The NeoKIP trial, Vietnam

Child survival has improved considerably since 1990. However, a persistent problem in many low- and middle-income countries has been a high neonatal mortality. Annually 2.8 million neonatal deaths occur worldwide (estimates from 2014) despite that three of four deaths could be prevented if available evidence-based interventions were used. However, how to translate these interventions into practice in an effective and sustainable way is still unclear.

This problem was addressed in a collaborative project in Quang Ninh province in Vietnam with researchers from Uppsala University (International Maternal and Child Health) and Dalarna University in Sweden and Uong Bi hospital in Quang Ninh, Ministry of Health and other actors in Vietnam. The study was a community-based cluster randomised trial - NeoKIP (Neonatal Knowledge Into Practice, trial registration ISRCTN44599712) - conducted in 90 communes in Quang Ninh province. After 3 years, the NeoKIP trial was completed in 2011. In the 44 intervention communes (vs. 46 control), laywomen from the local Women’s Union acted as facilitators, supporting stakeholder groups composed by primary care staff and local key persons in improving neonatal health. The rational for having Women’s Union representatives to enact the role of facilitators was to integrate the intervention into existing structures and thereby enhancing the likelihood of sustainability, but also for up scaling of the intervention. The NeoKIP intervention resulted in increased attendance to antenatal care and reduced neonatal mortality with 49% in the intervention communes compared with control communes (ORadj 0.51; 95% CI 0.30-0.89) after a latent period. The NeoKIP trial has so far resulted in 20 articles, 2 book chapters and 3 doctoral theses (by Mats Målqvist, Leif Eriksson and Nguyen T Nga). One PhD student is still in the process of using NeoKIP data (Duong M Duc). Sida was the main funder of this project and the Swedish Research Council has provided additional funds.

In 2014 we conducted a follow-up of the NeoKIP trial, three years after its completion, to assess the sustainability of the used approach. The evaluation included data on neonatal mortality rate, stillbirths, the local health system context, experiences concerning processes during the post-intervention period and factors that influence the sustainability of this kind of knowledge translation interventions. The Swedish Research Council and Uppsala University supported the NeoKIP follow-up.

In November (2014) the filmmaker Jakob Wallin joined the NeoKIP team to Quang Ninh province in Vietnam to document their achievements in improving neonatal health and survival. See the film:

