Knowledge retention after a single iron and folic acid training session among accredited social health activists in rural West Bengal, India: a quasi-experimental study

Background: Accredited social health activists (ASHAs) distribute iron and folic acid (IFA) tablets and counsel beneficiaries under the Anemia Mukt Bharat strategy, so their knowledge shapes delivery at village level. Training is the usual remedy for knowledge gaps, but how long the gains last is rarely measured. This study assessed a single training session and re-measured knowledge three months later. Methods: An institution-based, single-group, before-and-after quasi-experimental study was conducted among ASHAs of the rural field practice area of the All India Institute of Hygiene and Public Health, Singur, West Bengal. All 97 ASHAs were approached and 82 completed all three assessments. A pre-tested, investigator-developed 10-item questionnaire was administered immediately before training, immediately after, and at three months. Scores were compared using the Friedman test with Durbin-Conover post hoc comparisons. Results: Median knowledge rose from 6 (interquartile range, IQR 4-7) before training to 8 (IQR 7-9) immediately afterwards and was 7 (IQR 5-8) at three months; means were 5.50±2.19, 8.00±1.72 and 6.60±1.69. The Friedman test was significant (χ2=64.55, df=2, p<0.001; Kendall’s W=0.394), as were all three pairwise comparisons (p≤0.002). The immediate gain of 2.50 points, a 45.5% improvement, fell by 1.40 points over three months, leaving 44% retained. Baseline knowledge varied by age group (p=0.012) but not by education or length of service. Conclusions: A single session improved IFA knowledge substantially, but over half the improvement was lost within three months. Periodic refreshers, supportive supervision and job aids are likely needed to sustain the knowledge underpinning IFA distribution.