Abstract
BackgroundIn order to improve child survival there is a need to target neonatal mortality. In this pursuit, valid local and national statistics on child health are essential. We analyze to what extent births and neonatal deaths are unreported in a low-income country and discuss the consequences at local and international levels for efforts to save newborn lives.MethodsInformation on all births and neonatal deaths in Quang Ninh province in Northern Vietnam in 2005 was ascertained by systematic inventory through group interviews with key informants, questionnaires and examination of health facility records. Health care staff at 187 Community Health Centers (CHC) and 18 hospitals, in addition to 1372 Village Health Workers (VHW), were included in the study. Results were compared with the official reports of the Provincial Health Bureau.ResultsThe neonatal mortality rate (NMR) was 16/1000 (284 neonatal deaths/17 519 births), as compared to the official rate of 4.2/1000. The NMR varied between 44/1000 and 10/1000 in the different districts of the province. The under-reporting was mainly attributable to a dysfunctional reporting system and the fact that families, not the health system, were made responsible to register births and deaths. This under-reporting has severe consequences at local, national and international levels. At a local level, it results in a lack of awareness of the magnitude and differentials in NMR, leading to an indifference towards the problem. At a national and international level the perceived low mortality rate is manifested in a lack of investments in perinatal health programs.ConclusionThis example of a faulty health information system is reportedly not unique in low and middle income countries where needs for neonatal health reforms are greatest. Improving reporting systems on births and neonatal deaths is a matter of human rights and a prerequisite for reducing neonatal mortality in order to reach the fourth millennium goal.
Highlights
In order to improve child survival there is a need to target neonatal mortality
The aim of the present study is to analyse to what extent births and neonatal deaths go unreported in the official statistics in a province in Vietnam, and to discuss the consequences at local and national levels for future efforts to save newborn lives
Questionnaires were received from all midwifes at Community Health Centers (CHC) (n = 187) and 427 group interviews were conducted with Village Health Workers (VHW)
Summary
In order to improve child survival there is a need to target neonatal mortality. In this pursuit, valid local and national statistics on child health are essential. It is increasingly acknowledged that the neonatal period has been neglected in the pursuit of improved child survival [1] and that deaths in the neonatal period (the first 28 days after delivery) today constitute an increasing proportion of the overall under-5 mortality[2] This neglect is a matter of withheld interventions, and very much a question of invisibility of the problem[3]. Thousands of newborns are never registered as being born Within this group, the rate of neonatal deaths is higher than in the rest of the population as many unregistered neonatal deaths die before the registration of birth[4]. There is a need for valid health statistics[9,10]and data reporting on child births and deaths in order to have a sound basis for design and monitoring of interventions for improved child survival[8]
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