Product Requirements Document- ASHA Support Chatbot

Overview

This PRD outlines a multilingual AI-powered chatbot designed to support Accredited Social Health Activists (ASHAs) in India by answering queries related to their core responsibilities under the National Health Mission (NHM). The chatbot will deliver accurate, guideline-based information via FLW application to enhance ASHAs efficiency without replacing human oversight. The chatbot will serve as a 24/7 knowledge companion, reducing dependency on manual supervision and improving service delivery efficiency. Current support systems rely completely on manual supervision, leading to delays in decision-making and inconsistent guidance across different regions.
The ASHA Support Chatbot will provide instant, reliable, contextual, and standardized responses to programmatic and clinical questions that ASHAs face during field work. It aims to:

• Improve ASHAs knowledge and timely decision-making
• Reduce dependency on supervisors for routine clarifications
• Ensure alignment with national/state guidelines
• Provide 24/7 support, especially during last-mile service delivery

USER PERSONA- ASHA Worker

• Education: 8th–10th pass
• Digital familiarity: Basic smartphone experience
• Language preference: Hindi + local dialect
• Usage context: Field visits, low network areas
• Needs: Short, crisp, actionable guidance

2. Scope Definition

2.0.1 Definition of Programmatic vs Clinical Guidance

For the purpose of this chatbot:

• Programmatic guidance includes counselling messages, schedules, eligibility criteria, checklists, danger sign identification, referral protocols, and scheme-related information as defined under official ASHA guidelines.
• Clinical guidance includes diagnosis, prescription, treatment, dosage calculation, procedures, stabilization steps, or interpretation of diagnostic tests and is strictly out of scope.

The chatbot will provide only programmatic guidance aligned with ASHA's role and will not substitute clinical decision-making by ANMs or doctors.

2.1 In-Scope: ASHA Work Domains

The chatbot will ONLY answer queries related to the following official ASHA responsibilities:

2.1.1 Maternal Health

• Antenatal care (ANC) visits and scheduling
• Institutional delivery facilitation
• Postpartum home visits
• Birth preparedness and complication readiness
• Maternal nutrition counseling
• Identification of high-risk pregnancies
• JSY (Janani Suraksha Yojana) and other schemes enrollment

2.1.2 Child Health

• Immunization schedules and tracking
• Growth monitoring
• Newborn care protocols
• Breastfeeding promotion
• Complementary feeding guidance
• Management of common childhood illnesses (diarrhea, pneumonia, fever)
• HBNC (Home-Based Newborn Care) protocols

2.1.3 Family Planning

• Contraceptive methods and counseling
• Spacing and limiting methods
• Referral for sterilization
• Distribution of contraceptive pills and condoms

2.1.4 Communicable Disease Control

• TB-DOTS support and treatment adherence
• Malaria surveillance and RDT administration
• Leprosy case detection
• Vector-borne disease prevention
• COVID-19 and epidemic response protocols

2.1.5 Non-Communicable Diseases

• Hypertension and diabetes screening
• Referral protocols for NCD cases
• Health education for lifestyle modifications

2.1.7 Administrative and Compensation

• Incentive structures and payment timelines
• Report submission formats (MCTS, HMIS)
• Meeting attendance requirements
• Training and skill development opportunities

2.1.8 Community Mobilization

• VHSND organization
• IEC activities
• Formation and facilitation of SHGs related to health

2.1.9 Explicitly Allowed Medical Information (Within ASHA Role)

The chatbot may provide the following health-related information strictly within ASHA's programmatic role:

• Identification and counselling on danger signs (without management or treatment)
• Health counselling messages (nutrition, breastfeeding, hygiene, family planning)
• Referral protocols and escalation pathways (PHC/CHC/FRU/108)
• ORS + Zinc counselling as per national program guidelines (no individualized dosing decisions)
• IFA tablet distribution guidance (programmatic schedules only)
• Immunization schedules and tracking information
• Home visit schedules and checklists (HBNC/HBYC)

2.2 Out-of-Scope- ASHA is a link worker, service extender, and community mobilizer — NOT a clinician, diagnostician, or prescriber.

