Predictors of neonatal mortality among neonates admitted to public general hospitals in southern zone of Tigray, Ethiopia, 2021: unmatched case-control study

Neonatal mortality is a crucial indicator of neonatal health status. Globally, 2.3 million children died in the first four weeks of life in 2022, or approximately, 6500 deaths every day. Almost all (98%) neonatal deaths take place in low- and middle-income countries. The current reduction rate in neonatal mortality has been slower as compared to that of under-five mortality. Knowing the context-specific factors of neonatal mortality is paramount. Therefore, the aim of this study was to assess determinant factors associated with neonatal mortality in general hospitals of the southern zone of Tigray, Ethiopia, 2021. Methods An institution-based unmatched case-control study was conducted using data from neonate charts admitted to the neonatal intensive care unit between 2017 and 2020 at general hospitals of the southern zone of Tigray, Ethiopia. Data were entered into EpiData Version 4.6 software and exported to SPSS Windows version 22 for analysis. Multiple logistic regression analysis was undertaken to test associations with a P-value of < 0.05 (95% confidence interval (CI)) as a cutoff point to determine statistical significance. Results Using a systematic random sampling technique, a total of 495 (165 cases and 330 controls) neonatal charts were reviewed during the study period with a chart retrieval rate of 97%. This study found that instrumental delivery (AOR = 2.96: (95% CI: 1.56, 5.64; p = 0.001)), cesarean delivery (AOR = 1.29:(95% CI: 1.29, 3.41; p = 0.033 )), birth asphyxia (AOR = 4.93: (95% CI: 2.40, 10.14; p < 0.001)), presence of infections (AOR = 5.08: (95% CI: 2.95, 8.76; p = 0.001 )), and meconium aspiration syndrome (AOR = 1.98: (95% CI: 1.22, 3.23; p = 0.006)) were statistically significant predictors of neonatal mortality. Conclusion Findings of this study indicate that mode of delivery, birth asphyxia, neonatal infections, and meconium aspiration syndrome were independently significant factors for neonatal mortality. The finding of this study suggests that several of the identified factors may be amenable to improvement through strengthened intrapartum, postpartum, and neonatal care services. Therefore, attention should be given to basic emergency obstetric and newborn care, neonatal intensive care unit service, and health care providers capacity building should be prioritized. Clinical trial number Not applicable.