Indo American Journal of Pharmaceutical Research, 2017 ISSN NO: 2231-6876

KNOWLEDGE, ATTITUDE AND PRACTICE OF ANGANWADI WORKERS ON

HOMOEOPATHIC FORMULATIONS
Amulya Ratna Sahoo1, Biswaranjan Paital2*, Divya Taneja3, A.K. Hati5
1
S-2, Drug Proving Unit, Bhubaneswar.
2
Department of Zoology, College of Basic Science and Humanities, Orissa University of Agriculture and Technology, Bhubaneswar,
India.
3
S-1, CCRH headquarters, New Delhi.
4
Dynamic Homeopathic Centre, Industrial Colony, Kharvel Nagar, Unit-III, Bhubaneswar.

ARTICLE INFO ABSTRACT

Article history Homeopathic drugs are the most side effect less drugs and many homeopathic practitioners
Received 10/10/2017 claim about better curing effect of such drugs in children and mothers. Anganwadi workers
Available online (AWW) are community based workers, and work as one of the crucial media for the delivery
31/10/2017 of ICDS services to children and mothers. There is no scientific data available for identifying
their knowledge, attitude and practice (KAP) of homeopathic drugs. Therefore, an instrument
Keywords has been designed and tested to identify KAP of AWW on homoeopathic drugs. This can be
Anganwadi Workers, used for motivating AWW to participate in homeopathic drug delivery programs. It would
Homeopathic Medicines, result in sensitizing AWW on usefulness of homeopathy, especially in children. All the
Demographic Survey, AWW from the two specific areas, namely Niali and Kantapada of Cuttack district of Odisha
Knowledge, were included in this study. The study was undertaken by a survey that was carried out on a
Attitude, sample of 339 AWW in Cuttack district of Odisha to identify their KAP towards
Practice, homoeopathy drugs. A bilingual questionnaire was prepared and tested on the AWW subjects.
Cheap Remedy. In some instances, the questionnaire items were identified via telephonic interview with the
subjects. The questionnaire was tested in terms of its internal consistency, test-retest
reliability, and face and construct validity. Their KAP was recorded and analyzed. For the
study, it was observed that most of the AWW were young graduates with sound background
knowledge on homeopathic medicines. They opine that since these medicines are cheap, there
should not be any apprehension for treatment of diseases with such remedies especially in
children. Albeit, they lack with a complete idea about the usage of the homeopathic
medicines especially about their administration. Since AWW act as the bridge between
community and health services, government should emphasize to train all AWW of all the
poor states such as Odisha about homeopathic remedies especially their administration. A
special drive may be initiated by the government on availability of homeopathic remedies
with less or no cost at all health centers for their effective distribution through AWW.

Corresponding author
Biswaranjan Paital
Dept. of Zoology,
CBSH, Orissa University of Agriculture and Technology,
Bhubaneswar, India
[email protected]

+91-674- 2397029Please cite this article in press as Amulya Ratna Sahoo et al. Knowledge, Attitude and Practice of Anganwadi
574

Workers on Homoeopathic Formulations. Indo American Journal of Pharmaceutical Research.2017:7(10).

