Factors associated with neonatal outcome of referred neonates from lower-level health facilities to Jinja Regional Referral Hospital

Abstract

Background: Neonatal mortality is a key public health concern. The neonatal mortality rate currently stands at approximately 18 deaths per 1,000 live births, translating into millions of deaths annually. Almost half of all neonatal deaths occur in the first day of life, largely from preventable causes such as infection, asphyxia, and complications of prematurity. Despite efforts to improve neonatal care, outcomes remain suboptimal, particularly for neonates referred from lower-level facilities to regional hospitals. Late referrals, inadequate pre-referral stabilization, and resource constraints contribute to high mortality rates Objectives: This study aimed to determine the factors associated with neonatal outcomes among referred neonates at Jinja Regional Referral Hospital. Methods: A retrospective longitudinal study design employing documentary review of referred neonates at Jinja Regional Referral Hospital. A structured data extraction tool was used to collect data from neonatal records of all the referred neonates admitted to JRRH’s Neonatal Unit were reviewed between December 2024 and December 2023. The collected data were coded, entered into Excel spreadsheet, and analyzed using STATA 14. Data was presented in form of text, tables and graphs. Ethical approval and permission to access records obtained from JRRH management was obtained. Logistic regression was used to test for association while an prevalence ratio was as the measure of the association between the two variables and data was presented in term so text, table and pie-charts. Results: A total of 87 referred neonates admitted to JRRH’s Neonatal Unit were reviewed between December 2024 and December 2023 community members. From the study, the survival of referred neonates admitted to JRRH’s Neonatal Unit was at 63.2%. The most common primary reason for referral was prematurity, accounting for 35.6% of cases. Survival of the referred neonates admitted to JRRH’s Neonatal Unit was significantly associated with being referred from health facilities located within 10 km ((APR: 1.380; 95% CI: 1.076-1.584; p = 0.029), staying in the hospital for three days or less (APR: 1.240; 95% CI: 1.083–1.837; p = 0.024) and having not develop complications during hospitalization (APR: 1.202; 95% CI: 1.064-1.927; p = 0.034). Conclusion: The study found that survival was low. Therefore, it is recommended that the Ministry of Health should enhance neonatal referral systems, especially for facilities located more than 10 km from the referral hospital and prioritize equipping lower-level health facilities with basic neonatal care infrastructure and skilled personnel