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Perinatal services and outcomes in Quang Ninh province, Vietnam
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsa och nutrition/Persson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsa och nutrition/Persson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsa och nutrition/Persson)
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2010 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 10, 1478-1483 p.Article in journal (Refereed) Published
Abstract [en]

Aim: We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. Methods: Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. Results: Three quarters of pregnant women had >= 3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. Conclusion: A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality.

Place, publisher, year, edition, pages
2010. Vol. 99, no 10, 1478-1483 p.
Keyword [en]
Home delivery, Inequity, Neonatal mortality, Perinatal care, Vietnam
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-135024DOI: 10.1111/j.1651-2227.2010.01866.xISI: 000281556700013OAI: oai:DiVA.org:uu-135024DiVA: diva2:374307
Available from: 2010-12-03 Created: 2010-12-03 Last updated: 2013-02-11Bibliographically approved
In thesis
1. Neonatal Mortality in Vietnam: Challenges and Effects of a Community-Based Participatory Intervention
Open this publication in new window or tab >>Neonatal Mortality in Vietnam: Challenges and Effects of a Community-Based Participatory Intervention
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 98 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 853
Keyword
Facilitation, Local stakeholder group, Maternal-and-Newborn Health Group, Neonatal mortality, Primary health care, Vietnam
National Category
Medical and Health Sciences
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-188252 (URN)978-91-554-8567-2 (ISBN)
Public defence
2013-02-05, Rosensalen, Akademiska Sjukhuset, Entrance 95/96 nbv, Uppsala, 09:15 (English)
Opponent
Supervisors
Projects
NeoKIP project in Vietnam
Available from: 2013-01-15 Created: 2012-12-14 Last updated: 2014-01-21Bibliographically approved

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Nga, Nguyen T.Målqvist, MatsEriksson, LeifWallin, LarsPersson, Lars-ÅkeEwald, Uwe

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