Copy right © 2017 This is an Open Access article distributed under the terms of the Indo American journal of Pharmaceutical
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Research, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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INTRODUCTION
One of the major initiatives introduced by the Government of India, New Delhi was, the Integrated Child Development
Service Scheme (ICDS). It was aimed to provide services like health, nutrition and education to women and small children especially
those belong to rural areas or to communities of economically poor and backward. The Anganwadi Workers (AWW) are the
community-based salient volunteer and the most important functionary of the ICDS scheme. An anganwadi worker is a woman having
a decent personality and sound educational background, is chosen by the residents of the locality. Providing health service related
knowledge and materials, being their one of the most important works for which they are paid honorarium [1].
Homoeopathic literatures are vociferous in describing the efficacy of a number of constitutional as well as organopathic
medicines in treating patients suffering from BHP and make claims in achieving good response at individual levels. However
scientific documentation on knowledge, attitude and practice (KAP) of people is scanty [2]. Especially, KAP of paramedical staffs
working in different health sectors is too scanty and are not well documented. Homoeopathic science considers the human organism as
a triune entity of “mind, body and vital force” and envisages it as a subtle conglomeration of different parts regulated, harmonized and
co-ordinated by an omnipotent force (Vital force), which plays significant role both in healthy and disease conditions. It considers
“disease” as a “dynamic entity” and the derangement of the whole man, expressed through the particular organs of the body, i.e. the
“whole man” is primarily diseased and individual organs/parts are only secondarily affected [3]. It perceives each individual patient
suffering from different disease(s) as a separate entity from others suffering from the same disease, because individuals are unique by
virtue of their peculiar mental states, physical attributes and particular characteristics [4]. In short, it emphasizes, the ‘person
diagnosis’, instead of the ‘disease diagnosis’. Therefore, the same homeopathic remedy may work differently in different patients [1-
4]. The effectiveness of homeopathic drugs are claimed to be very high while the cost and side effects of the same is very low [5-7].
Probably this is the reason why homeopathy has greater demand in countries such as India with low GDP. Especially, the poor states
such as Odisha are believed to the prime target to use homeopathy remedies, albeit wide spread awareness is still to be generated to
sensitize paramedical staffs including AWW working in different health sectors [2, 9].
As an out come to overcome above lacuna in health sectors, Central Council for Research in Homoeopathy under directions
of Ministry of AYUSH, Government of India has developed a public health program, on Homoeopathy for Healthy Child in the year
2015. One of the strategies under that program is to sensitize AWW, who can then recommend parents and care givers to seek
homoeopathic treatment for common dentition related complaints in children in the age group of 6 months to 3 years. However, a
follow-up information about the KAP of AWW on homeopathy is not well documented. Therefore, the present study was undertaken
to study how AWW are sensitized about homeopathy remedies. AWW from two specific areas namely Niali and Kantapada block in
the Cuttack district of Odisha state were chosen for the current study. The objectives were to study the profile of AWW and their KAP
about homoeopathy and its usefulness.

MATERIAL AND METHODS

Questionnaire development: All total 12 questions were set in the questionnaire as in bi-lingual (Odia and English) after
discussing with the lecturers and medical officers of Dr.Abhin Chandra Homoeopathic Medical College and Hospital, Bhubaneswar as
follows.
Name of AWW, Block, date of study, Educational status, age, contact (mobile number) and economic status such as
poor/lower middle class/higher middle class/rich. Along with the above personal credentials, the other questions were offered to be
answered by them (Table 1).
The questionnaire was structured with fixed responses against each item. The bi-lingual (English and Odia) questionnaire
was checked for completion and any ambiguity when it was returned by the AWW. Clarifications, if any on the responses were taken
then and there.

Participants:
All total 339 AWW from Kantapada and Niali block of Cuttack district were invited to attend the sensitization program on
homoeopathy under the program on Homoeopathy for Healthy Child. Prior to undertaking the session, the questionnaire was
distributed to all AWW. A total 231 AWW from Niali block were invited to participate in the study out of which only 197 have turned
into the participation and all were responded into the questions. Similarly, from Kantapada block, out of total 151 invited AWW, 143
have participated and 142 responded.

Reliability study:
All 339 interns consented to participate after they were explained about the purpose of the study. Verbal consent was
obtained from all participants about the use and possible publication of the results. The participants were asked to put a tick mark on
the questions after carefully and completely understanding the fact as per best of their ability and they were also requested to write
their personal credentials out of which, their names were assured not to be revealed publicly or in the publication. The same
questionnaire was offered to them to re-test their responses. They were requested not to reveal their responses with the co-participants
until the re-test part has been completed. This was done to ensure that in re-test, individual responses of the participants are obtained
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impartially and correctly. The re-test was done after an hour of the test.
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Validation study:
Subjects who had participated in the study were asked about the questionnaire, if it was understandable. Their opinions about
the questionnaire, mostly in terms of difficulty faced in understanding of questions, clarity of questions, familiarity with questions,
problems while filing the questionnaire and any feedback related to questions, scale adopted for evaluation, and queries related to the
questionnaire were assessed and it was observed that since the question was bi-lingual, there was no problem with the questionnaire
for them.

