Factors Associated with Neonatal Mortality at the Mother and Child University Hospital of N'Djamena (Chad): A Retrospective Cohort Study

Introduction: Neonatal mortality is a major public health concern, especially in developing countries such as Chad. It is the result of several factors contributing to the maintenance of a high rate. The objective of this study was to determine the factors associated with hospital-based neonatal mortality at the Mother and Child University Hospital of N'Djamena in Chad. Methods: This was a retrospective cohort study conducted in the neonatology department of the Mother and Child University Hospital of N'Djamena and involved 1264 newborns hospitalized in the department in 2021. A logistic regression model was used to determine the factors associated with neonatal death, with a significance level of p<0.05. The variables of the final model were selected by a top-down approach based on the Akaike information criterion. Results: The cumulative incidence of deaths was 28.7% [26.4%; 31.3%]. The most lethal pathologies were: hypoxic-ischemic encephalopathy (53.5%), prematurity (47.5%), respiratory distress (45.9%), hypotrophy (43.6%), and hemorrhagic disease of the newborn (43.6%). In multivariate analysis, the factors associated with neonatal death were: preterm birth (OR=3.37 [2.27; 5.04]), hypotrophy (OR=2.32 [1.63; 3.31]), respiratory distress (OR=2.97 [2.06; 4.30]), hypoxic-ischemic encephalopathy (OR=1.85 [1.20; 2.88]), cyanosis (OR=2.67 [1.60; 4.51]), impaired consciousness (OR=2.05 [1.41; 2.98]), primary reflex abnormalities (OR=3.69 [2.46; 5.58]), blood transfusion (OR=2.23 [1.13; 4.42]), delivery outside the university hospital (OR=2.93 [2.09; 4.14]) and insufficient prenatal consultations (OR=1.42 [1.02; 1.98]). Conclusion: Hospital-based neonatal mortality is high at the Mother and Child University Hospital of N'Djamena. The implementation of maternal and neonatal health actions based on the identified risk factors will contribute to its reduction.