INTRODUCTION:

The neonatal period is defined as the first 28 days from birth; may be further classified, the very early (birth to <24hr.), early (24hr to <7days), and late neonatal periods 7 days to <28 days. Neonatal mortality rate (NMR) is an important indicator of health which refers to the number of deaths less than 28 days of age per 1000 live births.¹

The majority of neonatal mortality directly related to infections, prematurity, perinatal asphyxia, Congenital anomalies and other. For instance; Sub-Saharan Africa has the highest preterm birth rates whereas South Asia has the highest small for gestational age rates. Worldwide an estimated 15 million babies born preterm; especially of those younger than 32 weeks’ gestation are at the highest risk of neonatal death, with ongoing post-neonatal mortality risk. Four million neonates annually have other threatening or disabling conditions: like brain injury, severe bacterial infections, or pathological jaundice.^2,3

In low resource countries like India, Pakistan, Guatemala, the Democratic Republic of Congo, Kenya and Zambia where the highest neonatal mortality were happening the cause of neonatal deaths 33.1% were due to infection, 30.8% to prematurity, 21.2% to Asphyxia, 9.5% to Congenital anomalies and 5.4% of death was unknown causes. Prematurity and asphyxia related deaths were more common on the first day of life accounting 46.7% and 52.9% respectively. The most death due to infection occurred at early neonatal period of life 86.9%.³The neonatal period is a highly vulnerable time for an infant completing many of the physiologic adjustments requiring for life outside the uterus unless high rates of morbidity and mortality occurs. The three major causes of mortality in developing countries include: hypothermia, sepsis, and prematurity. Neonates often died within the first 24hours of age so timely intervention could decrease neonatal mortality and morbidities.⁴

The study conducted in Tigray region of Northern Ethiopia also showed the more than half deaths were due to prematurity 2334% and asphyxia 21 31%. Slight variance was seen between the mortality pattern in early and late neonatal periods. In early neonatal period, 37% were due to prematurity, while asphyxia 35% was more common in the late neonatal period. All infection related deaths occurred in neonate-mother dyads from community areas.⁵ Also, the study conducted in the East wollega Zone at Nekemte referral hospital revealed that the main factors identified in an increased risk of neonatal mortality were: home delivery, very low birth weight, and inability to cry at birth. and some missing variables like birth interval, income of the mother were not analyzed but might an important predictor of neonatal mortality.⁶

Currently, very nearly half of the under-five mortality will be neonates whose death can be prevented by getting high coverage of quality antenatal care, skilled care at birth, postnatal care for mother and baby, and care of small and sick newborns. On the other hand, the potential impact of midwives estimated on reducing newborn death and stillbirth identified a significant increase in coverage of midwife-delivered intervention could obviate 39% of newborn deaths and 26% of stillbirths, equating to 2.2 million deaths avert per year. Universal coverage of midwife-delivered interventions would obviate 64% of newborn deaths and 64% of still births, allowing 4.3 million lives estimated to be saved.^7,8

In the past ten years the country observed a decline of neonatal mortality from 39 per 1000 in 2005 to 37 per 1000 birth in 2011 and 29 per 1000 live birth in 2016. Even though in 2019 the neonatal mortality has been slightly inclining to 30 per 1000 live birth.⁹ In low income countries half of the newborn babies do not get a birth certificate, and most neonatal deaths and almost all still births have no death certificate.² Still today Ethiopia contributes high neonatal deaths which need further action like implementing sustainable developmental goal.

The neonatal mortality is masked. A few studies are available on neonatal mortality, which are done at the higher hospitals or national level and has restricted to a few determinants. And their extrapolation of the findings was significantly limited to the study area. In the BuleHora area the status of neonatal mortality is not known, so far no research has been conducted on neonatal mortality specific to the BuleHora.