Statistical Analysis
The data were tabulated electronically in Microsoft Excel and analyzed by using the Microsoft Excel formulae. Percentage of
the responded population in each category was calculated using the formula (no. of respondent in that category/total number of
respondents) X 100. In Table 2 to table 14, ppercentage of results for each category are given in parentheses. The demographical
details of the participants were expressed in frequency and percentage in Table 2 top Table 14. Intra-class coefficients for each item
and total score were estimated to assess test-retest reliability. Guttman’s λ was used to calculate internal consistency at p<0.05 level
(data not shown). It was assume that at p<0.05 level, the average correlation of a set of items is an accurate estimate of the average
correlation of all item as that portion to a certain construct. It works as a function of the number of items in a test, the average
covariance between item-pairs and the variance of the score [8].

Table 1. Questionnaire for the study.

SL No. Questions Put tick (√) mark on any of the followings answers
1 Have you ever taken a)Never b) Sometimes c) Mostly d) Always.
Homoeopathic Medicine?
2 Do Homoeopathic medicines work a) Yes b) Increases the c) sometimes it d) Never
? diseases works
3 Homoeopathic medicines can be a) a) Only children b) only women c) for all age d) only old age group.
used for? groups
4 For which diseases homoeopathic a) Skin disease b) Joint pains c) for all disease d) for all diseases except
medicines can be given? conditions emergency conditions.
5 Can Homoeopathic medicines be a) Yes b) No c) Don’t know d) None of the above.
simultaneously used with
allopathic medicines ?
6 Do Homoeopathic medicines have a) Yes b) No c) Don’t Know d) Too some extent.
side effects?
7 Are all homoeopathic medicines a) Yes b) No c) Don’t Know. ----
alike?
8 Are Homoeopathic medicines a) Yes b) No c) Don’t Know. ----
always taken in empty stomach?
9 How many persons in your a) No one b) A few c)Many d) All.
adjourning areas use homoeopathic persons
medicine and are aware of it ?
10 Is Homoeopathic safe for children? a)Yes b)No c) Don’t Know. ----
11 Are Homoeopathic medicines a)Yes b)No c) Don’t Know. ----
available free of cost in
government hospitals &
dispensaries?
12 Are Homoeopathic medicines a)Yes b)No c) Don’t Know. ----
highly helpful for problems during
dentition among children?

RESULTS
Profile of AWW
The profile of the AWW in the studied area are presented in Table 2. Out of 339 AWW surveyed, 142 (41.9%) were from
Kantapada block and 197 (58.1%) were from Niali block.
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Table 2. Profile of AWW. Percentage of results are given in parentheses.

Block Kantapada Niali Total

Age
20-30yrs – Group A 25 (17.6) 14 (7.1) 39 (11.5)
31-40yrs – Group B 55 (38.7) 110 (55.8) 165 (48.7)
41-50yrs – Group C 49 (34.5) 70 (35.5) 119 (35.1)
51yrs & above – Group D 9 (6.3) 2 (1.0) 11 (3.2)
Not answered – Group E 4 (2.8) 1 (0.5) 5 (1.5)
Educational qualification
Under Matric.-Group-A 3 (2.1) 0 3 (0.9)
10th pass- Group-B 34 (23.9) 43 (21.8) 77 (22.7)
+2 pass- Group-C 28 (19.7) 47 (23.9) 75 (22.1)
B.A -Group-D 67(47.2) 98 (49.7) 165 (48.7)
M.A.-Group-E 5 (3.5) 6 (3.0) 11 (3.2)
Not answered- Group-F 5 (3.5) 3 (1.5) 8 (2.4)
Economic status
Poor-Group-A 7 (4.9) 20 27 (8.0)
Lower middle class-Group-B 86 (60.6) 119 205 (60.5)
Upper middle class-Group-C 11 (7.7) 20 31 (9.1)
Rich--Group-A 0 0 0
Not answered-Group –E 38 (26.8) 38 76 (22.4)

