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Study on the Development and Assessment of Maternal and Child Health (MCH) Handbook in Bangladesh

Research Article

Study on the Development and Assessment of Maternaland Child Health (MCH) Handbook in Bangladesh

Shafi Ullah Bhuiyan *Yashuhide Nakamura **

Nahid Akhter Qureshi ***

ABATRACTA pilot study was carried out to develop MCH handbook and to assess its effect on mother’s

knowledge, practice and utilization of MCH services from September 2002-October 2003 atthe Maternal and Child Health Training Institute (MCHTI), in Dhaka, Bangladesh. In order todevelop a MCH handbook for pregnant mothers, a focus group discussion was carried out andsubsequent outcome measurement of handbook utilization involved a pre and post interventionsurvey following the introduction of the handbook.

A total of 600 samples who visited MCHTI first time in their current pregnancy were ran-domly selected, of which 240 were in study group receiving handbook and 360 were in controlsgroup receiving existing cards only. Data was analyzed by using multilevel analysis approach.Findings from the focus groups discussion emphasized the need for including MCH handbook inMaternal and child program in Bangladesh. In addition, quantitative data suggests that mothers instudy group had higher knowledge on MCH issues, better practices in MCH care and higherutilization on MCH services than mothers in control groups who used other health cards.

As the MCH handbook is developed utilizing problem–oriented approach and involving therecommendations of end users it is believed that it would contribute significantly in ensuring thequality of maternal and child health conditions in Bangladesh.

KEY WORDSMaternal and Child Health (MCH) Handbook Development Bangladesh

* M.B.B.S., M.P.H., Ph.D., ASEAN Institute for Health Development (AIHD), Mahidol University, Thailand** M.D., Ph.D., International Collaboration Division, Faculty of Human Sciences, Osaka University, Japan*** M.B.B.S., M.P.H., ASEAN Institute for Health Development (AIHD), Mahidol University, Thailand

Journal of Public Health and Development 2006 Vol. 4 No. 2

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INTRODUCTIONDuring the past 35 years, the Government

of Bangladesh together with NGOs has madeconsiderable efforts to provide health and familyplanning services, which has resulted in progressin some indicators. For example, the nationalinfant mortality rate (IMR) declined from 150per 1,000 live births in 1975 to 87 in 1999.Theannual crude death rate has also fallen from 19per 1000 in 1975 to just 5 in 2000. However,achievement in the field of maternal mortalityhas not matched that seen in these other relatedfields. Although the Maternal Mortality Ratio(MMR) did fall from 620 per 100,000 livebirths in 1982 to 440 in 2000 (World Bank,2001). This level is still considered unaccept-able high, with around 20,000 Bangladeshimothers dying each year due to causes related topregnancy and child birth (World Bank, 2001).Many strategies have been adopted and deve-loped for the improvement of maternal and childhealth (MCH) conditions of Bangladesh. One ofthe recent government strategies is to develop anational MCH tool through which vital informa-tion can be given to mothers in order to improvethe MCH services of the country.

Internationally most researchers seem toagree that providing MCH knowledge to themothers and families through a communicationtool will help to improve and sustain thematernal and child health conditions of a country.Albrecht (2000) stated that the focus of ante-natal care need to be shifted from schematic andineffective allocation of risk labels to competentand individualized counseling in order to empowermothers and their families to take informed

decisions. Cynthia (2001) found that the bestevidence of the program’s success is its accep-tance by the community and the participatingfamilies. Rodolf (2003) distinguished four typesof services by proximity to the resolution of lifethreatening maternal conditions: treatment, riskidentification, prevention and avoidance. Accord-ing to Choolani and Ratnam (1995) female healthliteracy can play a most vital role in order toreduce maternal mortality. Conventional wisdomlong held that giving people information couldchange behavior and thereby solve health andsocial problems. The idea of schemas suggestedthat a health message will be better understood ifit activates existing schemas-if, in other words,the receiver has a handy place to store the infor-mation and some conscious ideas regarding wherethe information is stored.

