Determinants of neonatal mortality in East Azarbaijan province: a population-based study from Iran

Neonatal mortality continues to pose a major challenge to achieving global sustainable development goals, especially in low- and middle-income countries. Consequently, this study focused on examining the factors influencing neonatal mortality in the East Azarbaijan province, Iran. A cross-sectional study based on population data was conducted utilizing the Iranian Maternal and Neonatal (IMAN) Network data (2018–2019). A multilevel binary logistic analysis was employed to determine the key factors influencing neonatal mortality. Adjusted Odds Ratios and population attributable risk (PAR) for the identified risk factors were presented. The neonatal mortality rate in East Azarbaijan province was 7.37 deaths per 1000 live births. Multivariate analysis indicated that neonates weighing less than 1000 g at birth with OR = 35.23 (PAR = 20.14%); 1000–1500 gram with OR = 12.85 (PAR = 8.03%) and 1500–2500 gram with OR: 3.24 (PAR = 1.62%), babies born with gestational age < 28 weeks was OR = 13.28 (PAR = 8.29%), 28–31 weeks OR = 6.81 (PAR = 4.10), 32–36 weeks OR = 4.33 (PAR = 2.39), male neonates OR = 1.41 (PAR = 0.30), stillbirth history of mothers OR = 2.24 (PAR = 0.90) were significantly associated with higher odds of neonatal mortality. The current study identified significant factors such as birth weight, gestational age, and a history of stillbirths among mothers as contributors to increased neonatal mortality. Prematurity (gestational age of < 37 weeks) and low birth weight (< 2500 g) together account for approximately 45% of the risk of neonatal deaths. Strategies to reduce neonatal mortality should prioritize the prevention of preterm births.