Most of the AWW were below the age of 40 years. It is observed that maximum and significant numbers of workers (48.7%)
possess graduation degree, while very few (0.88%) were below matriculation education. A very less percentage i.e. 3.24% of workers
were with postgraduate degree. The awareness in AWW was not region specific because AWW of both the studied region provided a
mixed result.
It is clear from the table 2 that a majority of the respondents (60.47%) belong to the lower middle-class group of economic
strata. None of the AWW belongs to rich class but 7.96% of the workers come from poor family. A total of 22.4 % have not
responded with respect to their economic status. Hence, women with lower income group are mostly employed as AWW. Out of the
total respondents, maximum (68.7 %) AWW have used homeopathic remedies (HR) occasionally, while minimum opinion (3.83%)
was that they were never used HR. However, significant numbers of them accounting about 21.23 % always prefer HR (Table 3).
Irrespective of use of HR, most (~88%) of AWW believe that HR cure a disease. Non-significant numbers (1.76%) of AWW opine
against the effectiveness of HR to cure disease. Surprisingly, none of them have suggested that HR have adverse effects on a disease
(Table 4).

Table 3. Responses on usage of homeopathic formulations.

*Type of Response Kantapada Niali Total

Never 3 (2.1) 10 (5.1) 13 (3.83)
Sometimes 101(71.1) 132 (67.0) 233 (68.73)
Mostly 26(18.3) 46 (23.4) 72 (21.23)
Always 12(8.5) 9 (4.6) 21 (6.19)
*Question: Have you ever taken homoeopathic Medicines?

Table 4. Responses on effectiveness of homeopathic medicines.

*Type of Response Kantapada Niali Total

Yes 132 (93.0) 166 (84.3) 298 (87.9)
Increases the disease 0 (0) 0(0) 0 (0)
Sometimes work 6 (4.2) 25 (12.7) 31 (9.14)
Never works 2 (1.4) 4 (2.0) 6(1.76)
No response 2 (1.4) 2 (1.) 4 (1.17)
*Question: Do homoeopathic medicines work?
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It was recorded that none of the AWW stated that HR are only effective on females or in elder age group. All most all of
them (97.644%) aware that HR is effective in all age group of people. Very less portion (2%) of the studies group indicate that HR are
only works on children (Table 5). Most (54.57%) of the AWW have knowledge that HR can clear all diseases while many of them
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(40%) also believe that it works against all diseases except they are ineffective during emergency care. Few of them also believe HR is
joint pain (0.58%) and skin diseases (2.35%) specific (Table 6). A unanimous opinion among AWW (85.84%) was recorded that HR
can be simultaneously prescribed to people. However, a minority (8.55%) of didn’t support the above idea (Table 7).

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Table 5. Opinion on age group and usage of homeopathic remedy.

*Type of Response Kantapada Niali Total

Only children 1 (0.7) 6 (3.0) 7 (2.06)
Only female -- -- 0 (0)
for all age groups 141 (99.3) 190 (96.4) 331 (97.64)
only old age group 0 (0)
No response -- 1 (0.5) 1 (0.29)
*Question: Homoeopathic medicines can be used for?

Table 6. Responses on type of diseases cured by homeopathic remedy.

*Type of Response Kantapada Niali Total

Skin disease 5 (3.5) 3 (1.5) 8 (2.35)
Joint pains 1 (0.7) 1 (0.5) 2 (0.58)
For all disease conditions 70 (49.3) 115 (58.4) 185 (54.57)
For all diseases except emergency conditions. 64 (45.1) 73 (37.1) 137 (40.41)
No response 2 (1.4) 5 (2.5) 7 (2.06)
*Question: For which diseases homoeopathic medicines can be given?

Table 7. Opinion on simultaneous use of homeopathic remedies.

*Type of Response Kantapada Niali Total

Yes 121 (85.2) 170 (86.3) 291 (85.84)
No 11 (7.7) 18 (9.1) 29 (8.55)
Don’t know 7 (4.9) 7 (3.6) 14 (4.12)
None of the above 1 (0.7) 1 (0.5) 2 (0.58)
No response 2 (1.4) 1 (0.5) 3 (0.88)

*Question. Can homoeopathic medicines be simultaneously used with allopathic medicines?

