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. 2022 Dec:34:100787.
doi: 10.1016/j.srhc.2022.100787. Epub 2022 Oct 20.

Evaluating the moderating role of accredited social health activists on adverse birth outcomes in rural India

Sandra Kiplagat  1 , Anisa Khan  2 , Diana M Sheehan  3 , Poornima Jaykrishna  2 , Kavitha Ravi  2 , Mary Jo Trepka  4 , Zoran Bursac  5 , Dionne Stephens  6 , Karl Krupp  7 , Purnima Madhivanan  8
Affiliations

Evaluating the moderating role of accredited social health activists on adverse birth outcomes in rural India

Sandra Kiplagat et al. Sex Reprod Healthc. 2022 Dec.

Abstract

Background: The Indian government established the Accredited Social Health Activists (ASHA) program in 2006 to improve access and healthcare coverage in rural regions. The objective of this study was to examine the moderating role of ASHA home visits and ASHA-accompanied antenatal care visits (ANC) on the relationship between sociodemographic latent classes of pregnant women and preterm birth and low birth weight infants in rural Mysore District, India.

Methods: Utilizing a prospective cohort study conducted between 2011 and 2014, secondary data analysis was performed among 1540 pregnant women in rural Mysore, India. Latent class analysis was performed to identify sociodemographic distinct patterns. Multivariable logistic regression was performed to examine the moderating effects of ASHA-accompanied ANC visits and ASHA home visits on preterm birth and low birth weight.

Results: Among women who never/rarely had ASHA-accompanied ANC visits, women in Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more" had higher odds of preterm birth (adjusted odds ratio [aOR]: 2.62, 95% confidence interval [CI]: 1.12-6.12 compared to Class 4 "high SES/later marriage/primigravida/no children.". Women in Class 3 "high SES/later marriage/multigravida/1 child or more" had higher odds of preterm birth compared to class 4. Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight infant.

Conclusion: The findings demonstrate that ASHA accompanying women to ANC moderates the risk of preterm births among women in high-risk SES groups. Targeted policies and interventions in improving and strengthening the ASHA program are needed to reduce inequalities in adverse birth outcomes in rural India.

Keywords: Accredited Social Health Activists; India; Latent Class Analysis; Low Birth Weight; Preterm Birth.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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