METHODS AND MATERIALS:

Study Area and Period:

West Guji Zone is found 470 km away from the capital city of Addis Ababa to the South. The study was conducted among neonates who were admitted in NICU of governmental hospital in West Guji Zone, Oromia, Ethiopia. West Guji Zone is one of the 20 Zones of Oromia region having nine districts and one Town. According to the population projection the Zone has an estimated 1,422,767 million total population. The proportion of male counts 679,155 and female accounts 743,612. The zone has three Governmental Hospitals those are BuleHora general hospital, Kerchaprimary hospital and Malka Soda primary hospital, 41 Health centers and 161 Health posts. This study was conducted in BuleHora general hospital NIC unit which is found at BuleHora Town and 1153 neonates were admitted in NICU during the study period. The study was conducted from January 1, to June 30, 2021 in BuleHora general hospital.

Study design:

Facility based cross-sectional study design was conducted to assess the magnitude and factors associated with Neonatal mortality in the NICU of BuleHora general hospital, South Oromia, Ethiopia, 2021.

Population:

Source of population:

All neonates admitted in neonatal intensive care unit of BuleHora general hospital in West Guji Zone.

Study population:

All neonates admitted in neonatal intensive care unit of Bule Hora general hospital from July 1, 2017 to June 30, 2020.

Study Unit:

Each selected neonate charts from July 1, 2017 to June 30, 2020 based on inclusion criteria

Inclusion criteria:

All charts of neonates who were admitted from July 1, 2017 to June 30, 2020 and their cards fulfilling at least age of neonate, neonatal medical diagnosis during admission and neonatal outcome were included in this study.

Exclusive criteria:

Neonate with incomplete chart and or referred to other facility was excluded from this study.

Sample size determination and Sampling Technique:

A single population proportion formula was used to calculate the sample size by considering the following assumption: p(proportion in the previous study in similar topic) as prevalence of neonatal mortality done on predictors of neonatal mortality at NICU of Ayder Comprehensive specialized hospital in Tigray Ethiopia was 16.7%.¹ (Zα/2)²= Standard normal distribution value for the 95% confidence interval with level of precision Zα/2=1.96. d= Margin of error as 5% and =(Zα/2)²p(1-p)/d² using the formula [(1.96)²_*0.167_*0.833/ (0.05)²] the sample was 213, further Considering 10% incomplete chart 213+21 the final sample was determined 235. (Table 1) The larger sample size was selected for final sample size 448.

Sampling technique:

There are three hospitals in West Guji Zone. These hospitals are Malka soda primary hospital, BuleHora general hospital and Karcha primary hospital. Among these, BuleHora general hospital was purposively selected because it is the biggest hospital in the Zone and only hospital that has neonatal intensive care unit service. From July 1, 2017 to June 30, 2020 the total admissions to neonatal intensive care unit was 1153 neonates, among these 448 neonates charts was selected using systemic random sampling technique using list of frame. (List of MRN of the charts from NICU registration book) and 440 neonates charts fulfill the inclusion criteria.

Data Collection procedure and instrument:

The data was collected by two trained BSc Nurses and one MSc supervisor working in the hospital by using 5% pretested extraction checklist to assess the available information on the patient charts. The check list was adapted from different related literatures. The check list consists three parts such as: Socio demographic characteristics, neonatal factors and maternal factors, a data collector used the pre tested check list to collect the information from the patient’s charts. The charts was retrieved using the patient’s medical registration number which is also found in data base in the electronic system and one data clerk in hospital supports them by identifying the charts. Necessary data was extracted by reviewing patient’s cards. Then all medical records of patients that fulfil the inclusion criteria in the NICU were reviewed retrospectively by data collectors from March 25, to April 22, 2021.

Study variable:

Dependent variable:

Neonatal mortality

Independent variable:

The independent variable is selected based on the objective of this study and their importance for neonatal survival as previously reported in the literature. The variables are grouped into socio-demography, Neonate, and Maternal factors. The Socio demographic factors: such as residence of mother, age of the neonate and sex of newborn. Neonatal factors: such as, low birth weight, prematurity, low APGAR, hypoglycemia, hypothermia, sepsis, perinatal asphyxia, meconium aspiration syndrome, respiratory distress syndrome, congenital anomalies and neonatal tetanus. Maternal factors: such as, parity, ANC visits PNC visits, multiple birth, and mode of delivery, place of delivery, medical diagnosis and obstetric diagnosis.

