Magnitude of institutional neonatal morality rates in neonatal intensive care units of developing regions of Ethiopia: a retrospective review.

Abstract

Abstract Background: Ethiopia is one of the top ten countries with the highest neonatal mortality rate in 2020. Nationally, 97,000 babies die every year in their first four weeks of life. Subnationalneonatal morality and hospital-level neonatal mortalities are variable, particularly in developing or pastoralist regions data are not readily available. This study aims to analyze the neonatal morality rate in eight hospitals in the four developing regions/pastoralist communities of Ethiopia. Method: A retrospective review of neonatal intensive care unit (NICU) routine facility follow-up data from eight hospitals in four developing regions of Ethiopia (Somali, Afar, Benishangul Gumuz, and Gambella) was conducted for the period of October 2020-September 2022. As part of the Transform Health in Developing Regional (THDR) activity, data wereroutinely collected from NICU service registers in these hospitals for routine activity monitoring purposes after NICU training and clinical mentorship was provided by pediatricians, neonatologists, and senior NICU mentor nurses from the Ethiopian Pediatric Society. Finally, descriptive analysis was carried out to determine institutional neonatal morality and its trend over time. Results: Over the course of three years, 3,150 newborns were admitted to the NICU in the eight hospitals. The overall neonatal morality rate was 12.3% in the eight hospitals. The majority (81.2%) of admissions were from three hospitals, namely, Gambella, Asossa, and Dubti general hospitals. The hospital neonatal mortality rates were very variable among hospitals; the lowest was in Asossa hospital (5%),and the highest was in Dubti hospital (15%) and Gambella hospital (17%). The average institutional morality for eight hospitals has decreased by 2.3 percentage points over three years from 10.3% in 2020 to 8% in 2022. Conclusion: The USAID's Transform HDR activity support provided to Hospital`s NICU service has contributed to the reduction of institutional neonatal morality rate by 2.3 percentage points over a three-year period. There was variability in the rates among different hospitals. Asossa Hospital had the lowest rate. In contrast, Dubti and Gambella hospitals had the highest rates. Further study is needed to determine why these events occurred and what factors contributed to these differences in these hospitals.