Gopalakrishnan Lakshmi, Patil Sumeet, Fernald Lia, Walker Dilys, Diamond-Smith Nadia
Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America.
NEERMAN, Mumbai, India.
PLOS Glob Public Health. 2024 Nov 13;4(11):e0003639. doi: 10.1371/journal.pgph.0003639. eCollection 2024.
Community Health Workers (CHWs) play crucial roles in health promotion and services in rural India. Previous research investigating the effectiveness of coordinated health promotion by different community health workers (CHWs) cadres on health practices is scarce. This study examines the effectiveness of coordinated health promotion by different CHW cadres, specifically Accredited Social Health Activists (ASHA) and Anganwadi Workers (AWW), on maternal health outcomes. Using endline data from a 2019 impact evaluation of 6635 mothers with children <12 months in Madhya Pradesh and Bihar, we compared the association between standalone and coordinated counseling by ASHA and AWW on various maternal health practices. Outcomes included four or more antenatal care visits, birth preparedness, institutional delivery, postnatal care visits, and contraceptive uptake. Fixed effects logistic regression with robust standard errors, corrected for multiple hypothesis tests, was used for analysis. Results showed that 39.6% of women received four or more ANC visits, 31.2% adopted birth preparedness practices, 79.6% had institutional deliveries, 23.3% received postnatal care, and 19.5% adopted a postpartum contraceptive method. Coordinated counseling from both ASHA and AWW was associated with a greater prevalence of four outcomes (birth preparedness, institutional delivery, PNC visit, and contraception) compared to standalone counseling from either ASHA or AWWs. These findings suggest that health promotion by AWW complements that of ASHA, collectively associated with improved health outcomes. This study underscores the effectiveness of coordinated health promotion and highlights the need for multisectoral and coordinated efforts among different CHW cadres at the community level. The results emphasize the importance of integrating various CHW roles to enhance maternal health practices and outcomes in rural India. Trial registration number: https://doi.org/10.1186/ISRCTN83902145. Date of registration: 08/12/2016.
社区卫生工作者（CHW）在印度农村地区的健康促进和服务中发挥着关键作用。以往关于不同社区卫生工作者（CHW）干部协调开展健康促进对健康行为有效性的研究较为匮乏。本研究考察不同CHW干部，特别是经认证的社会健康活动家（ASHA）和安格班迪工作人员（AWW）协调开展健康促进对孕产妇健康结局的有效性。利用2019年对中央邦和比哈尔邦6635名有12个月以下子女的母亲进行的影响评估的终期数据，我们比较了ASHA和AWW单独咨询与协调咨询对各种孕产妇健康行为的关联。结局包括四次或更多次产前检查、分娩准备、机构分娩、产后检查以及避孕措施的采用。采用固定效应逻辑回归并使用稳健标准误，对多重假设检验进行校正后用于分析。结果显示，39.6%的妇女接受了四次或更多次产前检查，31.2%采取了分娩准备措施，79.6%进行了机构分娩，23.3%接受了产后检查，19.5%采用了产后避孕方法。与ASHA或AWW单独咨询相比，ASHA和AWW的协调咨询与四种结局（分娩准备、机构分娩、产后检查和避孕）的更高患病率相关。这些发现表明，AWW的健康促进对ASHA起到了补充作用，共同与改善的健康结局相关。本研究强调了协调健康促进的有效性，并凸显了社区层面不同CHW干部之间多部门协调努力的必要性。结果强调了整合各种CHW角色以改善印度农村地区孕产妇健康行为和结局的重要性。试验注册号：https://doi.org/10.1186/ISRCTN83902145。注册日期：2016年12月8日。
