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Sciknow Publications Ltd. IJMCH 2015, 3(2):71-79
International Journal of Maternal and Child Health DOI: 10.12966/ijmch.05.03.2015
©Attribution 3.0 Unported (CC BY 3.0)
Knowledge Test Development & Motivational Skill Assessment of Com-
munity Health Workers (ASHA) on Maternal and Child Health Care: A
Micro Study in Rajasthan, India
Ghan Shyam Karol1,* B K Pattanaik2 Jayanta K Das1
1National Institute of Health and Family Welfare, Munirka, New Delhi-110067 India
2School of Extension and Development Studies, IGNOU, New Delhi-110068 India
*Corresponding author (Email: gskarol72@yahoo.co.in)
Abstract - This study on knowledge test development and assessment of motivational skill among ASHAs has covered 200
samples. The tryout of knowledge test was done over 100 samples, while final assessment of knowledge and motivational skill
was conducted over 200 ASHAs belonging to different age, caste and educational level groups. The result shows that, although
the knowledge level of ASHAs in MCH and family planning is high, yet their motivational skill is low as compared to knowledge
gained. As motivational skill is more important for a grassroots health worker in the delivery of preventive MCH and family
planning services, therefore, it is suggested that ASHAs training curriculum should be comprised exclusive module on motiva-
tion, communication, community participation and leadership skill components. The age, educational qualification and caste
found having negative correlation with motivation of MCH care and family planning services. Thus, when recruiting ASHAs
preferences must be given to those who are in the young age below 35 years. However, higher qualified women such as graduates
and post graduates and also women belonging to upper caste categories may not necessarily be considered as preferred choices
for the post of ASHAs over their counterpart with relatively less qualification and are in lower caste group. Women having more
motivation, leadership, counseling, convincing and communication skill with some work experience in health and health related
jobs be considered as first choice for the post of this grassroots health workers. Women those who are really motivated, have
grassroots connection, and with better communication skill are better stakeholders for the post of ASHA. It is suggested that
areas specific standardized knowledge test on Maternal and Child Health care and Family Planning should be developed by the
institutions monitoring and evaluating the activities of these grassroots preventive health care services providers and gaps
needed to be identified and on-the-job and hands-on training be continuously be imparted.
Keywords - Knowledge Test, Motivational Skill, MCH care, Family Planning
1. Introduction
Several countries in sub-Saharan Africa and South Asia are in
the process of scaling up CHW (Community Health Worker)
interventions in efforts to meet the Millennium Development
Goals in the run up to 2015(Rao, 2013). The CHWs enable
access to and utilization of health services and inculcate
healthy behaviours among the communities (Lewin, Muna-
bi-Babigumira and Glenton, 2010). They are preponderantly
deployed to cater to underutilized services, unmet health
behaviours and underserved populations (Lewin, Muna-
bi-Babigumira and Glenton, 2010).The CHW‟s contribution
to disease control, immunization and family planning pro-
grammes are already established (Shrestha, Baral and Weir,
2003).
In 2005, as a key component of efforts to expand access to
health services in underserved areas, India‟s National Rural
Health Mission (NRHM) introduced the accredited social
health activists (ASHA), a CHW (IFPS Technical Assistance
Project, 2012). Under the NRHM, the ASHA is a female
volunteer selected by the community, deployed in her own
village (one in every 1000 population) after a short training on
community health(MoHFW, 2005). She is preferred to be
between 25 and 45 years old, with minimum formal education
of 8 years and demonstrable leadership quality (MoHFW,
2005).Some of the important duties and responsibilities of
ASHAs are: (i) to create awareness and provide information
to the community on determinants of health; (ii) to counsel
women on maternal and child health care; (iii) to mobilize the
community and facilitate them in accessing health and health
related services; (iv) to provide primary medical care for
minor ailments; and (v) to impart health education on sanita-
tion and other health related problems. As a change agent in
the health sector, she will play a vital role in improving the
health indicators. A study conducted by Gosavi et.al. (2009)
72 International Journal of Maternal and Child Health (2015) 71-79
has found that the challenges faced by most of the ASHA
were lack of support from PHC staff, the lack of good training,
unclear reimbursement policy and poor clarity in how to
collaborate with the ANMs and Anganwadi workers. The
impact of NRHM and ASHA would be meaningful when the
individual ASHAs who are chosen and trained perform as
effective link workers for better use of health facilities and
basic health services (Bhargavi and Sharma, 2014).
