Globally neonatal mortality accounts for 40% of under-five deaths. Participatory interventions where the local problems are addressed have been successful in some settings. The aim of this thesis was to describe challenges in perinatal health in a Vietnamese province, and to evaluate the effect of a facilitated intervention with local stakeholder groups that used a problem-solving approach to neonatal survival during three years. The NeoKIP trial (Neonatal Knowledge Into Practice, ISRCTN44599712) had a cluster-randomized design (44 intervention communes, 46 control). Laywomen facilitated Maternal-and-Newborn Health Groups (MNHGs) and used Plan-Do-Study-Act cycles to address perinatal health problems. Births and neonatal deaths were monitored. Interviews were performed in households of neonatal deaths and randomly selected live births. Use of health services was mapped. The primary healthcare staff’s knowledge on newborn care was assessed before and after the intervention. Neonatal mortality rate (NMR) was 16/1000 live births (variation 10 - 44/1000 between districts). Home deliveries accounted for one fifth of neonatal deaths, and health facilities with least deliveries had higher NMR. Main causes of death were prematurity/low birth-weight (37.8 %), intrapartum-related deaths (33.2 %) and infections (13.0 %). Annual NMR was 19.1, 19.0 and 11.6/1000 live births in intervention communes (18.0, 15.9 and 21.1 in control communes); adjusted OR 1.08 [0.66-1.77], 1.23 [0.75-2.01], and 0.51 [0.30-0.89], respectively. Women in intervention communes more frequently attended antenatal care, prepared for delivery and gave birth at institutions. Primary healthcare staff’s knowledge on newborn care increased slightly in intervention communes. This model of facilitation of local stakeholder groups using a perinatal problem-solving approach was successful and may be feasible to scale-up in other settings. / NeoKIP project in Vietnam

La politique Trame verte et bleue [TVB], instituée en 2007 en France à la suite du Grenelle de l’Environnement, a pour objectif de contribuer à la préservation de la biodiversité par le maintien et/ou la restauration des continuités écologiques, et ce au-delà des zones protégées, dans les espaces de biodiversité « ordinaire » : espaces ruraux, périurbains et urbains notamment. Ce travail questionne l’appropriation de la TVB par les acteurs locaux, et les implications de sa mise en œuvre sur les pratiques de construction des territoires par leurs acteurs. Notre démarche repose sur un travail d’enquêtes qualitatives menées auprès de structures territoriales, d’élus locaux, d’agriculteurs et de particuliers, sur trois territoires situés au sud de la Région Midi-Pyrénées. Il a été démontré que le dispositif TVB, porté par un discours homogène et très institutionnalisé aux niveaux national et régional, se décline en situations adaptatives sur les territoires. D’un autre côté, le processus de construction de la TVB sur les territoires reste cantonné aux sphères politiques et techniques de l’Etat et des collectivités territoriales : les acteurs locaux, élus mais surtout acteurs privés (agriculteurs et particuliers) y sont peu associés. Néanmoins, ces acteurs se montrent intéressés par la question de la biodiversité, moins par le biais des discours politiques ou scientifiques que par celui des rapports à la biodiversité qu’ils construisent et nourrissent au quotidien. Par ailleurs, la convergence d’objectifs paysagers, socio-économiques et écologiques autour de la TVB peut favoriser son application locale, car pour des motivations différentes, les divers acteurs partagent des volontés d’action communes. Finalement, l’étude montre l’intérêt de connaître et de prendre en considération, dans les projets de mise en œuvre de la politique TVB, les motivations, les freins et les contraintes des acteurs locaux pour l’ancrer et la pérenniser sur les territoires. / The purpose of the Green and Blue Corridor (so called TVB) public policy, laid down in France at the “Grenelle de l’Environment” and established in 2007, is to contribute to the preservation of biodiversity by enhancing and/or restoring ecological continuity beyond the protected areas, in spaces of common biodiversity including rural, suburban and urban areas. This work questions the appropriation of TVB by local stakeholders and the consequences of its implementation in structuring territories. Our approach is based on qualitative surveys conducted together with territorial authorities, local elected officials, farmers and private individuals, in three zones of the southern Midi-Pyrénées Region. It has been shown that national TVB scheme, supported by an homogeneous and very institutionalized frame at national and regional levels comes in a range of adaptive situations in the territories. Moreover the construction process of TVB at the local scales remains confined to political and technical spheres of State and local authorities: local stakeholders, elected but mostly individuals (farmers and private people) are not very involved. Nevertheless these stakeholders are interested by the biodiversity matter, less through political or scientific discourses than in links with their own experience of biodiversity. Furthermore convergent aims (landscape, socio-economy and ecology) around TVB can facilitate its local setting up, because from spite of their diversity stakeholders share common action concerns, even if it is for different reasons. Finally, the study highlights the interest of knowing and considering motivations and constraints of local stakeholders in the TVB implementation plans, in order to root and perpetuate the TVB at the local level of the territories.