Nishchay- A GOI Program Under NRHM MOHFW, Govt.

of India Roll out by Hindustan

Latex Family Planning Promotion Trust (HLFPPT)

What is Nishchay?: What is Nishchay? Identifies presence of Human Chorionic

Gonadotropin (hCG) in urine Manufactured by Hindustan Latex Limited (HLL)

Genesis: Genesis Govt. of India introduced Nishchay Home based pregnancy test
card across the country Nishchay is not a product but a program. Intends to link
women to timely RCH and F.P. services.

Genesis: Genesis Nishchay would be available to all eligible women FREE OF COST
Kit will be made available through public health care system Rural women will get
kit through ASHA/ANM in the village itself.

Objective of the program: Objective of the program Early detection of pregnancy

rather than waiting for physical symptoms to show up. Early registration of pregnant
woman and early initiation of ante natal care. Enhanced decision making ability
regarding continuation of pregnancy. Increased scope to avail Family Planning
Services

Rationale of the program: Rationale of the program To address the anxiety due to
delayed or missed menstrual cycle and offer a simple home based test card through
which she herself can detect her pregnancy status, rather than awaiting for physical
symptoms to come up.

What is hCG ?: What is hCG ? A glycoprotein hormone secreted by developing

placenta shortly after implantation Can be identified 6-15 days after conception

hcg (contd.): hcg (contd.) hCG is measured in milii-international units per mili- litre
(mlU/ml) With Nishchay Pregnancy Test Card, hCG level above 25mlU/ml gives
positive result

hCG (contd.): hCG (contd.) Concentration of hCG increases to 50 mIu/ml one week
post implantation Reaches around 100 mIu/ml at the time of first missed menstrual
period Reaches peak at 1,00,000 to 2,00,000 mIu/ml at the end of first trimester

hCG (contd.): hCG (contd.) Test utilizes combination of monoclonal and polyclonal
antibodies reagents to selectively detect elevated hCG level in urine

hCG (contd.): hCG (contd.) Immunological specificity of the test card virtually
eliminates cross reactivity interferences from the structurally related glycoprotein
hormones FSH, LH, TSH at physiological levels

hCG (contd): hCG ( contd) Level of HCG should not be used to date a pregnancy.

Key Issues: Key Issues Low percent of women starting ANC in first trimester due to
late detection Contraceptive Provisioning (IUD/Pill) not started after ruling out
pregnancy High unsafe abortions due to late detection

NISCHAY: NISCHAY Access to 5 minutes pregnancy test kit through ASHA and or
PHCs and Sub- Centres An Entry Point for women to access Quality RCH & Family
Planning Services. Outreach communication of 5 minutes pregnancy test

PowerPoint Presentation: Birth Rate Institutional Delivery 10- 40% 40-60% 55-100%
15 25 30 UP, Raj, MP, Bih, Chtsg, Jhkd, Meghalaya Ngld, Assam, Orissa Uttranchal
Guj, Pun, J&K, Mnpr, Sikkim, Tripura, HP, Haryana, WB Ker, Goa, TN, AP, Krntka, Mah,
Mizoram, Delhi Phase I Phase II Phase III

How to test Urine: How to test Urine Collect card from ASHA / ANM Collect first
morning urine in a clean, dry glass or plastic container / bottle Open the packet
containing - the card - the plastic dropper - the silica gel packet

How to test urine: How to test urine Place the card on a flat surface. With the help of
plastic dropper put two drops of urine in the sample well of the card (marked S).
Wait for five minutes.

Test result: Test result Two purple lines one at C and one at T Woman is
pregnant One purple line at C Woman is not pregnant No purple line Perform
the test next morning with new card and fresh morning sample of urine

Why morning urine?: Why morning urine? Generally contains highest concentration
of hormones

Implementation Strategy: Implementation Strategy Supply of Home based

Pregnancy Test Card through PHS already reached district level in All the states It
is a free supply from GOI through ASHA, nodal person for the community
Empowering village women to test herself at home and know the result

Program strategy: Program strategy Training of ASHAs through Master Trainers

Master Trainers are expected to train maximum 35 ASHAs in a batch at PHC ASHA
trainings will be monitored

Program Strategy: Program Strategy Venue for ASHA training block PHCs Reporting
forms will be given to ASHAs

Role of ASHA: Role of ASHA Making available Nishchay PTC to community women.
Advice them on Nishchay use. Advice them on reading the test result. Counsel &
link them to health service provider. Maintain stock detail of Nishchay.

Support required from State: Support required from State District Medical Officers
(DMO) to issue required directives at the level of MO I/C Mobilization of ASHAs in
batches at block level

Nishchay - Rollout Plan: Nishchay - Rollout Plan Training of ASHA workers to support
in outreach communication and distribution, wherever needed Training kit and
supportive materials shall be provided by HLFPPT. Distribution of the kit to the
disrict offices shall be taken care by HLL.

