title: Impact of financial and educational interventions on maternity care: results of cluster randomized trials in rural China, CHIMACA.
abstract: To report on the design and basic outcomes of three interventions aimed at improving the use and quality of maternity care in rural China: financial interventions, training in clinical skills, and training in health education. Community-based cluster randomized trials were carried out in one central and two western provinces between 2007 and 2009: (1) financial interventions covered part of women's costs for prenatal and postnatal care, (2) training of midwives in clinical skills was given by local maternity care experts in two- or three-group training courses, (3) health education training for midwives and village doctors were given by local experts in health education in two- or three-group training courses. A survey was conducted in a stratified random sample of women who had been pregnant in the study period. 73% of women (n = 3,673) were interviewed within 1-10 months of giving birth. Outcomes were compared by the different intervention and control groups. Adjusted odds ratios were calculated by logistic regression to adjust for varying maternal characteristics. Most of the differences found between the groups were small and some varied between provinces. The financial intervention did not influence the number of visits, but was associated with increased caesarean sections and a decrease in many ultrasound tests. The clinical intervention influenced some indicators of care content. There was no consistent finding for the health education intervention. Financial and training interventions have the potential to improve maternity care, but better implementation is required. Unintended consequences, including overuse of technology, are possible.
authors.affiliation: National Institute for Health and Welfare, Lintulahdenkuja 4, P.O. Box 30, 00271 Helsinki, Finland. elina.hemminki@thl.fi
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.forename: Wei-Hong
authors.initials: WH
authors.lastname: Zhang
authors.forename: Zhuochun
authors.initials: Z
authors.lastname: Wu
authors.forename: Joanna
authors.initials: J
authors.lastname: Raven
authors.forename: Fangbiao
authors.initials: F
authors.lastname: Tao
authors.forename: Hong
authors.initials: H
authors.lastname: Yan
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Reija
authors.initials: R
authors.lastname: Klemetti
authors.forename: Tuohong
authors.initials: T
authors.lastname: Zhang
authors.forename: Elena
authors.initials: E
authors.lastname: Regushevskaya
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
mesh_terms: D000328:Adult; D002681:China; D016000:Cluster Analysis; D055812:Community-Based Participatory Research; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000191:economics* / Q000706:statistics & numerical data; D008880:Midwifery / Q000193:education*; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics*; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult