Maternal and child health (MCH) handbooks are comprehensive home-based
booklets designed to integrate MCH records. Although empirical evidence suggests
the handbooks are more effective than current card-type records, this has not been
scientifically demonstrated. The objectives of this study were to evaluate the impact
of the MCH handbook on maternal knowledge and behaviour as measured by
antenatal care (ANC) attendance, delivery with skilled birth attendants (SBAs) and
delivery at a health facility. The Cambodian version of the MCH handbook was
developed and introduced in two health centres, and two other health centres
served as controls. Pre-intervention and post-intervention surveys were conducted
with 320 women from the intervention areas and 320 women from the control areas
who had given birth within 1 year before the survey. We evaluated the impact of the
handbook by using difference-in-differences (DID) analysis and calculated
adjusted odds ratios for pre–post changes in key indicators by using logistic
regression. In addition, we interviewed multiparous women, health staff and
health volunteers to assess the acceptance and cultural appropriateness of the
handbook. Content analysis was performed with the English-translated transcriptions.
The DID analyses revealed that all key indicators increased in the intervention
group against counterfactual assumptions. The intervention also increased maternal
knowledge of all topics addressed except for the risk of severe bleeding after
delivery; this may be attributable to the influence of cultural belief. Logistic
regression showed that the intervention increased ANC attendance, delivery with
SBAs and delivery at a health facility, even after adjusting for maternal age,
education and economic conditions. The qualitative data indicated that the
handbook was well received and culturally appropriate. Thus, the MCH handbook is
a reasonable and superior alternative to current card-type maternal records.