***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Child development delays can cause lower school performance , which in turn can lead to long-term poverty , developmental delays in offspring and a vicious cycle of loss of human potential ( 1 ) . Effective prevention strategies are vital . It is well known that effective early child development programmes should integrate health and education with family support , programme , but coverage is often low ( 1 ) . Cost-effective , high- quality programmes should therefore be considered . The Japanese Maternal and Child Health ( MCH ) h and book has been shown to provide cost-effective , high-level coverage that assists child development ( 2 ) . We evaluated the h and books effectiveness on child development in Mongolia . A threeyear follow-up of a cluster r and omised controlled trial ( RCT ) was conducted . All mothers provided written , informed consent and the institutional ethical boards in Japan and Mongolia approved the study . All women living in the Bulgan province of Mongolia who gave birth between March and August 2010 participated in the study and the three-year follow-up if they still lived in the area . There were 18 clusters in the trial , and a simple r and omisation method featuring sealed envelopes was used . Details of the r and omisation and intervention procedure have previously been published ( 3 ) . Healthcare professionals were trained to distribute the h and book , at the first antenatal visit from May 2009 to January 2010 and explain its use . Three years later , from July to October 2013 , we paid home visits and collected data on the mothers basic characteristics and use of the h and book , together with child anthropometric and developmental measurements . The primary study outcome was risk of developmental delay as assessed by the Mongolian Rapid Baby Scale ( 4 ) . We also analysed how the mothers used the h and book three years after distribution , which helped predict differences in the primary outcome . Univariate analyses were performed to determine the risk of delay in all developmental domains in the intervention group using the generalised estimating equations method and considering the cluster effect at the village level ( data not shown ) . This showed that the childrens cognitive development was likely to be associated with the h and book . Furthermore , multivariable analyses were conducted using generalised estimating equations with logit link , exchangeable correlation structure and robust variance to examine cluster differences . As a result , the odds ratio for the risk of cognitive developmental delay was calculated with an adjustment for the main influencing factor – distribution of the h and book – and adjusted for the following confounding covariates : maternal age , maternal education , marital status , wealth index , primigravidity , number of antenatal visits , miscarriage , second-h and smoke and drinking during pregnancy , risk of maternal depression symptoms , pregnancy complications , gestational week , birthweight , Apgar score , initiation of breastfeeding and living in an overcrowded home . The trial was registered at the UMIN Clinical Trial Registry ( UMIN000001748 ) . In the baseline trial , 253 and 248 women participated in the intervention and control groups , respectively , and three years later , we followed 386 ( 77 % ) participants : 214 ( 84.5 % ) in the intervention group and 172 ( 69.3 % ) in the control group . Participants were lost to follow-up because they moved to different parts of the country . Thus , attrition bias might have occurred due to participant losses in the follow-up study . However , no baseline difference was observed between dropouts and the remaining mothers . Dropouts occurred more often in the control group than the intervention group . Therefore , the effectiveness of the intervention for preventing child developmental delays might have been underestimated . To the best of our knowledge , this was the first longitudinal RCT assessment of the effectiveness of the h and book on child development . We found that the distribution of the h and book had a protective effect on the risk of cognitive delay ( Table 1 ) , but poor cognitive development was increased by higher maternal age , maternal depression one month after delivery and pregnancy complications ( Table 1 ) At an antenatal clinic in St. Thomas 's Hospital , London , 246 expectant mothers were r and omly allocated to hold either their own maternity case notes or the st and ard co-operation card . Information was collected on three occasions during their care on attitudes and health behaviour . Clinical outcomes were recorded and the effects of the two systems on clinic administration were observed . More of the notes group expressed satisfaction with most aspects of their care and delivery and significantly more of the notes group felt well informed and satisfied with their companion during labour . There were no differences in clinical outcomes between the two groups except that , for no identifiable systematic reason , there were more assisted deliveries among the notes group . A number of administrative advantages result ed from mothers holding their own notes and although initial reservations were found amongst professional