Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

Abstract

Background: Unlike the infant mortality rate, the rate of neonatal mortality has not declined and remains a major health challenge in the low- and middle-income countries. There is an urgent need to focus on newborn care, especially during the first 24 hours after birth and the early neonatal period. Neonatal near miss (NNM) is an emerging concept similar to that of maternal near miss. NNM events occur three to eight times more often than the neonatal deaths. The objective of this study was to establish the prevalence of NNM and identify its associated factors. Methods: A hospital-based cross-sectional study was conducted at Koshi Hospital, Morang district, Nepal. Neonates and their mothers of unspecified maternal age and number of gestational weeks were enrolled. The key inclusion criterion was the pragmatic and management markers of NNM, and admission of newborn infants to the neonatal intensive care unit (NICU) in Koshi Hospital. Non-Nepali citizens were excluded. Consecutive sampling was used until the required sample size of 1,000 newborn infants was reached. Simple and multiple logistic regression analysis was performed using SPSS® version 24.0.Results: One thousand respondents were recruited. The prevalence of NNM was 79 per 1,000 live births. Severe maternal morbidity (adjusted odds ratio (AOR): 4.51, 95% confidence interval (CI): 2.07–9.84), maternal secondary (AOR: 0.46, 95% CI: 0.24–0.88) and tertiary education (AOR: 0.18, 95% CI: 0.05–0.56), multiparity (AOR: 0.52, 95% CI: 0.39–0.86), and caesarean section (AOR: 0.48, 95% CI: 0.19–0.99) were associated with NNM. Conclusions: The prevalence of NNM in Nepal was 7.9%. Mothers’ obstetric factors, maternal complications and education were associated with NNM. Referral hospitals should have safer access to caesarean section and be prepared to offer NICU intervention to save mothers and their newborns.