Singh Shambhavi, Tiwary Bhaskar, Barik Manish, Arora Hemlata, Abraham Sruthi Susan, Majumdar Piyusha, Sebastian Daliya, Closser Svea
Piramal Swasthya Management and Research Institute, Patna, 801506, India.
Monitoring, Evaluation, and Learning Unit, CARE, New Delhi, 110020, India.
BMC Health Serv Res. 2025 Jan 11;25(1):58. doi: 10.1186/s12913-024-12004-w.
Since the inception of the ASHAs in the year 2005, their work horizons have increased from Reproductive, Maternal, Newborn, Child, and Adolescent health (RMNCH + A), Communicable and Non-Communicable Diseases (CD & NCD) to oral health, ophthalmologic care, and other supportive community level healthcare services. The present literature lacks comprehensive understanding and synthesis of domain-wise knowledge of ASHAs and the factors affecting their knowledge. Therefore, this study aimed to synthesize and collate the relevant evidence to understand the overall knowledge of ASHAs.
This systematic review and meta-analysis sourced literature from Google Scholar, PubMed, and Web of Science. Of the 1062 articles identified, 37 articles were selected for narrative synthesis and meta-analysis which focused on knowledge of ASHAs. In meta-analysis, pooled prevalence was estimated using the random effect model. Meta-analysis was performed using the statistical software R version. 3.6.1 for Microsoft Windows.
The overall pooled prevalence of knowledge regarding maternal, neonatal/child health, communicable, and non-communicable diseases among ASHAs was 62%, 69%, 62%, and 73%, respectively. The level of education, years of experience, inadequate supervision, and training were the factors affecting their knowledge and subsequently its translation into practices within the community. The review also evidenced variation of knowledge among ASHAs across domains and geographical regions of India.
The systematic review and meta-analysis highlight that ASHAs have proven to be indispensable assets to India's healthcare system with their strengths lying in maternal and child health programs. To further enhance their impact, it is imperative to invest in areas where they lack knowledge such as disease surveillance, and preventive healthcare. Empowering ASHAs with necessary resources, and training will not only enhance their capabilities but also contribute to the overall improvement of the healthcare system in India.
自2005年印度健康活动家（ASHA）项目启动以来，她们的工作范围已从生殖、孕产妇、新生儿、儿童和青少年健康（RMNCH+A）、传染病和非传染病（CD&NCD）扩展到口腔健康、眼科护理及其他社区层面的支持性医疗服务。目前的文献缺乏对ASHA各领域知识及其知识影响因素的全面理解与综合分析。因此，本研究旨在综合整理相关证据，以了解ASHA的整体知识水平。
本系统综述和荟萃分析从谷歌学术、PubMed和科学网获取文献。在检索到的1062篇文章中，选取了37篇聚焦于ASHA知识的文章进行叙述性综合分析和荟萃分析。在荟萃分析中，使用随机效应模型估计合并患病率。使用适用于微软Windows系统的统计软件R 3.6.1进行荟萃分析。
ASHA在孕产妇、新生儿/儿童健康、传染病和非传染病方面的知识总体合并患病率分别为62%、69%、62%和73%。教育水平、工作年限、监督不足和培训是影响她们知识水平以及随后将其转化为社区实践的因素。该综述还证明了印度不同地区和不同领域的ASHA之间存在知识差异。
系统综述和荟萃分析表明，ASHA已被证明是印度医疗体系中不可或缺的资产，其优势在于母婴健康项目。为进一步增强其影响力，必须在她们缺乏知识的领域进行投资，如疾病监测和预防性医疗保健。为ASHA提供必要的资源和培训不仅会提高她们的能力，也将有助于印度医疗体系的整体改善。
