Effects of a community-based intervention package on postnatal care seeking behavior in rural Bangladesh: a cluster-randomized controlled trial

Mohammad Tajul Islam, Japan International Cooperation Agency
Nazrul Islam, University of British Columbia Faculty of Medicine
Costas Christophi, Harvard School of Public Health
Yukie Yoshimura, Japan International Cooperation Agency


Background: Community-based Postnatal Care (PNC) initiatives have been found to improve maternal and neonatal health.

Objectives: This paper aims at evaluating the effectiveness of a Community-Based Intervention Package in providing ‘limited’ PNC services by Community Support Systems (CmSS) and in increasing maternal PNC visits from Skilled Healthcare Providers (SHPs) in rural Bangladesh as well as identifying the predictors of maternal PNC from SHPs.

Methods: A cluster-randomized controlled trial was employed where 6 clusters (each with an average population of about 28,000) of Narsingdi District were randomly assigned to the intervention and the comparison group. Sample sizes for pre- and post-intervention were 675 and 702, respectively, collected in June 2010 and December 2011, respectively, from mothers with a recent live birth. Logistic regression was used in examining the main outcomes and the predictors of maternal PNC from SHPs.

Results: The coverage of ‘limited’ PNC services by the CmSS members to the mothers did not increase significantly (p=0.25), nor did the maternal PNC from SHPs (p=0.11). Both delivery at a Healthcare Facility and delivery by SHPs increased the odds of taking at least one PNC from SHPs 10-fold with 95% confidence intervals of 4.52-24.04 (p<0.0001) and 4.13-23.84 (p<0.0001), respectively, adjusting for family income, complicated delivery, and PNC visits by CmSS.

Conclusion: This intervention was found to be effective neither in providing limited PNC services by the CmSS members, nor in increasing maternal PNC from SHPs in our study. Further research with proper monitoring and sufficient number of clusters is recommended.