Summary
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.
Funding: Japan Society for the Promotion of Sciences (JSPS)
(16H06241)
Trial registration: UMIN000025628 Registered June 13, 2016