DISCUSSION
CoC
We conducted a pragmatic cluster randomized trial of a globally applicable intervention package targeted at improving MNCH service use and continuum of care among mothers in Angola. We found that distribution of the MCH handbook and its supplementary interventions did not increase MNCH service utilization sufficiently enough for the attainment of the primary outcome. Our study is, to the best of our knowledge, the first to compare different types of home-based records (integrated vs non-integrated record systems) in Africa, thus adding to the limited evidence on the debate regarding the superiority of the integrated MCH handbook over stand-alone home-based records.Our findings contradict those of a recent RCT in Bangladesh, which demonstrated significant improvement in CoC following use of the MCH handbook enhanced by mobile tools [Preliminary findings from its pilot use prior to intervention launch [The lack of significant improvement in study-defined CoC could be due to the post-hoc intra-cluster correlation being higher than expected, thus leading to our study being insufficiently powered to detect a difference. The trial sample included 10 clusters, making it sufficient for our statistical hypotheses, but relatively small, thus increasing the risk of the clusters not being similar. Simultaneously, the variation between clusters was large and the post-hoc intra-cluster correlation coefficient was estimated to be about 0.04, larger than the initially assumed value of 0.01. Under this assumption of 0.04, the power to detect the expected difference was low, at less than 50%, which is consistent with the non-significant results.Disparities in health outcomes by urban-rural location, and inequitable access to and use of prenatal care between urban and rural areas is pervasive in Angola [