The chatbot will NOT handle:

2.2.1 Medical Diagnosis or Treatment

A. Direct medical diagnosis of patients
Use Case- Any request that asks the chatbot to diagnose, treat, prescribe, or clinically manage a patient beyond ASHA's referral and counselling role.
Example Queries

• "Iske lakshan se batao kaunsa disease hai"
• "Is bukhar ke liye kaunsi dawa doon?"
• "BP 160/100 hai, kya treatment shuru karu?"
• "Ultrasound report normal hai ya nahi?"

Expected Chatbot Action

• Do NOT answer clinically
• Respond with: "ASHA diagnosis ya ilaaj nahi karti. Kripya turant ANM/PHC ko refer karein."
• Redirect to ANM/doctor

B. Prescription of medications beyond ASHA scope
Use Case- Any request that asks the chatbot to prescribe medicines or recommend treatment except ORS + Zinc (as per program), IFA tablets distribution, Condoms / OCP supply (no clinical decision)
Example Queries

• "Iske liye kaunsi dawa deni chahiye?"
• "Injection lagana hai kya?"
• "Dose kitni rakhein?"

Expected Chatbot Action

• No medicine names or doses
• "ASHA dawa prescribe nahi karti"

C. Emergency medical advice requiring immediate clinical intervention
Use Case- Queries related to acute emergencies requiring immediate clinical action.
Example Queries

• "Delivery ke time zyada bleeding ho rahi hai, kya karein?"
• "Baccha neela pad raha hai, ghar par kya karein?"
• "Fits aa rahe hain, kaunsa injection dena hai?"

Expected Chatbot Action

• _Immediate emergency referral message_is there a template message to be used?This is an emergency situation. Please immediately refer the case to ANM/PHC/CHC/FRU or call 108.
  or
  Yeh ek emergency sthiti hai.
  Kripya bina deri ke ANM / PHC / CHC / FRU le jaayein ya 108 par turant call kareinAdded this to the doc. @aman.dalmia@artpark.in.
  • Template: "This is an emergency situation. Please immediately refer the case to ANM/PHC/CHC/FRU or call 108." OR "Yeh ek emergency sthiti hai. Kripya bina deri ke ANM / PHC / CHC / FRU le jaayein ya 108 par turant call karein"
• _Display emergency numbers / facility guidance_should we just say that they should connect with these people or are there specific numbers/emails that should be included in the response?Question for piramal teamFor the MVP, the chatbot should display standard emergency numbers (e.g. 108) and generic facility references (ANM/PHC/CHC/FRU) or contact your ASHA supervisor (for technical app related issues).
  State- or district-specific contact details can be handled at the app configuration layer, not hardcoded in the chatbot logic.
• No step-by-step medical instructions

D. Interpretation of diagnostic test results
Use Case- Any interpretation of lab, imaging, or diagnostic results.
Example Queries

• _"Hb 7.5 hai, kya matlab hai?"_this can be interpreted also as a training question? implications of Hb 7.5? in that case, should it answer or not @aman.dalmia@artpark.in
  _Assigned to aman.dalmia@artpark.in_Just chipping in- Even if the query is framed as a "learning" or "training" question, numerical test value interpretation (e.g., Hb 7.5) is treated as clinical interpretation and remains out of scope for the chatbot.
  The chatbot may only advise referral, not explain implications.
• "Pregnancy test faint line hai – positive hai?"
• "X-ray report mein likha hai consolidation"

Expected Action

• State that interpretation is outside ASHA role
• Redirect to ANM/doctor

E. Management of complications beyond referral protocols
Use Case- Any request to chatbot seeking information that involves clinical decision-making, treatment, stabilization, dosage calculation, or procedural steps once a complication or danger sign has been identified.
Example Queries

