DOI:10.1016/S1470-2045(14)70029-4 · 24.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Despite the development of national community-based health worker (CBHW) programmes in several low- and middle-income countries, their integration into health systems has not been optimal. Studies have been conducted to investigate the factors influencing the integration processes, but systematic reviews to provide a more comprehensive understanding are lacking.
We conducted a systematic review of published research to understand factors that may influence the integration of national CBHW programmes into health systems in low- and middle-income countries. To be included in the study, CBHW programmes should have been developed by the government and have standardised training, supervision and incentive structures. A conceptual framework on the integration of health innovations into health systems guided the review. We identified 3410 records, of which 36 were finally selected, and on which an analysis was conducted concerning the themes and pathways associated with different factors that may influence the integration process.
Four programmes from Brazil, Ethiopia, India and Pakistan met the inclusion criteria. Different aspects of each of these programmes were integrated in different ways into their respective health systems. Factors that facilitated the integration process included the magnitude of countries' human resources for health problems and the associated discourses about how to address these problems ; the perceived relative advantage of national CBHWs with regard to delivering health services over training and retaining highly skilled health workers ; and the participation of some politicians and community members in programme processes, with the result that they viewed the programmes as legitimate, credible and relevant. Finally, integration of programmes within the existing health systems enhanced programme compatibility with the health systems' governance, financing and training functions. Factors that inhibited the integration process included a rapid scale-up process; resistance from other health workers; discrimination of CBHWs based on social, gender and economic status; ineffective incentive structures; inadequate infrastructure and supplies; and hierarchical and parallel communication structures.
CBHW programmes should design their scale-up strategy differently based on current contextual factors. Further, adoption of a stepwise approach to the scale-up and integration process may positively shape the integration process of CBHW programmes into health systems.
BMC Public Health 09/2014; 14(987). DOI:10.1186/1471-2458-14-987 · 2.26 Impact Factor
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