sense of ownership and the ability to create change. Nevertheless, the studies from India and Bangladesh demonstrate the importance of context for the effect of the intervention. What works in one setting does not necessarily work in another, and there is a need to pay attention to the design of the intervention as well as to contextual factors related to the health system and the society where the intervention takes place [21]. Neonatal health – Knowledge Into Practice (NeoKIP) Inspired by the Nepalese study by Manandhar and colleagues, research collaboration between Uppsala University, Uong Bi General Hospital and the Ministry of Health (MoH) in Vietnam was initiated in 2005. The resulting study, referred to as NeoKIP, [an acronym for “Neonatal Health – Knowledge Into Practice” (ISRCTN44599712)], was planned to investigate a method of knowledge translation through a population-based clusterrandomized design. This method, known as ‘facilitation’, can best be described as a group-based enabling approach utilized to support change. Facilitation has been shown to be a potentially favorable intervention for enhancing knowledge uptake [24]. The choice to investigate facilitation as a method of knowledge translation was based on research that suggests innovations and new knowledge are spread and utilized as an effect of interaction between individuals and social influence rather than on the availability of written information [25]. With the notion of social interaction 18 and group processes as the driving force for change, the NeoKIP project intended to investigate whether or not access to evidence-based knowledge (through the National Guidelines issued by the MoH), and the interaction between practitioners and key community members (through a problembased planned work method that was generated through facilitation support) would lead to a process of change and effectively achieve improvements in neonatal health. There was also a need to find ways to be able to scale-up this process, which had been proven successful in the Nepalese setting through a fairly large amount of women’s groups. The NeoKIP study therefore chose to plan the intervention within the existing health system by forming Maternal and Newborn Health Groups (MNHG) at Community Health Centers (CHCs). The research presented in this thesis was undertaken within the scope and organization of the NeoKIP project, with the intention to investigate obstacles and determinants of neonatal survival. The NeoKIP study is proposed to continue through July 2011, before the impact of facilitation on neonatal health can be fully analyzed. The Vietnamese setting Child health and inequity in Vietnam Vietnam is a country that for many years has shown relative good health statistics in relation to its overall economic status. Through sustained investments in primary health care, Vietnam has achieved great reductions in infant and child mortality rates [26]. Officially, the NMR in Vietnam is 12/1000 (2004) [27]. However, a study in Bavi district, a health surveillance site west of Hanoi, showed a persistent neonatal mortality rate over the last three decades of the last century (Figure 2) [28], exhibiting the same trend as has been shown in many other countries around the world. This study has influenced the choice of study topic for the NeoKIP project as well as for this thesis, and was a call for action in the Vietnamese setting. Recognizing this trend of persistent neonatal mortality, the Ministry of Health in Vietnam has made neonatal mortality and perinatal health a priority: evidence-based guidelines on reproductive health were launched in 2003 [29]. The Bavi study not only showed a stagnant neonatal mortality, but also indicated that ethnicity was a major risk factor for neonatal death, whereas education and economic status was not. Ethnic minorities in Vietnam are living in more remote mountainous areas compared to the hegemonic ethnic group (Kinh), and there was a sharp social inequity arising from minority status [30]. Minority groups are poorer and less educated compared to the Kinh group, and evidence shows that the minority groups benefitted by the ongoing 19 Figure 2. Neonatal mortality rate (NMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR) over time (moving 3-year averages) in Bavi district in northern Vietnam [28]. development in Vietnam to a smaller extent compared to the majority group [31]. The inequity does not, however, only go with resources, but is also due to a combination of social factors most likely involving both external barriers – such as language and discrimination – as well as such internal factors as traditions and seclusion. The inequity is also notable in health, with a higher IMR and shorter life expectancy among ethnic minorities [31]. There is evidence of ethnic differentials in health care-seeking behavior, which could be factors causing the discrepancy in health statistics between ethnic groups [32]. The overall institutional delivery rate is high in Vietnam, reportedly 64 to 79 % during the last couple of years according to different sources [33, 34]. Ethnic minorities are, however, more likely to deliver at home [35], resulting in an increased risk of both stillbirths and neonatal death for these groups. Son preference and SRB Vietnam is a country influenced by Confucianism, especially in the northern parts