Background: The World Health Organization (WHO) recommends early essential newborn care (EENC)-The First Embraceas a simple lifesaving procedure for newborns. The successful implementation of EENC at scale requires an understanding of health staff experiences, including facilitators, barriers, and local adaptations of EENC. This study aims to gain insight into health staff experiences with implementation of EENC guidelines after participation in training and coaching initiatives in Da Nang municipality and Quang Nam province in Viet Nam. Methods: In each province/municipality, we randomly selected one hospital from the following categories: public provincial/municipal hospital, public district hospital, and private hospital. We conducted in-depth interviews with 19 hospital staff (11 midwives, 5 doctors and 3 health managers) and two trainers during 7 days between September and October 2017. We used deductive/inductive thematic analysis to generate themes. Results: The health staff reported improved staff and mother satisfaction, and health benefits for both mothers and newborns after implementing EENC. Facilitators to successful implementation were management support for resource allocation and collaboration across departments, and creative demand generation. Barriers included staff shortage, skepticism about the new protocols and practices and challenges translating knowledge and skills from trainings and coaching into practice. Conclusions: After implementing EENC, through training and coaching using the WHO approach, health staff reported improved staff and mother satisfaction as well as health benefits for both mothers and newborns. An approach to develop competencies, with a focus on practical training and coaching, should be promoted to form, reinforce and sustain recommended EENC practices among health staff.
Regular access to ultrasound machines increases the frequency of POCUS usage in EDs in Vietnam. POCUS training was not as clearly associated with POCUS usage as those without formal training were equally likely to use POCUS as those with formal training. No single POCUS application stood out as strongly preferred by physicians in this survey.
Exclusive breastfeeding in the first six mo of life is critical to child development and health. Effective from May 1, 2013, Vietnam became one of the first lower‐ to middle‐income countries to offer 6‐month paid maternity leave (6mo‐PML). We analyzed data from different sources to 1) describe the process of adopting the 6mo‐PML policy, 2) examine perceptions of employed women about this policy, and 3) assess the association between maternity leave and the exclusive breastfeeding practice. Five key components leading to policy change were the establishment of partnerships, consensus building among various stakeholders, evidence‐based policy advocacy, development of messages and materials, and engaging the media. An online survey (n = 1,005) showed employed women believed that 6mo‐PML was beneficial for infant's health (72%), mother's health (59%), society (45%) and family (34%). To avail of 6mo‐PML, mothers needed support from employers to maintain positions (80%) and hire temporary staff (48%). Findings from an onsite survey (n = 6,240) show that the percent of mothers who returned to work when the infant was < 4 mo, 4 mo and 5 mo were 5%, 15% and 22%, respectively. Mothers who returned to work had a statistically lower prevalence of exclusive breastfeeding than those who did not in the overall sample (20% vs. 34%) and for all age groups (< 4 mo: 35% vs. 42%; 4 mo: 19% vs. 26%; and 5 mo: 9% vs. 15%). Adjusted OR for returning to work was 0.65 (95%CI 0.53, 0.80). With increasing numbers of women entering the labor force, adoption of maternity protection policies is critical to enabling working mothers to optimally breastfeed their children.Funding: Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360
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