Abstract
BackgroundAlthough achieved development goals on maternal and child health, in the era of Sustainable Development Goals (SDGs), Bangladesh still needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies. How to implement effective interventions by strengthening the community health system also remains as a crucial policy issue. The objective of the proposed study is to evaluate the impact of a community-based intervention as part of a bilateral development aid project on utilization of maternal and neonatal care provided by skilled providers and qualified facilities.MethodsA cluster randomized trial was conducted in Kalaroa Upazila of Satkhira District. Community Clinics (CCs) in the study setting were randomly allocated to either intervention or control. We recruited all eligible women covered by CC catchment areas who gave a birth during the past 12 months of data collection at the baseline and end-line surveys. In the intervention areas, three Community Support Groups (CSGs) were developed in each of the CC areas. The members of CSG were trained to identify pregnant women, educate community people on pregnancy related danger signs, and encourage them for utilization of skilled services in the community and health facilities. The primary outcomes were the utilization of services for antenatal care, delivery, postnatal care and sick newborns. Difference-in-Difference (DID) analysis was performed to identify the changes by the intervention with adjustment of cluster effects by generalized mixed effects regression models.ResultThe major indicators of the utilization of maternal and neonatal care among pregnant women with different wealth status showed significant improvement after the intervention. The impacts of the intervention were in particular significant among the women of 2nd and 3rd quintiles of household wealth status. The use of CCs increased after the intervention and private hospitals / clinics served as the major health providers. The study also identified increased practices of cesarean section.ConclusionThe success of the intervention suggests a potential of the government efforts to strengthen the community support system for promotion of safe motherhood. The intervention helps to identify and remove existing and emerging barriers that lie between women and healthcare providers for safe motherhood and continuum of care.Trial registrationUMIN Clinical Trial Registry UMIN000031789.
Highlights
Bangladesh has achieved a significant progress on reduction of maternal and child mortality in the Millennium Development Goal (MDG) era, and left issues and lessons in the era of post-2015 (Fig 1) [1,2]
The intervention helps to identify and remove existing and emerging barriers that lie between women and healthcare providers for safe motherhood and continuum of care
Utilization of essential maternal healthcare services (MHS) including family planning, antenatal care (ANC), postnatal care (PNC), facility-based delivery or delivery by skilled birth attendant (SBA), and emergency obstetric care (EmOC) are proved to reduce maternal mortality [5,6,7], it has been remarkably reported in many studies and official reports that Bangladesh needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies [1, 8,9,10]
Summary
Bangladesh has achieved a significant progress on reduction of maternal and child mortality in the Millennium Development Goal (MDG) era, and left issues and lessons in the era of post-2015 (Fig 1) [1,2]. Utilization of essential maternal healthcare services (MHS) including family planning, antenatal care (ANC), postnatal care (PNC), facility-based delivery or delivery by skilled birth attendant (SBA), and emergency obstetric care (EmOC) are proved to reduce maternal mortality [5,6,7], it has been remarkably reported in many studies and official reports that Bangladesh needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies [1, 8,9,10] Underlying this essential issue, the greatest challenge lies in a shortage of human resource, deficiency and poor performance of public healthcare facilities, and mobilization of community in rural areas [1]. The objective of the proposed study is to evaluate the impact of a community-based intervention as part of a bilateral development aid project on utilization of maternal and neonatal care provided by skilled providers and qualified facilities
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