Disparities in Neonatal Mortality and Newborn Care Practices Across Urban and Rural Communities in Adamawa State, North East Nigeria

Nigeria accounts for one of the highest absolute numbers of neonatal deaths globally, and intra-state disparities between urban and rural communities in the North East zone represent a critical and underexamined dimension of this burden. This study examines disparities in neonatal mortality rates and newborn care practices between urban and rural communities in Adamawa State. A mixed-methods cross-sectional design is applied to 320 mothers of live-born infants within the preceding 12 months, drawn from urban communities in Yola North and Jimeta, and rural communities in Song, Gombi, and Mayo-Belwa local government areas through stratified multistage sampling. Retrospective birth history interviews capture neonatal mortality rates, while a newborn care questionnaire assesses cord care, breastfeeding initiation, thermal care, birth asphyxia recognition, and care-seeking for neonatal danger signs. Mortality rates are compared using chi-square tests, and multivariate logistic regression identifies predictors of suboptimal newborn care. In-depth interviews with 20 mothers and ten community midwives explore barriers to optimal newborn care in rural settings. Adamawa State's 2022 Health Management Information System data estimate neonatal mortality rates three times higher in rural than urban settings. The Every Newborn Action Plan's four high-impact intervention domains guide the analytical framework. Findings will support Adamawa State's Integrated Maternal, Newborn and Child Health programme in addressing rural-urban service delivery gaps. Keywords: neonatal mortality, newborn care, urban-rural disparities, Adamawa State, North East Nigeria.