Short Birth Intervals, Maternal Care, and Neonatal Mortality in Rwanda: A Facility-Based Retrospective Cohort Study...

Area of Science:

• Public Health
• Neonatal Health
• Epidemiology

Background:

• Neonatal mortality is a significant public health issue in sub-Saharan Africa.
• Facility-based studies risk selection and referral biases.
• This study investigates factors influencing neonatal mortality in a Rwandan referral hospital.

Purpose of the Study:

• To examine associations between maternal, reproductive, and healthcare factors at different causal levels and neonatal mortality.
• To apply hierarchical modeling to understand complex relationships.
• To assess the impact of biases on study findings.

Main Methods:

• Retrospective cohort study of 1042 mother-neonate pairs (2022-2023).
• Variables categorized into distal, intermediate, and proximal levels.
• Sequential logistic regression and Directed Acyclic Graph used to analyze data and potential biases.

Main Results:

• 3.07% of neonates died; lower maternal education showed higher odds (aOR 2.18), potentially due to bias.
• Short birth intervals had unstable associations due to missing data.
• Inadequate antenatal care (aOR 3.12) and preterm birth (aOR 11.67) were strongly associated with neonatal mortality.

Conclusions:

• Proximal factors like preterm birth and insufficient antenatal care consistently predict neonatal mortality.
• Distal and intermediate factor associations were limited by bias and missing data.
• Hierarchical modeling and causal frameworks are valuable, but hospital data requires cautious interpretation.