Factors associated with neonatal mortality at the Kinshasa University Hospital: a retrospective analytical cohort study

Abstract

Context and objective. Neonatal mortality remains a major public health issue, particularly in sub-Saharan Africa. The present study aimed to identify factors associated with neonatal mortality. Methods. This was a retrospective analytical cohort study conducted from january 1, 2024 to october 31, 2025 in the neonatal unit, at the Kinshasa University Hospital. All hospitalized neonates with documented outcomes were included. Cox regression was used to identify factors associated with mortality, and survival was analysed using the Kaplan-Meier method. Results. A total of 1359 neonates were included, with 441 deaths, corresponding to an in-hospital neonatal mortality rate of 32.4%. Most deaths occurred early with a median survival of 17 days. Factors independently associated with mortality were: vaginal delivery (aHR=1.30 ; 95%CI :1.03-1.63), referral from facilities outside the Elonga perinatal network (aHR=1.37 ; 95%CI : 1.08-1.73), older age at admission (aHR=1.05 ; 95%CI : 1.04-1.07), resuscitation at birth (aHR=1.33 ; 95%CI : 1.07-1.66), hypothermia (aHR=1.54 ; 95%CI : 1.10-2.66), congenital malformations (aHR=1.86 ; 95%CI : 1.43-2.43) and perinatal asphyxia (aHR=1.64 ; 95%CI : 1.20-2.25). Conversely, gestational age ≥37 weeks and birth weight ≥2500g were protective. No statistically significant association was found between neonatal mortality and referral from facilities belonging to the Elonga perinatal network. Conclusion.  Neonatal mortality remains high and is mainly associated with neonatal severity factors and health system-related factors, particularly referral conditions. Strengthening perinatal care, immediate newborn management, and the referral system is essential to reduceneonatalmortality. Received January 11, 2026 Accepted April 22, 2026 https://dx.doi.org/10.4314/aamed.v19i3.3