Operational definitions:

Neonatal mortality:

Neonatal mortality is refers the number of neonates who died at the neonatal intensive care unit during the study period.

Magnitude of neonatal mortality:

Means the proportion of neonatal death among neonates admitted to NICU.

Complete chart:

A charts that had fulfilled at least age of neonate, medical diagnosis of neonate and neonatal out come during admission.

Data quality assurance:

The quality of data assurance was conducted by pre-testing the data collection checklist on 5% of cards in Kerch hospital other than the selected Hospital before the main data collection take place, and instrument adjusted accordingly. The training was given for one day for supervisors and data collectors a day before data collection. On each day of data collection, the collected data was rechecked for the completeness and consistency, and then entered at the same day.

Data processing and Analysis:

The data was coded and entered in to Epi data version 4.4.2.1 and transferred to SPSS version 25 accompanied by skilled assistants. The descriptive statistics was performed to calculate the frequencies, percentages and diagrams. Based on Hosmer and Lemeshow theory of 10 cases per independent variable, eleven variables to be used to develop multivariate logistic regression model.⁽¹⁴⁾ Prior to conducting the multiple logistic regressions, correlations among the predictor variables were checked to determine if the predictors were correlated. To determine the actual predictors for the neonatal mortality, binary logistic regressions was applied and the variables (p<0.25) found to have association with the outcome variable were entered multivariable analysis which was used to control confounding factors. The model fitness was checked by Hosmer and Lemeshow goodness of fit test (p>0.05). Then, odds ratio with 95% confidence interval was reported as factors having associations with the neonatal mortality. Finally, the variables which have significant association were identified by multivariate logistic regression based on p-values 0.05 and AOR, with 95% CI to measure the strength of the associations.

RESULTS:

Socio demographic factors:

A total of 440 neonate charts were included in this study from a total sample size of expected 448, with 98.2% response rate. Eight of them were excluded due to the incompleteness. The mean age of neonates admitted at NICU is 6.6 days and standard deviation is 7.64, majorities (78.4%) were from rural areas and (60.5%) were males as described in the table below (Table 2)

Table 2:-Socio demographic characteristics of neonates admitted in the NICU of BuleHora general hospital, West Guji zone, South Oromia, Ethiopia, 2021(n=440)

Variables	Categories	No.	(%)
Residence	Rural	345	(78.4)
Residence	Urban	95	(21.6)
Age of the neonate in days	≤ 14	352	(80.0)
Age of the neonate in days	> 14	88	(20.0)
Sex of new born	Male	266	(60.5)
Sex of new born	Female	174	(39.5)

Table 3 Distribution of Newborn Health conditions among neonates admitted in NICU of BuleHora general hospital, West Guji zone, South Oromia, Ethiopia, 2021(n=440)

Variable		Categories	No	(%)
Newborn weight with gestational age	< 1499g	VSGA	41	(14.9)
	1500-2499g	SGA	52	(18.9)
	>2500g<4500g& above	AGA and above	182	(66.2)
Gestational age	<37 weeks	Preterm	95	(26.3)
	>37 <42weeks	Term	241	(66.8)
	>42	Post term	25	(6.9)
Newborn medical diagnosed		Yes	413	(93.9)
Newborn medical diagnosed		No	27	(6.1)
Type of newborn medical diagnosis		Sepsis	275	(62.5)
		RDS	33	(9.0)
		MAS	37	(10.1)
		Perinatal asphyxia	19	(5.2)
		Hypoglycemia	6	(1.6)
		Hypothermia	31	(8.4)
		Tetanus	12	(3.3)
Feeding practice at NICU stay		Breast feeding	245	(55.8)
		Formula feeding	88	(20.0)
		Maintenance fluid	74	(16.9)
		Mixed fed	32	(7.3)
Newborn die		Within 24 hour	42	(50.6)
		Within 7 days of age	19	(23.2)
		B/n 7 and 28 days	22	(26.8)
Newborn with congenital anomalies		Neural tube defect	1	(5.3)
		Congenital heart disease	9	(47.4)
		Omphalocele	2	(10.5)
		Tracheoesophageal fistula	4	(21.1)
		Gastroschisis	2	(10.5)
		Down syndrome	1	(5.3)

