were 17,519 births in the province, and the NMR was 16/ 1,000 (38). The health care system in Quang Ninh province follows the national guidelines, with at least one commu- nity health centre (CHC) in each community and one district hospital (DH) in all district centres. In Ha Long City, the administrative centre of the province, there is a newly built provincial hospital with referral capacity, and in Uong Bi there is a regional hospital serving not only Quang Ninh but also the surrounding provinces. Women are free to go for antenatal care at any provider and there are many private ANC providers in the province, many of them specialised in ultrasound examinations. There are no private delivery care providers in QN. Study designs, population, and sample size We have analysed data from the NeoKIP baseline study, performed in early 2006, using a retrospective cross- sectional design registering all live births (n 17,519) and neonatal deaths (n 284) that occurred within the province during 2005. The neonatal mortality rates thus retrieved were compared to the official statistics reported to the MoH (38, 39). Furthermore, data from the NeoKIP intervention database have been used, applying a case-referent design. All mothers within the NeoKIP study area who lost a newborn during the first month after delivery and during the time period from July 2008 to December 2009 (n 197) were approached for interview and 183 were available for interview. During interviews a semi-struc- tured interview form was used. The same interview form was used to interview referent mothers randomly selected from the total population of live births. Data collection For the first two studies of the thesis (38, 39), data collection was mainly performed by compiling variables associated with deliveries and neonatal deaths. This information was derived from two major sources, health registers at all level of the health system and through group interviews with Village Health Workers. The WHO definitions of neonatal death and stillbirths were used by the NeoKIP data collectors to distinguish between death cases. Neonatal deaths were recorded by age, place of and assistance at delivery, place of death, birth weight, gestational age at birth, and gender. When a death case was found through any source, checking against the other sources on different levels was performed to verify each case. For the two following studies of the thesis (40, 41), a team of data collectors recorded all live births in the eight districts constituting the NeoKIP study area on a monthly basis between July 2008 and December 2009 visiting health facilities and village health workers. All live births were entered into a database and once a month Citation: Global Health Action 2011, 4: 5724 - DOI: 10.3402/gha.v4i0.5724 An invisible and marginalised trauma all new entries were grouped and assigned a number. By the use of a random number generator, 6% from each batch were selected as referents. With an estimated NMR of 20 25/1,000, a randomisation of 6% for referent interview assured a 2:1 ratio between referents and cases. Data collectors visited all sample mothers in their homes 8 to 10 weeks after delivery and conducted a semi- structured interview, gathering information about an- tenatal, delivery and postnatal care, as well as socio- economic factors. GIS coordinates were collected by the use of handheld GPS devices (Garmin GPS 60 or Garmin GPS 60Cx). All governmental health facilities and homes of respondents were recorded and entered into the database. Geographic background information was obtained from VidaGIS, a Vietnamese-Danish commercial GIS provider. From the results of interviews, an asset index was developed using principal component analysis in order to assess the economic status of respondents’ household. This was done by an inventory of 15 different assets and household characteristics conducted in the homes of interviewees (motorbike, car, stereo, TV, DVD/VHS, refrigerator, washing machine, gas stove, electrical stove, electric fan, AC, glass windows, flush toilet, running water, and whether or not the household was connected to the power grid). Ethical considerations The research presented in this thesis was conducted within the NeoKIP study, which has been approved by the Ministry of Health in Vietnam (ref 3934/QD-BYT), the Provincial Health Bureau in QN, and the Research Ethics Committee at Uppsala University, Sweden (ref 2005:319). Informed oral consent was obtained from all respondents prior to interview. Findings Under-reporting of births and deaths The official figures given by the Provincial Health Bureau of QN stated that 16,551 live births and 70 neonatal deaths had occurred in 2005, thus resulting in a neonatal mortality rate of 4/1,000. However, during the NeoKIP baseline, 17,519 live births and 284 neonatal deaths were registered to have occurred in Quang Ninh province in 2005. This resulted in a NMR of 16/1,000, thus four times higher than the official statistics. This substantial under- reporting was unevenly spread among the different districts of the province with a varying degree of discrepancy between official figures and NeoKIP baseline results. Determinants of neonatal mortality All neonatal deaths during 18 months (July 2008 to December 2009) in QN were registered as cases (n 197) 5 (page number not for citation purpose)