Maternal and Child Health Handbook to Improve Continuum of Maternal and Child Care in Rural Bangladesh: Findings of a Cluster Randomized Controlled Trials

Background: A cluster randomized controlled trial (RCT) has been implemented to evaluate the effectiveness of a maternal and child health handbook program enhanced by mobile tools. This study aimed to generate evidence informing decision making and resource allocation for the adoption of the program in the country. Methods: In Bangladesh, in Lohagora of Narail District and Dhamrai of Dhaka District, a total of 3,002 pregnant women were recruited. Their living unions, the smallest administrative region, were randomly allocated in either one of three groups: (1) intervention using both mobile platform and Mother and Child Handbook (MCH), (2) intervention using the handbook alone, or (3) the control. Findings: The interventions both significantly improved the utilization of continuum of care including antenatal care, facility-based delivery and postnatal care, although the overall proportion of continuum of care was relevantly low: 2.79% in the control (95% CI: 1.37-3.54%), 6.16% in the intervention using the handbook alone (95% CI: 4.67-7.86%), and 7.89% in the intervention using the both tools (95% CI: 6.29-9.90%). Interpretation: The explicit approach is expected to guide policy makers to adopt MCH interventions especially for vulnerable populations. Trial Registration: UMIN000025628 Funding Statement: Japan Society for the Promotion of Sciences (JSPS) (16H06241) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study received ethical clearance from the ethical committee of Bangladesh Medical Research Council (BMRC), Bangladesh and National Center for Child Health and Development (NCCHD), Japan.