Determinants of mortality among neonates admitted to neonatal intensive care unit at public hospitals, in the Somali region, eastern Ethiopia: unmatched case-control study

Introduction: neonatal death is a global issue in both developed and developing countries. Evidence on determinants of neonatal mortality is scarce, particularly in the pastoralist and agro-pastoralist areas of Ethiopia, including the Somali region. This study aimed to identify the determinants of mortality among neonates admitted to neonatal intensive care units at selected public hospitals, in the Somali region, eastern Ethiopia. Methods: an unmatched case-control study design was employed from January 1st-30th, 2020. The total sample size was 312 neonates (156 cases and 156 controls) who were admitted to the neonatal intensive care unit from January 2018 to December 30th, 2019. A simple random sampling technique was used to select neonates. The data were collected by a structured checklist. Data entry and analysis were done by EpiData version 4.6 and SPSS version 23, respectively. Binary logistic regression using bivariate and multivariable analysis was done to identify determinants. Odds ratios were computed at 95% CI and a P value <0.05 was considered statistically significant. Results: a total of 310 neonates with complete medical charts (155 cases and 155 control) were included in the study. Lack of antenatal care (AOR 4.71; 95%CI: 1.4115.75), rural residence (AOR=8.38; 95%CI: 2.2231.69), premature rupture of membrane (AOR=4.29; 95%CI: 1.21-15.19), five-minutes APGAR score below-seven (AOR=9.87; 95%CI: 2.3042.33), prenatal asphyxia (AOR=14.71; 95%CI: 2.7977.33) and length of hospital stay <= 3 days (AOR=15.09; 95%CI: 2.89-78.62) were significantly associated with neonatal mortality. Conclusion: this study identifies rural residence, lack of antenatal care, premature rupture of membranes, low APGAR scores, prenatal asphyxia, and short hospital stays as determinants. Hence, improving access to basic health services such as antenatal care and early screening for pregnant mothers and newborns is critical. By prioritizing these interventions, healthcare systems can effectively work towards reducing neonatal mortality rates, ultimately improving the health outcomes of infants and their mothers.