# Determinants of neonatal near miss among newborns admitted to SOS Mother & Child Hospital, Benadir region, Somalia: a case-control study

## TL;DR

This study identifies factors that increase the risk of neonatal near-miss cases in Somalia, highlighting the need for improved maternal and child health services.

## Contribution

The study provides new insights into the socio-demographic and clinical determinants of neonatal near-miss in a high-risk region.

## Key findings

- Lack of maternal and paternal education significantly increases the risk of neonatal near-miss.
- Low household income, lack of antenatal care, and home delivery are strong predictors of neonatal near-miss.
- Low birth weight is the strongest individual predictor of neonatal near-miss.

## Abstract

While the birth of a newborn is often a moment of great joy, it can be overshadowed by life-threatening complications that endanger survival in the early days of life. Neonatal near-miss (NNM) cases are infants who survive severe complications, offer a valuable lens for evaluating the quality of neonatal care. Somalia continues to have one of the highest neonatal mortality rates globally, with about 37 deaths per 1,000 live births, highlighting significant gaps in maternal and child health services. This study aimed to identify the determinants of neonatal near miss among neonates admitted to SOS Mother & Child Hospital, Banadir, Somalia.

An unmatched case-control study was conducted at SOS Mother and Child Hospital in Banadir region from December 2024 to April 2025. A total of 243 neonatal near miss (NNM) cases and 730 healthy neonate controls were included. Cases were identified using pragmatic and management criteria from the Centro Latinoamericano de Perinatología (CLAP) criteria. For each case, three controls were randomly selected. Data were collected using structured questionnaire and record reviews and analyzed using SPSS v25. Logistic regression was employed to identify independent predictors of neonatal near miss.

Significant predictors of neonatal near miss included lack of maternal (aOR: 2.61) and paternal education (AOR: 3.64), monthly household income below 100 USD (aOR: 2.82), short birth interval under 24 months (aOR: 1.97), lack of antenatal care (ANC) attendance (aOR: 6.25), history of stillbirth (aOR: 4.35), obstetric complications (aOR: 4.46), preterm or post-term birth (AOR: 1.89), prolonged labor (aOR: 3.58), home delivery (aOR: 4.76), maternal chronic illness (aOR: 3.37), male sex of the newborn (aOR: 1.86), and low birth weight (aOR: 9.34).

Neonatal near miss remains a pressing public health concern in Somalia, influenced by socio-demographic, obstetric, and neonatal factors. Strengthening maternal education, promoting antenatal care, ensuring skilled birth attendance, and improving facility-based delivery services are essential to reducing neonatal complications and improving outcomes. Policymakers and humanitarian partners must prioritize investments in maternal and newborn health to address these preventable risks.