Neonatal Mortality and Associated Factors among Neonatesin Kiryandongo Refugee Settlement, Western Uganda

Authors

  • Henry Irumba Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • Abudulmujeeb Babatunde Aremu Department Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • Swaibu Zziwa Department Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda Department of Public Health, Faculty of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
  • Naziru Rashid Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • Adinani Andama Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • James Nguza Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • Amina Byobona Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • Muhammad Alhassan Usman Tanimu Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • Ziada Nankinga Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • Sumayah Nakitende Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda
  • Kharim Mwebaza Muluya Department of Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda Department of Research and Innovations, Busoga Health Forum, Jinja, Uganda

DOI:

https://doi.org/10.26911/

Abstract

Background: Death of a live-born baby within the first 28 days of life remains a critical global public health concern, particularly in low- and middle-income countries such as in sub-Saharan African, where refugee settlements often show higher varying neonatal mortality rates. This study aimed at assessing neonatal mortality rate and associated factors among neonates in Kiryandongo Refugee Settlement, Western Uganda.

Subjects and Method: The study used a facility based retrospective cross-sectional design involving all neonates (0-28days) admitted over a 5-year study period at Panyadoli Hospital.  A total of 510 records of neonatal admissions selected using systematic sampling. Logistic regression analysis was used to determine the factors associated with neonatal mortality and odds ratio was used as a measure of association. All statistical tests were two-tailed and p-value less than 0.05 were considered significant.

Results: The neonatal death rate was 43 per 1,000 admissions. Neonatal mortality was significantly higher among mothers aged 25–34 years (aOR= 3.85; 95% CI= 1.74 to 8.90; p= 0.038) and ≥35 years (aOR= 7.88; 95% CI= 1.01 to 15.29; p= 0.049). It was also significant to those mothers delivering at home or in the community (aOR= 7.72; 95% CI= 2.04 to 31.45; p= 0.011), and those with pregnancy complications (aOR= 3.6; 95% CI= 1.93 to 8.14; p <0.001). Conversely, skilled birth attendance (aOR= 0.49; 95% CI= 0.21 to 0.69; p= 0.047) and an Apgar score of 4–6 at 1 minute (aOR= 0.12; 95% CI= 0.03 to 0.44; p= 0.002) were identified as protective factors.

Conclusion: This study found a high neonatal mortality rate of 43 deaths per 1,000 admissions, highlighting the urgent need to strengthen antenatal, intrapartum, and postnatal/postpartum maternal and neonatal care to improve neonatal survival.

Keywords:

neonatal mortality, associated factors, neonates, refugee settlement, maternal health

Published

2026-07-16

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Issue

Vol. 11 No. 4 (2026)

Section

Articles

How to Cite

Neonatal Mortality and Associated Factors among Neonatesin Kiryandongo Refugee Settlement, Western Uganda. (2026). Journal of Maternal and Child Health, 11(4), 226-243. https://doi.org/10.26911/

How to Cite

Neonatal Mortality and Associated Factors among Neonatesin Kiryandongo Refugee Settlement, Western Uganda. (2026). Journal of Maternal and Child Health, 11(4), 226-243. https://doi.org/10.26911/

Author Biographies

Henry Irumba

Department Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda

Abudulmujeeb Babatunde Aremu

Department Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda

Swaibu Zziwa

Department Public Health, Faculty of Health Sciences, Islamic University in Uganda, Kampala, Uganda

 Department of Public Health, Faculty of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda

References

Asadollahi K, Karimi A, Rezaei N, Mussavi M, Azizi M, Daliri S (2024). The apgar score: A predictor of clinical adverse outcomes during the neonatal period. J Bas Res Med Sci. 11(2):22-32. https://¬jbrms.medilam.ac.ir/article-1-794-en.pdf.

Austin A, Langer A, Salam RA, Lassi ZS, Das JK, Bhutta ZA (2014). Approaches to improve the quality of maternal and newborn health care: an overview of the evidence. Reprod Health. 11 (2):S1. https://doi.org/10.1186/1742-4755-11-s2-s1.