The knowledge of ASHA workers on maternal and child
health (MCH) care is critical to effective implementation of
MCH services at the grassroots level. Building of knowledge,
skill and attitude of ASHAs on maternal and child health care
is critical to effective delivery of their duties and responsibil-
ities. Srivastava and Srivastava (2012) found that despite the
training given to ASHAs lacunae still exists in their know-
ledge regarding various aspects of child health morbidity and
suggested that refresher training should be conducted for
newly recruited ASHA workers. The effectiveness of ASHA
worker largely depends on the training and support from both
the health system and the community (Shashank et. al., 2013).
Since the implementation of ASHA through NRHM less
number of studies has been conducted to develop a standar-
dized knowledge test for ASHA and on their knowledge and
motivation capabilities in various aspects of MCH care. In
this study an attempt has been made to develop a knowledge
test and assess the knowledge and motivation of ASHAs on
MCH care services.
2. Objectives
Objectives of this study are:
1. to develop a knowledge test for ASHAs in Maternal
and Child Health Care and family Planning;
2. to assess the knowledge level of ASHAs on various
aspects of MCH care and family planning; and
3. to study the motivational level of ASHAs on various
aspects of MCH care and family planning.
3. Methodology
At the outset, items on MCH acre and family planning
knowledge test for ASHAs were prepared by consulting
ASHA guide and other training modules prepared for the
grassroots level health workers by the government and other
non-governmental organizations. Total 50 items were con-
structed given two choices one correct and the other incorrect
answer. After the preparation of draft questionnaire, it was
canvassed on the experts in the areas of MCH care and family
planning for ensuring content validity, who made corrections
with additions and deletions. At last, 36 items were selected
and tried out on a sample of 100 ASHAs. The five themes on
which items have been prepared are: (i) general reproductive
health awareness; (ii) maternal health care; (iii) child health
care; (iv) family planning and HIV/AIDS; and (v) health
education and sanitation. Item Difficulty Index and Item
Discrimination Index were used for the selection of items and
the items having higher difficulty index were finally selected.
The questionnaire with item difficulty index and discrimina-
tion indices is given in Annexure-I. Out of total 36 items,
finally 26 items were selected. The number of items formu-
lated and selected with Item Difficulty Index and Item Dis-
crimination Index are given in Table-1 below. Content validly
was confirmed from the subject expert in the area of Maternal
and Child Health care.
Table 1. Item Difficulty Index and Item Discrimination Index on various Themes of MCH Care & Family Planning
Sl. No.
Aspects
Items Difficulty index
Items Discrimination index
No. of Items
formulated
No. of Items
selected
Items
Range
(Lowest)
Items
Range
(Highest )
Items
Range
(Lowest)
Items
Range
(Highest )
I.
General Reproductive
Health Awareness
6
2
0.92
1.00
0.84
1.00
II.
Maternal Health Care
9
7
0.89
1.00
0.56
0.96
III.
Child Health Care
12
8
0.76
0.98
0.48
0.96
IV
Family Planning &
HIV/AIDS
6
6
0.64
0.84
0.28
0.76
V.
Health & Sanitation
3
3
1.00
1.00
1.00
1.00
Total no. of Items &
average range(L-H)
36
26
84.2%
96.00%
46.64%
93.6%
Finally knowledge test was administered over 200 sample
ASHA workers to assess their knowledge on various aspects
of maternal and child health care. Besides knowledge, the
motivational skill of ASHAs in MCH was also assessed. The
age, caste, qualification and work experience profile of sam-
pled ASHA workers is given in Table-2
International Journal of Maternal and Child Health (2015) 71-79 73
Table 2. Age, Caste, Qualification & Work Experience Profile of ASHAs
Categories
Total
Age
20 – 25 yr.