• _"Bleeding zyada ho rahi hai, pehle kya karein ghar par_this sounds similar to the emergency use case, is that correct? in that case, shouldn't the appropriate response be to show that this is an emergency?Add on Qn: how does the model interpret difference between emergency and complication? or are they the same?Yes, you're right that this example overlaps with emergency scenarios.
  For the purposes of this chatbot, emergency and complication are not treated as separate response categories. Any situation involving a danger sign (e.g., heavy bleeding, fits, unconsciousness, breathing difficulty) is handled as an emergency from the chatbot's perspective.
  The distinction between "complication" and "emergency" is clinical, and not something the chatbot is expected to interpret. The chatbot's role is limited to recognising danger-sign language and triggering immediate referral / emergency messaging, without attempting management or triage.
  Therefore, for a query like "Bleeding zyada ho rahi hai, pehle kya karein ghar par?", the appropriate response is to treat it as an emergency and show urgent referral guidance (ANM/CHO/PHC/108), without any step-by-step instructions.?"
• "Fits aa rahe hain, injection ka naam batao"
• "Delivery ke baad placenta nahi nikla, kya karein?"
• "Zyada bleeding ho rahi hai, uterus massage kaise karein?"
• "Baccha saans nahi le raha, ghar par kya karein?"
• "Neela pad raha hai, oxygen ka jugad kaise karein?"
• "Bahut zyada dehydration hai, drip lagani chahiye?"
• "Fits aa rahe hain, kaunsa injection dena hota hai?"

Expected Action
Chatbot must respond only with referral-focused guidance:

• Emphasize the urgency
• Inform ASHA that she has identified a danger sign and she needs to immediately follow the referral protocol. (PHC/CHC/FRU/108)
• Chatbot will not give any "how-to" management steps

2.2.2 Personal Medical Consultation

• Personal health queries of the ASHA worker
• Medical advice for ASHA's family members
• Second opinions on personal medical conditions

Use Case- The chatbot must not act as a personal doctor for ASHAs or their relatives.
Example Queries

• "Mujhe khud diabetes hai, kya karun?"
• "Meri maa ke liye kaunsi medicine sahi rahegi?"

Expected Action

• Politely decline
• Suggest visiting nearest health facility

2.2.3 Administrative Disputes

General queries* Grievance redressal for compensation disputes

• Conflict resolution with supervisors or ANMs
• Employment termination or contractual issues
• Legal advice on labor rights
• Strikes or union related informationh3.Not complex queries (Chatbot can answer directly)Routine, informational, non-disputed queries with clear program rules.Examples:* "JSY ka paisa kis ko milta hai?" * "Incentive kitna milta hai ANC ke liye?" * "Payment usually kitne din mein aata hai?" * "Monthly meeting kab hoti hai?" * "MCTS/HMIS report ka format kya hai?" * "Training ke liye kaun eligible hai?" * "VHND ke din ka role kya hota hai?" Handling:* Chatbot gives standard, guideline-based information * No escalation required Complex queries (Auto-escalate message displayed to connect with supervisor)Queries involving dispute, conflict, grievance, or case-specific resolution.Examples:* "Mera incentive nahi mila, complaint kaise karein?" * "Payment galat account mein chala gaya" * "ANM meri baat nahi sun rahi" * "Supervisor mujhe kaam se nikaalne ki dhamki de raha hai" * "Mera naam list se hata diya gaya" * "Pichhle 6 mahine ka paisa pending hai" * "Mujhe unfairly blame kiya ja raha hai" Handling:* Chatbot does not give advice or steps * Responds with: ** Acknowledgement Message displaying "Please connect to your ASHA supervisor" Use Case- Issues related to grievances, disputes, legal matters, or service conditions.

  2.2.4 Political, personal or Social Issues

• Political opinions or affiliations
• Caste or religion-based queries
• Personal counseling unrelated to work

Use Case Political, religious, caste-based, or unrelated personal counseling queries.
Example Queries

• "Is scheme ke peeche kaun si party hai?"
• "Election mein ASHA ko kya role hota hai?"
• "Is area mein kaunsa dharm zyada hai?"
• "Ghar ke jhagdon ka solution batao"
• "Mujhe bahut tension rehti hai, kya karun?" (non-work related)

Expected Action

• Politely decline
• State chatbot scope is limited to ASHA work

2.2.5 Financial Services

• Loan applications or financial advice
• Banking services beyond JSY payment queries
• Investment advice
• Incentive payment (Crediting in ASHAs bank account) related information

Use Case Financial advice beyond program incentives.
Example Queries

• "Loan kaise milega?"
• "Bank account kholne mein help chahiye"
• "Paise invest karne ka best tareeka kya hai?"
• "Credit card ka process batao"
• "Personal loan ke liye documents kya lagenge?"
• "Mere account me incentives kab transfer hoga?"
• "Incentives?"/ "Incentive credit"

Expected Action

• Decline financial advice
• Only answer JSY and other program incentive-related questions barring payment status questions

