title: The Maternal and Child Health (MCH) handbook in Mongolia: a cluster-randomized, controlled trial.
abstract: OBJECTIVE
  To assess the effectiveness of the Maternal and Child Health (MCH) handbook in Mongolia to increase antenatal clinic attendance, and to enhance health-seeking behaviors and other health outcomes.
  
  
  METHODS
  A cluster randomized trial was conducted using the translated MCH handbook in Bulgan, Mongolia to assess its effectiveness in promoting antenatal care attendance. Pregnant women were recruited from 18 randomly allocated districts using shuffled, sealed envelopes. The handbook was implemented immediately for women at their first antenatal visit in the intervention group, and nine months later in the control group. The primary outcome was the number of antenatal care visits of all women residing in the selected districts. Cluster effects were adjusted for using generalized estimation equation. Masking was not possible among care providers, pregnant women and assessors.
  
  
  RESULTS
  Nine districts were allocated to the intervention group and the remainder to the control group. The intervention group (253 women) attended antenatal clinics on average 6•9 times, while the control group (248 women) attended 6•2 times. Socioeconomic status affected the frequency of clinic attendance: women of higher socioeconomic status visited antenatal clinics more often. Pregnancy complications were more likely to be detected among women using the handbook.
  
  
  CONCLUSIONS
  The MCH handbook promotes continuous care and showed an increase in antenatal visits among the intervention group. The intervention will help to identify maternal morbidities during pregnancy and promote health-seeking behaviors.
  
  
  BACKGROUND
  UMIN Clinical Trial Registry UMIN000001748.
authors: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors: Rintaro
authors: R
authors: Mori
authors: Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan.
authors: Naohiro
authors: N
authors: Yonemoto
authors: Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan.
authors: Hisashi
authors: H
authors: Noma
authors: Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
authors: Tumendemberel
authors: T
authors: Ochirbat
authors: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors: Emma
authors: E
authors: Barber
authors: Medical Care Policy Implementation and Coordination, Ministry of Health, Ulaanbaatar, Mongolia.
authors: Gochoo
authors: G
authors: Soyolgerel
authors: Department of International Collaboration, Graduate School of Human Sciences, Osaka University, Osaka, Japan.
authors: Yasuhide
authors: Y
authors: Nakamura
authors: Faculty of Health Science, Simon Fraser University, Vancouver, Canada.
authors: Oyun
authors: O
authors: Lkhagvasuren
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D002648:Child; D000067576:Child Health / Q000706:statistics & numerical data*; D016000:Cluster Analysis; D005260:Female; D015438:Health Behavior; D006801:Humans; D007223:Infant; D000068104:Infant Health / Q000706:statistics & numerical data; D000068097:Maternal Health / Q000706:statistics & numerical data*; D008986:Mongolia; D011247:Pregnancy; D014956:Writing