Maternal and child health handbook to improve continuum of maternal and
child care in rural Bangladesh: Findings of a cluster randomized
controlled trials
Abstract
Objective: This study aimed to evaluate the effectiveness of maternal
and child health handbook (MCH) enhanced by mobile tools and to generate
evidence informing the adoption of the program in Bangladesh Design:
Cluster randomized controlled trial Setting: Two Upazilas in Bangladesh
Population or Sample: Pregnant women Methods: Unions of the study
settings were randomly allocated in either one of three groups: (1)
Intervention 1 using both mobile platform and MCH, (2) Intervention 2
using MCH alone, or (3) the Control. A total of 3,002 participants were
recruited. The interventions were designed to promote two-way
communications between pregnant women/their families and community
health workers by an empowering approach. Main outcome measures:
continuum of care (CoC), neonatal mortality and morbidities Results: The
interventions both significantly improved the utilization of CoC,
although the overall proportion of CoC was relevantly low: 2.79% in the
Control (95% CI: 1.37-3.54%), 6.16% in Intervention 2 (95% CI:
4.67-7.86%), and 7.89% in Intervention 1 (95% CI: 6.29-9.90%).
Neonatal mortality rate with and without CoC was 5.43 per 1,000 (95%
CI: 3.63 - 9.57 per 1,000) and 34.8 per 1,000 (95% CI: 24.3 - 45.4 per
1,000), respectively. Conclusion: our study indicated the effectiveness
of the interventions by leveraging MCH and a mobile platform to promote
uptake of CoC throughout prepartum, intrapartum and postpartum/neonatal
periods, potentially bringing long-lasting benefits to mothers and their
offspring. The explicit approach is expected to guide policy makers to
adopt MCH interventions in primary healthcare strengthening at the
community level.