30(15%)
26 – 30 yr.
84(42%)
31 – 35 yr.
62(31%)
36 - 40 yr.
14(7%)
>41 yr.
10(5%)
Caste
General
68(34%)
SC
30(15%)
ST
52(26%)
OBC
50(25%)
Qualification
8th pass
64(32%)
10th pass
86(43%)
12th pass
28 (14%)
Graduation & Above
22(11%)
Work experience
Jeevan Dhara Project
6(3%)
Teacher pvt. school
4(2%)
AW Sahaika
10(5%)
ASHA Sahyogini
16(8%)
Source: Filed Data collected in 2014
Table-2 shows that majority of the of ASHAs are be-
longing between the age-group 25 to 35; 42 percent of them
are in the age group of 26 – 30 years and 31 percent of them
are in the age-group 31-35. Garg et al. (2013) also found from
his study that majority of ASHA workers were in the
age-group of 20-29 year (39.05), while Srivastava and Sri-
vastava (2012) found from their study that 47.9 percent of
ASHA workers were under the age 25 year. As far as caste
wise distributions of ASHAs are concerned, it is found from
the Table-2 that 34, 26, 25 and 15 percent belonging to Gen-
eral Caste, Scheduled Tribes, Other Backward Castes and
Scheduled Castes respectively. The spatial selection of
ASHAs shows inclusiveness, which cover all the caste com-
position available in the rural community. The analysis of
data shows that only 18 percent of the total ASHAs are having
work experience in various social development related
projects. However, as the ASHA workers are in the younger
age, they will be more proactive and deliver their duties and
responsibilities in a time-bound manner.
The present study was conducted in Jaipur and Tonk dis-
trict of Rajasthan, India. Rajasthan is a BIMARU state as far
as the status of fertility, mortality and access to MCH and
family planning services is concerned. A District Level
Household and Facility Survey conducted in Rajasthan en-
visaged that only 48.8 percent of children 12-23 months have
been fully immunized, 56.6 percent of ante-natal women have
received any ante-natal check up; as far as delivery is con-
cerned, percentage of institutional delivery is 45.5; 53.7 per-
centage of delivery was conducted at home and only 7.2
percent has been conducted by skilled personnel and so far as
use of family planning method is concerned, 57 percent of
eligible couples have been using any methods of family
planning (IIPS, 2008). The Annual Health Survey 2010-11 of
Rajasthan envisages the Maternal Mortality Ratio of 331 of
the state, of which Jaipur district is 319 and Tonk district 338
(GOI, 2011). The high infant and maternal mortality speaks
out the poor MCH status of Rajasthan.
4. Discussion
The effectiveness of ASHAs in delivery of MCH services
depends on their knowledge on various aspects of MCH care.
Therefore, under NRHM, before going for delivering services
at the grassroots, they are being imparted induction training
and from time to time refresher training on various aspects of
MCH care; family planning and health education. These in-
duction and on-the job training has enhanced their knowledge
in various aspects of MCH care and family planning. The
Table-3 depicts that ASHAs have scored 83.23 percent in
knowledge test.
74 International Journal of Maternal and Child Health (2015) 71-79
Table 3. Knowledge aspects on General, Maternal, Child Health, Family Planning & Health & Sanitation
Sl. No.
Aspects
Knowledge Score
Difference to total knowledge score
I.
General Reproductive Health
Awareness
1.81
(90.5%)
.19
(9.5)
II.
Maternal Health Care
6.07
(86.71%)
.93
(13.29)
III.
Child Health Care(immunization)
6.93
(86.62%)
1.07
(13.74)
IV.
Family Planning & HIV/AIDS
3.85
(64.16%)
2.15
(35.84)
V.