Key;-VSGA: Very Small Gestational Age AGA: Appropriate for Gestational Age RDS: Respiratory Distress Syndrome

Neonate health characteristics:

Most of the neonates (66.2%) had a birth weight of appropriate gestational age and above, and (18.9%) were small for gestational age and (14.9%) were very small for gestational age. Majority of neonates (66.8 %) were born at term and (26.3%) neonates were born before term delivery, regarding medical diagnosis of neonates most causes of admission were Sepsis (62.5), Meconium Aspiration Syndrome (10.1%) and Respiratory Distress Syndrome (9%). Just above half (55.8%) fed their mother breast while 20% were on formula feeding. Neonates died at NICU almost half (50.0%) were died within 24 hours of their life. Among totally 4.3% newborn with congenital defect, (47.4%) had congenital heart defect and (21.1%) had Tracheoesophageal fistula. The table below summarizes Neonatal characteristics. (Table 3)

Maternal health characteristics:

The majority of mothers, (85.4%) had given birth to less than 5 children. Only a few (24.8%) mothers had ANC visit during the last pregnancy and among these (41.3%) had attended focus ANC visits. Almost half (52.3%) mothers have not attended postnatal visit after birth and most (82%) of children were born through Spontaneous vaginal delivery, regarding the place of birth (59.3%) at health facility. Among the mothers with medical problems, just above half (52.6%) were diagnosed with hypertension during pregnancy and among mother with obstetric diagnosed (66.1%) were diagnosed with PPROM/PROM during pregnancy as described in the table below. (Table 4)

Table 4 Distribution of Maternal Health characteristics among neonates admitted to BuleHora general hospital NICU, West Guji Zone, South Oromia, Ethiopia, 2021. (n=440)

Variables	Categories	No.	(%)
Number of parities	Less than 5	375	(85.4)
Number of parities	More than 5	64	(14.6)
ANC visit	At least 1 visit	26	(23.85)
	2-3 visits	38	(34.86)
	4 visits and above	45	(41.28)
Had mother PNC follow up	Yes	210	(47.7)
Had mother PNC follow up	No	230	(52.3)
PNC Visit	1	178	(84.76)
PNC Visit	2	32	(15.2)
Mode of delivery	SVD	360	(81.8)
	CS	64	(14.5)
	Instrumental delivery	16	(3.6)
Place of delivery	Home	179	(40.7)
	Health center	58	(13.2)
	Hospital	203	(46.1)
Maternal medical diagnosis during pregnancy	Hypertension	10	(52.6)
	Diabetes	2	(10.5)
	HIV/ADIS	3	(15.8)
	Cardiac disease	4	(21.1)
Maternal obstetric diagnosed	Abruption placenta	6	(10.2)
	Sever preeclampsia	11	(18.6)
	Eclampsia	1	(1.7)
	Placenta previa	2	(3.4)
	PPROM/PROM	39	(66.1)

CS=Caesarian Section PPROM=Premature Preterm Rapture of Membrane

Magnitude of Neonatal Mortality at NICU:

The proportion of neonatal mortality is found to be 18.9%, n= 83, 95% 0f CI [15.4, 22.7] among these neonates 50.6% died in the first 24 hours of life, 30.12% after 1^st day to 7^th day of life. Among neonatesdead (51.6%) were male neonates. Neonatal mortality was found to be high in neonates less than 14 days old, (92.8%) and neonates who died were those with Apgar score of 5 and less (77.1%). The figure below shows the Magnitude of Neonatal Mortality at BuleHora general hospital NICU, West Guji Zone, South Oromia, Ethiopia, 2021 (Figure 1)

Figure 1 Piechart shows the Magnitude of Neonatal Mortality among neonates admitted in NICU of BuleHora general hospital, West Guji Zone, South Oromia, Ethiopia, 2021

Factors associated with neonatal mortality:

The logistic regression analysis of factors associated with neonatal mortality at BuleHora general hospital showed neonatal factors: such as neonate age less than 14 days, home delivery, APGAR score at the first minute of birthless than 5, congenital anomaly and lack of attending ANC were found to be significant factors.