The existing communication tools which arecurrently been practiced in Bangladesh are one-way communication type referred as treatmentcard, EPI card, antenatal card etc. There is nosuch evidence that mothers are being persuadedof these cards’s merit. Despite findings relatedto usefulness of providing information to client,research oriented tool has not been established yet inBangladesh which could satisfy clients’ need.Globally, success related to MCH handbook hasgained validity due to its contribution in MCHservices. However achievement has been madein county-based standpoint. Although much workhas been done to date to improve MCH situationin Bangladesh, studies need to be conducted todevelop and ascertain the usefulness and costeffectiveness of this MCH handbook in Bangladeshcontext.



The MCH handbook is one of the tools thathas been considered to carry out the quality healthcare for both mothers and children in many coun-tries. Some related studies have been conductedon MCH handbooks in Japan, Indonesia, Mexico,Brazil, Thailand, Laos, Vietnam and SouthKorea; after launching the MCH handbooks inthese countries. It is now well understood that theMCH handbook contributed greatly to qualityMCH service development. However, a reduc-tion in maternal and infant mortality in the abovecountries yet to be established (the 4th Interna-tional Symposium on MCH Handbook, Decem-ber 2004, Thailand) through evidence basedstudy.

Researcher tried to develop MCH handbookbased on the lesson learnt and concept from Japanand some other neighboring countries, which arepracticing MCH handbook in their regular MCHprogram. The purpose of this pilot study was todevelop the maternal and child health (MCH)handbook content by local experts, stakeholders,and providers- to assess its output and utilizationamong selected pregnant women at Maternal andChild Health Training Institute (MCHTI), Dhaka,Bangladesh.

MATERIALS AND METHODThis study was composed of qualitative and

quantitative part. Qualitative part was respon-sible for development of MCH handbook throughand quantitative part was performed to assess thehandbook utilization. Instruments for the quali-tative part were focus group discussion, keyinformants meeting, Observations and in-depthinterview. Quantitative part consists of survey,

conducted twice among pregnant mothers atMaternal and Child Health Training Institute(MCHTI) before and after intervention with MCHhandbook. Six hundred pregnant mothers on thefirst visit of their current pregnancy to MCHTI,at outpatient department were interviewed throughstructured questionnaire during the period ofNovember 2002 for initial survey and samemothers were again interviewed during the periodof October 2003 for second time. A systemicrandom sampling was carried out to select themothers from outpatient register. Before inter-vention providers were trained in the use of thehandbooks .Six providers were assigned to instructthe mothers about how to use the book. Among600 mothers 240 cases were provided with MCHhandbook and 360 mothers were provided withexisting cards.

Data was analyzed to compare the baselinecharacteristics of the respondents and to deter-mine the effectiveness of the handbook bycalculating the improvement rate. Quantitativedata was analyzed by SPSS soft wear 10.0versions. Chi-square test was applied to measurethe significance of the study.

RESULTSIn this current study there were qualitative

and quantitative results-qualitative results wasfor MCH content development and quantitativeresults for the baseline study, and for the useful-ness/effect or assessment of MCH handbookintervention study (pre and post intervention ) atMCHTI, Dhaka, Bangladesh. These results arestated as below.


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Qualitative Result: Development of maternal andchild health (MCH) handbook- Process ofdeveloping MCH handbook

Considering the principle of making infor-mation tool-which is locally developed, contentis bilingual (English/Bangle) with color illus-tration, distribution of handbook from hospital andpatient keep handbook. A brain storming sessionwas organized at MCHTI with some selectedproviders and clients to explore their ideas andviews about MCH handbook development inBangladesh. Three group’s discussion sessionswere conducted, first group consists of nearly 20medical doctors including 4 JICA experts,second group consists of 20 family welfarevisitors, midwifes and nurses and third groupconsists of 10 patients and their relatives or stake-holders at MCHTI. These FGD sessions wereconducted at MCHTI, Dhaka, Bangladesh duringthe period of September –October 2002.