Health Education & Sanitation
2.98
(99.33%)
.02
(.77)
Average score
21.64 (83.23%)
4.36 (16.77%)
Source: Filed Data collected in 2014
Note: Figures in parenthesis shows percentage
The Table-3 also depicts that the knowledge score of
ASHAs in Family Planning and HIV/AIDS is 64.16 percent,
which is lower than all other aspects of MCH care such as
maternal health care, child health care, and health education
and sanitation. The overall knowledge gap is 16.77 percent,
but the knowledge gap in family planning and HIV/AIDS is
35.84 almost double. This clearly reveals that they must be
given frequent training and guidance from the other gras-
sroots level health functionaries, particularly ANMs on var-
ious critical aspects of family planning and HIV/AIDS.
However, ASHAs have scored 99.33 percent in health edu-
cation and sanitation.
The Table-4 which depicts the gap between knowledge
and motivation clearly divulges that knowledge and motiva-
tional gap is highest in case of motivation of family planning
cases which is 33.67 percent. Out of the total number of cases
adopting various family planning methods only 30.49 percent
have been motivated by the ASHAs. This depicts poor moti-
vational power of ASHAs to restrict fertility among the rural
people in a demographically backward state of Rajasthan.
Table 4. Motivation Skill Assessment of ASHAs on ANC, Institutional Delivery, PNC, Immunization & Family Planning
Sl. No.
Aspects
Average no.
of cases
Average no. of cases
motivated by ASHA
Difference in total
number of cases (in%)
I.
Motivating for ANC(Early registration,
ANC-3 visits, 100 IFA tablets)
21.00
14.14
(67.33)
6.86
(32.67)
II.
Motivating for Institutional Delivery
19.47
13.88
(71.28)
5.59
(28.72)
III.
Motivated pregnant women Escorted for
Institutional Delivery
19.47
11.37
(58.39)
8.1
(41.61)
IV.
Motivating for Post Natal Care
18.10
13.57
(74.97)
4.53
(25.03)
V.
Motivating parents for Immunization of
children
61.76
49.89
(80.78)
11.87
(19.22)
VI.
Motivating Eligible for adoption of Fam-
ily Planning Cases
9.15
2.79
(30.49)
6.36
(69.51)
Average score
24.82
17.60 (63.87)
7.26 (36.13)
Source: Filed Data collected in 2014
Note: - Figure in parenthesis show percentage to total
The Table-4 depicts that ASHAs motivational skill in
motivating eligible couple for adoption of various family
planning methods for restricting fertility in rural areas in low.
They have only motivated 30.49 cases for family planning,
whereas out of the total children who have undergone various
immunizations, 80.78 percent have been motivated by the
ASHA workers. As compared to immunization, ASHAs mo-
tivational skill in family planning is low. They have also
shown comparatively lower skill in escorting pregnant
women to the health care institutions for institutional delivery.
This is critical for safe motherhood and child health care and
their motivational skill in this area needs to be improved.
International Journal of Maternal and Child Health (2015) 71-79 75
Table 5. Differences in Knowledge and Motivation Skill Assessment on ANC, Institutional Delivery, PNC, Immunization &
Family Planning
Sl. No.
Aspects
Knowledge
Score
Motivation
Percentage difference to
total knowledge score and
motivation score
I.
ANC(Early registration, ANC-3 visits,
100 IFA tablets)
6.07
(86.71)
14.14
(67.33)
19.38
II.
Institutional Delivery
1.97
(75.66)
13.88
(71.28)
4.38
III.
Escort for Institutional Delivery
1.67
(66.8)
11.37
(58.39)
8.41
IV.
PNC
1.67
(83.5)
13.57
(74.97)
8.53
V.
Immunization of children
6.93
(86.62)
49.89
(80.78)
5.84
VI.
Family Planning Cases
3.85
(64.16)
2.79
(30.49)
33.67
Average score
77.24
63.87
13.37
Source: Filed Data collected in 2014
The gap between knowledge and motivation exists in the
delivery of all MCH care services. The average knowledge
score is 77.24 percent but the average percentage of motiva-
tional in delivery of various MCH care services i.e. antenatal
care, institutional delivery, post natal care, immunization of
children and family planning services are only 63.87 percent.
