DETERMINANTS OF NEONATAL MORTALITY AND EVALUATION OF NEONATAL RESUSCITATION SERVICES AT SECONDARY CARE HOSPITAL OF DISTRICT PAKPATTAN

Abstract

Neonatal mortality remains a critical public health challenge, particularly in low- and middle-income countries, where preventable causes continue to contribute significantly to under-five child deaths. Despite being a national health priority, neonatal deaths remain high due to inadequate antenatal care, birth complications, infections, and limited access to quality neonatal care services. Identifying the determinants of neonatal mortality and assessing the availability and readiness of neonatal resuscitation services are essential steps toward improving newborn survival and achieving Sustainable Development Goals (SDGs). This study aimed to determine the prevalence of neonatal mortality, identify associated factors contributing to neonatal deaths, and assess the availability and quality of neonatal resuscitation services at District Headquarters (DHQ) Hospital, Pakpattan. A quantitative cross-sectional study was conducted at DHQ Hospital Pakpattan from May to July 2025. A total of 160 mothers and their newborns were selected through a simple random sampling technique. Data were collected using a structured questionnaire, hospital records, and a neonatal resuscitation facility assessment checklist adapted from the World Health Organization Service Availability and Readiness Assessment (WHO-SARA) guidelines. Data were analyzed using SPSS version 26. Descriptive statistics, including mean, standard deviation, frequencies, and percentages, were calculated. Associations between neonatal mortality and independent variables were assessed using chi-square tests and independent sample t-tests. Multiple binary logistic regression analysis was performed to identify independent predictors of neonatal mortality. A p-value <0.05 was considered statistically significant. Among the 160 newborns included in the study, 25 deaths were recorded, indicating a neonatal mortality prevalence of 15.6%. Bivariate analysis showed significant associations between neonatal mortality and maternal education, need for neonatal resuscitation, birth asphyxia, neonatal sepsis, antenatal care visits, birth weight, and one-minute APGAR score (p<0.05). No significant association was observed with postnatal visits, mode of delivery, availability of equipment, place of residence, maternal age, and parity. Multivariable logistic regression analysis revealed that the number of antenatal care visits (AOR=0.682, p=0.036) and one-minute APGAR score (AOR=0.652, p=0.027) were significant independent predictors of neonatal mortality. However, after adjusting for birth weight, birth hypoxia, and neonatal infection, these associations lost statistical significance. The study concluded that neonatal mortality remains high at DHQ Hospital Pakpattan. Lower APGAR scores and inadequate antenatal care were identified as important factors associated with neonatal deaths. Strengthening antenatal care services, improving early newborn assessment, ensuring timely neonatal resuscitation, and enhancing the quality of maternal and neonatal healthcare services may significantly reduce preventable neonatal deaths.