Each group discussion was held for one hourlong. Participants were discussed all the relatedmatter about MCH handbook developmentpossibilities and prospective issues. According toresearch background and interest the followingissues was discussed- 1) information about MCHhandbook, 2) usefulness of MCH handbook, 3)problem related to start of MCH handbook, and4) benefit of MCH handbook. Discussion resultsshowed that majority of the participants in eachgroup had no previous idea/information aboutMCH handbook. After briefing by the researcherabout MCH handbook almost every participantsfelt that it might be useful for health education aswell as a good IEC tool at MCHTI. Nearly oneforth of the total discussant pointed out that proper

fund allocation, orientation, training and alsoilliteracy might be problem for starting this pro-spective handbook for the first time at MCHTI.On the other hand majority agreed that it could bea best tool for health information, education andcommunication to ensure quality MCH servicesat MCHTI, Dhaka, Bangladesh.

Characteristics of Key Informants ParticipantsStakeholders

In this group there were 6 members and 2persons from each category, consisting of fathers,pregnant mothers and mothers-in-law. The ageof fathers was 30-40 years, while the mothers’age was between 20-35 years. Mothers-in-lawwere 45-55 years old. The education of motherswas generally 5th grade to 10th grade, whilefathers mostly completed college level educa-tion. Mothers-in-law were without formaleducation. Most of the mothers and mother-in-laws were housewives and had no other paidemployment; however fathers were eitherg overnment employees and or businessmen. Thenumber of existing children the mothers had isgenerally between 1-3 children.

Health Providers (Doctors, Midwives, FWVs,Nurses)

The number of the participants in this groupwas 8 persons, 2 persons from each category.FWVs education was high school level plus eigh-teen months of training; Midwives had six monthsmore training than nurses, especially in obstet-rics case management. Doctors were MBBS withpost graduation qualifications in obstetrics andgynecology.



GO-NGO Policy Maker and Donor AgenciesRepresentatives

This group consists of people from govern-ment offices, the Director (MCH-S) andProgram Manager (MCH-S); and from NGOs,Project Manager (RH), Assistant CountryRepresentative from UNFPA Bangladesh office,JICA funded HRDRH Bangladesh ProjectExpert, WHO Consultant for SBA Project inBangladesh. Out of total 6 persons there were5 medical graduates and one social sciencegraduate. All of these people had vast experiencein public health program planning, management,implementation, monitoring and evaluation andlocally resided in Dhaka Bangladesh.

MCH Handbook Content Formulation Infor-mation on the MCH Handbook

The majority of the participants did not knowanything about this handbook In particularmothers, fathers and mothers-in-law, had noknowledge or experience with the handbook. Asone participant said- “We have more than fourcards for our maternity care but we have neverheard about a handbook in our country”.Additionally very few providers had heard aboutthe MCH Handbook, and only a few policy makershad heard of the book from a previous tour ofJapan. These policy makers mentioned thepopularity of the MCH handbook in Japan.

Usefulness of MCH HandbookAfter an open discussion amongst partici-

pants, almost all felt that an MCH handbook wouldbe useful for health information and education atMCHTI. The client group, informed on the

global situation of MCH handbooks, felt that sucha handbook would be a good instrument for learn-ing in their own pregnancy. One pregnant mothersaid- “With existing cards we are not able toknow any health information, but if the prospec-tive handbook can provide us with some basichealth information it would be better for ourpregnancy care”. Policy makers and donors alsoagreed and according to them further emphasisshould also be given to the use of handbooks forrecord keeping and as a referral document.

Maternal and Child Health (MCH) HandbookSystem

Each group discussion was held for one hour.Participants discussed all of the issues related toMCH handbooks, including their thoughts on thehandbooks and the reasoning behind their beliefs.Some participants worried about the literacy ofwomen but other participants pointed out that inan urban area like Dhaka, it is usual that at leastone member of the family can read or write, sounderstanding the handbooks should not pose amajor difficulty for families. Easy and simplelanguage accompanied by nice pictures may alsohelp the MCHTI handbook’s usability. Also asimilar handbook system has been used succes-sively at the Diabetic Hospital, in Dhaka, for allDiabetic Patients on a regular basis.

