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Indian Journal of Community Medicine

Knowledge and Skills of Anganwadi Workers in Hooghly District, West Bengal

Author(s): D. Chattopadhyay

Vol. 29, No. 3 (2004-07 - 2004-09)

Abstract

Objective: To assess the knowledge and skills of Anganwadi workers.

Study Design: Cross-sectional study.

Setting: Hooghly District, West Bengal.

Participants: Anganwadi workers.

Sampling: Multistage sampling. A sample of 34 was taken up.

Method: Interview and on-job observation.

Results: 11.8% Anganwadi workers could define fever, 17.6% knew the age group for exclusive breast feeding and 32.4% knew the eligibility criteria for iron prophylaxis in children. No Anganwadi worker weighed a child twice to take the average and none recorded the weights in growth charts. No Anganwadi worker properly counted the beneficiaries for supplementary nutrition. Only 25% weigh 'corn soya blend' and 20% got the utensils cleaned by acceptable water. Though the knowledge of Anganwadi workers regarding other major activities is mostly adequate, their knowledge and skills in many key areas need improvement.

Key words: ICDS, Anganwadi Worker, Knowledge, Skill

Introduction

In pursuance of the National Policy for Children, 1974, Integrated Child Development Services (ICDS) Programme, 1975, is India's response to the challenge of meeting the holistic needs of the children.

After 25 years, it is the time to look ahead. The vision for tomorrow is to reach all children from disadvantaged groups, so that each of them can realise full development potential, with learning opportunities in early childhood1.

The partnership at community level, between frontline workers of different sectors and community groups, can make the vision a reality. The Anganwadi Worker is the community - based voluntary frontline workers of the ICDS Programme. Selected from the community, she assumes the pivotal role due to her close and continuous contact with the beneficiaries. The Anganwadi Worker monitors the growth of children, organises supplementary feeding, helps in organising immunization sessions, distributes vitamin A, iron and folic acid supplements, treats minor ailments and refers cases to medical facilities1.

Attainment of ICDS Programme goals depends heavily upon the effectiveness of the Anganwadi Workers, which, in turn, depends upon their knowledge, attitude and practice.

Thus the present study was proposed to examine the knowledge and skills of the Anganwadi Workers, with respect to a few key elements of the services provided by them, in a district of West Bengal.

Subject and Methods

The study was observational and cross-sectional in nature, through interview of the Anganwadi workers and observation of their on the job skills. The study was conducted from August 1998 to July 1999. The study population comprised of the Anganwadi workers, working at the anganwadi in ICDS projects of Hooghly District.

The sampling procedure adopted was multistage sampling. Of the 18 ICDS projects in the district, 2 ICDS projects, i.e., Singur and Chanditala-1 were selected by simple random sampling.

As the mean of Anganwadi workers per sector is 22 (Range 20-25), two Anganwadi workers were selected by simple random sampling from each of the 11 sectors of Singur ICDS Project and 6 sectors of Chanditala-1 ICDS Project. Thus a total of 34 Anganwadi workers were chosen as study samples.

Knowledge of Anganwadi workers on various components related to ICDS Programme was assessed by interviewing each Anganwadi worker under study separately by means of a pretested, self-administered, semi-structured questionnaire in local language (Bengali).

Their skills with respect to growth monitoring and supplementary nutrition were assessed by observing their performance while they were on job in their respective anganwadi by using a pretested structured checklist, which was prepared on the basis of existing literatures and in consultation with the experts. Whenever possible the skills of a Anganwadi worker was observed without her knowledge that she was being observed.

Results

Though only 11.8% Anganwadi workers could define fever, 91.2% knew how to prepare oral rehydration solution (ORS) and 79.4% of them knew when to discard that solution. 94.1% Anganwadi workers knew the name of the vector of malaria, but 50% could not mention it's breeding place correctly.

Regarding the knowledge of Anganwadi workers regarding child care components, it was observed that the main disorder prevented by vitamin A, interval between A doses and the target group of vitamin A prophylaxis were known to 97.1%, 94.1% and 79.4% Anganwadi Workers respectively. Though 94.1% of them knew the interval between two doses of DPT and oral polio vaccines, only 17.6% knew the age group for exclusive breast-feeding. Though 82.4% Anganwadi workers knew the source of vitamin D, only 32.4% knew the eligibility criteria for iron prophylaxis in children.

Fifty nine percent Anganwadi workers knew the total number of IFA (Iron, Folic Acid) tablets to be given to a pregnant mother and 64.7% knew that a minimum period of three years is necessary in between two childbirths. While 82.4% Anganwadi workers had correct knowledge regarding anti-tetanus immunization in pregnancy, only 41.2% could mention the minimum number of antenatal check-ups required by a pregnant mother.

Majority of Anganwadi workers (91.3%) suspended the scale freely and 65.2% suspended it at the level of the eye. 60.9% adjusted the scale to zero before weighing. All of them weighed the children with minimum clothing and without shoes and 60.9% took the reading from a distance of one foot. While 65.2% Anganwadi workers preferred to take the readings in fractions of 100 grams, none weighed twice to calculate the average and none put the readings on growth charts.

None of the Anganwadi workers properly counted the beneficiaries for supplementary nutrition, but all of them knew the mathematics to estimate the requirement of individual items. Only 25% Anganwadi workers weighed 'corn soya blend' and 20% got the utensils cleaned by acceptable water. 90% Anganwadi workers covered food after preparation and 65% of them distributed the prepared food uniformly amongst the beneficiaries by using a serving spoon.

Discussion

The present study reveals that the knowledge of Anganwadi workers is not consistent. Their knowledge regarding some components of childcare, maternal care and diarrhoea management is mostly adequate as they do what they have learnt and their knowledge is retained.