Campbell OMR, Aquino EML, Vwalika B, Gabrysch S. (2016). Signal functions for measuring the ability of health facilities to provide abortion services: an illustrative analysis using a health facility census in Zambia. BMC Pregnancy and Childbirth, 16(1): 105. https://doi.org/10.1186/s12884-016-0872-5.

CDC. (2022). Infant mortality rates by state. Retrieved from https://www.cdc.gov¬/nchs/state-stats/deaths/infant-mortality.html.

Cnattingius S, Johansson S, Razaz N (2020). Apgar score and risk of neonatal death among preterm infants. N Engl J Med. 383(1):49-57. https://doi.org/10.105-6/nejmoa1915075.

Cubitt RP, Starmer C, Sugden R (1998). On the validity of the random lottery incentive system. Experimental Econo¬mics. https://doi.org/10.1023/A:102-6435508449.

Dalawi I, Isa MR, Chen XW, Azhar ZI, Aimran N. (2023). Development of the Malay Language of understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAP¬HQ C-19): content validity & face validity analysis. BMC Public Health, 23(1): 1131. https://doi.org/10.1186¬/s12889-023-16044-5.

Desalew A, Sintayehu Y, Teferi N, Amare F, Geda B, Worku T, Abera K, Asefaw A (2020). Cause and predictors of neonatal mortality among neonates admitted to neonatal intensive care units of public hospitals in eastern Ethiopia: a facility-based prospective follow-up study. BMC Pediatrics, 20(1): 160. https://doi.org/10.1186/-s12887-020-02051-7.

Egesa WI, Odong RJ, Kalubi P, Yamile EAO, Atwine D, Turyasiima M, Kiconco G, et al. (2020). Preterm neonatal mortality and its determinants at a tertiary hospital in Western Uganda: a pros¬pective cohort study. Pediatric Health Med Ther. 11: 409–420. https://doi.-org/10.2147/phmt.s266675.

Ely DM, Driscoll AK. (2022). Infant morta-lity in the United States, 2020: data from the period linked birth/infant death file. In: National Vital Statistics Reports [Internet]. Hyattsville (MD): National Center for Health Statistics (US). 73(5). Available from: https://-www.ncbi.nlm.nih.gov/books/NBK606163/ doi: 10.15620/cdc/157006.

Engelhardt M, Gaudion M, Kamhiye J, Al-Munjid R, Borde T. (2022). Consequ-ences of housing conditions on mater-nal health of forced migrant women. Eur J Public Health. 32(3): ckac131.4-65. https://doi.org/10.1093/eurpub/-ckac131.465.

Israel GD. (1992). Determining sample size. Retrieved from https://www.gjimt.ac.¬in/web/wp-content/uploads/2017/10¬/2_Glenn-D.-Israel_Determining-Sample-Size.pdf

Kananura RM, Tetui M, Mutebi A, Bua JN, Waiswa P, Kiwanuka SN, Ekirapa-Kiracho E, Makumbi F. (2016). The neonatal mortality and its determi-nants in rural communities of Eastern Uganda. Reprod Health. 13(1): 13. https://doi.org/10.1186/s12978-016-0119-y.

Kruk ME, Leslie HH, Verguet S, Mbaruku GM, Adanu RMK, Langer A. (2016). Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys. Lancet Glob Health. 4(11):E845-E855. https:¬//doi.org/10.1016/S2214-109X(16)30¬180-2.

Kumar P, Rashmi R, Muhammad T, Srivas-tava S. (2021). Factors contributing to the reduction in childhood stunting in Bangladesh: a pooled data analysis from the Bangladesh demographic and health surveys of 2004 and 2017–18. BMC Public Health, 21(1): 2101. https:¬//doi.org/10.1186/s12889-021-12178-6.

Kyasimire L, Tibaijuka L, Ochora M, Kayondo M, Kumbakumba E, Nan-tongo J, Kyoyagala S. (2024). Clinical profiles, incidence and predictors of early neonatal mortality at Mbarara Regional Referral Hospital, south-western Uganda. BMC Pediatr. 24(1): 542. https://doi.org/10.1186/s12887-024-05014-4.

