Abstract
ObjectiveTo assess the effectiveness of the Maternal and Child Health (MCH) handbook in Mongolia to increase antenatal clinic attendance, and to enhance health-seeking behaviors and other health outcomes.MethodsA cluster randomized trial was conducted using the translated MCH handbook in Bulgan, Mongolia to assess its effectiveness in promoting antenatal care attendance. Pregnant women were recruited from 18 randomly allocated districts using shuffled, sealed envelopes. The handbook was implemented immediately for women at their first antenatal visit in the intervention group, and nine months later in the control group. The primary outcome was the number of antenatal care visits of all women residing in the selected districts. Cluster effects were adjusted for using generalized estimation equation. Masking was not possible among care providers, pregnant women and assessors.FindingsNine districts were allocated to the intervention group and the remainder to the control group. The intervention group (253 women) attended antenatal clinics on average 6•9 times, while the control group (248 women) attended 6•2 times. Socioeconomic status affected the frequency of clinic attendance: women of higher socioeconomic status visited antenatal clinics more often. Pregnancy complications were more likely to be detected among women using the handbook.ConclusionThe MCH handbook promotes continuous care and showed an increase in antenatal visits among the intervention group. The intervention will help to identify maternal morbidities during pregnancy and promote health-seeking behaviors.Trial RegistrationUMIN Clinical Trial Registry UMIN000001748
Highlights
Maternal and child health continues to present a significant public health challenge in Mongolia
The purpose of introducing the handbook to Mongolia, which was proposed by the Mongolian Ministry of Health, was to increase antenatal visits and enhance client-provider communication during pregnancy to improve long-term health outcomes for mother and child
The handbook was first considered by the Mongolian government as a key intervention in maternal and child health in 2007,[13] and our study initiated the national adoption of the Maternal and Child Health (MCH) handbook in Mongolia in 2010
Summary
Maternal and child health continues to present a significant public health challenge in Mongolia. Despite a marked improvement in the maternal and neonatal mortality ratios over the past 20 years, with 89Á6 per 100,000 births in 2007[1] and 14 per 1,000 births during 2001–2003[2], respectively, as well as a decline in the mortality of older children,[1] the quality of antenatal care is still low[3] and complications during pregnancy remain a significant hurdle for improving maternal health in Mongolia.[4, 5] Effective interventions to enhance maternal and child health outcomes are crucial to address these challenges and to maintain the achievement of health-related Millennium Developmental Goals (MDGs) 4 and 5.[6]. A high-quality study that assesses the effectiveness of the handbook to facilitate long-term information-sharing has not previously been undertaken.[16]
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