Introduction: Neonatal Near-Miss (NNM) cases refer to situations in which babies are on the verge of dying between the ages of 0 and 27 days due to severe morbidity that occurs during pregnancy, delivery, or extra-uterine life, but survive either by luck or due to high-quality treatment. A comprehensive and relevant approach to reduce neonatal death can be devised by assessing NNM cases and addressing determinants. Hence, this study aimed at finding out the determinants of NNM in neonates admitted to public hospitals in southern Ethiopia, 2021.
Methods: A hospital-based unmatched case-control study was conducted in three selected hospitals in southern Ethiopia from May 1 to June 30, 2021. A total of 484 participants took part in the study (121 cases and 363 controls). Controls were chosen using systematic sampling approaches, whereas cases were recruited consecutively at the time of discharge. Cases were chosen based on the Latin American Centre for Perinatology (CLAP) criteria of an NNM. Data were collected using an interviewer-administered structured questionnaire and a data abstraction tool. The Data were entered into Epi-Data version 3.1, after which it was exported to SPSS version 23 for analysis. A multivariable logistic regression analysis with a p-value of <0.05 was used to determine the determinants of NNM.
Results: The pragmatic and management criteria were encountered by 97 (80.1%) and 56 (46.2%) of cases, respectively. The most common pragmatic and management criteria were gestational age less than 33 weeks (44.6%) and intravenous antibiotic usage up to 7 days and before 28 days of life (27.3%), respectively. A short birth interval [AOR=2.15, 95% CI: 1.29, 3.57], lack of ANC [AOR=3.37; 95% CI: 1.35, 6.39], Caesarean mode of delivery [AOR=2.24; 95% CI: 1.20, 4.16], the occurrence of a third maternal delay [AOR=3.47; 95% CI: 2.11, 5.75], and poor Birth Preparedness and Complication Readiness (BPCR) plan [AOR=2.50; 95% CI: 1.49,4.13] were identified as a significant determinants of NNM.
Conclusion and recommendation: Stakeholders at the zonal and regional levels need to step up their efforts to address the barriers that prevent health facilities from providing adequate and appropriate care. Furthermore, to prevent major neonatal problems, women who have not had an ANC and who deliver by Cesarean section require closer attention from their family and health care providers. Finally, health care providers at the community (HEWs) and facility levels need to work together to improve BPCR practice and contraceptive provision.