Maternal and Child Health Handbook use for maternal and child care: a cluster randomized controlled study in rural Java, Indonesia

Abstract

Background: Effectiveness of the Maternal and Child Health Handbook (MCHHB), a home-based booklet for pregnancy, delivery and postnatal/child health, was evaluated on care acquisition and home care in rural Java, a low service-coverage area.

Methods: We conducted a health centre-based randomized trial, with a 2-year follow-up. Intervention included (i) MCHHB provision at antenatal care visits; (ii) records and guides by health personnel on and with the MCHHB; and (iii) sensitization of care by volunteers using the MCHHB.

Results: The follow-up rate was 70.2% (183, intervention area; 271, control area). Respondents in the intervention area received consecutive MCH services including two doses of tetanus toxoid injections and antenatal care four times or more during pregnancy, professional assistance during child delivery and vitamin A supplements administration to their children, after adjustment for confounding variables and cluster effects (OR = 2.03, 95% CI: 1.19-3.47). In the intervention area, home care (continued breastfeeding; introducing complementary feeding; proper feeding order; varied foods feeding; self-feeding training; and care for cough), perceived support by husbands, and lower underweight rates and stunting rates among children were observed.

Conclusion: MCHHB use promoted continuous care acquisition and care at home from pregnancy to early child-rearing stages in rural Java.

Keywords: children; health promotion; health services.

Figure 1

Enrolment of respondents according to the CONSORT 2010 flow diagram.

Appendix 3

Care sought for maternal and postnatal complications and child illness among reported cases. ⁺Maternal care includes care sought for pregnancy complications (bleeding, oedema, convulsion, fever, early rupture of amnion sack, less movement of the foetus, emesis and nausea/loss of appetite) and for delivery complications (prolonged delivery, bleeding, fever, umbilical cord or baby’s arm exposed from the birth passage, convulsion, mother cannot push any longer, muddy and smelly amniotic fluid, retention of placenta, mother experiences restlessness or considerable pain). ⁺⁺Postnatal care includes postpartum complications (bleeding, fever, convulsion, smelly fluid from birth passage, oedema, and swollen or reddish breasts) and newborn complications (small baby or low birth weight, baby does not want to suck nipples, convulsion, cold extremities, fever, icteric, wet and smelly umbilical cord, and weak movement of extremities). ^#ARI: acute respiratory infection with fever accompanied by rapid breath. ^##Homecare for diarrhoea includes more often than usual breastfeeding, administering oral rehydration solutions, and giving normal food portions. Homecare for cough includes more frequent breastfeeding, administering more fluids, keeping distance from smoke, refraining from burning garbage near children. **P value < 0.01.