Figures & Tables
Tables
Anganwadi Workers (AWWs) Accredited Social Health Activists (ASHAs) Employment Terms Part-time female workers recruited from local communities
Employed by the Integrated Child Development Services
Receive fixed monthly honorarium based on educational qualifications
May receive monetary incentives for specific activities
Encouraging families to use immunization
Encouraging families to use family planning services
Attending training sessions
Part-time female workers recruited from local communities
Employed by the National Rural Health Mission
Non-salaried but receive monetary incentives for specific activities
Promoting universal immunization
Promoting institutional deliveries
Referring clients to RCH & other programs
Constructing household toilets
Education Have at least 10th-grade education
Literate, preferably with at least 10th-grade education
Catchment Area Deliver services through Anganwadi centers, serving catchment area of 1,000 population
Deliver services in same catchment area as AWWs through home visits or in AWC
Services Provided Facilitate immunization
Provide monthly food supplements to pregnant women, lactating mothers, and children
Provide nutrition and health education, including information on pregnancy care and infant and child feeding practices, at AWCs and during home visits
Plan and organize immunization days and VHNDs once a month with ASHAs
Provide non-formal preschool education
Facilitate health check-ups
Provide referral services
Motivate families to use immunization
Motivate pregnant women to have institutional deliveries
Provide information on pregnancy, newborn, and infant care (including nutrition information)
Provide other services related to communicable diseases
Plan and organize immunization days and VHNDs once a month with AWWs
Motivate families to use family planning
Abbreviations: AWCs, Anganwadi centers; RCH, reproductive and child health; VHNDs, Village Health and Nutrition Days.
Value N Education and experience ASHAs who completed class 10+, % 43.5 382 AWWs who completed class 11+, % 39.3 377 ASHAs who have 6+ years of experience, % 52.6 382 AWWs who have 11+ years of experience, % 54.1 377 Monetary incentives AWWs who have ever received immunization incentives, % 24.9 370 AWWs who have ever received training incentives, % 37.1 356 Amount ASHAs receive for institutional delivery (100s), mean, rupees 3.91 369 AWWs who have experienced frequent delays in payments for immunizations, % 46.7 360 AWWs who have experience delayed payment for food supplements sometime in last 6 months, % 64.6 370 Primary reason for working is income generation, ASHAs, % 78.3 374 Primary reason for working is income generation, AWWs, % 61.3 372 Worker effort and organization AWWs who have held a designated immunization day, % 87.5 377 AWWs who have held a Village Health and Nutrition Day, % 7.4 376 ASHAs who keep children's immunization registry, % 88.2 382 AWWs who keep children's immunization registry, % 97.6 370 ASHAs who keep registry of pregnant women in village, % 58.9 382 ASHAs who attended 6+ meetings in past 6 months, % 74.3 382 AWWs who have weighing device for food, % 89.7 377 Supervision, training, and knowledge ASHAs who know who their supervisor is, % 45.1 381 AWWs who know who their supervisor is, % 92.6 377 ASHAs who have received training on pregnancy-related topics, % 70.5 308 ASHAs who have received training on nutrition-related topics, % 45.7 302 AWWs who have received training on nutrition-related topics, % 71.0 365 ASHAs who list pregnancy as one use of iron pills, % 84.6 382 ASHAs who know age to start liquids other than breast milk, % 86.6 382 AWWs who know age to start liquids other than breast milk, % 88.0 376 ASHAs who know age to start food other than breast milk, % 50.0 382 AWWs who know age to start food other than breast milk, % 66.0 377 Household and village variables Pregnant women in catchment area (10s), mean 1.52 374 Village population (1,000s), mean 2.07 354 Abbreviations: ASHAs, Accredited Social Health Activists; AWWs, Anganwadi workers.
