Reducing neonatal mortality in low resource settings through implementation of evidence based interventions

Neonatal mortality remains a major public health challenge, particularly in low-resource settings where progress in reducing newborn deaths has lagged behind improvements in overall child survival. Approximately 2.3 million newborns died globally in 2024, and the neonatal mortality rate in sub-Saharan Africa was approximately 27 deaths per 1,000 live births, more than twice the Sustainable Development Goal target of 12 deaths per 1,000 live births. This article examines current evidence on the determinants of neonatal mortality and argues for a shift from identifying risk factors toward implementing effective interventions. Existing research consistently demonstrates the contribution of maternal complications, intrapartum events, neonatal conditions, and health-system constraints to neonatal mortality. Evidence from Ethiopia and other low-resource settings indicates that many of these determinants are preventable through proven maternal and newborn health interventions. Evidence from Ethiopia also demonstrates measurable benefits of implementation-focused approaches; a quality improvement project at Gandhi Memorial Hospital in Addis Ababa was associated with a 25.6% reduction in prematurity-related neonatal mortality. Recent findings from neonatal intensive care units in Addis Ababa further highlight the persistence of preventable causes of neonatal death despite the availability of evidence-based interventions, underscoring a critical gap between knowledge generation and implementation. Future efforts should prioritize implementation science, quality improvement, and health-system strengthening to ensure that proven interventions are delivered consistently and at scale. Greater emphasis on translating evidence into routine practice may yield larger improvements in neonatal survival than continued reliance on descriptive epidemiological studies alone. Moving from risk factor identification to effective implementation offers the greatest opportunity to accelerate progress toward global newborn survival targets and reduce preventable neonatal deaths in low-resource settings.