Interpretation of results: Interpretation of results A false negative pregnancy test

means that you test negative but you ARE pregnant (clinically) A false positive
pregnancy test means that your test is positive but you are not pregnant (clinically)

Contd: Contd II. Positive: Two purple color lines appear True Positive Test-You are
pregnant False Positive- pregnancy test is positive but you are NOT pregnant
(clinically) Weak Positive Test- pregnancy test is positive but the colour of the line at
T end is weaker then the color of line at C end III. Invalid test/No test: single
Purple line appears at T end of result well or no line appears

Contd: Contd II. Positive: Two purple color lines appear True Positive Test-You are
pregnant False Positive- pregnancy test is positive but you are NOT pregnant
(clinically) Weak Positive Test- pregnancy test is positive but the colour of the line at
T end is weaker then the colour of line at C end III. Invalid test/No test: single
Purple line appears at T end of result well or no line appears

False Negative-Reason 1: False Negative-Reason 1 Early Detection Attempt - It is

possible that although your ovum might be fertilized, meaning you may be
pregnant, but your body has not started secreting enough Human Chorionic
Gonadotropin (hCG) for the test to be positive. Your body needs time for the
hormone to rise to a high enough level to be detected in a test.

Reason - 2: Reason - 2 Erratic Technique Most common reason In sample collectionnot collected in a container as mentioned in instructions In performing the testinsufficient quantity of urine, Card not placed on a flat surface In reading the test-if
negative, you may wait for extra five minutes before interpreting it as negative.
Delay in reading the test- In case the test is being read the next day or later than
that then the interpretation may be wrong as the evaporation has commenced and
may weaken the test line colour

Action recommended for false negative test: Action recommended for false negative
test If the home pregnancy test shows negative results but you still think you could
be pregnant, wait a few days and try again. A negative result can mean that you are
not pregnant, you took the test too early or you took the test wrong.

False Positive Test- Reasons: False Positive Test- Reasons Not performing the test as
per the mentioned instructions Fertility treatment Certain rare medical conditions
such as trophoblastic disease, islet-cell tumours Medications - Some drugs like
Methadone, chlordiazepoxide, or promethazine Defective Pregnancy Test - Expired
tests or faulty home pregnancy tests can also lead to false positive results. Always
check the expiration date before testing to assure accurate results. Keep in mind,
even with the highest quality control, an occasional defective test may occur.

Weak Positive Test: Weak Positive Test Test not performed as per instructions If
performed as per instructions, repeat the test again after 48-72 hours (hCG
doubling time is 48 hours) If still weak positive then indicating falling hCG
concentrations (spontaneous abortion, extra-uterine pregnancy). Refer to doctor
immediatelyNishchay- A GOI Program Under NRHM MOHFW, Govt. of India:
Nishchay- A GOI Program Under NRHM MOHFW, Govt. of India Roll out by Hindustan
Latex Family Planning Promotion Trust (HLFPPT)

What is Nishchay?: What is Nishchay? Identifies presence of Human Chorionic

Gonadotropin (hCG) in urine Manufactured by Hindustan Latex Limited (HLL)

Genesis: Genesis Govt. of India introduced Nishchay Home based pregnancy test
card across the country Nishchay is not a product but a program. Intends to link
women to timely RCH and F.P. services.

Genesis: Genesis Nishchay would be available to all eligible women FREE OF COST
Kit will be made available through public health care system Rural women will get
kit through ASHA/ANM in the village itself.

Objective of the program: Objective of the program Early detection of pregnancy

rather than waiting for physical symptoms to show up. Early registration of pregnant
woman and early initiation of ante natal care. Enhanced decision making ability
regarding continuation of pregnancy. Increased scope to avail Family Planning
Services

Rationale of the program: Rationale of the program To address the anxiety due to
delayed or missed menstrual cycle and offer a simple home based test card through
which she herself can detect her pregnancy status, rather than awaiting for physical
symptoms to come up.

What is hCG ?: What is hCG ? A glycoprotein hormone secreted by developing

placenta shortly after implantation Can be identified 6-15 days after conception

hcg (contd.): hcg (contd.) hCG is measured in milii-international units per mili- litre
(mlU/ml) With Nishchay Pregnancy Test Card, hCG level above 25mlU/ml gives
positive result

hCG (contd.): hCG (contd.) Concentration of hCG increases to 50 mIu/ml one week
post implantation Reaches around 100 mIu/ml at the time of first missed menstrual
period Reaches peak at 1,00,000 to 2,00,000 mIu/ml at the end of first trimester

hCG (contd.): hCG (contd.) Test utilizes combination of monoclonal and polyclonal
antibodies reagents to selectively detect elevated hCG level in urine

hCG (contd.): hCG (contd.) Immunological specificity of the test card virtually
eliminates cross reactivity interferences from the structurally related glycoprotein
hormones FSH, LH, TSH at physiological levels

hCG (contd): hCG ( contd) Level of HCG should not be used to date a pregnancy.