MCH Handbook Content FinalizationAfter careful analysis of the discussion, the

following summary was drawn for construction ofthe MCH Handbook content for the pilot study atMCHTI. Based on this content, the researcherdeveloped the final draft of the MCH Handbook.


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This draft also discussed with local providers,policy makers, and NGO representative anddonor representation for final comment. Afterreceiving comments from local experts, the finalMCH Handbook was discussed in internationalcollaboration course at Osaka University, Japanbefore being published for a pilot trial amongwomen during their first antenatal care visit toMCHTI .

Brief Contents of the MCH Handbook related tothe Pregnant Mothers-

General profiles name, address, birth date,guardian, phone, Guardian identity and child birthcertificate, Woman occupation and homesituation, Health record of pregnant mother,Menstrual history and history of previouspregnancy if any, Health education class record,Pregnancy record, Birth planning, Family healthinformation, Things to remember, Health infor-mation and information’s about complicationsduring delivery, Mother’s vaccine and lab report,Record of delivery, Post natal conditions and postnatal check up, Maternity information, Things tobe done by postpartum mothers, Family Planningetc.

MCH Handbook contents related to the Babies- Growth chart, Child development and

rearing, Child vaccination, Vitamin A capsuleschedule and breast-feeding, Control andmanagement of Diarrhea, Child’s cough and coldinformation, Baby’s sickness and treatment recordetc.

Quantitative Results: Baseline/Pre InterventionSurvey

Distribution of number and percentage ofmothers by general characteristic is presented intable 1.In case group majority of the mothers(90%) were housewife. Almost 75% of themothers were above 20 years. The majority ofthe mothers (68.3%) had primary schooleducation. Almost 60% had income more than5000 taka per month. In control group most(92.8%) of the mothers were housewife.Majority of the mothers had primary schooleducation. Almost 85% mothers were above theage of 20 years. Unlike the case group more thanhalf of the mothers (57.5%) in control group hadincome less than 5,000 taka per month. Forantenatal care 98.3% of case mothers and 94.4%of control mothers visited the hospital as anoutpatient.

Mothers’ KnowledgeResults shows that 10.0% of case mothers

and 13.9% of control mothers knew about ANCvisits, while 90.0% of case and 86.1% of thecontrol groups had no knowledge of ANC.Regarding Danger Signs, 75.0% of the case groupand 76.4% of the control group had no knowledge of the danger signs during pregnancy. Onthe topic of Mothers’ Tetanus Toxoid, 62.1% ofcase mothers and 64.4% of control mothers knewabout immunization (Vaccine). On the issue ofbreast feeding, 64.2% of mothers in case groupknew the issues related to breast-feeding and forthe control group this figure was 59.2%.



Regarding Child Vaccination, only 45.0% of casemothers and 40.8% of control mothers knew aboutEPI and vaccination. About Diarrhea, Most of themothers in the case group (88.8%) and controlgroup (85.8%) had adequate knowledge regard-ing diarrhea. Concerning family Planning, Veryfew case mothers (22.5%) and control mothers(26.4%) had a clear understanding of familyplanning methods.

Table 1 General Characteristics of Respondents

Data Case Control (n=240) (%) (n=360) (%)Occupation Housewife 216 90% 334 92.8% Job 24 10% 26 7.2%Age ≤ 19 years 62 25.8% 58 16.1% ≥ 20 years 178 74.2% 302 83.9%Education Primary-Secondary 164 68.3% 229 63.6% College-University 71 29.6% 51 14.1%Literate or Not Mother: Yes 235 97.9% 278 77.2% No 5 2.1% 82 22.8%Father: Yes 228 95% 309 85.8% No 12 5% 51 14.2%Family Income ≤ 4,999/- 97 40.4% 207 57.5% ≥ 5,000/- 143 59.6% 153 42.5%Hospital VisitReasons: ANC 236 98.3% 340 94.4% PNC & Others 4 1.7% 20 5.6%