2.2.6. Technical Issues/Concerns

• Data Syncing error

Use Case App or system-level technical problems.what is the exhaustive list of technical concerns that they typically ask about?Any app-, login-, sync-, or submission-related or app update issues should be treated as technical issues and redirected to supervisors / helpdesk.
Example Queries

• "Data sync nahi ho raha"
• "App bar-bar band ho ja raha hai"
• "Login nahi ho pa raha"
• "Report upload nahi ho rahi"
• "Password bhool gaye"

Expected Action

• Redirect to technical support and troubleshooting via the supervisor should we just say that they should connect with these people or are there specific numbers/emails that should be included in the response?Please connect to ASHA supervisor
• No troubleshooting beyond basic guidanceis this basic guidance present in the knowledge base? if not, do we want to rely on the LLM's innate knowledge to provide this basic guidance (which has a high risk of hallucination)?Please rely on the PDFs and the content of this PRD for the MVP.

2.3 Guardrails and Safety Mechanisms

2.3.1 Content Filtering

• Automatically flag and redirect medical emergencies to emergency services
• Block inappropriate, offensive, or abusive contentcan you give some examples? the overall idea makes sense but for the AI to perform accurately, we need to be very specific about what we mean by these termsPlease refer to the annexure
• Detect and refuse queries outside ASHA scope with polite redirection

2.3.2 Escalation Triggers

Auto-escalate to human supervisor when:

• Medical emergency keywords detected (severe bleeding, unconscious, convulsions)should we consider it an emergency just based on the detection of keywords? is this the exhaustive list of all keywords?
  is the presence of any one of the keywords enough to consider it an emergency?Might be useful to collate all list of trigger words. Request to Piramal team.Added in the Annexure
• Repeated failed query attempts (>3 times on same topic)
• User expresses dissatisfaction or frustrationMight be good to take an explicit feedback after every conversation. This will need to be built into the workflow by the Piramal team?Yes on their chat frontend this is eng requirement
• Query involves complex administrative disputecan you give examples of this? what is complex vs examples of what is not complex?I have edited this under section 2.2.3
• Safeguarding concerns (child abuse, domestic violence)is this the exhaustive list of situations falling under "safeguarding concerns"?Emergency detection will be based on a configurable list of keywords and patterns, validated by both the teams (some terms have been listed in the Annexure at the end of the doc) 
  Detection of any one high-risk keyword is sufficient to trigger emergency referral messaging.

2.3.3 Disclaimer Mechanism

Every session must include:

• Clear disclaimer that chatbot is for guidance onlyshould this be present at the end or start of each message?Might be useful to get the explicit content also (request to Piramal team)Added* "This chatbot provides guidance related to ASHA roles only. It does not offer medical diagnosis, treatment, or prescriptions. For emergencies or complex situations, please contact the ANM, ASHA supervisor, or nearest health facility"* Encouragement to consult ANM/supervisor for complex cases
• Emergency helpline numbers prominently displayed

2.3.4 Low-Confidence Response Handling

If the chatbot is unable to confidently answer a query due to insufficient informationthere could be insufficient information in the knowledge base for the query or the query could be missing information as well. E.g. if the query is related to pregnancy and the number of months that the mother has been pregnant is required to answer the query, should we specifically ask the ASHA to enter that information or continue to say that complete information is not present (similar to the text in hindi below)?add on qn: @aman.dalmia@artpark.in do we need some expert evaluation or data of what is sufficient information vs not? on what basis will the model classify sufficient information vs insufficient?artpark.in  We have Public Health experts in the PSMRI team and would be simultaneously validating this. However, we remain open to inviting an external expert to validate this., ambiguous input, or lack of validated content:

• The chatbot must not attempt a partial or speculative response
• It must clearly state its limitation and guide the ASHA to a human resource
• If a query is missing required contextual information (e.g., pregnancy month), the chatbot may ask one clarifying question.** If sufficient information is still unavailable, it must fall back to the low-confidence response and referral

Standard response example: "Is prashn par mujhe poori jankari uplabdh nahi hai. Kripya ANM ya supervisor se sampark karein."

