Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Predator Survival Tactics and Use of Habitat Cover in Rana Catesbeiana.

Predator-prey relationships are an important aspect of the natural world, and, because of its relevance to survival and natural selection, is an interesting relationship to study. In amphibian larvae, level of activity and landscape use are often what determines the survival as prey. I studied the anti-predator behavior of the North American bullfrog (Rana catesbeiana) tadpoles when presented with dragonfly (Aeshna) larvae, a known predator of tadpoles. Tadpoles were acclimated to four different habitats with varying degrees of habitat cover, and were transferred to a new habitat with a degree of cover equal to one of the acclimation tanks. A restrained predator, and thus its chemical cue, was introduced, and the behavior, particularly the use of the habitat cover to hide from the perceived risk of predation was observed. A significantly higher frequency of inactivity was found in tank I than in II and III, and inactivity followed a general trend of decreasing with increasing habitat cover. Difference in tank cover was not found to have a significant effect on swimming behavior, but did have a significant effect on hiding behavior, which increased with higher availability. Foraging decreased significantly with the addition of a predator, but did not vary significantly with different levels of cover. Hiding behavior and reducing conspicuous behaviors (like foraging) are probably the behaviors that afford the tadpole the most success at eluding a predator in their natural environment.