This clearly shows that although ASHAs have sufficient
knowledge on various aspects of MCH care, yet they have not
been sufficiently motivated to convert this knowledge into
action. This knowledge and motivation gap will produce
impact not only on service delivery but also on the achieve-
ment of maternal and child health care and family planning
indicators.
Table 6. Correlation and Regression between Dependent and Independent Variables
Sl. No.
Independent Variables
Dependent Variables
r
Beta Coefficient
I
Education
(i)
ANC
-.198*
.095
(ii)
Institutional Delivery
-.232*
.014
(iii)
Escort for Institutional Delivery
-.217*
-.016
(iv)
PNC
-.298**
-.296
(v)
Child Immunization
-.265**
-.230
(vi)
Family Planning Cases
-.160
.076
II
Caste
(i)
ANC
-.130
-.011
(ii)
Institutional Delivery
-.042
.346
(iii)
Escort for Institutional Delivery
-.178
.300
(iv)
PNC
-.183
-.289
(v)
Child Immunization
-.043
.144
(vi)
Family Planning Cases
-.069
-.092
III
Age
(i)
ANC
.176
.083
(ii)
Institutional Delivery
.220*
.169
(iii)
Escort for Institutional Delivery
.160
.155
(iv)
PNC
.117
-.092
(v)
Child Immunization
.142
-.223
(vi)
Family Planning Cases
-.126
-.048
IV
Work experience
Jeevan Dhara Project, Teacher pvt. School,
AW Sahaika, ASHA Sahyogni
.301
.338
Source: Filed Data collected in 2014
* Correlation is significant at the 0.05 level
** Correlation is significant at the 0.01 level
76 International Journal of Maternal and Child Health (2015) 71-79
Table-6 depicts the relationship between age, educational
qualification, and caste on motivation of MCH care and fam-
ily planning. The correlation between the education and mo-
tivation on MCH and family planning care is negative. In
other words, it shows that the ASHAs those are more educated
or having higher level of education have shown less motiva-
tional instinct for MCH and family planning care as compared
to those who are less educated. The Caste also has a negative
correlation with motivation of ASHA of MCH and family
planning services; this means ASHAs belonging to higher
caste group has motivated less number of cases than their
counter part of ASHAs belonging to lower castes. Indian
villages have strong caste and community feelings and
women belonging to upper caste are generally reluctant and
have poor attitude to deliver even awareness and motivational
services in the lower caste clusters. This is clearly reflected in
the Table-6. However, as far as relationship of age of ASHAs
and motivation of eligible couples for adoption of maternal
and child health care and family planning service is concerned,
age of ASHAs has a positive correlation with MCH care and
negative correlation with family planning services, which
means that young age group ASHAs have motivated more
number of eligible couples for the adoption of family planning
services than those who are more aged. Year of work expe-
riences has a positive correlation and impact on motivation
power of ASHAs in MCH care and family planning services.
5. Conclusion
ASHA workers are the grassroots level health care providers
on whose shoulders the maternal and child health care service
delivery lie. The study has found that these grassroots workers
are quite knowledgeable in various aspects of preventive
maternal and child health care. However, a gap between
knowledge and motivation to put the knowledge into practice
through appropriate motivation is observed. The ASHAs are
low motivational skill compared to knowledge and are found
to be less effective in motivating eligible couples to adopt
family planning services in order to restrict their family size.
In maternal and child health care service delivery, skill and
practices are more important than knowledge and awareness.
There is a negative correlation between caste and motivational
level, which shows that still the ASHAs belonging to upper
caste families do not appreciate to insist the country side
people to adopt various MCH and family planning services
through motivation. The analysis of data also reveals that
education level has a negative correlation with motivation,
which means that more educated ASHAs are less effective in
motivating the eligible couples to adopt MCH and family
planning services, particularly family planning methods.
