Determinants of neonatal near miss among neonates admitted at Bahir Dar public hospitals, North West Ethiopia: A case-control study

Background: Neonatal near miss is a significant public health issue in Ethiopia. Previous studies have often overlooked health system-related and behavioral factors of neonatal near miss. This study aimed to identify determinants of neonatal near misses in Bahir Dar public hospitals to fill those gaps in the aforementioned studies. Methods: An unmatched case-control study was conducted in Bahir Dar public hospitals from October to December 2022, involving 443 neonates (147 cases, 296 controls). Cases were recruited consecutively, while controls were selected using systematic sampling. Data were collected using a pre-tested structured interviewer-administered questionnaire at discharge and from patients' cards using Epicollect5. Data were analyzed with SPSS version 26 for bivariable and multivariable binary logistic regression at a 95% confidence interval (CI). The Hosmer and Lemeshow test checked the model fit, with p-value <0.05 considered significant. Results: Determinants of neonatal near misses included not receiving exclusive breastfeeding within an hour of delivery [AOR = 3.13, 95% CI: 1.25, 7.83], a history of pregnancy-induced hypertension [AOR = 5.55, 95% CI: 2.34, 12.85], fewer than four antenatal care visits [AOR = 8.38, 95% CI: 3.62, 19.44], and travel time over an hour to reach health facilities [AOR = 6.55, 95% CI: 2.56, 16.78]. Conclusion and recommendation: Delayed initiation of exclusive breastfeeding, pregnancy-induced hypertension, travel time to health facilities, and the number of antenatal care visits were key determinants of neonatal near miss. Enhancing maternal health services, such as exclusive breastfeeding practices, increasing antenatal visits, improving ambulance accessibility, and prioritizing mothers with pregnancy-induced hypertension, is essential.