Effect of a maternal and child health handbook on maternal knowledge and behaviour: a community-based controlled trial in rural Cambodia.
Effect of a maternal and child health handbook on maternal knowledge and behaviour: a community-based controlled trial in rural Cambodia.
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DOI：
10.1093/heapol/czu133
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发表时间：
2015-11
影响因子：
3.2
通讯作者：
Nakamura Y
中科院分区：
文献类型：
--
作者：
Yanagisawa S;Soyano A;Igarashi H;Ura M;Nakamura Y
妇幼健康 (MCH) 手册是综合性的家庭小册子，旨在整合 MCH 记录。尽管经验证据表明这些手册比当前的卡片式记录更有效，但这尚未得到科学证明。本研究的目的是评估《妇幼保健手册》对孕产妇知识和行为的影响，通过产前护理 (ANC) 出勤率、熟练接生员 (SBA) 分娩以及在医疗机构分娩来衡量。柬埔寨版的妇幼保健手册已在两个卫生中心制定并推出，另外两个卫生中心则作为对照。对干预前1年内生育过的320名干预区妇女和320名对照区妇女进行了干预前和干预后调查。我们通过双重差分（DID）分析评估了手册的影响，并通过逻辑回归计算了关键指标前后变化的调整优势比。此外，我们采访了多产妇女、卫生工作人员和卫生志愿者，以评估该手册的接受度和文化适宜性。对英文翻译的转录进行内容分析。 DID 分析显示，与反事实假设相比，干预组的所有关键指标均有所增加。干预措施还提高了母亲对除产后严重出血风险之外的所有主题的了解；这可能是由于文化信仰的影响。逻辑回归显示，即使在调整了产妇年龄、教育程度和经济条件后，干预措施也增加了 ANC 出勤率、SBA 分娩率和医疗机构分娩率。定性数据表明该手册很受欢迎并且适合文化。因此，MCH 手册是当前卡片式孕产妇记录的合理且优越的替代方案。
Maternal and child health (MCH) handbooks are comprehensive home-based booklets designed to integrate MCH records. Although empirical evidence suggests the handbooks are more effective than current card-type records, this has not been scientifically demonstrated. The objectives of this study were to evaluate the impact of the MCH handbook on maternal knowledge and behaviour as measured by antenatal care (ANC) attendance, delivery with skilled birth attendants (SBAs) and delivery at a health facility. The Cambodian version of the MCH handbook was developed and introduced in two health centres, and two other health centres served as controls. Pre-intervention and post-intervention surveys were conducted with 320 women from the intervention areas and 320 women from the control areas who had given birth within 1 year before the survey. We evaluated the impact of the handbook by using difference-in-differences (DID) analysis and calculated adjusted odds ratios for pre–post changes in key indicators by using logistic regression. In addition, we interviewed multiparous women, health staff and health volunteers to assess the acceptance and cultural appropriateness of the handbook. Content analysis was performed with the English-translated transcriptions. The DID analyses revealed that all key indicators increased in the intervention group against counterfactual assumptions. The intervention also increased maternal knowledge of all topics addressed except for the risk of severe bleeding after delivery; this may be attributable to the influence of cultural belief. Logistic regression showed that the intervention increased ANC attendance, delivery with SBAs and delivery at a health facility, even after adjusting for maternal age, education and economic conditions. The qualitative data indicated that the handbook was well received and culturally appropriate. Thus, the MCH handbook is a reasonable and superior alternative to current card-type maternal records.