Prevalence and factors associated with neonatal mortality at Masaka Regional Referral and Teaching Hospital in central Uganda: A facility based cross sectional study

Background: Globally, approximately 4 million of the 130 million infants born each year die within their first 28 days of life, accounting for nearly 46% of all under five deaths. Neonatal mortality—the death of a live-born infant within the first 28 days—remains a critical public health issue, particularly in Sub-Saharan Africa and Uganda, with rates of 27 and 22 deaths per 1,000 live births, respectively, contributing more than twice the World Health Organization's target of fewer than 12 per 1,000. Despite this burden, data on the prevalence and contributing factors to neonatal mortality remain scarce in many low- and middle-income countries (LMICs), including Masaka Regional Referral and Teaching Hospital (MRRTTH), which hampers the development of effective, evidence-based policies and interventions. The primary objective of this study was to assess the prevalence and key determinants of neonatal mortality, and the secondary objective was to evaluate the patterns of maternal and neonatal healthcare service utilization and their associations with neonatal outcomes at MRRTTH. The study hypothesized that neonatal mortality at MRRTTH mirrors the national average and that there are no significant associations between neonatal mortality and major sociodemographic variables. Methods: A facility-based cross-sectional study of 378 participants was conducted between October and November 2020 at the postnatal ward, neonatal intensive care unit (NICU), and Young Child Infant Clinic of MRRTTH. The mothers and/or caregivers of the neonates were randomly selected. Data were collected via an open data kit (ODK) via a researcher-administered electronic questionnaire. Descriptive statistics and regression analyses were performed via R Studio (version 4.4.1). Results : A total of 20.9% of the participants reported a history of neonatal death from birth asphyxia (44.3%), prematurity (27.8%), neonatal sepsis (17.7%), or other causes (10.1%). The factors associated with increased odds of neonatal mortality included maternal age 30–39 years, p <0.05 ^* , 95% CI (0.37–3.55), age 40–49 years, p <0.05 ^** , 95% CI (0.95–4.51), pregnancy complications p <0.05 ^*** , 95% CI (0.77–1.91) and the perception of the need for staff recruitment, p<0.05**, 95% CI (0.29–1.55). Conclusion : Neonatal mortality at MRRTH remains high, with birth asphyxia, prematurity, and neonatal sepsis as the primary causes. Key associations include advanced maternal age, pregnancy-related complications, and the perception of inadequate staffing. Clinical trial number : not applicable