staff interviewed at the start of the study , the results proved persuasive and the practice of giving mothers their own notes is now to be extended throughout the department Objective To assess the effectiveness of the Maternal and Child Health ( MCH ) h and book in Mongolia to increase antenatal clinic attendance , and to enhance health-seeking behaviors and other health outcomes . Methods A cluster r and omized trial was conducted using the translated MCH h and book  in Bulgan , Mongolia to assess its effectiveness in promoting antenatal care attendance . Pregnant women were recruited from 18 r and omly allocated districts using shuffled , sealed envelopes . The h and book was implemented immediately for women at their first antenatal visit in the intervention group , and nine months later in the control group . The primary outcome was the number of antenatal care visits of all women residing in the selected districts . Cluster effects were adjusted for using generalized estimation equation . Masking was not possible among care providers , pregnant women and assessors . Findings Nine districts were allocated to the intervention group and the remainder to the control group . The intervention group ( 253 women ) attended antenatal clinics on average 6•9 times , while the control group ( 248 women ) attended 6•2 times . Socioeconomic status affected the frequency of clinic attendance : women of higher socioeconomic status visited antenatal clinics more often . Pregnancy complications were more likely to be detected among women using the h and book . Conclusion The MCH h and book promotes continuous care and showed an increase in antenatal visits among the intervention group . The intervention will help to identify maternal morbidities during pregnancy and promote health-seeking behaviors . Trial Registration UMIN Clinical Trial Registry Despite the widespread use of home based child health records of varying complexity in Engl and , there is a notable absence of their evaluation . Such a record booklet developed in the West Lambeth Health Authority has been used by parents , doctors , and community nurses to build up an independent chronological record of a child 's birth statistics , health , growth , immunisation , development checks , and contacts with health services . A r and omised controlled evaluation of the record , analyses of entries in it , and a survey of the views of mothers and health professionals using the record have been carried out . The need for such a record was confirmed by those question ed and analyses of entries in the booklet helped to modify and improve it . The evaluation was unable to show , however , any effect of the record on immunisation and developmental assessment service uptake . Its value in improving communication between the numerous health and other care agencies was dependent on its proper use In Pakistan during 2000 - 2004 , about 11 - 13 % of children who received the first dose of diphtheria-pertussis-tetanus ( DPT1 )  failed to complete its third dose ( DPT3 ) . We assessed the effect of a re design ed immunization card and center-based education to mothers on DPT3 completion . We enrolled 1500 mother-child units at DPT1 , r and omized them to three intervention and one st and ard care groups , and recorded their DPT3 visits during a 90-day follow-up . In multivariable analysis , a significant increase of 31 % ( adjusted RR=1.31 , 95 % CI=1.18 - 1.46 ) in DPT3 completion was estimated in the group that received both re design ed card and center-based education compared with the st and ard care group Background Maternal and Child Health ( MCH ) H and book , an integrated MCH home-based record , was piloted in four provinces of Vietnam ( Dien Bien , Hoa Binh , Thanh Hoa and An Giang ) . The study is aim ed at assessing the changes in pregnant women ’s behavior towards the frequencies of their antenatal care service utilizations and their subsequent breastfeeding practice s up to six months of age , through the MCH H and book intervention . This is because the levels of pregnant women ’s knowledge , attitude and practice s ( KAP ) towards their antenatal care service utilizations and exclusive breastfeeding practice s have been previously neither analyzed nor reported in relation to MCH home-based records in the country . Methods To compare pre-intervention baseline in 2011 , post-intervention data were collected in 2013 . Structured interviews were conducted with r and omly selected 810 mothers of children 6 - 18 months of age in the four provinces . A focus group discussion among mothers in each of four provinces was conducted . Results There was no significant difference in pregnant women ’s knowledge about the need for ≥3 antenatal care visits between pre- and post- interventions . Yet , the proportion of pregnant women who made ≥3 antenatal care visits in post-intervention was significantly higher than in pre-intervention . Thus , MCH H and book is likely to have contributed to practicing ≥3 antenatal care visits , by changing their attitude . The proportion of mothers who know the need for exclusive breastfeeding necessary during the initial six months significantly increased between pre- and post- interventions . The proportion of those practicing exclusive breastfeeding