Assessment of Awareness and Practices About Home-Based Care for Young Child (HBYC) Among Mothers and Healthcare Providers in Urban and Rural Areas of Belagavi – An Explanatory Sequential Mixed Method Study

India accounts for nearly 20 percent of global under five mortality. According to the National Family Health Survey Five 2019 to 2021, less than 12 percent of children aged 6 to 23 months receive an adequate diet, only 36 percent of children aged 12 months are fully immunized, and about 67 percent of children under five years are anemic.

To address the high burden of neonatal and child mortality, the Government of India launched the Home Based Newborn Care program in 2011 to ensure optimal health and survival of newborns and young infants. Under this program, Accredited Social Health Activists conduct six structured home visits for institutional deliveries on the third, seventh, fourteenth, twenty first, twenty eighth, and forty second days after birth and an additional visit within 24 hours for home deliveries. ASHAs receive an incentive of 250 rupees per newborn after completion of all scheduled visits. However, a gap in continuity of care persisted after the neonatal period of 42 days, leaving many infants and mothers without follow up support.

Recognizing the critical role of nutrition in child survival and development, the Government of India launched the Poshan Abhiyaan to reduce stunting and undernutrition among children aged 0 to 6 years by 2 percent annually and to lower the prevalence of anemia among children aged 6 to 59 months by 3 percent per year. Child nutrition is also intrinsically linked to water, sanitation, and hygiene practices. To strengthen sanitation efforts and promote hygienic behaviors, the Swachh Bharat Mission was introduced in 2014, aiming to achieve universal sanitation coverage and improved hygiene practices at both household and community levels.

Over the past decade, India has achieved notable progress, with the under five mortality rate declining to 39 per 1000 live births as per the Sample Registration System 2016. Despite this improvement, nearly one third of these deaths continue to result from preventable diseases such as diarrhea, pneumonia, and measles, while around 35 percent are attributed to undernutrition, a consequence of suboptimal breastfeeding and complementary feeding practices. Malnutrition impairs both cognitive and physical development, weakens immunity, and increases susceptibility to infections. These effects cumulatively lead to poor educational performance, reduced productivity in adulthood, and significant economic losses at the national level. Addressing these issues is essential for achieving the goals of the National Health Policy, the Sustainable Development Goals, and the Poshan Abhiyaan.

In response to these challenges, the Home Based Care for Young Child program was launched in 2018 under the National Health Mission and Poshan Abhiyaan. The program focuses on children aged 3 to 15 months, aiming to enhance their health and nutrition, reduce morbidity and mortality, and promote early childhood development. Under HBYC, Accredited Social Health Activists conduct five home visits at the third, sixth, ninth, twelfth, and fifteenth months of life, receiving an incentive of 250 rupees per child after completion of all scheduled visits.

The key components of the HBYC program are as follows

Nutrition

• Exclusive breastfeeding for the first six months
• Adequate complementary feeding
• Continued breastfeeding up to two years of age
• Iron and folic acid supplementation
• Promotion of fortified foods

Child Health

• Complete immunization
• Regular growth monitoring
• Use of oral rehydration solution during diarrhea
• Early care seeking during illness

Water, Sanitation, and Hygiene (WASH)

• Handwashing with soap and promotion of hygienic sanitation practices

Given these objectives, this study aims to assess the awareness, implementation, and practices related to Home Based Care for Young Child among mothers and Accredited Social Health Activists in both urban and rural areas of Belagavi district.