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

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.

Fig 1. Flow diagram of the study population.

Fig 2. 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.

Fig 3. Primary outcome: Risk ratio by wealth index.

The y-axis shows the risk ratio with confidence intervals of the number of women who made six antenatal care visits during their pregnancy in the intervention and control groups. The x-axis shows the wealth index quintile.

Fig 4. Primary outcome: Risk difference by wealth index.

The y-axis shows the risk differences with confidence intervals of the number of women who made six antenatal care visits during their pregnancy in the intervention and control groups. The x-axis shows the wealth index quintile. Note: 1^st quintile represents the highest wealth index, and the 5^th represents the lowest.