significantly increased between pre- and post- interventions , too . Thus , MCH H and book is likely to have contributed to the increase in both knowledge about and practice s of exclusive breastfeeding . Conclusion The results of study imply that MCH H and book contributed to the increase in pregnant women ’s practice s of ≥3 antenatal care visits and in their knowledge about and practice of exclusive breastfeeding . While there is room for improvement in the level of its data recording , the study confirmed that MCH H and book plays a catalytic role in ensuring a continuum of maternal , newborn and child care . Note that this study is the first study that attempted to estimate pregnant women ’s  behavioral changes through MCH H and book intervention in Vietnam OBJECTIVE During pregnancy , the information needs of patients are high and effective information sharing between patients and health care providers is of particular importance . We conducted a r and omized controlled trial to evaluate the effect of providing pregnant women with secure access to their antenatal health records on their uptake of , and satisfaction with , relevant information . METHODS Women presenting to a primary care maternity centre before 28 weeks ' gestation were r and omized to receive access either to a secure website with links to general pregnancy health information alone ( GI group ) or to the same website with access to their own antenatal health record ( PI group ) . Primary outcomes included frequency of use , and satisfaction with and perceived usefulness of the web-based information . RESULTS We approached 199 women regarding participation in the study ; 193 agreed to participate , and 97 were r and omized to the PI group and 96 to the GI group . The mean number of log-ins to the website in the PI group subsequently was almost six times the number of log-ins in the GI group ( 10.4 + /- 17.8 vs. 1.8 + /- 1.4 ; P < 0.001 ) , and 84.2 % of log-ins in the PI group accessed the antenatal health record . The responses of participants to questions about the website 's ease of use and value in providing information about pregnancy indicated a high level of satisfaction , with no significant difference in responses between groups . CONCLUSION Pregnant patients are prepared to use a health information website and web-based health records . When personal information is provided there is greater use than when general pregnancy information alone is provided . Given the almost universal availability of the Internet , this option has the potential for wider application to patient-related outcomes To assess a policy of women holding and thus having constant access to their own obstetric records , 290 women attending a peripheral consultant clinic in Newbury , West Berkshire , were r and omly allocated to hold either their full case notes , or the more usual co‐operation card . Women holding their full records were significantly more likely to feel in control of their antenatal care ( rate ratio 1·45 ; 95 % confidence interval 1·08–1·95 ) and to feel it was easier to talk to doctors and midwives ( rate ratio 1·73 ; 95 % confidence interval 1·16‐2·59 ) . No other beneficial effects were detected . Asked about their preferences for any subsequent pregnancies , women holding their own records in the index pregnancy were more likely to say they would prefer to hold the same kind of record again in a subsequent pregnancy than were women holding a co‐operation card ( rate ratio 1·56 ; 95 % confidence interval 1·34–1·81 ) . There was no evidence of negative effects . In particular , women holding their case notes did not feel more anxious than co‐operation card holders . The policy of women holding their notes result ed in savings in elerical time , without evidence of an increase in the rate of lost notes OBJECTIVE A substantial dropout from the first dose of diphtheria-tetanus-pertussis ( DTP1 ) to the 3rd dose of DTP ( DTP3 ) immunization has been recorded in Pakistan . We conducted a r and omized controlled trial to assess the effects of providing a substantially re design ed immunization card , centre-based education , or both interventions together on DTP3 completion at six rural exp and ed programme on immunization ( EPI ) centres in Pakistan . METHODS Mother-child pairs were enrolled at DTP1 and r and omized to four study groups : re design ed card , centre-based education , combined intervention and st and ard care . Each child was followed up for 90 days to record the date s of DTP2 and DTP3 visits . The study outcome was DTP3 completion by the end of follow-up period in each study group . RESULTS We enrolled 378 mother-child pairs in re design ed card group , 376 in centre-based 
    Output:
    
HBRs used during the life cycle of women and children in Indonesia showed benefits for continuity of care .
There were no significant effects on healthy pregnancy behaviors such as smoking and consumption of alcohol during pregnancy .
There were no statistically significant effects on newborn health outcomes .
HBRs show modest but important health effects for women and children .
These effects with minimal-to-no harms , multiplied across a population , could play an important role in reducing health inequities in maternal , newborn , and child health