ASHAs age are being negatively correlated with motivation,
which means ASHAs with younger age group are more keen
and active in motivating eligible couple for the adoption of
family planning services than their counter part those who are
aged. Therefore, it is suggested that ASHAs training pro-
gramme must be included exclusive module on motivation,
communication, community participation and leadership skill
aspects. ASHAs should be provided with adequate IEC (In-
formation Education and communication) materials on vari-
ous aspects of MCH and family planning. Performance based
incentives and remunerations will motivate these community
level workers to be intimately involved in the delivery of
MCH and family planning services. Women in younger age
group below 35 years of age with some work experience in
health and health related fields should be given preference in
the recruitment of ASHAs. The women those who have
grassroots connections, better communication and motiva-
tional skills and who can frequently meet eligible couples
belonging to different communities without any preferences
and discrimination are better suited for the position of ASHAs.
It is suggested that areas specific standardized knowledge test
on Maternal and Child Health care and Family Planning
should be developed by the institutions monitoring and eva-
luating the activities of these grassroots preventive health care
services providers and gaps needed to be identified and
on-the-job and hands-on training be continuously given. Be-
sides, she should be given opportunity to participate in the
integrated training programme along with the other grassroots
level development functionaries such as village development
officers, anganwadi workers, elected representatives of pan-
chayati raj institutions, ANMs, etc so that she will be able to
coordinate with other developmental functionaries while
dealing with his duties and responsibilities.
References
Bhargavi, C. N., & Sharma, A. (2014). “A study on awareness of ASAH
workers of Delhi state on MCH care and services” International
Journal of Nursing Education, 6(1), 281-284.
Garg, P. K., Bhardwaj, A., Abhishek, S., & Ahluwalia, S. K (2013). “An
evaluation of ASHA workers awareness and Practice of their respon-
sibilities in rural Haryana”, National Journal of Community Medicine,
4(1), 76-80.
GOI (2011). Annual Health Survey Bulletin, 2010-11, Rajasthan, Office of
the Registrar General & Census Commission Government of India,
Ministry of Home Affairs, Vital Statistics Division, New Delhi.
Gosavi, S. V., Raut, A. V., Deshmukh, P. R., Mehendale, A. M., & Garg, B. S.
(2009). “ASHA‟s awareness and perceptions about their roles and re-
sponsibilities: A study from rural Wardha”, see
http://medind.nic.in/jaw/t11/i11/jawt11.1p33.pdf.
IFPS Technical Project (2012). “Community based Workers Improving
Health Outcomes in Uttarkhand, India”, IFPS Technical Assistance
Project, USAID.
IIPS (2008). District level House Hold & Facility Survey-3 Fact Sheet,
Rajasthan, International Institute of Population Sciences, Mumbai.
Lewin, S., Munabi-Babigumira, S. L., & Glenton, C. (2010). “Lay Health
workers in primary and community health care for maternal and child
health and the management of infectious diseases”, Cochrane Data-
base System Review, (3), CD004015.
MOHFW (2005): National Rural Health Mission: Framework for Imple-
mentation (2005-2012), Ministry of Health & Family Welfare, Gov-
ernment of India, New Delhi.
Rao, T. (2013). “The impact of a community health worker programme on
childhood immunization: Evidence from India‟s „ASHA‟ Workers”,
Cornell University, New York, also see
http://editorialexpress.com/egi-bin/conference (accessed on
19/05/2014).
Shashank, K. J., Angadi, M. M., Masali, K. A., Wajantri, P. B., & Jose, A. B.
(2013). “A study of evaluation working profile of ASHA and to assess
their Knowledge about infant health care”, IJCRR, 5 (12), pp 97-103.
International Journal of Maternal and Child Health (2015) 71-79 77
Shrestha, R, Baral, K., & Weir, N. (2003). “Community ear care delivery by
community ear assistants and volunteers: A pilot programme”, J La-
rygol Utol, 115, 869-873.
Srivastava, S., & Srivastava, P. (2012).: “Evaluation of trained accredited
social health activist (ASHA) Workers regarding their knowledge and
attitude and practice about child health”, Rural and Remote Health, 12
(4), 2099(online).
