Abstract
ObjectivesWe evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh.MethodsFour districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared before-and-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider.FindingsIncreased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and -20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother’s knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm.ConclusionMedically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.
Highlights
There has been substantial progress in reducing maternal, neonatal and under-five mortality rates over the past two decades [1]
Inequalities in access to health services widen the gap in mortality rates between the rich and poor in lowincome countries (LICs), which account for 99% of global maternal deaths [5]; the maternal mortality ratio (MMR) is reported to be14-times higher in LICs than developed countries [4]
The effects of intervention on antenatal care, deliveries attended by community-based skilled birth attendants, and postnatal care were especially high in the fouryear exposure area compared to the comparison area
Summary
There has been substantial progress in reducing maternal, neonatal and under-five mortality rates over the past two decades [1]. Between 1990 and 2013, the global maternal mortality ratio (MMR) decreased by 45% (380 to 210 deaths per 100,000 live births) [2].the global neonatal mortality rate (NMR) decreased by 30% (33 to 21 deaths per 1,000 live births)and under-five mortality by 41% (90 to 48deaths per 1,000 live births) over the same period [1, 3]. Inequalities in access to health services widen the gap in mortality rates between the rich and poor in lowincome countries (LICs), which account for 99% of global maternal deaths [5]; the MMR is reported to be14-times higher in LICs than developed countries [4]. By following global community advice, the Government of Bangladesh (GoB) has set its own goal to improve maternal and child health as per the Millennium Development Goals (MDGs), MDG 4 (reduce child mortality rate) and MDG 5 (improve maternal health) by 2015. To keep pace with MDG targets and GoB strategies, different governmental (GO) and non-governmental organizations (NGO), bilateral agencies, and donors have implemented various health interventions either individually or in partnership with the government to achieve MDG 4 and 5 targets, amongst the poor
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
