Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trial
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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. METHODS AND FINDINGS: 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.
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The NeoKIP trial demonstrated a reduced neonatal mortality of 49% in the third year of the intervention.
“Using lay members of the community who received training in facilitation techniques such as PDSA and group consensus building, the study demonstrated a reduced neonatal mortality of 49 % in the third year of the intervention [56].”
From PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice (2015) · cites this paper as [56]
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- Authors
- Persson, L. Å., Nga, N. T., Målqvist, M., Thi Phuong Hoa, D., Eriksson, L., Wallin, L., Selling, K., Huy, T. Q., Duc, D. M., Tiep, T. V., Thi Thu Thuy, V., & Ewald, U.
- Affiliations
- Uppsala University (SE)
- Dalarna University (SE)
- Ministry of Health (VN)
- Corresponding author
- Persson, Lars Åke
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-05-14
- Volume
- 10
- Issue
- 5
- Pages
- e1001445
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC3653802
- OpenAlex
- W2121089097
- Cited by
- 83
- References
- 38
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 5 · 2023: 9 · 2022: 5 · 2021: 6 · 2020: 8 · 2019: 5 · 2018: 11 · 2017: 7 · 2016: 6 · 2015: 12 · 2014: 2 · 2013: 3
- FWCI
- 7.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Dalarna University College Electronic Archive (submittedVersion, other-oa)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Greater South Information System
- Funders
- Styrelsen för Internationellt Utvecklingssamarbete
- Vetenskapsrådet
- Uppsala Universitet
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- neonatal mortality, stakeholders, community facilitation, problem-solving approach, maternal and newborn care, antenatal care attendance, healthcare workers, local politicians, perinatal outcomes, Quang Ninh province
- MeSH terms
- Administrative Personnel, Adult, Child Health Services, Community-Institutional Relations, Cooperative Behavior, Female, Health Personnel, Humans, Infant Mortality, Infant, Newborn, Health Knowledge, Attitudes, Practice, Maternal Health Services, Patient Acceptance of Health Care, Pregnancy, Problem Solving, Social Facilitation, Socioeconomic Factors, Time Factors, Vietnam, Odds Ratio, Interdisciplinary Communication, Live Birth, Young Adult
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