Mothers’ AttitudeRegarding pregnancy care, in the case group

82.5%, and in the control group 83.3%, ofmothers had good attitudes towards pregnancy. Onthe issue of Health Care Support: In the case group65.0% of case and 63.9% of control mothershad good attitudes towards health care support.About child care, in the case group 70.4%, andin the control group 73.9%, of mothers had goodattitudes towards child care. Regarding Role ofhusband, in the case group 64.6%, and in thecontrol group 72.5%, of mothers had goodattitudes towards the role of their husband.

Mothers’ Practice on MCH ServicesStudy shows 28.3% of case mothers made

an ANC visit during their last pregnancy, while30.6% of mothers in the control group utilizedthe same services.81.7% of case mothers breast-fed in their last pregnancy, while 90.3% mothersin the control group breast fed their children.Regarding Child Vaccination, 84.6% of casemothers and 80.5% of control mothers hadvaccinated their youngest children (born prior tocurrent pregnancy). About Iron supplement,82.7% of case mothers received iron supplementsin their last pregnancy while 80.0% of mothersin the control group received the same. On theissue of Family Planning, 42.1% of case motherspracticed family planning during their lastpregnancy, while 35.3% of mothers in thecontrol group practiced the same. RegardingMothers’ Immunization, 40.0% of case motherswere vaccinated during their last pregnancy, while46.4% of mothers in the control group werevaccinated.


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Post-Intervention Survey Results: Changes inKnowledge, Attitudes and Practice FollowingUtilization of the MCH Handbook

MCH handbook intervention study wasshowed that changes in women’s knowledge ofantenatal care visits were 78.0% and 8.3% forcase and control groups respectively (p<0.05).The change in knowledge of danger signs were46.9% and 5.0% respectively. For breast feed-ing, 28.7% of case and 4.6% of controlsdemonstrated a change in knowledge. Vaccina-tion was 32.4% and 5.7% for case and controlsrespectively, and for family planning thesefigures were 60.8% and 5.0%.

Intervention also encouraged some positivechange in women’s attitudes. These positivechanges in attitude, for case and control groupsrespectively were: on pregnancy care, 5.7% and2.0%; on support of health staff during pregnancy,6.7% and 2.6%; on child care, 7.2% and 3.0%;and on the role of their husband during thepregnancy period, 3.6% and 3.3% .

Figure 1 Change of mother’s knowledge following Utilization of the MCH Handbook

0%

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ANC DSn TTm BF FP

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MCH Handbook Assessment ResultsResults show that 84.2% of case mothers

read all content. 76.1% of case mothers recordall, 83.3% always bring and 99.50% womenkept their handbooks. Mothers perceive MCHhandbook as useful tool, were 78.0% and only22.0% think sometime useful to them. Mothersrequested to include of HIV/AIDS and STD in-formation were 4.8%.

Following the intervention, some changes alsowere noted in practice of antenatal care visits,55.9% and 35.5% for the case and control group,respectively (p<0.05). Other noticeable changesfor case and controls were: practice in mother’stetanus toxoid, 15.1% and 6.6%; breast feed-ing, 16.9% and 0.7%; child vaccination, 8.3%and 1.5%; vitamin A and iron supplementation,17.6% and 1.4%; and family planning 41.5%and 2.0% .

Figure 2 Change of mother’s Practice following Utilization of the MCH Handbook



(99.50%)

(73.20%)

(61.20%)

(69.90%)

(83.30%)

(76.10%)

(84.20%)

(81.30%)

(88.00%)

(78.00%)

(80.40%)

(89.50%)

(53.60%)

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ANC Inform atio

Delivery Inform ation

New Born Inform ationC hild Inform ation

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EPI Inform ation

Health Education

Usefullness

Full Satisfaction

handbook compare to 89.9% for moderate tohighly educated women. The percentage of lesseducated women recorded information in all ofthe necessary sections of the MCH handbooks was79.4% compare to 69.6% of moderately andhighly educated mothers. However, no statisti-cal significant result was found (p>0.05).

Relationship between MCH Handbook Utiliza-tion and Family Income

The current study showed that low and highincome group had almost same percentage (83%and 83.5%) in bringing MCH handbook on theirhospital visits. Regarding reading of all contentsof the handbook, 82.2% of women belonged tolow income families and 85.3% of womenbelonged to middle income families. Women inthe low income group were 79.4% compare tothe women in the middle income groups were73.8% who recorded information in all of thenecessary sections of MCH handbooks. However,the current study was not able to demonstrate anyrelationship between family income and MCHhandbook utilization (p>0.05).

MCH Handbook content Suggestions fromUsersFigure 4 MCH Handbook Users’ Suggestion for

Handbook Improvement

Relationship between MCH Handbook Utiliza-tion and Mothers’ Age

The percentage of case mothers who alwaysbrought the MCH handbook during hospital visitwas 79.6% for younger women (<19 yrs)compare to 84.4% of women over 19 yrs of age.77.6% of women in the younger age group readthe entire contents compare to 75.6% of the oldergroup read the same. 83.7% of the younger womenrecorded information in all of the necessarysections while this figure was 84.4% for the oldergroup. However there was no significant relation-ship between women’s age and utilization of theMCH handbook (p>0.05).

Relationship between MCH Handbook Utiliza-tion and Mothers’ Education

Considering educational level, 81.6% of lesseducated women (primary and secondary leveleducation only) always brought the handbook,compare to 85.5% of highly educated women(college and university level). 80.9% of casesin less educated read all of the contents of the

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HIV/STD Information

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Fathers' Page

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Figure 3 MCH Handbook Utilization AssessmentResults


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In terms of improvement to the handbook,about 59.3% of case mothers suggested the needfor more illustrations and color pages; while23.9% of women mentioned increasing thenumber of pages with simple content. Some12.0% of the mothers requested the inclusion ofmore pages for fathers and information on theirinvolvement; and 4.8% mentioned the inclusionof HIV/AIDS and sexually transmitted disease(STD) information as desirable.

DISCUSSIONOf the total maternal death in Bangladesh,

69% are due to direct obstetric causes. The mostcommon obstetric causes to maternal deaths arepostpartum heaemorrahge, eclampsia complica-tion of abortion, obstructed labor and postpartumsepsis. Government of Bangladesh does haveadequate infrastructure to provide health careservices to the public from the national level toeven the rural, hard-to-reach places. Yet, 63%of mothers do not receive antenatal care(MOH&FW 1998). Furthermore, almost 92%births are delivered at home, often in unsafe andunhygienic conditions. Factors potentially influ-encing low uptake of services by women are;lack of information, motivation and empower-ment of mothers and lack of communicationbetween providers and client. If mothers are beingmotivated and empowered through some infor-mation tool, many unwanted maternal death couldbe prevented and at the same time communica-tion between service providers and pregnantmothers would be improved in substantial level.The purpose of this present study is to develop aMCH information communication tool and to

observe how this tool would improve the utility ofthe MCH services.

The results of this study show that there hasbeen satisfactory improvement of knowledgeregarding antenatal care, danger signs, breast-feeding and vaccination among case group afterintervention of MCH handbook. While knowledge remained almost the same for the controlgroup who was provided with conventional cardsonly. The study also shows some positive changesin women’s attitudes. Specifically, change inattitude toward pregnancy care, support of healthstaff during pregnancy, childcare, role of thehusband during the pregnancy period. Aftergetting MCH handbook, practice in antenatal carevisits increased to considerable level in the casegroup. Other notable changes were: practicein case mother’s tetanus toxoid (TT), breastfeeding, child vaccination, vitamin A and ironsupplementation, and family planning. Weoriginally assumed that mothers would be ableto utilize MCH hand irrespective of age, educa-tional level and family income. Present studyresults are in substantial agreement with thoseassumptions. There was no relationship foundbetween a pregnant women’s age, educationallevel, or family income, and the utilisation of theMCH handbook (i.e. through reading, writing andbring the handbook on subsequent visits). Assess-ment study indicated that most women broughtthe handbook on subsequent visits. The majorityof the women kept the handbook and found it highlyuseful. Regarding opinion about the handbook,the majority of case mothers suggested the needfor more illustrations and color pages; among otherrecommendations increasing thenumber of pages



