Can distributing a maternal and child health handbook to women improve maternal, newborn and child health service utilisation?

INTERVENTION: Intervention arm treatment: Distribution of MCH Handbook to women seeking MNCH services at public healthcare facilities in intervention municipalities, healthcare provider training on MCH Handbook operation and utilization and community sensitization and mobilization among women on the use of the MCH Handbook. Control arm treatment: Distribution of mother’s card/book to pregnant women and child’s card for infants and healthcare provider training on the estimation of the probable delivery date (PDD) only. The total duration of treatment and follow‐up: 13 months. Randomisation process: The unit of randomisation in this trial is the municipality. Benguela province consists of 10 municipalities of varying sizes ‐ Baia Farta, Balombo, Benguela, Bocoio, Caimbambo, Catumbela, Chongoroi, Cubal, Ganda and Lobito. All ten municipalities will be included in the study. Municipalities were allocated to either intervention or control arms using block randomization taking into consideration the size and baseline characteristics of each municipality. The intervention and control arms each consist of five municipalities namely: Lobito, Cubal, Chongoroi, Bocoio and Balonmo and Benguela, Catumbela, Baia Farta, Ganda and Caimbambo respectively. CONDITION: Health service utilization ; Not Applicable PRIMARY OUTCOME: Continuum of care (CoC) completion rate. CoC completion is a time‐dependent composite outcome to be measured during follow‐ up at 2 3 months postpartum among all pregnant women recruited into the study. CoC completion will consist of a minimum number of ANC visits, facility‐based delivery, postnatal check‐ups of mother and newborn and full child immunization up to 2 3 months’ infant age. As a sub‐group analysis, the stratified analysis by the timing of the first ANC visit will be performed. INCLUSION CRITERIA: 1. Became pregnant at the beginning of the trial period. 2. Probable date of delivery (PDD) date from 01/12/2019 to 31/01/2020 or last menstrual period (LMP) between 01/03/2019 to 30/04/2019. SECONDARY OUTCOME: ; 1. Rate of MNCH service utilisation is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.; 2. Overall CoC completion rate is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.; 3. Neonatal mortality rate is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.; 4. ANC service utilization is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.; 5. Facility‐based delivery is measured at follow‐up. Data will be collected through structured interviews or abstracted from home‐based record books.; 6. Infant health check‐up is measured by maternal recall through structured interviews and records abstracted from home‐based record books. Data will be collected at follow��up.; 7. Maternal morbidity and pregnancy complications detection rate is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.; 8. Infant morbidity rate is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.; 9. Number of infant deaths is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.; 10. Maternal health behavior is measured using structured interviews at baseline and follow‐up.; 11. Maternal depression is measured using the Edinburgh Postpartum Depression Scale at follow‐up.; 12. Infant feeding practices are measured using structured interviews at follow‐up; 13. Child vaccination rate is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.; 14. Utilisation of postnatal care services is measured at follow‐up. Data will be collected through structured interviews and abstracted from home‐based record books.;