Rahman, Mahfuzar, Fakir Md. Yunus, Rasheduzzaman Shah et al., “A Controlled Before-and-After Perspective on the Improving Maternal, Neonatal, and Child Survival Program in Rural Bangladesh: An Impact Analysis,” PLOS ONE 11, no.9 (September 2016), doi:10.1371/journal.pone.0161647

URL: journals.plos.org/plosone/article?id=10.1371/journal.pone.0161647

Abstract

Objectives: We evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh.

Methods: Four districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared before-and-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider.

Findings: Increased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and -20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother’s knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm.

Conclusion: Medically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.

Analyzing a grass-roots, community based public health intervention in Bangladesh aimed at improving maternal, neonatal, and child survival, Rahman et al. (2016) conclude that such interventions can significantly improve and increase antenatal and postnatal visits, which in turn decreases poor health and mortality rates. However, not all efforts at educating, providing, and encouraging the utilization of antenatal and postnatal healthcare have the impact desired. Governmental, cultural, and familial factors will influence the care received, thereby requiring continued efforts to provide ethical and quality care that takes into account the surrounding context.