with simple content.Experience in many developed and develop-

ing countries showed that the MCH handbook hasmany benefits (2nd International Symposium onMCH Handbook, Manado, Indonesia, 2001). Thehandbook serves as a general basic tool for motherand child health care, and additionally it canperform one or more of the following specificfunctions: a) provide information and educationmaterials for health education, b) provideinformation on the continuity of mother and childhealth care, c) serve as a communication toolbetween health service providers and pregnantmothers, and d) serve as a document for motherand child health home-based record, e) serves asa referral document. Nakamura (2001) pointedout some limitations of MCH handbook; the costof printing; the possibility of missing handbooks;and the overshadowing of the importance of trainingcourses for health professional and users. Although,when there are two or three kinds of charts/cardsthat are used for mothers and children, the cost ofprinting MCH handbooks turn to be cheaper thanthat of printing charts/cards.

According to a US-Japan collaborativeresearch study, one of the possible factors for thereduction in infant mortality rate and maternalmortality ratio in Japan is the maternal and childhealth (MCH) handbook Program. (Nakamura &Sato, 2000).In Thailand prior to 1985, the healthcheck-up information of mother and child wererecorded separately on cards. This method of recordkeeping was inconvenient for the clients and manyrecords were lost. Subsequently a MCH hand-book was introduced in order to gather all healthcards into one handbook (Sirikul, 2001). In

Indonesia, since 1996, there has been a widedistribution of MCH handbooks to target users. Itwas found to be a useful tool with high satisfac-tion rate. Users even stated that they would liketo pay for it. In Vietnam, the MCH handbook isrecognized as an effective tool for reproductivehealth promotion, and nutrition, immunization,family planning, infectious disease prevention,community based rehabilitation (CBR), and HIV/AIDS (Vu Huy Dinh, 2001). Moreover, thehandbook is sometimes considered as a usefulreference when a child or pregnant women isreferred from a health centre to a clinic or hospi-tal. A MCH handbook has been in use for nearly20 years in Korea. It has been designed to keeprecords of prenatal care, from early pregnancy todelivery, and childhood health care, so that thecontinuity of care, an essential element of qualitycare, can be ensured. It also contains importanthealth information for pregnant woman on deliv-ery and childcare, which can be used for healtheducation (Shin, 1998).

Application of MCH handbooks is notlimited to a single issue, they address manyexamples of the wide scope of MCH service-from their provision of information for mothers totheir role in promoting policy change (Ory, 1998).MCH handbooks may also be considered as a toolto motivate the registration of pregnancies, tomotivate the use of MCH services, as a medicalrecord, as a regular self-check system, as certi-fication, as a health educational material, and asa diary of memories (Hashizume, 1998).According Nakamura, (2001) The MCH hand-book is most effective when the health caredelivery system exits, and where there are many


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health professionals and health workers workingactively on Reproductive Health. Referred fromBangladesh Health Bulletin (1998-1999),existing infrastructures seem to be enough toprovide necessary MCH services. In addition,comprehensive program have been made inBangladesh with special emphasis on humanresource development. Existing resource inBangladesh and demand from MCH service implythat there are enough reasons to set up MCH handbook in Bangladesh. Study result suggests thatlaunching MCH handbook program would adjoinMCH services activities and in the long run itmight help to eliminate maternal and child healthproblem in Bangladesh.

