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The Maternal and Child Health (MCH) handbook in Mongolia: a cluster-randomized, controlled trial.

Mori R, Yonemoto N, Noma H, Ochirbat T, Barber E, Soyolgerel G, Nakamura Y, Lkhagvasuren O - PLoS ONE (2015)

Bottom Line: To 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.Cluster effects were adjusted for using generalized estimation equation.The intervention will help to identify maternal morbidities during pregnancy and promote health-seeking behaviors.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.

ABSTRACT

Objective: To 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.

Methods: A 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.

Findings: Nine 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.

Conclusion: The 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 registration: UMIN Clinical Trial Registry UMIN000001748.

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Related in: MedlinePlus

Primary outcome: Mean difference by wealth index.The y-axis shows the mean difference with confidence intervals of the number of antenatal care visits between the intervention and control groups. The x-axis shows the wealth index quintile.
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pone.0119772.g002: Primary outcome: Mean difference by wealth index.The y-axis shows the mean difference with confidence intervals of the number of antenatal care visits between the intervention and control groups. The x-axis shows the wealth index quintile.

Mentions: In the primary GEE analysis, there is no significant difference between the two groups in the number of antenatal care visits and the proportion of women who have visited more than 6 times. The travel time to antenatal clinics did not significantly affect the association between the intervention and the primary outcome. However, socioeconomic status was found to influence the frequency of clinic attendance: women of a higher socioeconomic status visited antenatal clinics more often than women from a lower socioeconomic background. Socioeconomic status acted as a statistically significant effect modification on outcomes by the multivariate GEE analyses. Therefore the analysis of primary outcomes was stratified by socioeconomic-status quintile. Results of the GEE analysis of primary outcomes stratified by wealth index are presented in Figs. 2, 3 and 4.


The Maternal and Child Health (MCH) handbook in Mongolia: a cluster-randomized, controlled trial.

Mori R, Yonemoto N, Noma H, Ochirbat T, Barber E, Soyolgerel G, Nakamura Y, Lkhagvasuren O - PLoS ONE (2015)

Primary outcome: Mean difference by wealth index.The y-axis shows the mean difference with confidence intervals of the number of antenatal care visits between the intervention and control groups. The x-axis shows the wealth index quintile.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390384&req=5

pone.0119772.g002: Primary outcome: Mean difference by wealth index.The y-axis shows the mean difference with confidence intervals of the number of antenatal care visits between the intervention and control groups. The x-axis shows the wealth index quintile.
Mentions: In the primary GEE analysis, there is no significant difference between the two groups in the number of antenatal care visits and the proportion of women who have visited more than 6 times. The travel time to antenatal clinics did not significantly affect the association between the intervention and the primary outcome. However, socioeconomic status was found to influence the frequency of clinic attendance: women of a higher socioeconomic status visited antenatal clinics more often than women from a lower socioeconomic background. Socioeconomic status acted as a statistically significant effect modification on outcomes by the multivariate GEE analyses. Therefore the analysis of primary outcomes was stratified by socioeconomic-status quintile. Results of the GEE analysis of primary outcomes stratified by wealth index are presented in Figs. 2, 3 and 4.

Bottom Line: To 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.Cluster effects were adjusted for using generalized estimation equation.The intervention will help to identify maternal morbidities during pregnancy and promote health-seeking behaviors.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.

ABSTRACT

Objective: To 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.

Methods: A 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.

Findings: Nine 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.

Conclusion: The 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 registration: UMIN Clinical Trial Registry UMIN000001748.

Show MeSH
Related in: MedlinePlus