Table 8. Opinion on side effects of homeopathic formulations.

*Type of Response Kantapada Niali Total

Yes 5 (3.5) 13 (6.6) 18 (5.3)
No 78 (54.9) 106 (53.8) 184 (54.37)
Don’t know 16 (11.3) 21 (10.7) 37(10.91)
Up to some extent 39 (27.5) 52 (26.4) 91(26.84)
No response 4 (2.8) 5 (2.5) 9(2.65)
*Question: Do homoeopathic medicines have side effects?

More than half (54.37%) of the participated AWW population think that HR have no side effects, albeit a significant portion
(26.84%) of them also believe that HR do have some side effects. A very less of them (5.3%) do believe on side effects of HR (Table
8). Interestingly, almost equal (≥31%) numbers of them gave an ambiguous statement that all HR looks like similar (Table 9).
Similarly, almost equal proportion of AWW (≥44%) thinks that HR can be taken in empty stomach or after food (Table 10).

Table 9. Responses on similar look of homeopathic remedies.

*Type of Response Kantapada Niali Total

Yes 51 (35.9) 61 (31.0) 112 (33.03)
No 48 (33.8) 62 (31.5) 110 (32.44)
Don’t know 35 71 (36.0) 106(31.26)
None of the above 0 0 0(0)
No response 8 3 (1.5) 11(3.24)
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*Question: Are all homoeopathic medicines alike?

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Table 10. Responses on administration time of homeopathic formulations.

*Type of Response Kantapada Niali Total

Yes 77 (54.2) 91 (46.2) 168(49.55)
No 62 (43.7) 88 (44.7) 150(44.24)
Don’t know 3 (2.1) 15 (7.6) 18(5.3)
None of the above 0 0 0(0)
No response 0 3 (1.5) 3 (0.88)
*Question: Are homoeopathic medicines always taken in empty stomach?

Table 11. Responses of AWW on public awareness of homeopathic formulations.

*Type of Response Kantapada Niali Total

No one 1 (0.7) 3 (1.5) 4 (1.17)
A few persons 93 (65.5) 119 (60.4) 212 (62.53)
Many 36 (25.4) 69 (35.0) 105(30.97)
All 12 (8.5) 6 (3.0) 18(5.3)
No response 0 0(0)
*Question: How many persons in your adjourning areas use homoeopathic medicine and are aware of it?

Majority (62.53%) of AWW replied that HR or the homeopathic treatment system is not common in public. Indicating less
public awareness on HR. However, a significant of them (31%) were also agreed that HR is well popular in the study area. A non-
significant total of 5.3% of them opined that all are aware about HR in their area. On the other hand, 1.17% also do believe that no one
understand about HR treatment system in their area. It justify, public are well acquainted with HR system (Table 11).

Table 12. Responses on side effects of homeopathic formulations in children.

*Type of Response Kantapada Niali Total

Yes 140 (98.6) 192 (97.5) 332(97.93)
No 1 (0.7) 2 (1.0) 3 (0.88)
Don’t Know -- 1 (0.5) 1 (0.29)
None of the above -- -- 0 (0)
No response 1 (0.7) 2 (1.0) 3 (0.88)
*Question: Is homoeopathy safe for children?

Table 13. Opinion on availability and cost of homeopathic medicines.

*Type of Response Kantapada Niali Total

Yes 56 (39.4) 96 (48.7) 152 (44.83)
No 73 (51.4) 69 (35.0) 142 (41.88)
Don’t Know 13 (9.2) 30 (15.2) 43(12.68)
None of the above 0 0 0(0)
No response 0 2 (1.0) 2 (0.58)
*Question: Are homoeopathic medicines available free of cost in government hospitals & dispensaries?

Table 14. Responses on effects of homeopathic remedies during dentition.

