Abstract:
Background: Neonatal mortality is a major global public health challenge, especially
pronounced in low- and middle-income countries, with a notable impact in Sub-Saharan
Africa. Although there are studies done on neonatal mortality in different areas, as to our search
of pieces of literature, there is a limited study on pooled prevalence, spatial distribution, and
determinants of neonatal mortality in sub-Saharan Africa after initiation of sustainable
development goal.
Objective: To assess pooled prevalence of neonatal mortality, its spatial distribution and
associated factors in Sub-Saharan Africa countries based on Demographic and Health Survey
2015 to 2023.
Methods: Community based cross-sectional study was conducted among a weighted sample
of 294,410 mothers of live birth in Sub-Saharan Africa countries. The source data was
Demographic and Health Survey conducted from 2015 to 2023 in 26 Sub Saharan African
countries. The global spatial autocorrelation was assessed using the global Moran’s-I to
evaluate the spatial clustering of neonatal mortality. Significant clusters with high and low
rates of neonatal mortality were explored. A multilevel binary logistic regression was fitted to
identify the significant determinants of neonatal mortality. Variables with a p-value < 0.02 in
the bivariate analysis were considered in the multivariable analysis. Adjusted Odds Ratio
(AOR) with 95% Confidence Interval (CI) at p value<0.05 were reported to declare statistically
significant determinants of neonatal mortality.
Result: - The pooled prevalence of neonatal mortality in sub-Saharan African countries was
25.87 (95% CI, 23.71, 28.23) per 1000 live births. Hot spot areas were located in Nigeria,
Benin, the western part of Senegal, Guinea, the western part of Burkina Faso, Malawi, central
Ethiopia, Uganda, the central part of Madagascar, and Angola. In multilevel analysis Mother’s
with age >35 years (AOR=1.38, 95%CI:1.25,1.52), male neonates (AOR=1.31,95% CI:
1.21,1.42), smaller birth weight (AOR=2.90, 95%CI:2.44,3.44) and large birth weight
(AOR=4.11, 95%CI:3.67,4.60), birth interval less than 2 years (AOR=1.77,95%CI:1.6-1.96),
late initiation of breast feeding (AOR=3.79,95%CI:3.45,4.16), multiple birth newborns
(AOR=9.22,95%CI:7.99,10.64), had no ANC visit (AOR=1.50,95%CI:1.32,1.70), and C/S
delivery (AOR=1.43,95%CI:1.2,1.66),rural residence (AOR=1.22,95%CI:0.75, 1.38) and
unimproved water source (AOR=1.2,95%CI:1.02,1.31) were statistically significant variables
for neonatal mortality.
Conclusion: - Neonatal mortality in sub-Saharan Africa was unacceptably high and the spatial
distribution of neonatal mortality was significantly varied across the sub-Saharan African
country. Both individual and community-level factors were significantly associated with the
neonatal mortality. Therefore, public health programmers and other stalk holders who are
involved in neonatal and maternal healthcare should work together and give priority to hotspot
areas of neonatal mortality in sub-Saharan Africa.
