Table 2. Multivariate logistic regression model with prox- imate determinant of neonatal mortality in NeoKIP study area in Quang Ninh province, Vietnam Health facility delivery Home delivery ANC attendance No ANC attendance Close to any health facility Remote from any health facility Ref (n) Cases (n) OR 95% CI 519 80 507 91 358 239 125 58 113 70 78 102 1.01 2.65 1.51 3.75 Ref 1.63 Ref 2.38 Ref 1.47 1.03 2.11 mix distal and proximal determinants in the analysis, stratification was used to investigate the influence of proximal determinants in each socio-economic subgroup. When stratifying by ethnicity, there were still associations between the proximate variables and neonatal mortality (Table 3). A similar pattern was seen when stratifying by education (data not shown). Discussion The results from the four studies presented in this article highlight different structural obstacles for improved neonatal survival in Quang Ninh province, Vietnam. A faulty data reporting system hides the magnitude of the problem and obstructs evaluation of interventions made. Group differences based on ethnicity with ethnic minor- ity mothers at a marked increased risk of neonatal Ethnicity Kinh Minority Ethnicity Kinh Minority Ethnicity Kinh Minority Distance to closest health facility Close Remote Close Remote ANC visit Yes No Yes No Place of delivery Health facility Home Health facility Home Table 3. Odds ratios (OR) for neonatal mortality risks related to delivery place, ANC attendance, and distance to health facility, divided by ethnic belonging Citation: Global Health Action 2011, 4: 5724 - DOI: 10.3402/gha.v4i0.5724 7 (page number not for citation purpose) An invisible and marginalised trauma mortality are grounded in societal structures and may be difficult to fully understand and target. Consequences of under-reporting The first structural obstacle on the road to better neonatal survival is the lack of valid statistics (42). This is not an isolated problem for Vietnam but has been described from many places and settings (28, 43 48). In the Vietnamese setting, there seems to be various reasons why births and neonatal deaths are under-reported. These range from a poor understanding among health staff regarding the rationale and importance for adequate statistics to systematic errors within the health care system. Utmost, however, the responsibility is put on the family when it comes to registering births and deaths and there are multiple reasons why the family is not always interested in reporting such events. Further, a living newborn who has died before it has been registered as a birth might not be reported as a death. Even if there has been a relaxation in the Vietnamese family planning laws that are now advocating a ‘small family size’ policy, the norm of one to two children may be a cause for the third and subsequent children to go unreported (49). If, instead, the reporting of births and deaths was fully the responsibility of the health system, our results indicate that the level of accuracy would increase considerably. The problem with under-reporting neonatal deaths may have severe consequences. At national and provincial levels, the low neonatal mortality rates will be misleading for policy and decision-makers and health plans will not be able to target those most in need. At the local level, the faulty statistics will preserve status quo by keeping the OR Ref 1.31 2.12 3.46 Ref 1.14 1.73 5.52 Ref 0.91 2.05 4.20 95% CI 0.75 2.27 1.27 3.54 2.24 5.35 0.45 2.87 1.14 2.62 3.45 8.82 0.11 7.68 1.37 3.07 2.67 6.59 OR Ref 1.61 Ref 3.20 Ref 2.05 95% CI 0.99 2.62 1.97 5.20 1.28 3.26