Intervention
EVENTS
We based our study rationale on research gaps highlighted in the 2018 WHO recommendations on home-based records for maternal, newborn, and child health [Study interventions leveraged existing health care infrastructure to facilitate intervention delivery, which was divided into three parts: 1) distribution of MCH handbook; 2) health care provider training on MCH handbook operation, and 3) community sensitization and mobilization among pregnant women on the use of the MCH handbook. We provided the MCH handbook to women during their first contact with health care facilities to receive MNCH services for the index pregnancy, with explanations on when and how to use the MCH handbook and on data recording. Women also received health education based on the contents of the MCH handbook during routine prenatal classes. Women in the control group continued to benefit from the traditional use of two stand-alone home-based records – the prenatal card and child health card. In both study groups, we asked women to bring their MCH handbook or prenatal card and child health card to every occasion of MNCH service consultation. We trained health care providers on MCH handbook operation prior to distribution of the MCH handbook to pregnant women/mothers. Initially, we provided a five-day training of trainers for selected health care professionals from participating facilities in the intervention group. Subsequently, trainers from each health care facility provided on-the-job training to health care providers at their respective facilities. The training focused on fundamentals of MNCH services, how to use and record information in the MCH handbook during regular consultations, how to explain the use of the MCH handbook to pregnant women/mothers, and how to interpret data entries from the MCH handbook. To enhance eligibility assessment, health care providers in both study groups received training on interviewing techniques for determining the date of the last menstrual period and on methods for calculating probable delivery date. We provided in-facility refresher training of trainers if required following periodic visits by the study team to intervention group facilities. Community sensitization and mobilization involved the provision of community events and mothers’ classes using the MCH handbook material as educational material.