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Secular trend, seasonality and effects of a community-based intervention on neonatal mortality: follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Research Institute for Child Health, Hanoi, Vietnam.
Hanoi University of Public Health, Vietnam.
Hanoi University of Public Health, Vietnam.
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2018 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 9, p. 776-782Article in journal (Refereed) Published
Abstract [en]

Background: Little is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stakeholders employing a problem-solving approach for 3 years. In this analysis, we aim at disentangling the secular trend, the seasonal variation and the effect of the intervention on neonatal mortality during and after the trial.

Methods: In Quang Ninh province, 44 communes were allocated to intervention and 46 to control. Births and neonatal deaths were assessed in a baseline survey in 2005, monitored during the trial in 2008–2011 and followed up by a survey in 2014. Time series analyses were performed on monthly neonatal mortality data.

Results: There were 30 187 live births and 480 neonatal deaths. The intervention reduced the neonatal mortality from 19.1 to 11.6 per 1000 live births. The reduction was sustained 3 years after the trial. The control areas reached a similar level at the time of follow-up. Time series decomposition analysis revealed a downward trend in the intervention areas during the trial that was not found in the control areas. Neonatal mortality peaked in the hot and wet summers.

Conclusions: A community engagement intervention resulted in a lower neonatal mortality rate that was sustained but not further reduced after the end of the trial. When decomposing time series of neonatal mortality, a clear downward trend was demonstrated in intervention but not in control areas.

Trial registration number: ISRCTN44599712, Post-results.

Place, publisher, year, edition, pages
2018. Vol. 72, no 9, p. 776-782
National Category
Medical and Health Sciences
Research subject
International Health; Epidemiology; Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-365036DOI: 10.1136/jech-2017-209252ISI: 000445084200004PubMedID: 29764902OAI: oai:DiVA.org:uu-365036DiVA, id: diva2:1261637
Funder
Swedish Research Council, 348-20136546Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2018-11-28Bibliographically approved

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Eriksson, LeifBergström, AnnaMålqvist, MatsEwald, UwePersson, Lars-ÅkeEkholm Selling, Katarina

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