Knowledge Test of ASHA Workers
Q. No.
Question
Difficult Index
Discrimination Index
General Health Care
1.*
Which age group is the most appropriate to plan conception (for
mother)?
Answer: a) 20 – 25 yr.
b) 40 – 45 yr.
1.00
1
2.*
Chances of conceiving are maximum at?
Answer: a) Beginning five days after menstruation cycle
b) Middle (10th-20th days) of menstruation cycle
0.92
0.84
3.
How do you recognize that a woman is pregnant?
Answer: a) She misses her periods, Nausea, vomiting (early morning
usually), frequency of passing urine
b) Increase in appetite
1.00
1
Maternal Health Care
4.*
How many minimum visits are required for full ANC checkups?
Answer : a) Three or more visits
b) One visit only
0.89
0.96
5.*
What types of checkups are done during the first visit
(ANC registration) of pregnant women?
Answer: a) Only history of current pregnancy
b) Complete history of current pregnancy and previous
pregnancies, Weight, B. P., Abdominal examination, TT injection,
IFA tablets etc.
0.94
0.88
6.
Why should Inj. T. T. be given to a pregnant women?
Answer: a) To prevent tetanus in mother and sibling
b) It is given only for routine purpose & there are no other
benefits
1.00
1
7.
What are the indicators/danger signs in pregnancy? If the mother
Answer: a) Women is more than 35 yrs, has more B. P. swelling of
leg, weak or no foetal movements
Lazy mother
0.98
0.96
8.
During pregnancy what type of diet should you advice to the pregnant
mother?
Answer: a) Diet full of desi ghee, panjiri & ladoo also
b) Diet rich in green, leafy vegetables like
palak and sarson, dals, milk, Jaggery, eggs, fish, meat,
etc.
0.98
0.96
9.
What is the role of ASHA in case of emergency for a pregnant
woman?
Answer: a) Ensure the availability of transport to the nearest FRU/&
escort her for institutional delivery
b) Call Dai for handling/ delivery
1.00
1
10.*
What are the benefits of the colostrum?
Answer: a) It makes the baby healthy
b) It prevents the baby from infections.
0.88
0.56
11.*
How many check-ups are required for PNC within two weeks of
delivery?
Answer: a) Two check-ups
None
0.96
0.92
12.*
What advice is are you giving to the mother/ families regarding the
cord care?
Answer: a) Dressing/ medicine to be applied on cord.
0.90.
0.80
78 International Journal of Maternal and Child Health (2015) 71-79
b) No dressing/ medicine to be applied on cord
13.*
What are the benefits of Janany Suraksha Yojana(JSY) scheme?
Answer: a) Provision of Rs. 1400/- for rural areas women provide if
she deliver a baby in Govt. or Govt. accredited identified hospitals &
Provision of Rs. 600/- for rural areas ASHA provide if she escort with
the pregnant woman for delivery.
Rs. 2000/- is given to mother & Rs.500/- to ASHA
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14.*
What is your role in JSY Scheme?
Answer: a) Advice to the pregnant mother for early registration,
Explain the benefits of the institutional delivery and explain the
monitory benefits of the scheme
b) Nothing
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15.
Is ANC registration necessary for getting the benefits of the JSY
scheme?
Answer: a) Yes, it is necessary
b) No idea
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Child Health Care
16.*
At what age, which immunization is to be given to a child?
Answer: a) BCG & Polio at birth, DPT at 6 weeks, 10 weeks, 14
weeks & Polio, Measles at 9 months, Booster at 15
months, Booster at 18 months of DPT/ polio
b) BCG up to 3 months, Polio & DPT up to 1 year & measles
at 6 months, Booster at 5 years 8 months of DPT/ polio
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17.
If a child is not given the immunization in time, what do you do?
Answer: a) Mobilize them immediately and complete the primary
immunization before the child reaches his/ her first birthday.
b) If he/ she is notgiven the right vaccine in time it is not
possible to immunize the child.
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18.
If the child is suffering from heavy fever, what advice do you given to
mother?
