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Impact of Financial and Educational Interventions on Maternity Care: Results of Cluster Randomized Trials in Rural China, CHIMACA

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Hemminki, Elina, Long, Qian, Zhang, Wei-Hong, Wu, Zhuochun, Raven, Joanna, Tao, Fangbiao, Yan, Hong, Wang, Yang, Klemetti, Reija, Zhang, Tuohong, Regushevskaya, Elena and Tang, Shenglan (2013) 'Impact of Financial and Educational Interventions on Maternity Care: Results of Cluster Randomized Trials in Rural China, CHIMACA'. Maternal and Child Health Journal, Vol 17, Issue 2, pp. 208-221.

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Abstract

Objective To report on the design and basic outcomes of three interventions aimed at improving the use and quality of maternity care in rural China: financial interventions, training in clinical skills, and training in health education.
Methods Community-based cluster randomized trials were carried out in one central and two western provinces between 2007 and 2009: 1) financial interventions covered part of women’s costs for prenatal and postnatal care, 2) training of midwives in clinical skills was given by local maternity care experts in two- or three-group training courses, 3) health education training for midwives and village doctors were given by local experts in health education in two- or three-group training courses. A survey was conducted in a stratified random sample of women who had been pregnant in the study period. 73% of women (n=3673) were interviewed within 1-10 months of giving birth. Outcomes were compared by the different intervention and control groups. Adjusted odds ratios were calculated by logistic regression to adjust for varying maternal characteristics.
Results Most of the differences found between the groups were small and some varied between provinces. The financial intervention did not influence the number of visits, but was associated with increased caesarean sections and a decrease in many ultrasound tests. The clinical intervention influenced some indicators of care content. There was no consistent finding for the health education intervention.
Conclusions Financial and training interventions have the potential to improve maternity care, but better implementation is required. Unintended consequences, including overuse of technology, are possible.

Item Type: Article
Uncontrolled Keywords: financial intervention, educational intervention, maternity care, rural China, cluster randomized trial
Subjects: WA Public Health > WA 100 General works
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1007/s10995-012-0962-6
Depositing User: q Moody
Date Deposited: 20 Mar 2013 18:21
Last Modified: 06 Feb 2018 13:04
URI: http://archive.lstmed.ac.uk/id/eprint/2826

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