Empirical Analysis of Neonatal Mortality and Its Predictors at Tertiary Hospitals in Anambra State, South East Nigeria

Neonatal mortality accounts for nearly half of all under-five deaths globally, yet neonatal-specific data from south-eastern Nigeria remain scarce, limiting evidence-based policy. This prospective cohort study determines the incidence, cause-specific proportions, and independent predictors of neonatal mortality at two tertiary hospitals in Anambra State, South East Nigeria over a 24-month period from January 2022 to December 2023. All consecutive live births admitted to the neonatal units were enrolled, yielding a cohort of 1,842 neonates. Standardised data collection tools captured gestational age, birth weight, Apgar score, mode of delivery, maternal risk factors, primary diagnosis, and outcome. Primary diagnosis at death was assigned by the attending paediatrician. Neonatal mortality rate was 32.6 per 1,000 live births. Birth asphyxia (28.4%), neonatal sepsis (26.1%), and respiratory distress syndrome of prematurity (22.8%) were the leading causes of neonatal death. Multivariate Cox proportional hazards analysis identified very low birth weight (HR 5.4), Apgar score below 7 at five minutes (HR 4.2), and lack of antenatal care (HR 2.9) as the strongest predictors of neonatal death. Most deaths (68.3%) occurred within the first 72 hours of life, highlighting the critical early neonatal period. The study recommends prioritising antenatal care attendance, skilled birth attendance, and early neonatal stabilisation as high-impact strategies to reduce neonatal mortality in south-eastern Nigeria. Keywords: neonatal mortality, birth asphyxia, neonatal sepsis, Anambra State, South East Nigeria.