Introduction
Although Bangladesh has achieved a significant progress on reduction of maternal and child mortality during the past decades, unmet targets on delivery and utilization of maternal and neonatal healthcare services have left the issue in an agenda of Sustainable Development Goals (SDGs). The new goals of the SDGs are to reduce the maternal mortality ratio (MMR) to less than 70 per 100,000 live births and neonatal mortality ratio (NMR) to 12 per 1,000 live births by 20301-3. So far, the effectiveness of interventions for saving the lives of mothers and babies have been proven2, 4-7, but challenges remain in health-care seeking and practices across the full continuum of maternal and child care, including the utilization of antenatal care, birth with a skilled attendant or standard facilities, emergency obstetric care in case of complications or illness for women and newborn, essential neonatal care, and postnatal visits for women and babies in resource constrained settings 8-10.
The World Health Organization (WHO) 11, 12 recommended a home-based maternal record (HMR), an effective tool to actively link pregnant women and their families to community health workers and professional hospital staffs, raise knowledge and awareness on maternal and child health, identify complications in pregnancy and labor and common illness of mothers and babies, and consequently to improve delivery and utilization of maternal and child care services13-20. Among antenatal notes, immunization cards, child health books and the integrated document, the maternal and child health handbook (MCH) is the most comprehensive home-based book that encompasses all the records of the continuum of care for both mothers and children, including antenatal care, labor and delivery, postpartum care, newborn and child care, immunization and family planning. The integration of the different types of records is much more effective compared to the fragmented implementation, saving both financial and human resources for the intervention 21-22. Besides the records, the handbook also contains guiding information on seeking care for mothers and children conveyed through ample illustrations. The recently launched WHO guideline has recommended the use of home-based records to complement facility-based records 23. So far, its effectiveness to improve health seeking behaviors, home care practices, male involvement and communication between health professionals and women / caregivers, and feasibility has been proven by empirical epidemiological studies in various developing settings15-20. However, there was insufficient evidence on the type, content and implementation of HBR, which needs to be tailored to different sociocultural and epidemiological contexts23.
In Bangladesh, a pilot MCH project showed strong positive impact on mother’s knowledge, practices, record keeping, service utilization and empowerment of women 24,25. After the approval by the Government of Bangladesh, a project-based utilization of HBRs has been widely implemented by NGOs; however, the current system of HBRs is fragmented, with various types provided by different organizations. Therefore, we implemented the first cluster randomized controlled trial (RCT) to examine the effectiveness of MCH enhanced by a mobile platform in two counties of rural Bangladesh (protocol available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902947/)26. The existing version of the Bangladeshi MCH designed by Bhuiyan et al were used in the intervention. The reason for enhancing it with a mobile platform was to boost communications between pregnant women, their family and community health workers, principal healthcare providers in the rural area, and to catalyze the potential advantages of the mobile platform in knowledge dissemination, guidance and promotion of healthcare utilization 27. We hypnotized that the proposed interventions will benefit the continuum of care and lead to better maternal and neonatal outcomes. The study aimed to assess the effectiveness of the interventions on the improvement of the target outcomes, in order to inform updates of the MCH in the context of Bangladesh and policy making for the targets of SDGs related to maternal and neonatal health.