ASHA Worker vs Auxiliary Nurse Midwife (ANM) - Park's Community Medicine

1. Basic Profile

2. Roles and Responsibilities

ASHA - Key Responsibilities

1. Health promotion/awareness - Creates awareness on nutrition, sanitation, hygiene, healthy living, and available health services.
2. Counseling - Counsels women on birth preparedness, safe delivery, breastfeeding, complementary feeding, immunization, contraception, RTI/STI prevention, and young child care.
3. Community mobilization - Mobilizes community to access services at anganwadi/sub-centre/PHC (immunization, ANC, PNC, nutrition, sanitation).
4. Village health planning - Works with Village Health and Sanitation Committee to develop a comprehensive village health plan.
5. Escort/accompaniment - Escorts/accompanies pregnant women and children requiring treatment to PHC/CHC/First Referral Unit.
6. Primary medical care - Provides primary care for minor ailments (diarrhoea, fevers) and first aid for minor injuries; provides DOTS under RNTCP.
7. Depot holder - Holds essential drugs/supplies: ORS, IFA tablets, chloroquine, disposable delivery kits, oral pills, condoms.
8. Vital events reporting - Reports births, deaths, and disease outbreaks to sub-centre/PHC.
9. Sanitation promotion - Promotes construction of household toilets.
10. Drug kit - Provided a drug kit with both AYUSH and allopathic formulations.

ASHA may have her role expanded (graded training for newborn care, management of common childhood illnesses).

ANM (Health Worker Female) - Key Responsibilities

• Registers and provides care to pregnant women throughout pregnancy
• Ensures minimum 4 ANC visits per pregnancy
• Tests urine for albumin and sugar; estimates haemoglobin
• Refers for RPR test (syphilis) at PHC
• Conducts deliveries when called; supervises Dai-conducted deliveries
• Post-natal home visits on 0, 3, 7, and 42nd day (home/sub-centre delivery); 3, 7, and 42nd day (institutional delivery)
• For low-birth-weight baby: 6 PNC visits (0, 3, 7, 14, 21, 28th day)
• Initiates early breastfeeding within 1 hour of birth
• Assesses growth/development of infants and under-5 children
• Treats diarrhoea, ARI, minor ailments; refers severe cases per IMNCI guidelines
• Implements JSY (Janani Suraksha Yojana) - identifies beneficiaries, obtains approvals, disburses funds
• Tracks all pregnancies by name for ANC/PNC services

• Maintains eligible couple and child register (up to date at all times)
• Distributes conventional contraceptives and oral contraceptives
• Follow-up of female family planning acceptors; manages minor side effects; refers to PHC if needed
• Establishes female depot holders for contraceptive supply
• Builds rapport with ASHA, Dais, village leaders
• Identifies women leaders; helps train them

• Identifies women needing MTP; refers to nearest approved institution
• Educates community on septic abortion and MTP services

• Identifies malnutrition among children (0-5 years); treats and refers
• Distributes IFA tablets to pregnant women, nursing mothers, young children
• Administers Vitamin A solution to children per guidelines

• Immunizes pregnant women with TT
• Administers pentavalent, DPT, OPV, IPV, measles, Hepatitis B, BCG vaccines per schedule
• Ensures injection safety, manages AEFI
• Submits weekly/monthly reports

• Passive surveillance for malaria; collects blood slides
• Disease control activities for filariasis, TB, blindness, NCDs
• IEC for NCD prevention and detection

• Registers pregnant women, infants (0-1 year), under-5 children, women (15-44 years)
• Maintains prenatal, maternity, child care, family planning records
• Submits weekly/monthly reports to Health Assistant (Female)

• Attends staff meetings at PHC/CD Block
• Coordinates with Health Worker Male (HWM), ASHA, and Dais
• Coordinates with PRI and Village Health and Sanitation Committee
• Meets Health Assistant (Female) weekly
• Disposes medical waste per guidelines

3. Key Differences at a Glance

4. Hierarchy

Medical Officer (PHC)
        ↓
Health Assistant Female (LHV)
        ↓
ANM (Health Worker Female) - Sub-centre
        ↓
ASHA - Village level
        ↓ (guidance from)
Anganwadi Worker (AWW)

Random Sampling Techniques - Park's Textbook of Preventive and Social Medicine

What is Sampling?

The Sampling Frame

"A sampling frame is a listing of the members of the universe from which the sample is to be drawn."

Sampling Methods

1. Simple Random Sample

• Every unit in the sampling frame is assigned a number.
• A table of random numbers is then used to decide which units are included.
• Random numbers are a haphazard collection of numbers arranged to eliminate personal selection or unconscious bias.
• Each unit has an equal chance of being drawn.
• This technique provides the greatest number of possible samples.

Key feature: Equal probability for every unit; uses random number tables.

2. Systematic Random Sample

• Every 5th or 10th unit is picked at regular intervals.
• Example: To carry out a filaria survey in a town with a 10% sample -
  • Houses are numbered first.
  • A number is selected at random between 1 and 10 (say 4).
  • Then every 10th number is selected from that point: 4, 14, 24, 34... and so on.
• Each unit in the sampling frame has the same chance of being selected.
• However, the number of possible samples is greatly reduced compared to simple random sampling.

Key feature: Picks every nth unit after a random start; practical and quick.

3. Stratified Random Sample

• The sample is deliberately drawn so that each portion of the sample represents a corresponding stratum of the universe.
• Particularly useful when one wants to analyze data by a specific characteristic of the population (e.g., Hindus, Christians, Muslims; age groups, etc.) - because these groups are not equally distributed in the population.
• Ensures proportional representation of all subgroups.

Key feature: Population divided into strata first, then random sampling within each stratum.

Sampling Errors

1. Size of the sample - larger sample = smaller error
2. Natural variability of individual readings - more variability = more error between samples

"As the size of the sample increases, sampling error will decrease."

Non-Sampling Errors

• Inadequately calibrated instruments
• Observer variation
• Incomplete coverage of selected subjects
• Conceptual errors

These are often more important than sampling errors.

Standard Error

• If random samples (n) are repeatedly taken from a population, each sample has a different mean (x̄).
• The distribution of all sample means follows a normal distribution, centred around the true population mean (μ).
• The standard error (SE) = σ/√n - it measures how reliable a sample mean is.
• 95% of sample means will lie within μ ± 2 (σ/√n) of the true population mean.

SE enables us to judge whether the mean of a given sample is within the set confidence limits.

• Greek letters (μ, σ) = population parameters
• Roman letters (x̄, s) = sample characteristics

Quick Summary Table