Determinants of preterm neonatal mortality in two rural district hospitals of Gatsibo, Rwanda

Preterm birth remains a critical global health issue, contributing to approximately one-third of neonatal deaths worldwide. In Rwanda, complications of preterm birth contributed to the second cause on neonatal mortality with specifically two district hospitals (i.e. Kiziguro and Ngarama) located in Gatsibo district reported threefold higher preterm neonatal mortality as compared to national average. We aimed to determine the proportion and determinants of preterm neonatal mortality in two rural hospitals in Gatsibo district, Rwanda. We conducted a retrospective cross-sectional study using records of all preterm neonates admitted to Kiziguro and Ngarama hospital neonatal units, between January 2020 and December 2024. Data were extracted from neonatal files and maternity registers. Descriptive statistics were used to describe the study variables. Bivariate and multivariable logistic regression analyses were conducted to identify the determinants of preterm neonatal mortality. We reported odds ratios, 95% CIs, and p values, and we set the significance at the 95% confidence level. The majority of preterm deaths occurred at Kiziguro district hospital (21.0%, n = 1217). The determinants of preterm neonatal mortality were early gestational age (aOR = 2.47, 95% CI: 1.30–4.65), neonatal sepsis (aOR = 3.35, 95% CI: 1.98–5.69), hypothermia (aOR = 1.72, 95% CI: 1.12–2.66), need for special care unit services (aOR = 5.32, 95% CI: 2.61–11.96), poor respiratory support (aOR = 7.63; 95% CI: 3.69–15.80), poor bilirubin management (aOR = 2.82, 95% CI: 1.50–5.27), and inadequate kangaroo mother care practices (aOR = 51.82, 95% CI: 31.77–84.51). The proportion of preterm mortality was approximately similar to the national figures. Key determinants associated with preterm neonatal mortality included: early gestational age, maternal infections, inadequate kangaroo mother care (KMC), neonatal sepsis and inadequate respiratory support. Thus, continuous neonatal capacity building, improved KMC practices, appropriate use of neonatal equipment and regular cleanliness are recommended. Preterm birth is the major leading cause of neonatal and under five-year mortality worldwide, especially in low- and middle-income countries. - This study identified determinants of preterm neonatal mortality in Gatsibo district, which is different from the findings of other studies, such as the provision of respiratory support and limited specialized care (neonatal intensive care). - Some regions may have a higher preterm neonatal mortality rate than the national level. The findings of this study may provide insight into the urgent need for maternal and neonatal health programs in low- and middle-income countries. - This study may be used as evidence to prioritize resource allocation to district hospitals.