Answer: a) To take heavy food.
b) Take enough fluids to drink, eat soft and easily digesting
food and seek doctors help.
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19.*
What are the danger signs for a baby to be referred immediately to
FRU?
Answer: a) No meconium passed within 24 hours of birth, poor
sucking of breast, fast breathing/or difficulty in breathing, no urine
passed in 48 hours
b) Baby having mild loose motions running nose & mild
fever.
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20.*
What additional Supplements are to
be given to a baby who is being
exclusively breastfed, within first six
months?
Answer: a) Honey/water
b) Nothing
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21.*
What are the symptoms of diarrhoea?
Answer: a) Child passes the watery stools 3-5 times a day.
Child passes the watery stools more than five times in a day.
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22.
What advice would you give to the
Mother whose child is suffering
from diarrhoea?
Answer: a) Give home available fluids (HAF) and give Oral Rehy-
dration Solution (ORS) and seek doctors advice
b) Advise to give anti diarrhea medicine and stop fluids
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23.
What steps are taken to prevent dirrhoea in a child?
Answer: a) Thorough hand washing before cooking food and feeding
the child; keeping the food covered, consuming freshly prepared
food.
Putting kala tilak on fore head of child, putting spices in fire & call a
priest at home for puja etc.
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24.*
When do you advise the mother to take the baby to FRU in case of
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International Journal of Maternal and Child Health (2015) 71-79 79
Diarrhoea?
Answer: a) Child becomes lethargic, not able to drink or breast feed,
Blood appears in the stool, does not pass urine for eight hours
b) Immediately when child starts having loose motions
25.*
What are the symptoms of Acute Respiratory Infection (ARI) in a
child?
Answer: a) Cough, running nose slight fever
b) Fever, difficulty in breathing, cough, running nose
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26.*
What are the symptoms of malnourishment in a child?
Answer: a) The child is not eating properly not studying, playing too
much
The child is not gaining height & weight for the age and stunted,
obese.
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27.*
What diet is required from preventing the malnutrition?
Answer: a) Desi ghee sweets, lot of rice, dry fruits etc.
Carbohydrates, fats, proteins are required in large amounts (macro
nutrients), while some nutrients e.g. Vitamins, Iron, Calcium, Iodine
etc. in small amounts
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Family Planning and HIV/AIDS
28.*
Till how many weeks pregnancies can be terminated at PHC?
Answer: a) Till eight weeks (2 months).
Till 20 weeks
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29.*
Within how many hours of
Un protected intercourse, should
Emergency Contraceptive Pills
(ECP) be taken?
Answer: a) Within 24 hours of unprotected sex Within 72 hours of
unprotected sex
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30.*
What are the different contraceptives available at the sub centre?
Answer: a) Nirodh, Oral Pills (Mala-D, N), IUD/CuT, Emergency
Contraceptive Pills(ECP)
Nirodh, Oral Pills (Mala-D, N)
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31.*
What advice are you giving to the E. C. to delay the pregnancy?
Answer: a) Permanent methods
Temporary methods
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32.*
HIV/AIDS spreads by?
Answer: a) Hand Shake, Touching, Mosquito bite
Unprotected sex with infected partner, infected mother to child,
Contaminated needles, blood transfusion with contaminated blood.
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33.*
What is your role in Preventing HIV/AIDS in the area?
Answer: a) Awareness generation/counselling
Advice them to take treatment
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Health Education and Sanitation
34.*
What is the role of ASHA in preparation of village health plan?
Answer: a) Facilitating preparation and implementation of village
health plan
b) Nothing
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35.*
Who are the members of the Village Health and Sanitation Commit-
tee?
Answer: a) AWW, ANM, SHG member, Panchayat members of the
village
b) Only the Panchayat members
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36.*
What types of advice given to the community on hygiene and sanita-
tion issues?
Answer: a) Creating awareness and providing information to the
community on nutrition, hygiene and sanitation
b) Nothing, ASHAs is role only on health issues
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* Selected question after difficult index and discrimination index.