MAGNITUDE OF NEONATAL NEAR MISS AND ASSOCIATED FACTORS AMONG NEONATES BORN IN PUBLIC HOSPITALS IN HARARI REGION, EASTERN ETHIOPIA

Abstract

Neonatal mortality has remained a major health challenge in low and middle income countries; still in focus. Neonatal near miss is an emerging concept and key indicator which offers evidence for detecting preventable and treatable causes of neonatal morbidity and mortality. Although it is a developing concept analogous to the maternal near-miss concept, there is a paucity of evidence on the magnitude and associated factors in eastern Ethiopia. Objective: To assess the magnitude of neonatal near miss and associated factors among neonates born in public hospitals in Harari Region, Eastern Ethiopia; from June 20 to August 20, 2021. Methods: A facility-based cross-sectional study was employed using a systematic sampling to select 405 participants. A pre-tested and interviewer-administered structured questionnaire accompanied by a review of medical records was used to collect data from the mothers and a checklist was used for their neonates. Neonatal near-miss was identified using a combined set (any pragmatic and management) of criteria; like Apgar score of 5th minutes, birth weight, respiratory distress, and others. Data were entered into Epi-Data 3.1 and exported to SPSS 25 for analysis. Crude and adjusted logistic regression analysis was done to identify factors associated with a neonatal near miss. All variables with a p-value of < 0.25 in the crude analysis were entered into the multivariable analysis. Finally, significance was set at a p-value < 0.05. Results: Of a total 401 respondent neonates, 126 (31.42%); (95% CI: 26.9-36.2%) developed neonatal near-miss cases. Neonates whose mothers were referred from other health facilities (AOR: 2.24; 95%CI: 1.25-4.03), have no antenatal care visit (AOR: 2.08; 95%CI: 1.10-3.93), had antepartum hemorrhage (AOR: 4.29; 95%CI: 2.16-8.53), and premature rupture of membranes (AOR: 4.07; 95%CI: 2.05-8.07) were more likely to develop neonatal near-miss. In addition, obstructed labor (AOR: 2.61; 95%CI: 1.23-5.52), non-vertex presentation (AOR: 3.03; 95%CI: 1.54-5.95), and primiparous (AOR: 2.67; 95%CI: 1.49-4.77) were found a positively associated with a neonatal near miss. Conclusion: Three out of ten neonates developed neonatal near-miss at discharges. Obstetrics complications were the leading factors associated with a neonatal near miss in this study. Ensuring a continuum of care from antepartum to intrapartum; strengthening ANC, attention to primiparous, and referral linkage might have a contribution to minimize neonatal near miss cases