Effectiveness of an intervention package on the continuum of care among mothers and their knowledge of non-communicable diseases: a cluster randomised controlled trial in Myanmar

Abstract Background Strategies for the continuum of care (CoC) for mothers and newborns have yet to be adequately evaluated in Myanmar. Similarly, the feasibility of integrating non-communicable diseases (NCDs) education into routine maternal, newborn and child health (MNCH) services remains unexamined. This study assessed the effect of an intervention package on achieving the CoC for mothers and their knowledge of NCDs in Myanmar. Methods In three townships (Pantanaw, Wakema and Ingapu) of Myanmar, we randomly allocated clusters (primary health centres) to the intervention group (n=16) and the control group (n=16). The intervention group received a package, including a one-page CoC card and four health education sessions on NCDs from pregnancy to postpartum. The control group received routine services. We enrolled pregnant women who received their first ANC visit between 12 and 20 weeks of gestation during the trial enrolment period. The outcomes were (1) the CoC completion among women with babies born alive (measured by the proportion of mothers who received ANC at least four times, delivered with a skilled birth attendant, and received postnatal care four times) and (2) their NCD knowledge (measured by a test on NCDs in general, hypertension, diabetes, anaemia and nutrition). The analysis was conducted following the intention-to-treat (ITT) and per-protocol (PP) principles. A mixed-effect logistic regression was used to assess the effect of the CoC card, and a generalised estimation equation was used to assess the effect of health education. Results A total of 630 pregnant women participated at the baseline. The intervention group was more likely to complete CoC, with adjusted odds ratios (AOR) 6.8 (95% confidence interval (CI) 2.3-20.4) in the ITT analysis and AOR 7.0 (95% CI 2.3-21.6) in the PP analysis (both p = 0.001). NCD knowledge scores also improved in the intervention group by 2.2 points in the ITT and 3.5 points in the PP analyses (p = 0.010 and p < 0.001, respectively). Conclusions The intervention package enhanced the CoC completion of mothers and their NCD knowledge. Given the success of this intervention, future efforts that prioritise integrating health education for NCDs into routine MCH services are warranted into routine MCH services at the primary healthcare level in Myanmar and similar LMIC settings. Clinical trial number NCT03145155. Registered on April 20, 2017