*Type of Response Kantapada Niali Total

Yes 133 (93.7) 187 (94.9) 320 (94.95)
No -- 2 (1.0) 2 (0.59)
Don’t Know 9 (6.3) 8 (4.1) 17 (5.04)
None of the above -- -- 0(0)
No response -- -- 0(0)
*Question: Are homoeopathic medicines highly helpful for problems during dentition among children?
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Being the first line first aid box for the rural public, most of the participated AWW unanimously believe that HR is side
effect less in children (Table 12). However, a mixed opinion was obtained about the cost effectiveness of the HR, being ≥ 41% of
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AWW answered in either side of the cost effective ness of HR, and 12 % of the participated AWW state that they are not sure about
the cost of HR (Table 13). An important stage of childhood development is dentition. Unanimously, significant of the participated
AWW (95%) stated that HR is very important during dentition of children (Table14).

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DISCUSSION
Design and methods:
Many homeopathic doctors claim that HR are the most cost effective side effect less formulations with better and long term
curing effects against majority of the diseases. AWW are community level workers and considered as crucial media for the delivery of
ICDS services to children and mothers [9]. Literature on their knowledge, KAP on HR system is very scanty in all states of Indian
subcontinent. Therefore, a study was designed to collect information on KAP on HR in AWW with an objective to use the data to
motivate them to participate in homeopathic drug delivery public programs. Based on the obtained information, they would be
sensitized on usefulness of HR specifically in children. For this study, all AWW from Niali and Kantapada of Cuttack district of
Orissa state were invited to answer a common bilingual questionnaire.
Many researches have been conducted to evaluate and assess the impact of the ICDS programme, but very few studies have
been carried out to know KAP of Anganwadi workers on HR system. In this survey, Anganwadi workers had to be sensitized about
availability of homoeopathic medicines for children. In fact, it was desirable that the knowledge and attitudes of AWW are considered
prior to undertaking such a sensitization programme.
As the Anganwadi workers play an important role due to their close and continuous contact with the people of the
community, especially the children and women, so it is important to assess their level of available treatment and their awareness for
homeopathic medicines. So, the study was conducted to recognize the current level of knowledge regarding homeopathic medicines
among AWW.
It was observed that more AWW from Niali block was participated in the survey Kantapada block and most of them were
young. They posses usually higher educational degrees such as graduation or even post graduation. It is an indication that they can
better serve in delivering ICCD programmes. Socio-economically, majority of them belong to the lower middle-class group or even
few of them belong to poor family. So it indicates that women with lower income group are mostly employed as AWW. Most of them
are also experienced HR during their lifetime. Therefore, majority of them believe that HR can cure a disease. From their experience,
they strongly state that HR have no adverse effects on a disease and are effective against any disease in any age group of people
inspective of gender. However, a partial biasness was observed that few of them believe that HR are effective in women. There was
also a common opinion that HR are ineffective during emergency medical cases. Many of them also state that HR can be
simultaneously prescribed along with other medicines although 1/3 rd of them do not have a clear idea about that each HR are different.
They also states that HR can be consumed in either empty stomach or after food. Majority of AWW replied that HR or the
homeopathic treatment system is not very common in few public, indicating need of more public awareness on it. One of the most
important outcomes of this survey was AWW believe that HR are most helpful in children even during dentition. However, they also
believe that HR are not cost effective.
The above discussion indicates that AWW are somehow sensitized with well idea about HR but they need to be boosted to
use HR for distribution. A clear cut idea lacks in them for which they need assistance or training to devolve skill to administer HR
after a consultation with practitioner.
Results of the present study indicates that more literate women with graduation degree are working as AWW, while previous
studies have reported that maximum of Anganwadi workers were matriculates (10). Most of them were within the upper age limit of
young age while others authors documented similar profile of AWW. Sondakar et al. [10] documented that maximum AWW are
usually within the age group of 30-49 years old.

CONCLUSION
Most of the AWWs were young, graduate and experienced, with sound knowledge of homeopathic medicines. Since these
medicines are economical, AWWs do not have any apprehensions in following the homeopathic treatment for many diseases and even
accept it as safe for children. There is a need to enhance their knowledge and clear their doubts regarding the usage of the
homeopathic medicines especially administration of HR, because they are the bridge between community and health services.
Government should emphasise on its availability at all health centres for their effective distribution.

ACKNOWLEDGEMENTS
The work was done without any financial support.
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