Neonatal Mortality in Vietnam : Challenges and Effects of a Community-Based Participatory Intervention

Abstract: Globally neonatal mortality accounts for 40% of under-five deaths. Participatory interventions where the local problems are addressed have been successful in some settings.The aim of this thesis was to describe challenges in perinatal health in a Vietnamese province, and to evaluate the effect of a facilitated intervention with local stakeholder groups that used a problem-solving approach to neonatal survival during three years.The NeoKIP trial (Neonatal Knowledge Into Practice, ISRCTN44599712) had a cluster-randomized design (44 intervention communes, 46 control). Laywomen facilitated Maternal-and-Newborn Health Groups (MNHGs) and used Plan-Do-Study-Act cycles to address perinatal health problems. Births and neonatal deaths were monitored. Interviews were performed in households of neonatal deaths and randomly selected live births. Use of health services was mapped. The primary healthcare staff’s knowledge on newborn care was assessed before and after the intervention.Neonatal mortality rate (NMR) was 16/1000 live births (variation 10 - 44/1000 between districts). Home deliveries accounted for one fifth of neonatal deaths, and health facilities with least deliveries had higher NMR. Main causes of death were prematurity/low birth-weight (37.8 %), intrapartum-related deaths (33.2 %) and infections (13.0 %). Annual NMR was 19.1, 19.0 and 11.6/1000 live births in intervention communes (18.0, 15.9 and 21.1 in control communes); adjusted OR 1.08 [0.66-1.77], 1.23 [0.75-2.01], and 0.51 [0.30-0.89], respectively. Women in intervention communes more frequently attended antenatal care, prepared for delivery and gave birth at institutions. Primary healthcare staff’s knowledge on newborn care increased slightly in intervention communes.This model of facilitation of local stakeholder groups using a perinatal problem-solving approach was successful and may be feasible to scale-up in other settings.