- TABLE 3. Percentage of Households Reporting Receipt of Health and Nutrition Services, Bhojpur District, Bihar State, India
Service and Surveyed Sample Immunization Food Supplements Pregnancy Care Information General Nutrition Information HHs with children 0–2 y (N = 1,199) HHs with pregnant women or children 6 m–3 y (N = 2,038) HHs with pregnant women or children 0–3 m (N = 500) HHs with pregnant women or children under 6 y (N = 1,764) Received service 31 13 11 5 Received service at government facilities AWCs 46 100 NA NA PHCs 7 NA NA NA SCs 8 NA NA NA Received service during home visits via: ANMs 48 NA 21 NA ASHAs NA NA 72 47 AWWs NA NA 15 78 Abbreviations: ANMs, auxiliary nurse-midwives; ASHAs, Accredited Social Health Activists; AWCs, Anganwadi centers; AWWs, Anganwadi workers; HHs, households; NA, not applicable (service not available at that location or through that provider cadre); PHC, primary health center; SCs, sub-centers.
- TABLE 4. Relationship Between Frontline Worker and Household Characteristics and Household Receipt of Health and Nutrition Services, Bhojpur District, Bihar State, India
Service and Sample Reporting Receipt of Service Immunization Food Supplements Pregnancy Care Information General Nutrition Information HHs with children 0–2 y (N = 1,199) HHs with pregnant women or children 6 m–3 y (N = 2,038) HHs with pregnant women or children 0–3 m (N = 500) HHs with pregnant women or children under 6 y (N = 1,764) Education and experience, % (95% CI) ASHAs who completed class 10+ 46 (43–49) NA 43 (39–47) 45 (42–47) AWWs who completed class 11+ 40 (37–43) 40 (38–42) NA 40 (38–42) ASHAs who have 6+ years of experience 56 (53–59) 66 (62–70) 65 (63–67) AWWs who have 11+ years of experience 56 (53–58) 59 (57–61) NA 59 (57–61) Monetary incentives, % (95% CI) AWWs who have ever received immunization incentives 22 (20–25) 25 (23–26) NA 22 (20–24) AWWs who have ever received training incentives 38 (35–41) 40 (37–42) NA 44 (42–46) Amount ASHAs receive for institutional delivery (100s), rupees NA NA 3.95 (0.99) 3.88 (0.95) AWWs who have experienced frequent delays in payments for immunizations 47 (44–50) NA NA NA AWWs who have experienced delayed payment for food supplements sometime in last 6 months NA 65 (63–67) NA NA Primary reason for working is income generation, ASHAs 79 (76–81) NA 76 (73–80) 76 (74–78) Primary reason for working is income generation, AWWs 60 (58–63) 62 (60–64) NA 63 (60–65) Worker effort and organization, % (95% CI) AWWs who have held a designated immunization day 89 (88–91) NA NA NA AWWs who have held a VHND 8 (7–10) 8 (7–9) 6 (4–8) 7 (6–8) ASHAs who keep children's immunization registry 90 (88–91) NA NA NA AWWs who keep children's immunization registry 98 (97–99) NA NA NA ASHAs who keep registry of pregnant women in village NA NA 63 (59–68) NA ASHAs who attended 6+ meetings in past 6 months 79 (77–82) NA 83 (79–86) 80 (78–82) AWWs who have weighing device for food NA 90 (89–91) NA NA Supervision, training, and knowledge, % (95% CI) ASHAs who know who their supervisor is 46 (43–49) NA 50 (46–55) 52 (50–55) AWWs who know who their supervisor is 92 (91–94) 93 (92–94) 92 (91–94) ASHAs who have received training on pregnancy-related topics NA NA 72 (68–76) NA ASHAs who have received training on nutrition-related topics NA NA NA 46 (43–48) AWWs who have received training on nutrition-related topics NA NA NA 73 (71–75) ASHAs who list pregnancy as one use of iron pills NA NA 83 (80–86) NA ASHAs who know age to start liquids other than breast milk 89 (88–91) AWWs who know age to start liquids other than breast milk NA NA NA 87 (86–89) ASHAs who know age to start food other than breast milk NA NA NA 49 (47–51) AWWs who know age to start food other than breast milk NA NA NA 69 (67–71) Household and village variables ASHAs and household head of same caste, % (95% CI) 5.0 (3.8–6.2) NA 5.0 (3.1–6.9) 5.8 (4.7–6.9) AWWs and household head of same caste, % (95% CI) 5.1 (3.8–6.3) 5.9 (4.9–6.9) NA 7.2 (6.0–8.4) Pregnant women in catchment area (10s), mean (SD) NA NA 1.55 (0.80) NA Household heads who have completed class 7+, % (95% CI) 42 (39–45) 42 (40–44) 43 (38–47) 43 (41–45) Household socioeconomic status index, mean (SD) 3.20 (1.41) 3.13 (1.44) 3.26 (1.42) 3.06 (1.43) Village population (1,000s), mean (SD) 2.08 (2.34) 2.11 (2.38) 2.37 (2.75) 2.27 (2.58) Abbreviations: ASHAs, Accredited Social Health Activists; AWWs, Anganwadi workers; NA, not applicable; SD, standard deviation; VHND, Village Health and Nutrition Day.