2.4 Data Privacy and User Safety

• The chatbot will not require or store personally identifiable patient information
• Beneficiary names, phone numbers, or addresses will not be requested
• Chat interactions will not be used for performance evaluation of ASHAs
• All data handling will comply with applicable Government of India IT and data protection guidelineswhat does this mean? what are the guidelines that we have to comply with?As per the Digital Personal Data Protection Act. This act ensures protection of digital personal data outlining the responsibilities of institutions/ organizations collecting the data.Specific guidelines to comply with-
  IT Act 2000 and amendments
  Digital Personal Data Protection Act 2023
  MoHFW data security protocols
  State-level health data policies
  No PII storage without consent
  Data encryption in transit and at rest

3. Features in the Chatbot

1. Natural Language Query Handling

• Free-text input in regional languages
• Recognizes domain-specific queries:
  • "HBNCcan we get a list of acronyms/vocabulary that is used amongst this user base? (which are outside the protocols)Yes if they have some data on itadded in the annexure visit kab karna hota hai?"
  • "JSY ka paisa kis ko milta hai?"
  • "Bacche ko bukhar ho toh ASHA kya kare?"

3.1 Offline and Low-Connectivity Support

• Chatbot should support basic functionality in low or intermittent network areas
• Frequently asked questions (FAQs) and critical guidance should be cached locally where feasible
• In case of connectivity failure, chatbot should display:

"Network uplabdh nahi hai. Kripya pehle se saved jankari dekhein ya supervisor se baat karein."

• The chatbot must not generate unverified responses when connectivity is poorthis will be handled by the app and not the backend, right?artpark.in @aman.dalmia@artpark.in caching do we want to keep in scope for this MVP?Let's skip this in mvp...

3.2 Language and Tone Guidelines

• Simple, clear Hindishould it always use devnagri script or always use hinglish or should it mimic the user?Mimicking is ideal. However for MVP we can go with Devnagri and Hinglish. suitable for 8th–10th grade comprehension
• Respectful and supportive tone
• No medical jargon or technical terminology
• Uses "aap" form, not informal language
• Avoids authoritative or judgmental phrasing

1. Handles voice input our recommendation is to move to voice in the next stage once we have tested the overall experience in the text domain so that we can isolate the errors being caused by the voice interpretation - does that make sense?We understand that, however based on the field surveys we have seen greater participation from ASHAs via voice to text than text alone.

1. System will be trained on:

• ASHA training modules (Module 1–7)
• National RMNCAH guidelines
• HBNC & HBYC guidelines
• Immunization handbook
• ASHA incentives guidelinesdo the PDFs provided cover all these documents?There were 2-3 docs that would comprehensively cover these topics, please find them attached to the latest email reply.
• State-specific circulars (if provided)
• All content passes through MoHFW-approved content validation.

1. Structured Responses

• Bullet points for clarity
• Stepwise counselling messages
• Referral steps

1. Task Guidance by generating automated answers for: Visit schedules, Warning signs, Checklists, Incentive eligibility etc.

1. Multilingual Support- Hindi, English and addition of languages as per requirements.does this mean it should understand hindi/english and other languages but always respond still in hindi?Yes. Hindi or Hinglish.For scope of current engagement we should limit to Hindi and english.Yes

1. Development of FAQ Repository where Chatbot shows related FAQs after answering.Would be good to keep this in next stage of the roadmap. MVP should be limited to Q&A to keep the scope in check. 
   In the meantime, from a program PoV, Piramal can begin creating this FAQ so we can build on it in subsequent efforts.I think these are just things to track not kpis right? If they are then yes agree with your point

4. Success Metrics and Evaluation

The effectiveness of the ASHA Support Chatbot will be measured using:

