Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
TA Networking Corp., Tokyo, Japan.
J Glob Health. 2023 Feb 3;13:04022. doi: 10.7189/jogh.13.04022.
The maternal and child health (MCH) handbook is promoted as a tool for strengthening continuum of care. We assessed the effect of a MCH handbook intervention package on continuum of maternal and child health care and health outcomes for mother and child.
We conducted an open-label, parallel two-arm cluster randomized controlled trial in Angola. We randomly assigned municipalities in Benguela province through block randomization to a group using a package of enhanced maternity care service (which included the MCH handbook distribution and its supplementary intervention) and another using usual care (two stand-alone home-based records). We included women who were pregnant at the beginning of the trial period and attended a public health care facility for maternity care services. Neither health care providers, study participants nor data assessors were masked, but the statistician was. The primary outcome was a measure of service utilization assessed via achievement of maternal behavior-based continuum of care at three months postpartum. We conducted an intention-to-treat analysis in women with available data.
We randomized 10 municipalities to either the intervention (five clusters) or control (five clusters) group. Of the 11 530 women approached between June 8, 2019, and September 30, 2020, 11 006 were recruited and 9039 included in the final analysis (82%; 3774 in the intervention group and 5265 in the control group). The odds for achievement of maternal behavior-based continuum of care in the intervention group was not significantly different from that in the control group (adjusted odds ratio (aOR) = 1.18, 95% confidence interval (CI) = 0.46-2.93) at three months postpartum. However, the odds of initiating antenatal care clinic use were significantly higher in the intervention group (odds ratio (OR) = 5.16, 95% CI = 2.50-10.67). No harms associated with the intervention were reported.
Distribution of the MCH handbook and its supplementary interventions promoted initiation of antenatal care service use, but did not increase service utilization sufficiently enough for attainment of study defined maternal behavior-based continuum of care.
ISRCTN20510127.
《母婴保健手册》被宣传为加强母婴保健服务连续性的工具。我们评估了母婴保健手册干预包对母婴保健服务连续性和母婴健康结果的影响。
我们在安哥拉开展了一项开放标签、平行、双臂、集群随机对照试验。我们通过整群随机分组，将本格拉省的市分配到使用强化产妇保健服务包（包括《母婴保健手册》的分发及其补充干预措施）的组和使用常规护理的组（两个独立的家庭记录）。我们纳入了在试验开始时怀孕并在公共保健机构接受产妇保健服务的妇女。医护人员、研究参与者和数据评估者均未设盲，但统计师设盲。主要结局是通过评估产后三个月母婴保健行为连续性来衡量服务利用情况。我们对有可用数据的妇女进行了意向治疗分析。
我们将 10 个市随机分配到干预组（5 个集群）或对照组（5 个集群）。在 2019 年 6 月 8 日至 2020 年 9 月 30 日期间，共接触了 11530 名妇女，其中 11006 名妇女接受了招募，9039 名妇女纳入最终分析（82%，干预组 3774 名，对照组 5265 名）。产后三个月，干预组实现母婴保健行为连续性的可能性与对照组无显著差异（调整后的优势比（aOR）=1.18，95%置信区间（CI）=0.46-2.93）。然而，干预组开始产前检查的可能性显著更高（比值比（OR）=5.16，95%置信区间（CI）=2.50-10.67）。没有报告与干预相关的任何伤害。
《母婴保健手册》及其补充干预措施的分发促进了产前保健服务的利用，但不足以使母婴保健服务达到研究定义的母婴保健行为连续性。
ISRCTN20510127。
