Assessing Community Based Improved Maternal Neonatal Child Survival (IMNCS) Program in Rural Bangladesh.
OBJECTIVE
A community based approach before, during and after child birth has been proven effective address the burden of maternal, neonatal and child morbidity and mortality in the low and middle income countries. We aimed to examine the overall change in maternal and newborn health outcomes due the "Improved Maternal Newborn and Child Survival" (IMNCS) project, which was implemented by BRAC in rural communities of Bangladesh.


METHODS
The intervention was implemented in four districts for duration of 5-years, while two districts served as comparison areas. The intervention was delivered by community health workers who were trained on essential maternal, neonatal and child health care services. A baseline survey was conducted in 2008 among 7, 200 women with pregnancy outcome in last year or having a currently alive child of 12-59 months. A follow-up survey was administered in 2012-13 among 4, 800 women of similar characteristics in the same villages.


RESULTS
We observed significant improvements in maternal and essential newborn care in intervention areas over time, especially in health care seeking behaviors. The proportion of births taking place at home declined in the intervention districts from 84.3% at baseline to 71.2% at end line (P<0.001). Proportion of deliveries with skilled attendant was higher in intervention districts (28%) compared to comparison districts (27.4%). The number of deliveries was almost doubled at public sector facility comparing with baseline (P<0.001). Significant improvement was also observed in healthy cord care practice, delayed bathing of the new-born and reduction of infant mortality in intervention districts compared to that of comparison districts.


CONCLUSIONS
This study demonstrates that community-based efforts offer encouraging evidence and value for combining maternal, neonatal and child health care package. This approach might be considered at larger scale in similar settings with limited resources.
Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
Mahfuzar
M
Rahman
Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
Fatema Tuz
FT
Jhohura
Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
Sabuj Kanti
SK
Mistry
Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
Tridib Roy
TR
Chowdhury
Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
Tanveen
T
Ishaque
Department of Global Health, Save the Children USA, Washington, D.C., United States of America.
Rasheduzzaman
R
Shah
Health, Nutrition, Population Program, BRAC, Dhaka, Bangladesh.
Kaosar
K
Afsana
D000328:Adult; D001459:Bangladesh; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D003150:Community Health Workers / Q000458:organization & administration; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data*; D006700:Home Childbirth / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D008428:Maternal Mortality / Q000639:trends; D015997:Neonatal Screening; D011247:Pregnancy; D015397:Program Evaluation / Q000706:statistics & numerical data*; D012424:Rural Population