Lawn JE, Blencowe H, Oza S, You D, Lee ACC, Waiswa P, Lalli M, et al. (2014). Every Newborn: progress, priorities, and potential beyond survival. Lancet. 384(9938): 189–205. https://doi.org-/10.1016/s0140-6736(14)60496-7.

Lee C, Lakhanpaul M, Stern BM, Sarkar K, Parikh P. (2021). Associations between the household environment and stunted child growth in rural India: a cross-sectional analysis. UCL Open Environment. 3:e014. https://doi.org-/10.14324/111.444/ucloe.000014.

Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, et al. (2015). Global, regional, and national causes of child mortality in 2000–13, with pro¬jections to inform post-2015 priorities: an updated systematic analysis. Lancet. 385(9966): 430–440. https://¬doi.org/10.1016/s0140-6736(14)6169¬8-6.

Mannah MT, Warren C, Kuria S, Adegoke AA (2014). Opportunities and challenges in implementing commu-nity based skilled birth attendance strategy in Kenya. BMC Pregnancy Childbirth. 14:279. https://doi.org/-10.1186/1471-2393-14-279.

Masaba BB, Mmusi-Phetoe RM. (2020). Neonatal survival in Sub-Sahara: a review of Kenya and South Africa. J Multidiscip Healthc. 13: 709–716. https://doi.org/10.2147/JMDH.S260058.

Ministry of Health Knowledge Management Portal (2024). Uganda National Health Products Traceability Strategy 2024/25 - 2028/29 retrieved from https://library.health.go.ug/category/health-information-systems?f%5B0%-5D=category%3A242.

Ministry of Health the Republic of Uganda (2022). Essential maternal and newborn clinical care guidelines for Uganda. Retrieved from: https://-library.health.go.ug/sites/default/files/resources/Essential%20Maternal%20Newborn%20Care%20Guidelines%202022%20V3.pdf.

Moxon SG, Ruysen H, Kerber KJ, Amouzou A, Fournier S, Grove J, Moran AC, et al. (2015). Count every newborn; a measurement improvement roadmap for coverage data. BMC Pregnancy and Childbirth. 15(2): S8. https://doi.org¬/10.1186/1471-2393-15-S2-S8

Mugisha J, Kinyanda E, Osafo J, Nalukenge W, Knizek BL. (2020). Health care professionals’ perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with HIV/AIDS and mental distress in a rural district in central, Uganda. Child Adolesc Psy¬chiatry Ment Health. 14(1): 26. https:-//doi.org/10.1186/s13034-020-0033-2-8.

Musoke D, Ssemugabo C, Ndejjo R, Atusing¬wize E, Mukama T, Gibson L. (2019). Strengthening the community health worker programme for health improvement through enhancing training, supervision and motivation in Wakiso district, Uganda. BMC Res Notes. 12(1): 812. https://doi.org/10.-1186/s13104-019-4851-6.

Nanyonjo A, Bagorogoza B, Kasteng F, Ayebale G, Makumbi F, Tomson G, Källander K, inSCALE study group. (2015). Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated com-munity case management programme in Uganda. BMC Health Serv Res. 15(1): 347. https://doi.org/10.1186/s1-2913-015-1019-5.

Okello G, Izudi J, Ampeire I, Nghania F, Dochez C, Hens N. (2022). Two decades of regional trends in vaccina-tion completion and coverage among children aged 12-23 months: an ana-lysis of the Uganda Demographic Health Survey data from 1995 to 2016. BMC Health Serv Res. 22(1): 40. https://doi.org/10.1186/s12913-021-07443-8.

Okemo JK, Kamya D, Mwaniki AM, Temmerman M. (2021). Determinants of preconception care among pregnant women in an urban and a rural health facility in Kenya: A qualitative study. BMC Pregnancy and Childbirth, 21(1): 752. https://doi.org/10.1186/s12884-021-04201-w.

Qiu Y, Liu L, Lai X, Qiu Y. (2019). An online test for goodness-of-fit in logistic regression model. IEEE Access. 7: 107179–107187. https://doi.org/10.11-09/ACCESS.2019.2927035.

