Báo cáo nghiên cứu khoa học: Bằng chứng về hiệu quả của các can thiệp trong chăm sóc trẻ sơ sinh: có đơn vị chăm sóc sơ sinh huyện giải quyết các vấn đề về sức khỏe trẻ sơ sinh trong Như Thành và các bệnh viện Ngọc Lặc, tỉnh Thanh Hóa, Việt Nam?

Tuyển tập các nghiên cứu khoa học của trường đại học Huế đề tài: Bằng chứng về hiệu quả của các can thiệp trong chăm sóc trẻ sơ sinh: có đơn vị chăm sóc sơ sinh huyện giải quyết các vấn đề về sức khỏe trẻ sơ sinh trong Như Thành và các bệnh viện Ngọc Lặc, tỉnh Thanh Hóa, Việt Nam?..
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Báo cáo nghiên cứu khoa học: "Bằng chứng về hiệu quả của các can thiệp trong chăm sóc trẻ sơ sinh: có đơn vị chăm sóc sơ sinh huyện giải quyết các vấn đề về sức khỏe trẻ sơ sinh trong Như Thành và các bệnh viện Ngọc Lặc, tỉnh Thanh Hóa, Việt Nam?"152JOURNAL OF SCIENCE, Hue University, N0 61, 2010 EVIDENCE FOR EFFECTIVENESS OF INTERVENTIONS IN NEWBORN CARE: HAS DISTRICT NEWBORN CARE UNIT ADDRESSED NEWBORN HEALTH PROBLEMS IN NHU THANH AND NGOC LAC HOSPITALS, THANH HOA PROVINCE, VIETNAM? Nguyen Van Hai Save the Children SUMMARY Introduction: The Vietnamese health care system faces many challenges in ensuring thesurvival of newborns with over 20,000 newborns still dying each year. The hierarchical healthsystem is not able to provide quality newborn care services. For example, district hospitals andcommune health centers are poorly equipped and have a lack of staff with adequate training inessential newborn care, and management of newborn complications. Household-level newborncare is provided through village health workers who lack standard communication materials,training, supervision and monitoring. Misconceptions about newborn care at birth andbreastfeeding exist, especially in places with high rates of home births. Methods: ThisOperation Research (OR) study consists of a comprehensive newborn care intervention packagewhich was introduced. The intervention included delivery care and postnatal care but moreeffort was focused on immediate postnatal care and management of newborn complications. TheOR set four intermediate results (IRs): IR 1: Increased access and availability of newbornservices and supplies; IR 2: Improved quality of newborn care at health facilities; IR 3:Enhanced community knowledge of newborn care practices and demand for newborn careservices; IR 4: Promotion of an enabling policy environment for scaling up newborn care. Thispaper only covers facility-based interventions while other impacts will be reported at the end ofthe project. Results: After 1.5 years of intervention, the OR has helped to significantly reducethe neonatal mortality rate: 19.4%o (2006) to 14.4%o (2009) in Ngoc Lac, and 21.9%o (2006)to 8.5%o (2009) in Nhu Thanh. The referral rate of newborn complications and home birthrates also declined sharply in both districts. Conclusions: Neonatal deaths in Ngoc lac and NhuThanh districts of Thanh Hoa province can be averted with low cost interventions through theestablishment of a district newborn care unit, and the health care system will benefit fromhaving a functional district newborn care unit. Key words: neonatal death, district newborn care unit, facility-based intervention. 1531. Introduction Vietnam is poised to achieve most, if not all, of its Millennium DevelopmentGoals. Vietnam has already met the target of reducing the under-five mortality rate to 18per 1,000 live births by 2015. However, the Vietnamese health care system faces manychallenges in ensuring the survival of newborns with over 20,000 newborn .deaths eachyear. Neonatal deaths account for over 70% of the infant mortality rate, and variesacross 7 regions of Vietnam with the highest neonatal death rate occurring in thenorthern mountainous and the northern central coast regions. One of the determinants ispoor access to newborn care in rural areas (geographic access, cultural barriers andquality of care), where twice as many newborns die than in urban settings. The hierarchical health system is not able to provide quality newborn careservices. Both district hospitals and commune health centers are poorly equipped andstaff lack adequate training in essential newborn care, and management of newborncomplications such as neonatal resuscitation, thermal care, and infections. Few CHCsand district hospitals are capable of managing particular neonatal complications, andmost cases are referred to higher level facilities. This often results in unnecessarilyoverloading provincial and central hospitals where only critical cases should be referred. Many people also often bypass health services at commune health stations anddistrict hospitals and go directly to higher- level facilities, because they lack confidencein the competence of services provided at lower-level facilities. This may result inaggravating the condition of newborns during transportation, as they may not receiveproper care for some manageable situations, such as attending to the newborn’s bodytemperature. This situation also results in families spending more money, and increasedhuman resources to care for the newborns in the hospital. There is a severe short ...