Abstract:
Background: Despite global efforts to reduce neonatal mortality, deaths within the first 24 hours
remain a critical challenge, with Sub-Saharan Africa bearing the highest burden. Magnitude and
geographic disparities in newborn mortality within 24 hours remain unexplored in Sub-Saharan
Africa. Understanding these variations and identify factors correlated with newborn mortality
within 24 hours after birth is essential to enhance targeted interventions.
Objective: To assess the prevalence, spatial variation and determinants of mortality among
newborns on the day of birth in Sub-Saharan Africa using DHS 2015 to 2024
Methods: A secondary data analysis of 308,775 live births from 28 Sub-Saharan countries was
conducted. Data extraction, cleaning, and recoding were conducted using STATA 17.
Descriptive spatial analysis was conducted using ArcGIS 10.7 and SatScan 9.6. Spatial
multilevel analysis was performed using Spatial Delta-Generalized Linear Mixed Models
Template Model Builder approach in R software to identify covariates associated with newborn
mortality on the day of birth. A Gaussian Markov random field was used to incorporate
conditional dependencies using a sparse precision matrix. Model performance was assessed
using Deviance and Akaike information criterion. Variables with a p-value <0.05 were
considered statistically significant.
Result: The pooled prevalence of newborn mortality on the day of birth in Sub-Saharan Africa
was 15 per 1,000 live births (95% CI: 13.00, 16.00). Maternal age 15-19 years (AOR = 1.77,
95% CI: 1.55, 2.02), 35-49 years, (AOR = 1.27, 95% CI: 1.17, 1.38), absence of immediate
postnatal care (AOR = 1.21, 95% CI: 1.10, 1.33), underweight birth (AOR = 9.46, 95% CI: 8.53,
10.50), overweight birth (AOR = 2.09, 95% CI: 1.83, 2.38), cesarean section deliveries, (AOR =
1.35, 95%CI: 1.20, 1.51), multiple pregnancies (AOR = 5.07, 95% CI: 4.61, 5.59), non ANC
visits (AOR = 1.26, 95%CI: 1.08, 1.45), preterm birth (AOR = 1.74, 95% CI: 1.57, 1.92), and
consumption of unimproved sources of drinking water (AOR = 1.10, 95% CI: 1.02, 1.19) were
significant determinants of newborn mortality on the day of birth
Conclusion: The combined prevalence of mortality among newborns on the day of birth in SubSaharan
Africa
was
higher
than
global
targets,
which
is
<12
per
1000
live
births,
with
individual
and
community-level factors playing a significant role. This study highlights the need for
geographically targeted interventions, focusing on antenatal and postnatal care
