ASHA being the first port of call to the deprived population are expected to facilitate community participation in public health programmes, especially among women and children. ASHA has to counsel pregnant women about Antenatal Care (ANC), birth preparedness and danger signs during pregnancy.

She has to provide information about the importance, duration, and frequency of breastfeeding to lactating mothers. Information about contraception and Reproductive Tract Infections (RTIs)/ Sexually Transmitted Diseases (STDs) has to be given to the eligible couple.

In most of the villages where the healthcare facilities are located far from the personal residence, they have to be dependent on ASHA for basic healthcare facilities like medicines for minor ailments, assistance in ANC, Intra Natal Care (INC) and Post Natal Care (PNC). After 12 years of the launch of ASHA services, now the community acceptance and utilization of ASHA services have increased [3]. ASHA's knowledge about these healthcare facilities will be critical in reducing the mortality and morbidity related to maternal and child health in any community.

ASHA being a link between the community and the health facilities should improve the community by providing health education and increasing service utilization. But studies have shown that the knowledge level of ASHA in most of the places was not complete that may lead ASHA to provide incorrect information to the community. Hence this study is conducted to assess the level of knowledge of ASHA workers about maternal health.

Study design: It is a community based cross-sectional study

Study setting: Mysuru Taluk, Karnataka

Study duration: The study was conducted from January 2019 to April 2019. Data collection from all the PHCs of Mysuru Taluk was done during January and February 2019.

Study population: Trained ASHA workers in Mysuru Taluk, who had experience of at least 1 year were the study participants.

Sample size: A study conducted in Udupi Taluk in 2017 has revealed that the knowledge among ASHA workers about ANC and PNC as 82%. That is taken as the prevalence of knowledge.

Validity of the tool: The questionnaire was validated by a pilot study conducted on 29 ASHA workers of Mysuru Taluk. Necessary changes were made and the tool was finalized for the study. Cronbach’s alpha was 0.76.

Procedure of data collection: Data collection was carried out by the researcher through self administered questionnaire. All the Medical Officers (MO) of PHCs in Mysuru Taluk were contacted and obtained permission for data collection during their monthly meetings with ASHA workers or any other possible days when ASHAs can gather.

On prescribed dates ASHAs of respective PHCs were administered with the questionnaire. Details about the researcher, purpose and nature of study was explained. Information about voluntary participation was given. Written consent was taken from all the participants.

Data analysis: The collected data was entered and edited in SPSS version 16.0. Descriptive data was analyzed by using frequency, percentage, mean and standard deviation. For the association between variables, Chi-square / Fisher’s exact test was used. Ρ value less than 0.05 was considered as statistically significant.

Ethical considerations: Ethical clearance was obtained from Institutional Ethics Committee, K S Hegde Medical Academy, Nitte (Deemed to be University) (#INST. EC/EC/136/2018-19). To conduct the study, permission was obtained from the Director, Health and Family Welfare services, Bengaluru.

Participants were explained about the objectives and the nature of the study. Informed consent was taken from each participant before administering the questionnaire. Identity of the participants was anonymized.

Socio-Demographic characteristics: The number of ASHA workers participated in the study was 295. Out of that 51.9% of them belonged to the age group of 25 to 34 years. The age of participants ranged from 21 years to 53 years, mean age being 34.35 with Standard Deviation (S.D) 5.95 years. More than half of the participants (61.3%) were educated up to 8^th to 10^th standard. Among the participants, 86.4% were married, 11.2% were widowed and 0.7% of them were un-married.

Table-2: Knowledge of the respondents about Maternal and Child Health

Figure-1: Classification of participants based on knowledge score

Knowledge about ANC: Need for early identification of pregnancy was correctly identified by 76.3% of the respondents. Minimum number of ANC visits was answered correctly as 4 by 98% but almost 30% of them could not answer correctly about the ANC visit schedule.

About 60% of the respondents could identify all the laboratory investigations done during ANC visits. Number of TT injections to be given to pregnant women during first pregnancy was known to 95.6% of the respondents. Ideal weight gain during pregnancy per month was correctly known by only 34.2% of the participants.

Knowledge about PNC: There was correct knowledge about cord care among 97.6% and 90.8% of them correctly identified the scheduled days an ASHA should visit recently delivered mother. Only 30.2% of the respondents could answer correctly about the weight to be considered as Low Birth Weight (LBW) soon after birth. Advising about kangaroo mother care was known to be given to LBW baby by 95.3%.

Knowledge about Breastfeeding: Time of initiation of breastfeeding was correctly known by 96.9% of the respondents.

^*p value <0.05

^**p value <0.01

In the present study it was found that about half of the respondents (51.9%) were aged 25 to 34 years. Similar findings were obtained in a study conducted by Desai et al. in which around 71% of the ASHA workers were aged between 25 to 34 years [4]. ASHA workers are involved in mobilizing the community, the age group is an important factor since it requires physical strength. Hence the ideal age group recommended by NHM is 25 to 45 years. This study found that more than 90% of the ASHA workers belonged to this age group. In this study, 61.4% of the study participants were educated up to High school, and 13.6% were educated up to 7^th standard. These findings are similar to the study conducted by Nagaraj et al. where 77.3% were educated up to high school and 9.7% up to middle school [5].

About 83% of the ASHA workers covered the population up to 2000 and the rest of them covered the population of more than 2000 similar results was found in the study conducted by Bhandari et al. that is 73.75% of them were covering the population of 1000 to 1500, and 5% of them were covering the population of more than 1500 [6]. Even though the maximum population to be covered by each ASHA is 1000, due to lack of availability of human resources they have been allotted more than the ideal number of populations.

In the present study it is found that only 47.2% of the respondents have good knowledge about ANC. A study conducted by Kori et al. found that 12.5% and 14.7% of the respondents had very good and good knowledge about ANC respectively [7]. The minimum number of ANC visits was correctly identified as four by 98% of the respondents, but the recommended schedules of these visits were known only by 70.8%. The number of TT injections to be given in the first pregnancy and number of IFA tablets to be taken was also known correctly by 96.6% and 79.7% respectively. But only 24.4% of the respondents could identify all the three listed side effects of IFA tablets.

In this study knowledge about immunization was found to be good among 78% of the study participants. According to the study conducted by Kori et al. in 2015 more than 60% of the respondents had good knowledge about the immunization [7]. Good knowledge about the immunization schedule is important for ASHA workers to guide the community to get timely immunization services. The minimum spacing between two children was correctly answered as three years by 93.9% of the respondents, and 94.9% could correctly identify the spacing method among other permanent contraceptive methods. The study conducted by Ratnam et al. found that 100% of the ASHA workers knew the permanent and spacing methods of contraception provided by the government [13]. The knowledge about the types of contraceptive methods is important to be known by ASHA workers since it helps them to counsel the couple based on whether the family size is complete or not.

Since it is a cross sectional study, enhancement or declination in knowledge over time could not be studied. The knowledge level is studied only on a selected district, so generalization was not possible.

The level of knowledge was average among almost half of the participants. Community mobilization is an important responsibility of ASHA workers especially for ANC visits of pregnant women. But the knowledge about the schedule for the same was lacking among one third of the respondents. In spite of being trained regularly and more than one-third of them having field experience of more than six years, few ASHAs were still recommending pre-lacteal feeds, and most of them are not aware of the concept of exclusive breastfeeding till six months after birth. The knowledge about important elements like identification of the danger signs in pregnancy and birth preparedness plan were incomplete.

In the aspects such as knowledge about pregnancy testing kit, ANC, PNC, immunization, and family planning most of their knowledge was found to be good, but the detailed knowledge about all these