title: Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trial.
abstract: BACKGROUND
  Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam.
  
  
  RESULTS
  In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff 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. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]).
  
  
  CONCLUSIONS
  A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period.
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Lars Åke
authors.initials: LÅ
authors.lastname: Persson
authors.forename: Nguyen T
authors.initials: NT
authors.lastname: Nga
authors.forename: Mats
authors.initials: M
authors.lastname: Målqvist
authors.forename: Dinh
authors.initials: D
authors.lastname: Thi Phuong Hoa
authors.forename: Leif
authors.initials: L
authors.lastname: Eriksson
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
authors.forename: Katarina
authors.initials: K
authors.lastname: Selling
authors.forename: Tran Q
authors.initials: TQ
authors.lastname: Huy
authors.forename: Duong M
authors.initials: DM
authors.lastname: Duc
authors.forename: Tran V
authors.initials: TV
authors.lastname: Tiep
authors.forename: Vu
authors.initials: V
authors.lastname: Thi Thu Thuy
authors.forename: Uwe
authors.initials: U
authors.lastname: Ewald
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D002662:Child Health Services; D003159:Community-Institutional Relations; D003299:Cooperative Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D050498:Live Birth; D008427:Maternal Health Services; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011340:Problem Solving; D012932:Social Facilitation; D012959:Socioeconomic Factors; D013997:Time Factors; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult