Effect of Facilitation of Local Maternal-and-Newborn Health Groups on Continuum of Perinatal Care : Results from the NeoKIP Trial in Northern Vietnam

• 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.

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