Determinants of Neonatal Mortality in Neonatal Intensive Care Unit of Dilla University Referral Hospital, Southern Ethiopia; 2019-2020: A matched Case Control Study

Abstract Background: Neonatal mortality rate is deaths occurring from birth to 28 days life per1000 Live Births. The global neonatal mortality rate fell from 37 deaths per 1,000 live births in 1990 to 18 in 2017, where as it was 27deaths/1000 life birth in the Sub-Saharan. Ethiopia plans to reduce the neonatal mortality rate from 28 to 11/1,000 live births by 2020 and to end all preventable child deaths by 2035. Objective: The aim of this study was to identify risk factors associated with neonatal mortality in neonatal intensive care unit of Dilla University Referral Hospital Methods: An age matched case control study was conducted at Dilla University Referral Hospital’s neonatal intensive care unit. Two controls having age 2days before or after the case were used for matching. One hundred eighteen cases (died) and 236 age matched control (survived) neonates who were admitted to the neonatal intensive care unit during January 11, 2018 to February 25, 2020 were studied. Missed data was filled by multiple imputations. Multicollinearity was checked by variance inflation factor. Outliers were checked by cooks distance. For variables with P value <0.02 on bivariable conditional logistic regression, multivariable conditional logistic regression analysis was done to control for confounder using clogit command in a survival package to identify risk factors for neonatal mortality using R version 3.6.3. Result: Gestational age <37 weeks (Adjusted matched odds ratio-AmOR: 14.02; 95%CI: 3.68 – 53.46), having first minute APGAR score < 7(AmOR: 5.68; 95%CI: 1.76-18.31), diagnosing with perinatal asphyxia (AmOR: 4.62; 95%CI: 1.15 – 18.53) and being twin (AmOR: 6.84; 95%CI: 1.34-34.96) were significantly associated with neonatal deaths in our study. Having ante natal care following up during pregnancy (AmOR: 0.15; 95%CI: 0.04-0.53) and having a normal random blood sugar level at admission (AmOR: 0.1; 95%CI: (0.02 - 0.66) were found to be protective against neonatal mortalities in our study. Conclusion: Gestational age less than 37 weeks, first minute APGAR score <7, being a twin and diagnosing with perinatal asphyxia were significantly associated with neonatal death in neonatal intensive care unit of Dilla university referral hospital where as maternal ante natal care follow up during pregnancy and neonatal having normoglycemia at admission were found to be protective.