• Percentage of queries resolved without human escalationwhat is the event to identify as 'resolved'? will we have a feedback button?We can discuss collaboratively what can be quantitatively vs. qualitatively measured via a field survey/interview.
• Reduction in routine clarification calls to supervisors
• Accuracy of emergency escalation and referrals
• ASHA user satisfaction and feedback scores
• Average response time under normal and low-bandwidth conditionsartpark.in @aman.dalmia@artpark.in should we keep this in or out of scope for MVP? Our focus right now is not latency right?
  _Assigned to jigar@artpark.in_It's just saying that's a metric to track, they aren't putting a number on it
  Annexure 1Safeguarding Concerns – Indicative Keyword List(For escalation to human supervisor / helpline)1. Child Abuse / NeglectHindi / Hinglish examples:* "Bacche ko maara ja raha hai" * "Bachchi ke saath galat ho raha hai" * "Child abuse" * "Bachcha band karke rakha hai" * "Bachcha khana nahi mil raha" * "Bachcha chhod diya gaya" * "Minor ke saath zabardasti" English keywords:* child abuse * child neglect * minor abuse * abandoned child * violence against child ----2. Domestic Violence / Gender-Based ViolenceHindi / Hinglish:* "Ghar mein maar-peet hoti hai" * "Pati roz peetta hai" * "Saas-sasur torture karte hain" * "Hinsa" * "Zabardasti" * "Maarna-peetna" * "Ghar ka jhagda zyada ho gaya" * "Violence ho rahi hai" English:* domestic violence * abuse * assault * physical violence * harassment ----3. Sexual Violence / ExploitationHindi / Hinglish:* "Balatkar" * "Sexual abuse" * "Zabardasti sambandh" * "Galat kaam karwaya" * "Cheḍ-chhaḍ" * "Molestation" English:* rape * sexual assault * sexual abuse * exploitation * molestation ----4. Human Trafficking / Forced SituationsHindi / Hinglish:* "Bachchi ko kahin bhej diya" * "Baccha bech diya" * "Jabardasti kaam karwa rahe" * "Majdoori mein bandha hua" * "Trafficking" English:* human trafficking * forced labour * bonded labour * exploitation ----5. Self-harm / Extreme Distress (rare but critical)Hindi / Hinglish:* "Marna chahti hoon" * "Jee nahi lag raha" * "Khud ko nuksaan" * "Suicide" English:* suicide * self-harm * want to die (Even one such phrase should trigger escalation)
  Annexure 2
  Medical Emergency Keywords
  1. Maternal Emergencies
  A. Bleeding (Hemorrhage)
  Hindi/Hinglish:
• "Bahut zyada khoon beh raha hai"
• "Bleeding nahi ruk rahi"
• "Khoon ka bahav zyada hai"
• "Delivery ke baad bahut bleeding"
• "Pregnancy mein heavy bleeding"
• "Khoon ka dhara"
• "Raktasrav"
• "Excessive bleeding"
• "Hemorrhage"
• "Postpartum bleeding bahut zyada"
• "Khoon thama nahi"

English:

• severe bleeding
• heavy bleeding
• hemorrhage
• postpartum hemorrhage
• excessive blood loss
• uncontrolled bleeding
• continuous bleeding

B. Seizures/Convulsions (Eclampsia)
Hindi/Hinglish:

• "Fits aa rahi hain"
• "Jhatkay aa rahe hain"
• "Convulsion ho raha hai"
• "Dakke lag rahe hain"
• "Mirgi jaise attack"
• "Body akad gayi"
• "Hath-paon akad gaye"
• "Seizure aa gaya"
• "Bechaini bahut zyada"
• "Hosh kho diya"

English:

• seizures
• convulsions
• fits
• eclampsia
• unconscious after fits
• body stiffening
• jerking movements

C. High Blood Pressure Crisis
Hindi/Hinglish:

• "BP bahut zyada hai"
• "Blood pressure 160/110 se zyada"
• "Sar mein bahut dard"
• "Aankhon ke aage andhera"
• "Chakkar bahut aa rahe hain"
• "Ulti ke saath chakkar"
• "Severe headache with BP"
• "Vision dhundhla ho gaya"

English:

• very high blood pressure
• severe hypertension
• BP crisis
• severe headache with BP
• vision problems with BP
• dizziness with high BP

D. Prolonged/Obstructed Labor
Hindi/Hinglish:

• "Delivery nahi ho rahi"
• "12 ghante se pain hai par baccha nahi nikla"
• "Pani toot gaya par delivery nahi hui"
• "Labour bahut lamba chal raha"
• "Baccha fas gaya"
• "Push karne par kuch nahi ho raha"
• "Prolonged labour"
• "Obstructed delivery"
• "Sar dikh raha par nahi aa raha"

English:

• prolonged labor
• obstructed labor
• labor not progressing
• baby stuck
• delivery complications
• failed delivery
• labor more than 12 hours

