An Assessment of Home-Based Newborn Care Plus Innovation in Six districts of Rajasthan: A Cross Sectional Comparative Analysis

Abstract

Background: To improve coverage of key child health community practices, Home Based Infant Care (HBNC+) was implemented with support of Norway India Partnership Initiative (NIPI) in 4 States of Rajasthan, Madhya Pradesh, Bihar and Odisha. The innovation aimed at improving coverage of key child health interventions through home visits by community health worker, Accredited Social Health Activist (ASHA). Aims & Objective: This paper elucidates the results from the assessment of implementation in intervention versus control districts of Rajasthan. Material & Methods: A cross-sectional intervention-control design with a sample size of 3211 mothers of children in age group 0 to 23 months was adopted. Results: 85 percent of the children (aged 3-23 months) received at least one infant care home visit in the intervention districts in comparison to 32 percent in control. Significant improvements were found in terms of exclusive breastfeeding, weighing and Iron Folic Acid (IFA) consumption and availability of ORS and Iron Syrup in intervention districts. 15 percent additional children had weight plotted in growth charts and 24 percent more consumed IFA syrup bi-weekly in intervention districts. Conclusion: Home visits in infancy is a scalable model and can lead to improvement of community child health practices.

Role of Mitanin community health workers in improving complementary feeding practices under scaled-up home-based care of young children in a rural region of India

“…These studies attributed the poor coverage of nutrition counseling to over-burdened CHWs and absence of payment for this work [ 18 , 35 ]. A study in Rajasthan had reported a coverage rate of 46% among the 3–15 months age children by the ASHA CHWs [ 19 ]. A study from Mali found that 54.6% households had received a visit from a CHW during the preceding 3 months [ 36 ].…”

“…CHW action is likely to be more effective when they are enabled to work on social determinants of health and nutrition and the necessary linkages are developed with other sectors and services [ 57 ]. Earlier Indian studies showed that ASHA based HBYC interventions were able to improve CHW competence but were not so effective in improving complementary feeding on the ground [ 18 , 19 ]. The underlying reasons were the poorer payment and lower priority given for HBYC in comparison to other tasks of CHWs [ 18 , 19 ].…”

“…Earlier Indian studies showed that ASHA based HBYC interventions were able to improve CHW competence but were not so effective in improving complementary feeding on the ground [ 18 , 19 ]. The underlying reasons were the poorer payment and lower priority given for HBYC in comparison to other tasks of CHWs [ 18 , 19 ]. Studies have found health systems factors such as poor support to CHWs, gaps in training and poor availability of medicines as the main factors impeding success [ 18 , 54 ].…”

“…An evaluation of this intervention showed that although the coverage of young children was greater in the intervention arm, it did not result in improved IYCF outcomes [ 18 ]. Another study of the same intervention showed the intervention areas achieved greater coverage of iron folic acid (IFA) supplementation and growth monitoring but not much difference was found in breastfeeding and complementary feeding [ 19 ]. Those studies did not shed much light on the identification and management of illnesses in children.…”

Coverage of home-based newborn care and screening by ASHA community health workers: Findings from a household survey in Chhattisgarh state of India

“…An intervention study on HBNC conducted in Rajasthan showed that 85% of newborns in the intervention group received a home visit by ASHAs. [ 24 ] A study in Kenya had reported that 93% of newborns received three home visits. [ 25 ] The coverage of three home visits in the current study was 89%.…”