Incidence and predictors of mortality among asphyxiated neonates in Ethiopia, 2025: a prospective follow-up study

In environments with limited resources, birth asphyxia remains a major cause of neonatal mortality. There is little information on the outcomes and predictors of mortality among asphyxiated newborns in Ethiopia, despite efforts to improve neonatal care. Therefore, this study aimed to assess the incidence and predictors of mortality among asphyxiated neonates in Southern Ethiopia. A prospective follow-up study was carried out on 418 systematically selected asphyxiated newborns admitted to hospitals in the Sidama region and Gedio Zone, Ethiopia. Neonates were followed until discharge or the end of the study. Kaplan-Meier curves and log-rank tests were used to assess and compare survival time. Bivariate and multivariable Cox regression models were used to examine predictors associated with mortality. The model assumption was checked by a global test. In the multivariable analysis, variables with p < 0.05 were considered statistically significant to determine the predictors of death. A total of 480 neonates were followed for 2,744 person-days. The mortality rate was 29.7% (95% CI; 25.5, 34.2). The incidence density and median survival time were 45.51 (95% CI: 37.79, 53.89) per 1000 person-days and 20 (95% CI: 15, 27) days, respectively. Low birth weight [AHR: 2.56; 95% CI (1.15, 5.6)], low oxygen saturation [AHR (adjusted hazard ratio): 9.28; 95% CI (2.28, 38.71)], pregnancy-induced hypertension [AHR: 2.78; 95% CI (1.70, 4.54)], inadequate antenatal care visits [AHR: 1.73; 95% CI (1.03, 2.91)], shock [AHR: 2.80; 95% CI (1.31, 4.64)], obstructed labour [AHR: 1.89; 95% CI (1.08, 3.31)], and prolonged labour [AHR: 2.79; 95% CI (1.81, 4.30)] were significant predictors for mortality of asphyxiated neonates. The mortality rate among asphyxiated neonates was high. Inadequate antenatal care visits, pregnancy-induced hypertension, low birth weight, low oxygen saturation, obstructed labour, prolonged labour, and shock were significant predictors for neonatal mortality. To decrease this burden, the ANC and intrapartum monitoring should be strengthen, along with neonatal resuscitation training. Moreover, healthcare professionals, the Federal Ministry of Health, policymakers, and stakeholders should work together and focus on improving care for asphyxiated neonates.