Table 3 Reasons found for under-reporting births and neonatal deaths in Quang Ninh province, Vietnam, 2005.

Local level

• Poor understanding of the rationale and importance for registering among health staff and families.

• Poor access to registrars.

• Difficulties in defining a neonatal death as opposed to a stillbirth.

• Local health staff having poor access to data due to family seclusion and high mobility in society.

• Reports by Village Health Workers being based on verbal reporting.

Health system level

• Reports being based on aggregates and not on individual data, making cross checking and additions impossible.

• The responsibility of reporting not being clearly communicated within the health system.

• Inadequate report forms.

• Infant mortality, but not neonatal mortality, being used in national statistics and surveys.

• Families and not the health system being ultimately responsible to register a birth or death.