Prevalence rates and 95% confidence interval are reported for all binary variables. For non-binary variables, means and standard deviations are reported.
- TABLE 5. Multivariate Logistic Regression Model Showing Predictors of Receipt of Immunization Services For Households With Children 0–2 Years, Bhojpur District, Bihar State, India (N = 1,199)
OR 95% CI P Education and experience ASHAs who completed class 10+ 0.929 0.694–1.244 .62 AWWs who completed class 11+ 1.040 0.769–1.408 .80 ASHAs who have 6+ years of experience 0.853 0.636–1.144 .29 AWWs who have 11+ years of experience 1.120 0.786–1.595 .53 Monetary incentives AWWs who have ever received immunization incentives 1.552 1.019–2.363 .04 AWWs who have ever received training incentives 0.967 0.719–1.301 .83 AWWs who have experienced frequent delays in payments for immunizations 0.999 0.743–1.344 1.00 Primary reason for working is income generation, ASHAs 0.766 0.538–1.091 .14 Primary reason for working is income generation, AWWs 1.266 0.936–1.711 .13 Worker effort and organization AWWs who have held a designated immunization day 1.119 0.764–1.641 .56 AWWs who have held a VHND 1.078 0.695–1.670 .74 ASHAs who keep children's immunization registry 0.860 0.538–1.373 .53 AWWs who keep children's immunization registry 0.742 0.329–1.673 .47 ASHAs who attended 6+ meetings in past 6 months 0.936 0.663–1.322 .71 Supervision, training, and knowledge ASHAs who know who their supervisor is 0.999 0.746–1.338 1.00 AWWs who know who their supervisor is 0.906 0.501–1.640 .75 Household and village variables ASHAs and household head of same caste 1.863 1.048–3.312 .03 AWWs and household head of same caste 0.445 0.217–0.913 .03 Household heads who have completed class 7+ 1.385 1.052–1.823 .02 Household socioeconomic status index 1.043 0.944–1.153 .41 Village population (1,000s) 0.885 0.816–0.959 <.001 Abbreviations: ASHAs, Accredited Social Health Activists; AWWs, Anganwadi workers; CI, confidence interval; OR, odds ratio; VHND, Village Health and Nutrition Day.
Variables shown in italics are statistically significant at P < .10.
- TABLE 6. Multivariate Logistic Regression Model Showing Predictors of Receipt of Food Supplements For Households With Pregnant Women or Children 6 Months to 3 Years, Bhojpur District, Bihar State, India (N = 2,038)
OR 95% CI P Education and experience AWWs who have completed class 11+ 1.303 0.931–1.824 .12 AWWs who have 11+ years of experience 0.838 0.581–1.210 .35 Monetary incentives AWWs who have ever received immunization incentives 1.220 0.773–1.925 .39 AWWs who have ever received training incentives 0.885 0.633–1.237 .47 AWWs who have experience delayed payment for food supplements sometime in last 6 months 1.022 0.694–1.504 .91 Primary reason for working is income generation, AWWs 1.079 0.781–1.492 .64 Worker effort and organization AWWs who have held a VHND 0.847 0.497–1.446 .54 AWWs who have weighing device for food 1.275 0.735–2.211 .39 Supervision, training, and knowledge AWW knows who is their supervisor 1.599 0.812–3.151 .18 Household and village variables AWWs and household head of same caste 1.011 0.536–1.907 .97 Household heads who have completed class 7+ 0.839 0.633–1.112 .22 Household socioeconomic status index 0.871 0.789–0.962 .007 Village population (1,000s) 1.015 0.972–1.060 .51 Abbreviations: AWWs, Anganwadi workers; CI, confidence interval; OR, odds ratio; VHND, Village Health and Nutrition Day.