E. Ruptured Uterus
Hindi/Hinglish:

• "Pet mein bahut tez dard"
• "Bachedani phat gayi"
• "Delivery ke time andar kuch toot gaya"
• "Bahut sharp pain in abdomen"
• "Pet mein tear ho gaya lagta hai"

English:

• ruptured uterus
• uterine rupture
• severe abdominal pain during labor

F. Placenta Problems
Hindi/Hinglish:

• "Placenta bahar nahi aa raha"
• "Delivery ke baad ari nahi nikli"
• "Ari andar reh gayi"
• "Placenta retained hai"
• "30 minute ho gaye placenta nahi nikla"

English:

• retained placenta
• placenta not delivered
• placenta stuck

G. Severe Pregnancy Complications
Hindi/Hinglish:

• "Pregnancy mein severe pain"
• "Ectopic pregnancy"
• "Bachedani ke bahar pregnancy"
• "Pet mein bahut dard with bleeding"
• "Miscarriage ho raha hai bahut bleeding ke saath"
• "Garbhpat emergency"

English:

• ectopic pregnancy
• severe abdominal pain in pregnancy
• pregnancy rupture
• severe miscarriage

2. Newborn/Child Emergencies
A. Breathing Problems
Hindi/Hinglish:

• "Baccha saans nahi le raha"
• "Breathing nahi ho rahi"
• "Chest andar jaa raha hai"
• "Naak phanph raha hai"
• "Saans mein awaz aa rahi hai"
• "Neela pad raha hai"
• "Blue ho gaya"
• "Cyanosis hai"
• "Oxygen nahi mil raha"
• "Ghut raha hai"
• "Saans phool rahi hai bahut"
• "Respiratory distress"
• "Gasping kar raha hai"

English:

• not breathing
• difficulty breathing
• severe breathlessness
• chest indrawing
• cyanosis
• blue baby
• respiratory distress
• gasping
• choking
• suffocating

B. Severe Dehydration
Hindi/Hinglish:

• "Baccha bahut sukh gaya"
• "Aankhen andar ghus gayi"
• "Taalu sukh gaya"
• "Peshab bilkul nahi aa raha"
• "Bahut zyada dast"
• "Ulti-dast nahi ruk raha"
• "Skin uthake nahi aa rahi"
• "Severe dehydration"
• "Fontanelle andar ghus gaya"
• "Twacha loose pad gayi"

English:

• severe dehydration
• sunken eyes
• no urine output
• very dry mouth
• skin turgor poor
• sunken fontanelle
• excessive diarrhea
• continuous vomiting and diarrhea

C. Unconsciousness/Lethargy
Hindi/Hinglish:

• "Baccha behosh hai"
• "Hosh nahi hai"
• "Bilkul sunn pada hai"
• "Jaag nahi raha"
• "Bahut sust hai"
• "Response nahi de raha"
• "Unconscious ho gaya"
• "Coma jaisa"
• "Jawaab nahi de raha"
• "Bilkul jimmedar nahi"

English:

• unconscious
• unresponsive
• very lethargic
• not waking up
• comatose
• no response
• extremely drowsy

D. Seizures/Convulsions (Child)
Hindi/Hinglish:

• "Bacche ko fits aa rahe"
• "Jhatkay lag rahe hain"
• "Convulsion ho raha"
• "Dakke maar raha"
• "Aankhen palat gayi"
• "Hath-paon akaड़ gaye"
• "Febrile seizure"
• "Bukhar mein fits"

English:

• child having seizures
• convulsions
• fits in child
• febrile convulsions

E. Severe Fever
Hindi/Hinglish:

• "Bahut tez bukhar"
• "Fever 104 se zyada"
• "Body bahut garam"
• "High grade fever"
• "Bukhar nahi utar raha"
• "Bukhar ke saath kaan dard"
• "Fever with rash"
• "Petechial rash"

English:

• very high fever
• fever above 104°F
• fever with rash
• fever not responding
• high grade fever

F. Severe Malnutrition Complications
Hindi/Hinglish:

• "Baccha SAM hai aur bimar bhi"
• "Severe acute malnutrition with complications"
• "Bahut kamzor aur bimar"
• "Edema bhi hai"
• "Sunn pada hai aur marasmus"

English:

• SAM with complications
• severe malnutrition with illness
• edema with malnutrition