Ranganathan P, Deo V, Pramesh CS. (2024). Sample size calculation in clinical research. Perspect Clin Res. 15(3):155–159. https://doi.org/10.4103/picr.pic-r_100_24.

Ranganathan P, Caduff C. (2023). Designing and validating a research question¬naire-Part 1. Perspectives in Clinical Research, 14(3): 152–155. https://doi.-org/10.4103/picr.picr_140_23.

Sartorius V, Philibert M, Klungsoyr K, Klimont J, Szamotulska K, Drausnik Z, Velebil P, et al. (2024). Neonatal mortality disparities by gestational age in European countries. JAMA Network Open. 7(8): e2424226. https://doi.org-/10.1001/jamanetworkopen.2024.24226.

Serdar CC, Cihan M, Yücel D, Serdar MA (2021). Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies. Biochem Med (Zagreb). 31(1):010502. https://doi.-org/10.11613/BM.2021.010502.

Taber KS. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Res Sci Educ. 48(6): 1273–1296. https://doi.org/10.1007/s11165-016-9602-2.

Tappis H, Ramadan M, Vargas J, Kahi V, Hering H, Schulte-Hillen C, Spiegel P. (2021). Neonatal mortality burden and trends in UNHCR refugee camps, 2006–2017: a retrospective analysis. BMC Public Health. 21(1): 390. https://doi.org/10.1186/s12889-021-10343-5.

UNHCR. (2022). Saving maternal and new¬born lives in refugee situations. Retrieved from https://www.unhcr.-org/sites/default/files/legacy-pdf/62-960e0b4.pdf.

UNHCR (2025). Country – Uganda – Ope-rational Data Portal. Retrieved from https://data.unhcr.org/en/country/uga.

UNICEF. (2025). Neonatal Mortality. Re-trieved from https://data.unicef.org-/topic/child-survival/neonatal-morta-lity/.

Verschuuren AEH, Tankink JB, Postma IR, Bergman KA, Goodarzi B, Feijen-de Jong EI, Erwich J. (2024). Suboptimal factors in maternal and newborn care for refugees: Lessons learned from perinatal audits in the Netherlands. PLoS One, 19(6): e0305764. https://-doi.org/10.1371/journal.pone.0305764.

Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, Papageorghiou AT. (2021). Maternal and neonatal morbidity and mortality among preg-nant women with and without COVID-19 infection: The INTERCOVID multi¬national cohort study. JAMA Pediatr. 175(8): 823–834. https://doi.org/10.-1001/jamapediatrics.2021.1050.

Waiswa P, Kallander K, Peterson S, Tomson G, Pariyo GW. (2010). Using the three delays model to understand why newborn babies die in eastern Uganda. Trop Med Int Health. 15(8): 964–972. https://doi.org/10.1111/j.1365-3156.-2010.02557.x.

World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva. Retrieved from https://-www.who.int/publications/i/item/9789241549912.

World Health Organization. (2018). Births attended by skilled health personnel. Retrieved from https://www.who.int/-Data/Nutrition/Nlis/Info/Births-Attended-by-Skilled-Health-Personnel.

World Health Organization (2024). Neo-natal Mortality. Retrieved from https:-//www.who.int/News-Room/Fact-Sheets/Detail/Newborn-Mortality.

World Health Organization - Global Health Observatory. (2026). Neonatal morta-lity rate, 2023. Our World in Data. Retrieved from https://ourworldin-data.org/grapher/neonatal-mortality-rate-gho.

Zeitlin J, Mortensen L, Cuttini M, Lack N, Nijhuis J, Haidinger G, Blondel B, et al. (2016). Declines in stillbirth and neonatal mortality rates in Europe between 2004 and 2010: results from the Euro-Peristat project. J Epidemiol Community Health, 70(6): 609–615. https://doi.org/10.1136/jech-2015-207013.

Zietsch J, Ziegenhagen N, Heppner FL, Reuss D, von Deimling A, Holtkamp N. (2010). The 4q12 amplicon in malig¬nant peripheral nerve sheath tumors: consequences on gene expression and implications for sunitinib treatment. PloS One, 5(7): e11858. https://doi.-org/10.1371/journal.pone.0011858.