Researchers

Sweden

Professor Lars-Åke Persson
Email: lars-ake.persson@kbh.uu.se

Professor Uwe Ewald
Email: uwe.ewald@kbh.uu.se

Professor Lars Wallin
Email: lwa@du.se

Associate Professor Mats Målqvist
Email: mats.malqvist@kbh.uu.se

Dr Leif Eriksson
Email: leif.eriksson@kbh.uu.se

Dr Anna Bergström
Email: anna.bergstrom@kbh.uu.se

Dr Katarina Selling
Email: katarina.selling@kbh.uu.se

Vietnam

Associate Professor Dinh Phuong Hoa
Email: phuonghoa55@yahoo.com

Dr Nga Nguyen
Email: nga.nguyen@kbh.uu.se

Mr Duc Minh Duong
Email: duc.duong@kbh.uu.se

List of publications

Peer-reviewed articles

  1. Eriksson L, Huy TQ, Duc DM, Ekholm Selling K, Hoa DP, Thuy NT, Nga NT, Persson LÅ, Wallin L. Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in Quang Ninh province, Vietnam. Trials. 2016, Jan 13; 17:23.
  2. Målqvist M, Hoa DPT, Persson LÅ, Ekholm Selling K. Effect of Facilitation of Local Stakeholder Groups on Equity in Neonatal Survival; Results from the NeoKIP Trial in Northern Vietnam. PLoS One. 2015, Dec 29; 10 (12).
  3. Duc DM, Bergström A, Wallin L, Ha BTT, Eriksson L, Eldh AC. Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam: a qualitative study. BMC Public Health. 2015, Aug 22; 15(1):814.
  4. Eriksson L, Duc DM, Eldh AC, Thanh VPN, Tran Q Huy, Mats Målqvist, Lars Wallin. Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam. BMC Pregnancy and Childbirth 2013, 13:234.
  5. Persson LÅ, Nga NT, Målqvist M, Hoa DP, Eriksson L, Wallin L, Huy HQ, Tiep TV, Thuy VT, Ewald U. Effect of facilitation of local maternal-and-child stakeholder groups on neonatal mortality. The NeoKIP cluster-randomised trial in Quang Ninh province, Vietnam. PLoS Medicine 2013 May;10(5).
  6. Goland E, Hoa DP, Målqvist M. Inequity in maternal health care utilization in Vietnam. International Journal for Equity in Health. 2012, 11:24.
  7. Hoa DP, Börjesson L, Nga NT, Johansson A, Målqvist M. Sex of newborn associated with place and mode of delivery; a population-based study in northern Vietnam. Gender Medicine, 2012; 9(6):418-23.
  8. Nga NT, Hoa DP, Målqvist M, Persson LÅ, Ewald U. Causes of neonatal death: results from NeoKIP community-based trial in Quang Ninh province, Vietnam. Acta Paediatrica 2012 Apr; 101(4):368-73.
  9. Wallin L, Målqvist M, Nga NT, Eriksson L, Persson LÅ, Hoa DP, Huy TQ, Duc DM, Ewald U. Implementing knowledge into practice for improved neonatal survival; a cluster-randomised, community-based trial in Quang Ninh province, Vietnam. BMC Health Services Research 2011, 11:239.
  10. Eriksson L, Nga NT, Hoa DP, Persson LÅ, Ewald U, Wallin L. Newborn care and knowledge translation - perceptions among primary healthcare staff in northern Vietnam. Implement Sci. 2011 Mar 29;6:29.
  11. Målqvist M, Nga NT, Eriksson L, Wallin L, Hoa DP, Persson LÅ. Ethnic inequity in neoantal survival; a case-referent study in northern Vietnam. Acta Paediatrica 2011 Mar;100(3):340-6.
  12. Målqvist M. Neonatal mortality: an invisible and marginalised trauma. Glob Health Action 2011; 4.
  13. Bhutta ZA. Seeing the unseen: targeting neonatal mortality in rural Vietnam. Glob Health Action 2011; 4.
  14. Målqvist M, Sohel N, Do TT, Eriksson L, Persson LÅ. Distance decay in delivery care utilisation associated with neonatal mortality. A case referent study in northern Vietnam. BMC Public Health 2010 Dec 13;10:762.
  15. Nga NT, Målqvist M, Eriksson L, Hoa DP, Johansson A, Wallin L, Persson LÅ, Ewald U. Perinatal services and outcomes in Quang Ninh province, Vietnam. Acta Paediatrica 2010 Oct;99(10):1478-83.
  16. Eriksson L, Nga NT, Målqvist M, Persson LÅ, Ewald U, Wallin L. Evidence-based practice in perinatal health - knowledge among primary health care staff in northern Vietnam. Human Resources for Health Apr 2009 (24);7:36.
  17. Wallin L. Evidence-based practice in a global context: the case of neonatal mortality. Worldviews Evid Based Nurs 2008; 5(4): 167-9.
  18. Målqvist M, Nguyen Thu N, Eriksson L, Wallin L, Ewald U, Persson LÅ. Delivery care utilization and care seeking in the neonatal period; a population-based study in Vietnam. Annals of Tropical Paediatrics 2008; 28: 191–198.
  19. Målqvist M, Eriksson L, Nga NT, Fagerland LI, Hoa DP, Wallin L, Ewald U, Persson LÅ. Unreported births and deaths, a severe obstacle for improved neonatal survival in low-income countries; a population based study. BMC Int Health Hum Right 2008, Mar 28;8:4.
  20. Hoa DP, Nga, NT, Målqvist M, Persson LÅ. Persistent neonatal mortality despite improved under-five survival: a retrospective cohort study in northern Vietnam. Acta Paediatrica 2008; 97(2): 166-70. 

Phd-theses and Book chapters

  1. Eriksson L and Wallin L. Using Facilitation to Improve Neonatal Health and Survival in Vietnam. In: Harvey G and Kitson A (editors). Implementing Evidence-Based Practice in Healthcare. A Facilitation Guide. Routledge; 2015.
  2. Eriksson L. Strategi för förbättrad vård av nyfödda barn i Vietnam. In: Nilsen P. (editor). Implementering av evidensbaserad praktik. Malmö: Gleerups; 2014.
  3. Nga NT. Neonatal Mortality in Vietnam : Challenges and Effects of a Community-Based Participatory Intervention. Uppsala: Acta Universitatis Upsaliensis, 2013. 98 s. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206; 853.
  4. Eriksson L. Knowledge Translation in Vietnam : Evaluating facilitation as a tool for improved neonatal health and survival. Uppsala: Acta Universitatis Upsaliensis, 2012. 59 s. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206; 785.
  5. Målqvist M. Who can save the unseen? : Studies on neonatal mortality in Quang Ninh province, Vietnam. Uppsala: Acta Universitatis Upsaliensis, 2010. 74 s. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206; 587.
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