Predictors of Neonatal Mortality in Tema General Hospital, Greater Accra Region of Ghana

Abstract

Background: Neonatal mortality (NNM), the death of a newborn within the first 28 days of life, accounts for 60% of infant deaths in middle- and low-income countries, with over two million deaths globally in 2021. In Ghana, maternal, delivery, foetal, and socio-economic factors are key contributors. This study examines the determinants of neonatal mortality at Tema General Hospital in the Greater Accra region. Methods: A 1:2 unmatched case-control study with 180 participants (60 cases and 120 controls) was conducted at Tema General Hospital from January to August 2024. Cases were neonatal deaths within 28 days of delivery, and controls were newborns who survived the neonatal period. Data analysis utilized univariate and multivariate logistic regression in Stata version 17, reporting odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI). A p-value <0.05 indicated statistical significance. Results: Of the sixty (60) cases, 49 (81.7%) were early neonatal deaths and 11 (18.3%) were late neonatal deaths. Factors substantially related with reduced odds of newborn mortality were mothers’ education (OR = 0.1, 95%, C.I: 0.0 - 0.5), fathers’ occupation (OR = 0.9, 95%, C.I: 0.3 - 2.8), birthweight above 2.5 (OR=0.3, 95% C.I: 0.1 - 0.5) and ANC attendance (OR = 0.2, 95% C.I: 0.1 - 0.7). Whereas those associated with increased odds were Obstetric complications (OR = 6.0, 95%, C.I: 2.4 - 15.0), History of abortion or miscarriage (OR = 3.4, 95%, C.I: 1.8 - 6.4), Physical/Sexual assault (OR = 8.9, 95% C.I: 3.2 - 23.8), Congenital malformation (OR = 4.4 95%, C.I: 1.6 - 11.8), aggressively resuscitation (OR = 9.6, 95% C.I: 4.7 - 18.6), delivery by induction is (OR = 5.9, 95%, C.I: 1.2-28.4) and gestational age below 37 weeks (OR = 6.2, 95%, C.I: 0.1 - 0.3) Conclusion: Parental factors such as mother's secondary education and an employed father combine with other factors such as, a higher number of ANC visits, and a gestational age of 37 weeks or more may protect against neonatal mortality, whereas obstetric complications, a history of abortion(s), physical or sexual abuse, a low birthweight of less than 2.5kg, the presence of congenital malformations, and aggressively resuscitating a baby may increase the odds of neonatal mortality. Targeted campaigns and health education in the communities must be implemented to create awareness and increase ANC attendance. Refresher skill-based training for midwives and provision of logistics for NICU should be prioritised to mitigate the effects of these factors.