Introduction
Although Bangladesh has achieved a significant progress on reduction of
maternal and child mortality during the past decades, unmet targets on
delivery and utilization of maternal and neonatal healthcare services
have left the issue in an agenda of Sustainable Development Goals
(SDGs). The new goals of the SDGs are to reduce the maternal mortality
ratio (MMR) to less than 70 per 100,000 live births and neonatal
mortality ratio (NMR) to 12 per 1,000 live births by 20301-3. So far, the effectiveness of interventions for
saving the lives of mothers and babies have been proven2, 4-7, but challenges remain in health-care seeking
and practices across the full continuum of maternal and child care,
including the utilization of antenatal care, birth with a skilled
attendant or standard facilities, emergency obstetric care in case of
complications or illness for women and newborn, essential neonatal care,
and postnatal visits for women and babies in resource constrained
settings 8-10.
The World Health Organization (WHO) 11, 12 recommended
a home-based maternal record (HMR), an effective tool to actively link
pregnant women and their families to community health workers and
professional hospital staffs, raise knowledge and awareness on maternal
and child health, identify complications in pregnancy and labor and
common illness of mothers and babies, and consequently to improve
delivery and utilization of maternal and child care services13-20. Among antenatal notes, immunization cards,
child health books and the integrated document, the maternal and child
health handbook (MCH) is the most comprehensive home-based book that
encompasses all the records of the continuum of care for both mothers
and children, including antenatal care, labor and delivery, postpartum
care, newborn and child care, immunization and family planning. The
integration of the different types of records is much more effective
compared to the fragmented implementation, saving both financial and
human resources for the intervention 21-22. Besides
the records, the handbook also contains guiding information on seeking
care for mothers and children conveyed through ample illustrations. The
recently launched WHO guideline has recommended the use of home-based
records to complement facility-based records 23. So
far, its effectiveness to improve health seeking behaviors, home care
practices, male involvement and communication between health
professionals and women / caregivers, and feasibility has been proven by
empirical epidemiological studies in various developing settings15-20. However, there was insufficient evidence on the
type, content and implementation of HBR, which needs to be tailored to
different sociocultural and epidemiological contexts23.
In Bangladesh, a pilot MCH project showed strong positive impact on
mother’s knowledge, practices, record keeping, service utilization and
empowerment of women 24,25. After the approval by the
Government of Bangladesh, a project-based utilization of HBRs has been
widely implemented by NGOs; however, the current system of HBRs is
fragmented, with various types provided by different organizations.
Therefore, we implemented the first cluster randomized controlled trial
(RCT) to examine the effectiveness of MCH enhanced by a mobile platform
in two counties of rural Bangladesh (protocol available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902947/)26. The existing version of the Bangladeshi MCH
designed by Bhuiyan et al were used in the intervention. The reason for
enhancing it with a mobile platform was to boost communications between
pregnant women, their family and community health workers, principal
healthcare providers in the rural area, and to catalyze the potential
advantages of the mobile platform in knowledge dissemination, guidance
and promotion of healthcare utilization 27. We
hypnotized that the proposed interventions will benefit the continuum of
care and lead to better maternal and neonatal outcomes. The study aimed
to assess the effectiveness of the interventions on the improvement of
the target outcomes, in order to inform updates of the MCH in the
context of Bangladesh and policy making for the targets of SDGs related
to maternal and neonatal health.