The role of home-based records in the establishment of a continuum of care for mothers- newborns- and children in Indonesia.


BACKGROUND: The provision of appropriate care along the continuum of maternal- newborn- and child health (MNCH) service delivery is a challenge in developing countries. To improve this- in the 1990s- Indonesia introduced the maternal and child health (MCH) handbook- as an integrated form of parallel home-based records. OBJECTIVE: This study aimed to identify the roles of home-based records both before and after childbirth- especially in provinces where the MCH handbook (MCHHB) was extensively promoted- by examining their association with MNCH service uptake. DESIGN: This was a cross-sectional study using nationally representative data sets- the Indonesia Demographic and Health Surveys (IDHSs) from 1997- 2002-2003- and 2007. The IDHS identifies respondents\' ownership of home-based records before and after childbirth. Multivariate logistic regression was used to examine associations between record ownership and service utilisation in national data and data from two provinces- West Sumatra and North Sulawesi- where ownership of pre- and post-natal records served as a proxy for MCHHB ownership. RESULTS: Pre- and post-natal record ownership increased from 1997 to 2007. Provincial data from 2007 showed that handbook ownership was associated with having delivery assisted by trained personnel adjusted odds ratio (aOR): 2.12- 95% confidence interval (CI): 1.05-4.25- receiving maternal care (aOR: 3.92- 95% CI: 2.35-6.52)- completing 12 doses of child immunisation for seven diseases (aOR: 4.86- 95% CI: 2.37-9.95)- and having immunisation before and after childbirth (aOR: 5.40- 95% CI: 2.28-12.76)- whereas national data showed that service utilisation was associated with ownership of both records compared with owning a single record or none. CONCLUSION: Our results suggest that pre- and post-natal home-based record use may be effective for ensuring service utilisation. In addition- since the handbook is an efficient home-based record for use throughout children\'s life courses- it could be an effective tool for promoting the continuum of MNCH care in Indonesia.