Variables shown in italics are statistically significant at P < .10.
- TABLE 7. Multivariate Logistic Regression Model Showing Predictors of Receipt of Pregnancy Care Information For Households With Pregnant Women or Children Under 3 Months, Bhojpur District, Bihar State, India (N = 500)
OR 95% CI P Education and experience ASHAs who have completed class 10+ 1.113 0.591–2.094 .74 ASHAs who have 6+ years of experience 0.740 0.371–1.473 .39 Monetary incentives Amount ASHAs receive for institutional delivery (100s) 1.519 0.989–2.334 .06 Primary reason for working is income generation, ASHAs 1.095 0.535–2.241 .80 Worker effort and organization AWWs who have held a VHND 1.097 0.344–3.497 .88 ASHAs who keep registry of pregnant women in village 2.254 1.072–4.740 .03 ASHAs who have attended 6+ meetings in past 6 months 1.355 0.490–3.748 .56 Supervision, training, and knowledge ASHAs who know who their supervisor is 1.501 0.761–2.964 .24 ASHAs who have received training on pregnancy-related topics 0.580 0.249–1.355 .21 ASHAs who list pregnancy as one use of iron pills 1.180 0.482–2.888 .72 Household and village variables ASHAs and household head of same caste 1.198 0.392–3.659 .75 Pregnant women in catchment area (10s) 0.495 0.260–0.942 .03 Household heads who have completed class 7+ 1.099 0.608–1.984 .76 Household socioeconomic status index 1.002 0.790–1.271 .99 Village population (1,000s) 1.076 0.985–1.175 .11 Abbreviations: ASHAs, Accredited Social Health Activists; AWWs, Anganwadi workers; CI, confidence interval; OR, odds ratio; VHND, Village Health and Nutrition Day.
Variables shown in italics are statistically significant at P < .10.
- TABLE 8. Multivariate Logistic Regression Model Showing Predictors of Receipt of General Nutrition Information For Households With Pregnant Women or Children Under 6 Years, Bhojpur District, Bihar State, India (N = 1,764)
OR 95% CI P Education and experience ASHAs who have completed class 10+ 0.770 0.466–1.271 .31 AWWs who have completed class 11+ 1.181 0.719–1.940 .51 ASHAs who have 6+ years of experience 0.764 0.456–1.279 .31 AWWs who have 11+ years of experience 1.588 0.923–2.732 .10 Monetary incentives AWWs who have ever received immunization incentives 1.919 1.081–3.406 .03 AWWs who have ever received training incentives 1.340 0.820–2.190 .24 Amount ASHAs receive for institutional delivery (100s) 0.988 0.748–1.303 .93 Primary reason for working is income generation, ASHAs 1.180 0.674–2.066 .56 Primary reason for working is income generation, AWWs 1.139 0.684–1.895 .62 Worker effort and organization AWWs who have held a VHND 1.182 0.432–3.239 .75 ASHAs who have attended 6+ meetings in past 6 months 0.903 0.520–1.571 .72 Supervision, training, and knowledge ASHAs who know who their supervisor is 1.179 0.698–1.992 .54 AWWs who know who their supervisor is 0.828 0.324–2.113 .69 ASHAs who have received training on nutrition-related topics 0.982 0.602–1.603 .94 AWWs who have received training on nutrition-related topics 1.300 0.769–2.197 .33 ASHAs who know age to start liquids other than breast milk 1.611 0.586–4.431 .36 AWWs who know age to start liquids other than breast milk 1.081 0.524–2.229 .83 ASHAs who know age to start food other than breast milk 1.093 0.677–1.765 .72 AWWs who know age to start food other than breast milk 0.792 0.487–1.289 .35 Household and village variables ASHAs and household head of same caste 1.477 0.524–4.162 .46 AWWs and household head of same caste 0.672 0.229–1.972 .47 Household heads who have completed class 7+ 1.286 0.782–2.115 .32 Household socioeconomic status index 1.069 0.912–1.254 .41 Village population (1,000s) 0.957 0.865–1.058 .39 Abbreviations: ASHAs, Accredited Social Health Activists; AWWs, Anganwadi workers; CI, confidence interval; OR, odds ratio; VHND, Village Health and Nutrition Day.
Variables shown in italics are statistically significant at P < .10.
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