CONCLUSIONS
Although our trial was unable to help us understand the superiority of the MCH handbook over stand-alone home-based records, we were able to show an intervention effect on initiating antenatal care use among women. This is an important finding, considering that antenatal care improves the survival and health of babies indirectly by providing an entry point for health contacts with women at a vital stage in the continuum of care. We also showed that the MCH handbook does not work in isolation and is more likely to fulfil its functional role in an improved health system. Further impact evaluation in similar settings is clearly needed to address the questions regarding superiority of the MCH handbook over stand-alone home-based records, with careful consideration for cluster selection and strategies for adequate training of health care providers.