Despite advancements in technologies and interventions made for improving the life of newborns, neonatal death remains an unfinished agenda as a serious public health concern in developing countries, including Ethiopia. Therefore, we conducted this prospective study to determine the causes and predictors of neonatal mortality in the NICUs in eastern Ethiopia. Accordingly, the proportion of neonatal deaths was 20% (95% CI: 16.7–23.8%). This resulted mainly from preventable causes, which are unconscionable in the twenty-first century. The present finding is in agreement with studies conducted in Ethiopia and other developing countries such as India (18.69%), Eastern Nepal (20.2%), Nigeria (18.8%), and Central Ethiopia (23.3%) [16, 19,20,21]. However, it was greater than the studies carried out in Northern Vietnam (13.9%), India (7.16%), Ghana (16%), South Africa (13.8%), and Cameroon (15.7%) [5, 22,23,24,25]. These variations between studies might be explained, in part, by the discrepancy in the follow-up time, sample size, and quality of prenatal care delivered in these facilities. Also, the present study was conducted in hospitals with a recently established NICU; this might result in a difference in the distribution of essential equipment and skilled manpower. Additionally, disparities in socioeconomic conditions of the population well as geographical locations could have contributed to the variation.
In the current study, the main causes of death were complications of preterm birth (28.58%), birth asphyxia (22.45%), and neonatal infection (18.36%). This was supported by reports and findings from the WHO, Northern Vietnam, India, Ghana, Nigeria, Cameroon, South Sudan, and Southern and Northern Ethiopia [5, 11, 19, 20, 22,23,24, 26,27,28,29,30]. The findings of our study showed that more than 70% of neonatal deaths were attributed to prematurity, neonatal sepsis, and birth asphyxia. This finding suggests the need for intensive neonatal survival interventions targeting the intrapartum period as well as in immediate and early neonatal periods to reduce neonatal mortality.
Birth asphyxia, preterm, low birth weight, and failure to initiate early feeding were significant factors that increased the likelihood of neonatal deaths. These findings are consistent with previous studies in Ethiopia and other countries, in which intrapartum and neonatal conditions were found to be important predictors of neonatal mortality [21, 25, 28, 30,31,32,33]. Preterm and low birth weight babies were more likely to be prone to complications such as hypothermia, infections, and birth asphyxia (resulting in tissue hypoxia and multi-organ failure). Therefore, provisions of quality neonatal care, including quality resuscitation, thermal care, and appropriate feeding, are important to avert some of these factors [34,35,36,37].
Furthermore, a short duration of less than 3 days of life in the NICU was found to be significantly associated with neonatal death. This is in contrast with a study in the Somali region, where a shorter stay in the NICU was protective against mortality . However, this is consistent with the fact that most neonatal deaths occur in the first 72 h after birth. This suggests that any intervention at this critical time has a significant contribution to saving the life of the neonates [38, 39]. Besides, febrile illness (≥37.5 oc) on admission was found to be a significant predictor of neonatal mortality. This is likely due to the high proportion of neonatal infections in the present study setting.
This finding emphasizes the need to improve the quality of care in health facilities. In particular, we strongly believe that achieving high-quality intrapartum and postnatal care is required to improve neonatal health. A significant proportion of neonatal deaths can be avoided by appropriate resuscitation care [40, 41]. Most of the infection-related deaths can be avoided by treating maternal infections during pregnancy, ensuring a clean birth, care of the umbilical cord, and exclusive breastfeeding [42, 43]. There is a range of available evidence-based interventions that can improve the survival of premature and low-birth-weight newborns. The promotion of early and exclusive breastfeeding, prevention, and treatment of hypothermia, including kangaroo mother care [43, 44], and topical skin-cleansing with chlorhexidine may reduce morbidity and mortality secondary to infection [45, 46]. The gap for the care of mothers and babies in the first few days of life is important even when women deliver in facilities. Moreover, communities and decision-makers need to be informed that neonatal deaths are a huge portion of child deaths, and need therefore to receive adequate attention.
The strengths of this study were that the inclusion of multiple facilities and prospective follow-up of neonates from admission to discharge or death. In addition, it was carried out without sampling; therefore, the possibility of sampling error was eliminated. However, the relatively small sample size and wide CI in the multivariable model associated with some variables may undermine the strength of this study. The study was conducted at hospitals; therefore, neonates delivered at home and died at home could be missed. Hence, this study does not reflect population-based neonatal mortality rather; it reflects institution-based neonatal death in the given period.