Survival Status and Risk Factors for Neonatal Mortality in a Byumba Level Two Teaching Hospital: A Prospective Cohort Study

Abstract Neonatal mortality remains a major public health issue in Rwanda, contributing to more than 42% of underfive deaths despite overall improvements in child survival. This prospective cohort study aimed to identify key factors influencing neonatal survival among 385 newborns admitted to the neonatology unit at Byumba Level Two Teaching Hospital between May and October 2024. The data were analyzed via SPSS version 28, with survival assessed via Kaplan‒Meier curves and predictors identified via Cox proportional hazards models. The study revealed that 89.9% of neonates survived, whereas 10.1% died during the neonatal period. Several factors were significantly associated with increased mortality risk. Maternal education level was a strong predictor: neonates born to mothers with no formal education faced the highest risk of death (AHR = 19.329; p = 0.002), followed by those whose mothers had primary or secondary education. Limited antenatal care (fewer than three visits) also increased mortality risk (AHR = 3.576; p = 0.005). Other key risk factors included low APGAR scores at one minute (AHR = 4.251; p = 0.003), multiple gestations (AHR = 3.264; p = 0.001), the need for resuscitation at birth (AHR = 2.527; p = 0.014), and the need for respiratory support (AHR = 2.548; p = 0.028). Neonatal infections were the strongest predictor of mortality (AHR = 16.306; p < 0.001). The absence of Kangaroo Mother Care and low birth weight were also associated with poorer outcomes. The findings underscore the need for targeted, evidence-based interventions to improve neonatal survival and inform policy and health planning in Rwanda.