title: A Controlled Before-and-After Perspective on the Improving Maternal, Neonatal, and Child Survival Program in Rural Bangladesh: An Impact Analysis.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh.
authors: Mahfuzar
authors: M
authors: Rahman
authors: Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh.
authors: Fakir Md
authors: FM
authors: Yunus
authors: Department of Global Health, Save the Children USA, Washington, DC, United States of America.
authors: Rasheduzzaman
authors: R
authors: Shah
authors: Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh.
authors: Fatema Tuz
authors: FT
authors: Jhohura
authors: Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh.
authors: Sabuj Kanti
authors: SK
authors: Mistry
authors: Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh.
authors: Tasmeen
authors: T
authors: Quayyum
authors: Health, Nutrition, and Population Programme, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh.
authors: Bachera
authors: B
authors: Aktar
authors: Health, Nutrition, and Population Programme, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh.|James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Bangladesh.
authors: Kaosar
authors: K
authors: Afsana
mesh_terms: D000328:Adult; D001459:Bangladesh; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D016019:Survival Analysis; D055815:Young Adult