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

Ethiopia is one of the five nations that bear the global burden of nearly 50% maternal mortalities and newborn deaths. Cause-specific maternal mortality and newborn death information are vitally important for prevention, but little is known about the causes of deaths. Many maternal mortalities and newborn deaths occur at home, outside the formal health sector, and few are attended by qualified medical professionals. Despite the fact that, non-medical factors are often more important in determining whether a woman/newborn lives or dies than the medical cause of death itself. This study determines and explores factors contributing to maternal mortalities and newborn deaths in Ethiopia with the aim of developing a community-based model for averting maternal mortalities and newborn deaths in Ethiopia. The study was organised in three phases. In Phase 1, a community-based-retrospective approach using explorative, descriptive and contextual study design, combining both qualitative and quantitative methods (mixed methods) were used to make an in-depth investigation and analysis of the circumstances and events surrounding individual cases of maternal mortality and newborn deaths. The result of the study revealed various direct and indirect as well as possible contributing factors to maternal mortalities and newborn deaths which outlined bases for forwarding Phase 2 of the study called concept analysis. In Phase 3, a prototype model was developed according to Chinn and Kramer’s approach to theory generation: initially, based on the empirical perspectives of the study, concept analysis was conducted. The structure and process of a model to avert maternal mortality and newborn death were described; and, six survey list; namely, agent, recipient, context, procedure, dynamic and terminus of Dickoff, James and Wiedenbach (1968) form the basis for development and description of a model for averting maternal mortality and newborn deaths in Ethiopia. Impediment in receiving prompt, adequate and appropriate care were common problems encountered even after reaching an appropriate medical facility. For any attempt to attain a significant reduction in maternal mortality and newborn death, the health care system in Ethiopia must assume its tasks to institute critical changes in both the structure and process of health care delivery services. / Health Studies / D. Litt. et Phil. (Health Studies)

Global maternal and newborn mortality have made much progress in recent years. Forexample, newborn deaths have almost halved since the 1990s, and the global maternalmortality rate (MMR) has been reduced by nearly 38 percent during the same period.Maternal and newborn deaths are still unacceptably high, and an estimated 2.7 millionnewborns die worldwide each year, most of them in low-income countries (Lawn et al.,2016). The Mayuge District in rural southeastern Uganda is a district experiencing significantmaternal and newborn health difficulties. According to Willey et al. (2018), 438 expectantmothers die from childbirth-related complications per 100,000 live births, and 23 newbornsdie per 1000 live births in the Mayuge District. The 3-delays model is used in researchconcerning maternal and newborn health worldwide and works to simplify and categorize thecauses of poor maternal and newborn health (Bergström et al., 2009). The delays aredescribed as follows; (1) delay in seeking care; (2) delay in reaching a healthcare facility; and(3) delay in receiving appropriate care.This study focuses on the first delay, which is the delay in seeking healthcare, and examinesif stigma and social identity affect health-seeking behavior in the district. Other identifiedfactors affecting health-seeking behavior will be presented during the study and compiledalongside possible recommended interventions to combat the issues. According to the resultspresented in this study, stigmatization, culture, tradition, and misinformation are evidentdrivers for the delay in seeking healthcare in the Mayuge district in Uganda. This studyfurther reveals that inherited social identity could be identified as traditional aspects andaffect people's health-seeking behavior. It is shown that the district suffers from poormaternal and newborn health caused by all of the three delays presented in this study.However, the results of this study show that the first delay is one of the least researched andthat the local government gives little to no attention to the delay in seeking healthcare in thedistrict.