Key Issues: Key Issues Low percent of women starting ANC in first trimester due to
late detection Contraceptive Provisioning (IUD/Pill) not started after ruling out
pregnancy High unsafe abortions due to late detection

NISCHAY: NISCHAY Access to 5 minutes pregnancy test kit through ASHA and or
PHCs and Sub- Centres An Entry Point for women to access Quality RCH & Family
Planning Services. Outreach communication of 5 minutes pregnancy test

PowerPoint Presentation: Birth Rate Institutional Delivery 10- 40% 40-60% 55-100%
15 25 30 UP, Raj, MP, Bih, Chtsg, Jhkd, Meghalaya Ngld, Assam, Orissa Uttranchal
Guj, Pun, J&K, Mnpr, Sikkim, Tripura, HP, Haryana, WB Ker, Goa, TN, AP, Krntka, Mah,
Mizoram, Delhi Phase I Phase II Phase III

How to test Urine: How to test Urine Collect card from ASHA / ANM Collect first
morning urine in a clean, dry glass or plastic container / bottle Open the packet
containing - the card - the plastic dropper - the silica gel packet

How to test urine: How to test urine Place the card on a flat surface. With the help of
plastic dropper put two drops of urine in the sample well of the card (marked S).
Wait for five minutes.

Test result: Test result Two purple lines one at C and one at T Woman is
pregnant One purple line at C Woman is not pregnant No purple line Perform
the test next morning with new card and fresh morning sample of urine

Why morning urine?: Why morning urine? Generally contains highest concentration
of hormones

Implementation Strategy: Implementation Strategy Supply of Home based

Pregnancy Test Card through PHS already reached district level in All the states It
is a free supply from GOI through ASHA, nodal person for the community
Empowering village women to test herself at home and know the result

Program strategy: Program strategy Training of ASHAs through Master Trainers

Master Trainers are expected to train maximum 35 ASHAs in a batch at PHC ASHA
trainings will be monitored

Program Strategy: Program Strategy Venue for ASHA training block PHCs Reporting
forms will be given to ASHAs

Role of ASHA: Role of ASHA Making available Nishchay PTC to community women.
Advice them on Nishchay use. Advice them on reading the test result. Counsel &
link them to health service provider. Maintain stock detail of Nishchay.

Support required from State: Support required from State District Medical Officers
(DMO) to issue required directives at the level of MO I/C Mobilization of ASHAs in
batches at block level

Nishchay - Rollout Plan: Nishchay - Rollout Plan Training of ASHA workers to support
in outreach communication and distribution, wherever needed Training kit and
supportive materials shall be provided by HLFPPT. Distribution of the kit to the
disrict offices shall be taken care by HLL.

Interpretation of results: Interpretation of results A false negative pregnancy test

means that you test negative but you ARE pregnant (clinically) A false positive
pregnancy test means that your test is positive but you are not pregnant (clinically)

Contd: Contd II. Positive: Two purple color lines appear True Positive Test-You are
pregnant False Positive- pregnancy test is positive but you are NOT pregnant
(clinically) Weak Positive Test- pregnancy test is positive but the colour of the line at
T end is weaker then the color of line at C end III. Invalid test/No test: single
Purple line appears at T end of result well or no line appears

Contd: Contd II. Positive: Two purple color lines appear True Positive Test-You are
pregnant False Positive- pregnancy test is positive but you are NOT pregnant

(clinically) Weak Positive Test- pregnancy test is positive but the colour of the line at
T end is weaker then the colour of line at C end III. Invalid test/No test: single
Purple line appears at T end of result well or no line appears

False Negative-Reason 1: False Negative-Reason 1 Early Detection Attempt - It is

possible that although your ovum might be fertilized, meaning you may be
pregnant, but your body has not started secreting enough Human Chorionic
Gonadotropin (hCG) for the test to be positive. Your body needs time for the
hormone to rise to a high enough level to be detected in a test.

Reason - 2: Reason - 2 Erratic Technique Most common reason In sample collectionnot collected in a container as mentioned in instructions In performing the testinsufficient quantity of urine, Card not placed on a flat surface In reading the test-if
negative, you may wait for extra five minutes before interpreting it as negative.
Delay in reading the test- In case the test is being read the next day or later than
that then the interpretation may be wrong as the evaporation has commenced and
may weaken the test line colour

Action recommended for false negative test: Action recommended for false negative
test If the home pregnancy test shows negative results but you still think you could
be pregnant, wait a few days and try again. A negative result can mean that you are
not pregnant, you took the test too early or you took the test wrong.

False Positive Test- Reasons: False Positive Test- Reasons Not performing the test as
per the mentioned instructions Fertility treatment Certain rare medical conditions
such as trophoblastic disease, islet-cell tumours Medications - Some drugs like
Methadone, chlordiazepoxide, or promethazine Defective Pregnancy Test - Expired
tests or faulty home pregnancy tests can also lead to false positive results. Always
check the expiration date before testing to assure accurate results. Keep in mind,
even with the highest quality control, an occasional defective test may occur.

Weak Positive Test: Weak Positive Test Test not performed as per instructions If
performed as per instructions, repeat the test again after 48-72 hours (hCG
doubling time is 48 hours) If still weak positive then indicating falling hCG
concentrations (spontaneous abortion, extra-uterine pregnancy). Refer to doctor
immediately