Factors associated with mortality among neonates admitted to Special Care Baby Unit: evidence from a matched case-control study in a rural general hospital in Northern Uganda

Abstract

Neonatal mortality remains a major public health challenge in sub-Saharan Africa. Despite the high burden, few studies have examined the risk factors linked to these deaths. This study aims to explore factors associated with neonatal mortality in a rural setting of a low-income country. A case-control study matched in the ratio 0f 1:1 by age at admission was conducted at Anaka General Hospital Special Care Baby Unit (SCBU) in Northern Uganda between June 1, 2020, and May 31, 2023. Cases were neonates who died during hospitalization and controls were those discharged alive within 28 days of life. Data was retrospectively extracted from hospital records. Multivariable logistic analysis was conducted to identify factors associated with mortality. Overall, 1,282 were recruited, of which 118(9.2%) died. A 1:1 case-control matching yielded 94 cases and 94 controls. In multivariable analysis, male sex, Complications during birth[OR, 63.31( 95% CI, 4.77–840.50), p = 0.002], APGAR score at 5 min < 7[OR, 3.71( 95% CI, 1.03–13.33), p = 0.045], Prematurity[OR, 19.19( 95% CI, 13.75–98.4), p < 0.001], Respiratory distress syndrome system (OR, 8.24( 95% CI, 1.25–54.1), p = 0.028], First antenatal care visit > 4 month [OR, 7.64( 95% CI, 1.51–38.80), p = 0.014], Resuscitation at birth [OR, 5.81( 95% CI, 1.02–33.08), p = 0.047], and Oxygen therapy[OR, 6.39( 95% CI, 11.10-37.26), p = 0.039] associated with mortality. We found that male sex, complications during birth, APGAR score of less than 7 at 5 min, prematurity, respiratory distress syndrome, late first antenatal Care visit, resuscitation at birth, and oxygen therapy were associated with increased risk of mortality, reflecting a mismatch between neonatal needs and the available care.