It was observed by BNS Walia et al that there was a wide gap in the knowledge and skills of Anganwadi workers to carry out their assignment of screening children suffering from minor ailments and treating them2. The study of Walia et al shows the Anganwadi Workers need more practical training in the recognition and treatment of minor ailments. This training can best be imparted at health sub-centres2.

The present study shows that about two third of the Anganwadi workers have average skills regarding growth monitoring 60.9% of them adjusted the scale to zero before weighing, but none put the readings on growth charts. In a similar study by Walia et al only 46.15% Anganwadi Workers knew that the scale pointer had to be brought to zero before putting the child on the swing and none of them knew how to chart the observed weight on the weight record charts2.

In Singur ICDS Project Salter weighing scales and in Chanditala-1 ICDS Project UNICEF baby scales (CWM-8505) were used. Since the latter is bar type, it was found to be difficult to suspend them freely. This is evident from the fact that, though all Anganwadi workers in Singur ICDS Project suspended the scale freely, only 60% of them in Chanditala-1 ICDS Project did the same. Though, in Singur, 72.2% Anganwadi Workers adjusted the sacle to zero, before weighing a child, only 20% of them in Chanditala-1 did the same. On the contrary, In Chanditala-1, 100% Anganwadi Workers took the readings in fractions of 100 grams whereas in Singur only 55.6% did the same. So these shortcomings may be instrument-specific and may be removed, if Salter weighing machines with better provision of readings in fractions of 100 grams are made universally available.

In 11 Anganwadis the weighing scales were either out of order or were kept in safe custody as some Anganwadi centres were even located in verandas of privately owned houses. On verification it was found that the main instruments, marked 'out of order', were actually in working condition, though the accessories were torn and replaceable. Salter scales were used even in absence of accessories for weighing older children, but the bar balances could not be used.

In a multicentric study in Kerala in 1994-95 all Anganwadi workers were able to handle Salter spring type weighing scales and to plot the weight on the growth charts3.

Though no Anganwadi workers of Chanditala-1, using UNICEF bar balance, was found to weigh 'corn soya blend' prior to preparation of supplementary nutrition, 45.5% Anganwadi Workers of Singur ICDS Project, using Salter scale, were found to weigh the same. This difference may also be attributed to different weighing machines. It is found to be convenient, though may be less accurate, to use Salter weighing scale than to use UNICEF Baby Scale (CWM-8505).

In one anganwadi supplementary nutrition could not be prepared as the helper was absent. In 13 other anganwadis raw food materials were out of stock. In 80% anganwadis pond water was used to clean utensils.

In a study involving 134 Anganwadi workers in 1985, proper growth charts were recorded by 76.9% Anganwadi Workers. More than 80%

Anganwadi Workers responded with correct answers related to antenatal care, post-natal care, family welfare services, management of diarrhoea and prevention of vitamin A deficiency and nutritional anaemia3.

There are extremes of observations in different studies. In a study by Lalit Kant et al 92.71% Anganwadi Workers could not tell full form of ICDS4. On the other hand, B.N. Tandon commented that the knowledge, attitude and practice of Anganwadi workers with respect to growth monitoring, supplementary nutrition and immunization are adequate5.

Moreover, it was felt by Udani et al that, although the Anganwadi workers deliver the package, they fail to communicate and impact whatever knowledge they have to the community6. Kapil and Tandon observed that the quality of training of Anganwadi workers, conducted mainly by the voluntary agencies, required improvement7.

This study shows that the knowledge and skills of Anganwadi Workers in respect to different components of their sphere of activity vary from very bad to very good. The weaker spots can be identified, if a checklist of items concerning the quality of care is worked out and is effectively utilised in monitoring the work. Tsiantis et al published a similar checklist for developing criteria for quality assurance to ensure that both the physical and psychological well being of those being served is catered for8. Corrective actions must be undertaken by means of regular continuing education and field-based refresher training programmes for Anganwadi workers to update their knowledge and skills, including their communication skills.

Acknowledgements

The author expresses his sincere gratitude and thankful appreciation to Professor Ranadeb Biswas, Head of the Department, Department of P.S.M., AIIH & PH, Kolkata for his invaluable help and guidance in each and every stage of this study.

References

  1. Govt. of India. Integrated Child Development Services. Dept. of Women and Child Development, Ministry of Human Resources Development, New Delhi 1995; 1-24.
  2. Walia BNS, Gambhir SK, Narang A, Gupta KB. Evaluation of Knowledge and Competence of Anganwadi Workers as Agents for Health Care in a Rural Population. Indian Pediatrics 1978; 15(10): 797-801.
  3. Integrated Child Development Services - Survey, Evaluation and Research, 1975-1995. Central Tech. Committee (Integrated Mother and Child Development), New Delhi 1996; 120-171.
  4. Kant L, Gupta A, Mehta SP. Profile of anganwadi workers and their knowledge about ICDS. Indian J Pediat 1984; 51:401-402.
  5. Tandon BN. ICDS - Past, Present and Future. Indian Pediatrics 1997; 34: 187-191.
  6. Udani RH, Patel RB. Impact of knowledge of anganwadi workers or slum community. Indian J Pedat 1983; 50: 157-159.
  7. Kapil U, Tandon BN. ICDS Scheme - Current Status, Monitoring, Research and Evaluation System. IJPH. 1990; 34: 41-47.
  8. Tsiantis J, Caldwell B, Dragonas T et al. Development of a WHO child care facility schedule (CCFS), a pilot collaborative study. Bulletin of the WHO 1991; 69: 51-57.

Dr. D. Chattopadhyay,
35/3, Kankraparelane, Howrah - 711104,
West Bengal

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