CONCLUSIONThis study showed that pregnant women in

the case group had higher knowledge on MCHissues, better practices in MCH care, and higherutilisation of MCH services than mothers in thecontrol groups who used alternative health cards.Furthermore, public health expert, GO-NGOpolicy makers, providers and MCH handbook usersseem to be enthusiastic in pilot development andimplementation process. If the maternal and childhealth (MCH) handbook is developed with afocus on utilising a problem–oriented approachand involving the recommendations of end-users,it is anticipated that the handbook wouldcontribute significantly to ensuring the qualityMCH service in Bangladesh. Before expansionof MCH Handbook initiative nationwide,researchers recommend that similar research

would be worthwhile in different urban, rural andcommunity settings.

ACKNOWLEDGEMENTWe gratefully acknowledge the funding of this

research (as a Ph.D. thesis-research grant, OsakaUniversity, 2004) by international collaborationdivision, Faculty of Human Sciences, Osaka Uni-versity, Japan. We appreciate the local andinternational public health experts’ kindcooperation’s to conduct this study at M.C.H.T.IDhaka, Bangladesh and also acknowledge thecontributions of DG-FP, M.C.H.T.I staff andrespondent pregnant mothers. During the variousstages of this study, its preliminary result waspresented in some international public healthconferences (i.e. The 6th World Conference inPerinatal Medicine, Kobe, 2003; The 4th WorldConference on Health Education and Promotion,Melbourne, Australia, 2004; The 10th WorldFederation of Public Health Conference, Brighton,U.K., 2004; The 4th International Conferenceon Urban Health, Canada, 2005). Furthermore,several discussions were made in JICA and otherMCH handbook conferences in Japan, Indonesiaand Thailand.So, feedbacks from multidisciplinaryinternational experts are sincerely acknowledgedfor the development of this paper.



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ชาหฟ อลลาห บยนหยาสฮเดะ นากามระ

นาหอด อกกเตร คเรสชห บทคดยอ

ในระหวางเดอนกนยายน พ.ศ. 2545 ถงเดอนตลาคม พ.ศ. 2546 ไดมการศกษานำรองเพอพฒนาสมดคมออนามยแมและเดก และเพอประเมนผลของสมดคมอทมตอแมในดานความร การปฏบตและการใชบรการดานสขภาพอนามยแมและเดก ทสถาบนฝกอบรมอนามยแมและเดกในเมองดากา(Dhaka) ประเทศบงคลาเทศ เกบรวบรวมขอมลโดยใชวธสนทนากลม ทำการสำรวจ ขอมลกอนและหลงการใชสมดคมอฯ

จากหญงตงครรภทมาใชบรการทสถาบนฯ เปนครงแรกจำนวน 600 คน สมเลอกให 240 คนไดรบสมดคมอฯ และ 360 คน ไดรบบตรสขภาพทใชกนอยในปจจบน ขอมลถกวเคราะหโดยวธ วเคราะหหลายระดบ ผลจากการสนทนากลมยอยเนนใหเหนถงความจำเปนของสมดคมอฯ ในโครงการแมและเดกในประเทศบงคลาเทศ นอกเหนอจากน ผลจากการสำรวจ ขอมลเชงปรมาณ ไดพบขอเสนอแนะวาความรดาน อนามยแมและเดกของแมทไดรบสมดคมอฯ สงกวาแมทไดรบบตรสขภาพฯ นอกจากนยงมการปฏบตทดกวา ในดานการดแลอนามยแมและเดกและ มการใชบรการดานอนามยแมและเดกสงกวาอกดวย สมดคมออนามย แมและเดกไดถกพฒนาโดยใชวธศกษา จากปญหาการใช และขอเสนอแนะจากผใชจงเชอไดวาสมดคมอฯ จะทำใหแนใจไดวาอนามยแมและเดกในประเทศบงคลาเทศจะมคณภาพ

คำสำคญอนามยแมและเดก สมดคมอ การพฒนา ประเทศบงคลาเทศ


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Documents

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