M. M a˚lqvist and 6% of all live births during the same period were randomly chosen as referents (n 686). Mothers of 183 cases and 599 referents responded. Mean age of case mothers was 24.1 years and for referent mothers 25.4 years (p B.001). Socio-economic determinants Ethnic minority mothers constituted 38% of referent mothers (228/599) and 63% (130/183) of case mothers. This resulted in an elevated risk of neonatal mortality for ethnic minority mothers (COR 2.75, 95% CI: 1.94 3.91). Maternal and paternal education co-varied and, hence, maternal education level was used alone. A larger proportion of case mothers had not completed primary school (less than 5 years) (29%) compared to referent mothers (18%). There were no differences in neonatal mortality risks between different levels of education once mothers had completed primary school. There was, however, an increased risk for mothers who had not attended school or done so less than five years, compared to mothers who at least had finished primary school (COR 2.60, 95% CI: 1.96 3.93). Referent interviews were used to generate an asset index using primary component analysis. By applying the generated asset index, sample households were classified into five quintiles. Households were labelled as ‘poor’ when having an asset index score of less then the cut-off point of the 20th percentile among referent mothers. When dichotomising the wealth quintiles into poor and non-poor, there was a more than double risk for new- borns of mothers from poor households compared to the non-poor to die within the first month after delivery (COR 2.21, 95% CI: 1.53 3.18). When combining ethnicity, education, and economic status in a multivariate logistic regression model, an increased risk of neonatal mortality was shown for ethnic minority mothers and mothers with low education but could not be confirmed for mothers from poor house- holds (Table 1). Proximate determinants In a first analysis of the proximate variables investigated, ANC attendance, delivery place, and distance to the closest health facility showed an association with neona- tal mortality. Even if it has been previously noted in the literature, there was neither increased risk for young or old mothers in the material nor was parity associated with neonatal mortality. Family structure and marital status were investigated as well but showed no association with the outcome. Mothers who had not attended any antenatal check- ups had a more than threefold risk of neonatal mortality (COR 3.45, 95% CI: 2.35 5.06) compared to mothers who had attended at least one ANC visit. Likewise, there was an increased risk for newborns to die before reaching 6 (page number not for citation purpose) Table 1. Multivariate logistic regression model with mater- nal ethnicity, household economic status, and maternal education with adjusted odds ratios for neonatal mortality in Quang Ninh province, Vietnam Ref (n) Cases (n) OR 95% CI Kinh Minority Non-poor Poor Primary school or higher 492 No primary school 106 370 228 476 122 67 114 116 65 116 65 Ref 2.08$ 1.39 3.10 Ref 1.28 0.84 1.94 Ref 1.65* 1.08 2.53 *pB.05, $pB.001. Note: An asset score below the 20th percentile was considered poor. Primary school or higher completed representing ]5 years of schooling. 1 month of age if the mother delivered at home (COR 3.01, 95% CI: 2.02 4.49) compared to a health facility delivery. The GIS coordinates for the homes of 597 referents and 181 cases were recorded. Straight-line distances from respondents’ homes and all health facilities were calcu- lated. Most mothers lived closest to a CHC. Distances to the closest health facility among different levels of the health system were divided into quintiles based on data from referents. The 40% living farthest away were labelled as being ‘remote’ compared to the rest that were labelled as ‘close.’ There was an increased risk of neonatal mortality for mothers living farthest away (COR 1.96 95% CI: 1.40 2.74) from any health facility. When combining the variables that were associated with neonatal mortality (place of delivery, antenatal care attendance, and distance to health facilities) all three were still significant risk factors for neonatal mortality (Table 2). It can, however, be argued that these variables are all in the casual pathway of neonatal mortality and should thus not be combined in the same multivariate model. Nevertheless, by doing so and still maintaining the association to neonatal mortality hints to the individual impact of each variable. Furthermore, mothers who did not attend antenatal care and who also delivered at home were at an even higher risk of experiencing neonatal mortality (OR 4.79 95% CI: 2.98 7.71). Combining distal and proximate determinants We have thus far demonstrated the association of the distal socio-economic variables, ethnicity, and education and of three different proximate variables (place of delivery, antenatal care and distance to health facilities) to neonatal mortality. According to the conceptual framework earlier presented and the intention not to Citation: Global Health Action 2011, 4: 5724 - DOI: 10.3402/gha.v4i0.5724