Effects of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality. The NeoKIP Cluster-Randominsed Trial in Quang Ninh Province, Vietnam.:
(English)Manuscript (preprint) (Other academic) [Artistic work]
Background: Interventions by facilitation of local women’s groups are effective in reducing neonatal mortality in some low- income settings. It is not known whether facilitation of participatory groups composed by staff from local health services and local politicians can improve perinatal outcomes. We hypothesized that facilitation of local stakeholder groups would improve coverage of services and reduce neonatal mortality in a province in Vietnam.
Methods and Findings: By use of a cluster-randomised design in 90 communes in Quang Ninh province 44 communes 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, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. There were 22,377 live births (11,818 in intervention clusters, 10,559 in control). Women in intervention communes were more likely to attend antenatal care, prepare for delivery and give birth at institutions. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1000 (195 deaths per 11818 live births) in the intervention communes compared with 18.4/1000 (194 per 10559 live births) in control communes (adjusted odds ratio 0.96 [95% CI 0.73-1.25]). Annual NMR was 19.1, 19.0 and 11.6 in intervention communes compared with 18.0, 15.9 and 21.1 in control communes (adjusted odds ratios 1.08 [0.66-1.77], 1.23 [0.75-2.01], and 0.51 [0.30-0.89], respectively). There was a significant downward time trend of NMR in intervention communes (p=0.003) but not in control communes (p=0.184).
Conclusions: A randomised facilitation intervention with local stakeholder groups composed by primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increase in continuum of perinatal care and reduced neonatal mortality after a latent period.
Trial registration: Current Controlled Trials ISRCTN44599712
Funding Swedish International Development Cooperation Agency (Sida), Swedish Research Council and Uppsala University.
Competing interests: Authors have no competing interests to declare.
Facilitation; Maternal-and-Child Stakeholder Groups; Problem-Solving cycle; Neonatal Mortality; Cluster-randomized trial; Vietnam
Medical and Health Sciences Medical and Health Sciences
Research subject International Health
IdentifiersURN: urn:nbn:se:uu:diva-187149OAI: oai:DiVA.org:uu-187149DiVA: diva2:580028