G. Injuries/Accidents
Hindi/Hinglish:

• "Gir gaya bahut oonchay se"
• "Head injury ho gayi"
• "Sar mein chot lagi"
• "Kisi cheez se lag gaya"
• "Jal gaya bahut"
• "Burn bahut bada hai"
• "Zeher kha liya"
• "Poisoning ho gayi"
• "Kuch galat chiz kha li"

English:

• severe fall
• head injury
• serious burn
• poisoning
• accidental ingestion
• major trauma

H. Bleeding (Child)
Hindi/Hinglish:

• "Khoon bahut nikal raha"
• "Bleeding nahi ruk rahi"
• "Chot se bahut khoon"
• "Naak se bahut bleeding"
• "Peshab mein khoon"
• "Ulti mein khoon"
• "Potti mein khoon bahut zyada"

English:

• severe bleeding
• uncontrolled bleeding
• blood in vomit
• blood in stool
• bleeding not stopping

3. General Emergency Indicators
A. Unconsciousness/Collapse
Hindi/Hinglish:

• "Behosh ho gaya"
• "Gir gaya achanak"
• "Hosh kho diya"
• "Sudden collapse"
• "Chakkar aakar gir gaya"
• "Sense nahi hai"

English:

• unconscious
• collapsed suddenly
• loss of consciousness
• fainted
• unresponsive

B. Severe Pain
Hindi/Hinglish:

• "Bahut tez dard"
• "Unbearable pain"
• "Dard bardaasht nahi ho raha"
• "Severe pain"
• "Chilla raha dard se"
• "Acute pain"

English:

• severe pain
• unbearable pain
• acute pain
• extreme pain

C. Shock
Hindi/Hinglish:

• "Thande pasina aa raha"
• "Body thandi pad gayi"
• "Pulse bahut kamzor"
• "BP bahut low"
• "Cold and clammy"
• "Shock mein hai"
• "Hath-paer thande"

English:

• shock
• cold and clammy
• very low BP
• weak pulse
• going into shock

D. Severe Allergic Reaction
Hindi/Hinglish:

• "Injection ke baad problem"
• "Face suj gaya achanak"
• "Saans lene mein problem achanak"
• "Allergic reaction bahut bura"
• "Anaphylaxis"
• "Gala suj gaya"

English:

• severe allergic reaction
• anaphylaxis
• sudden swelling
• reaction to injection/medicine

4. Communicable Disease Emergencies
A. Severe Infections
Hindi/Hinglish:

• "Pneumonia bahut severe"
• "Saans mein bahut problem"
• "Meningitis lagta hai"
• "Gardan akaड़ gayi"
• "Sepsis"
• "Bahut bimar aur bukhar"
• "Infection bahut fail gaya"

English:

• severe pneumonia
• meningitis
• sepsis
• severe infection
• systemic infection

B. Diphtheria/Severe Throat
Hindi/Hinglish:

• "Gala bahut suj gaya"
• "Saans nahi aa raha throat se"
• "Khans-khans bahut severe"
• "Diphtheria"

English:

• severe throat obstruction
• diphtheria
• airway obstruction

5. Action Keywords (Immediate Danger)
Hindi/Hinglish:

• "Turant"
• "Emergency"
• "Bachao"
• "Mar jayega/jayegi"
• "Jaan ja rahi hai"
• "Khatara hai"
• "Gambhir"
• "Buri haalat"

English:

• emergency
• urgent
• critical
• life-threatening
• dying
• severe
• serious danger

6. Specific Danger Signs
Newborn Danger Signs
Hindi/Hinglish:

• "Thanda ho gaya"
• "Garam nahi hai"
• "Doodh nahi pee raha"
• "Chati se nahi chipak raha"
• "Umbilicus se pus"
• "Naabhi se badbu"
• "Peshab nahi kiya 24 ghante"

English:

• hypothermia
• not feeding at all
• not latching
• umbilical infection
• no urine for 24 hours

Pregnancy Danger Signs
Hindi/Hinglish:

• "Pani aa raha bahut smell ke saath"
• "Bahut jyada ulti"
• "Bukhar with pregnancy"
• "Baccha bahut din se nahi chala"
• "Movement nahi feel ho rahi"

English:

• foul-smelling discharge
• hyperemesis
• fever in pregnancy
• reduced fetal movements
• no fetal movement

Annexure 3