Role Of ASHA Worker In Neonatal And Child Health

Introduction

The Accredited Social Health Activist (ASHA) is a trained female community health worker instituted by the Government of India under the National Health Mission (NHM). She acts as the primary interface between the community and the public health system, selected from the village itself (usually 1 per 1000 population), playing a pivotal role in reducing neonatal and child mortality.

Role In Neonatal Health

Home-Based Newborn Care (HBNC)

The HBNC scheme is the cornerstone of an ASHA's neonatal responsibilities, aimed at reducing the Neonatal Mortality Rate (NMR) through protocol-based home visits.

• Visit Schedule:
  • Institutional Delivery: 6 visits on days 3, 7, 14, 21, 28, and 42.
  • Home Delivery: 7 visits on days 1, 3, 7, 14, 21, 28, and 42.
• Core Activities During HBNC:
  • Anthropometry: Recording birth weight and monitoring weight gain.
  • Temperature Regulation: Measuring temperature, demonstrating skin-to-skin contact, and promoting Kangaroo Mother Care (KMC) for low birth weight (LBW) and preterm babies.
  • Feeding Support: Counseling on early initiation of breastfeeding, exclusive breastfeeding (EBF), and identifying attachment/positioning issues.
  • Essential Newborn Care: Examining the umbilical cord (preventing harmful applications), skin care, and eye care.
  • Danger Sign Identification: Active screening for lethargy, poor suck, fast breathing (>60/min), severe chest indrawing, hypothermia (<36.5 C), or fever (>37.5 C).
  • Referral: Facilitating immediate referral of sick neonates to the nearest Special Newborn Care Unit (SNCU) or First Referral Unit (FRU).

Prevention Of Vertical Transmission And Birth Preparedness

• Tracking pregnant women, ensuring Institutional Deliveries under Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK) to ensure clean and safe delivery practices.
• Educating mothers on the importance of maternal tetanus toxoid/Td immunization to prevent neonatal tetanus.

Role In Child Health

Home-Based Care Of Young Child (HBYC)

An extension of the HBNC program, bridging the gap between infancy and early childhood (up to 15 months).

• Visit Schedule: 5 additional visits at months 3, 6, 9, 12, and 15.
• Core Activities:
  • Promoting appropriate complementary feeding starting at 6 months alongside continued breastfeeding.
  • Monitoring growth using MUAC (Mid-Upper Arm Circumference) tapes and growth charts.
  • Counseling on early childhood development (ECD) and age-appropriate play.
  • Ensuring sanitation, safe drinking water, and handwashing practices (WASH).

Immunization

• Microplanning: Assisting the Auxiliary Nurse Midwife (ANM) in preparing the "Due List" for vaccination.
• Mobilization: Bringing beneficiaries to the session site on Village Health Sanitation and Nutrition Day (VHSND).
• Tracking: Identifying and tracking drop-outs and left-outs under Mission Indradhanush.
• Adverse Events: Reporting any Adverse Events Following Immunization (AEFI) in the community.

Management Of Childhood Illnesses (Community Level)

ASHA workers are trained in Integrated Community Case Management (iCCM) / IMNCI principles to tackle major killers of children under five:

• Diarrhea Management: Provision of prophylactic and therapeutic Oral Rehydration Salts (ORS) packets and Zinc supplementation (14-day course) at the doorstep.
• Acute Respiratory Infections (ARI): Screening for pneumonia by counting respiratory rate, dispensing basic oral antibiotics (e.g., Amoxicillin/Cotrimoxazole based on state-specific protocols) for non-severe pneumonia, and referring severe cases.
• Malaria Endemic Zones: Performing Rapid Diagnostic Tests (RDT) for fever cases and providing Artemisinin-based Combination Therapy (ACT) or Chloroquine.

Nutrition And Supplementation

• National Iron Plus Initiative (NIPI): Distributing Iron and Folic Acid (IFA) syrup (bi-weekly) to children aged 6 to 59 months to combat anemia.
• Vitamin A: Mobilizing children for biannual Vitamin A supplementation.
• Severe Acute Malnutrition (SAM): Identifying children with SAM using MUAC <11.5 cm or presence of bilateral pitting edema, and referring them to Nutrition Rehabilitation Centers (NRCs). Follow-up of children discharged from NRCs.

Specific National Programs

• National Deworming Day (NDD): Assisting in the administration of tablet Albendazole (400 mg) to children biannually.
• Rashtriya Bal Swasthya Karyakram (RBSK): Mobilizing children from the community and Anganwadi centers for screening of the 4Ds (Defects, Deficiencies, Diseases, Developmental delays) by Mobile Health Teams.