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Effect of Facilitation of Local Maternal-and-Newborn Health Groups on Continuum of Perinatal Care: Results from the NeoKIP Trial in Northern 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). (Internationell barnhälsa och nutrition/Persson)
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). (Internationell barnhälsa och nutrition/Persson)
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). (Internationell barnhälsa och nutrition/Persson)
Hanoi School of Public Health.
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2012 (English)In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048Article in journal (Other academic) [Artistic work] In press
Abstract [en]

Background:

Continuum of maternal, delivery and newborn is a prerequisite for improved neonatal health and survival. This requires involvement from households, health system, and the society as a whole. In a community-based trial using facilitation of local perinatal health stakeholder groups in northern Vietnam neonatal mortality was reduced (NeoKIP trial; ISRCTN44599712). In this report we analyse the effect by the intervention on continuum of anternal, delivery, and newborn care. We also assess in perinatal health knowledge among primary health care staff in the area that could be associated with the intervention.

Methods:

The trial had a cluster-randomised design; 44 communes in Quang Ninh province were allocated to intervention and 46 to control. Laywomen recruited from Women’s Union facilitated monthly meetings during 3 years in groups composed by staff from health centres and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored. A sample of 6% all live births was randomly selected each month to represent the entire birth cohort. Mothers of these newborns were interviewed at home 8-10 weeks after delivery. Information was collected on use of antenatal, delivery, and postpartum health services. Primary healthcare staff was also interviewed assessing their knowledge on newborn care before and after the intervention. Results were compared between intervention and control communes.

Results:

Of the 22 377 live births occurring in the study area during the three years of trial, 1338 (5.9%) were randomly selected for home interview with the mothers. In total, 1243 interviews with mothers of surviving neonates were completed in intervention and control communes. Intervention and control areas were comparable in social characteristics. Coverage differed between intervention and control communes regarding antenatal care (difference 8.7 percent units, 95%CI 5.0-12.6) and most of its included service components, birth preparedness (difference 3.6 percent units, 0.2-7.0) and institutional delivery (difference 3.8, 0.3-7.4). Primary healthcare staff’s knowledge on newborn care also increased in intervention communes while there was no change in control communes.

Conclusions:

A community-based participatory intervention by facilitation of local stakeholder groups that resulted in decreased neonatal mortality was linked to small positive differences in continuum of maternal and neonatal care and in primary healthcare staff’s knowledge on newborn care. This may reflect the process of change in utilization of services and performance of services that ultimately lowered neonatal mortality in the area.

Place, publisher, year, edition, pages
2012.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-187176OAI: oai:DiVA.org:uu-187176DiVA: diva2:579366
Available from: 2012-12-20 Created: 2012-12-03 Last updated: 2017-12-06Bibliographically 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 ThuMålqvist, MatsEriksson, LeifSelling, Katarina EkholmEwald, UwePersson, Lars-Åke

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