Five variables were found to have significant statistical association with neonatal mortality after multivariate logistic regression analysis. Three variables: home delivery (AOR 4.62, 95% CI (2.38, 9.01), P<0.001), new born with congenital anomalies (AOR 9.37, 95% CI (3.29, 26.71), P<0.001) and neonate born from mother having no ANC visit (AOR 2.79, 95% CI (1.53, 5.08), P<0.001) were having strong association. The other two variables: age of the neonate less than 14 (AOR 4.37, 95% CI (1.69, 11.27), P<0.005) and APGAR score at the first minute of birth less than five (AOR 2.68, 95% CI (1.28, 5.6), P<0.005 were also found to have significant statistical association.

Those neonate with Age less than 14 days and admitted to NICU are 4 times more likely to die than those whose age is 14 days and more at (AOR of 4.37(1.69, 11.27)), with 95% CI. Neonate born at home and admitted at NICU are 4.6 times more likely to die than those born at Health facilities (AOR, of 4.6 (2.38, 9.01)), with 95% CI.

Table 5: Shows the factors associated with neonatal mortality analysis among neonates admitted to BuleHora general hospital NICU, West Guji Zone, South Oromia, Ethiopia, 2021

		Neonatal outcome
		Death		Alive
		No.	(%)	No.	(%)	COR (95%CI)	AOR (95%CI)	P-Value
Age of the neonatal in days
	> 14	77	(21.9)	275	(78.1)	1	1
	< 14	6	(6.8)	82	(93.2)	3.82(1.60, 9.10)	4.37(1.69, 11.27)	0.002*
Sex of new born
	Male	43	(16.2)	223	(83.8)	1	1
	Female	40	(23.0)	134	(77.0)	1.54(0.95, 2.50)	1.52(0.88, 2.60)	0.127
Place of delivery
	Health Facility	33	(12.6)	228	(87.4)	1	1
	Home	50	(27.9)	129	(72.1)	2.67(1.64, 4.37)	4.63(2.38, 9.01)	<0.001*
APGAR score at first minute
	> 5	64	(17.9)	293	(82.1)	1	1
	< 5	19	(22.9)	64	(77.1)	1.36(0.88, 2.72)	2.68(1.28, 5.60)	0.008*
Newborn medical diagnosed
	No	75	(18.2)	338	(81.8)	1	1
	Yes	8	(29.6)	19	(70.4)	1.89(0.80, 4.49)	2.04(0.77, 5.36)	0.146
Newbornwithcongenital anomalies
	No	68	(16.3)	349	(83.7)	1	1
	Yes	15	(65.2)	8	(34.8)	9.62(3.92, 23.58)	9.37(3.29, 26.71)	<0.001*
Newborn weight with gestational age
	SGA	8	(12.5)	56	(87.5)	1	1
	VSGA	68	(18.9)	292	(81.1)	1.63(0.74, 3.57)	1.29(0.51, 3.23)	0.580
	AGA & above	7	(43.8)	9	(56.3)	5.44(1.58, 18.71)	2.38(0.46, 12.09)	0.296
Had mother ANC follow up
	No	53	(16.0)	278	(84.0)	1	1
	Yes	30	(27.5)	79	(72.5)	1.99(1.19, 3.32)	2.79(1.53, 5.08)	0.001*

Statistically significant = *

Neonates with APGAR Score at the first minute of birth less than 5 and admitted to NICU are 2.7 times more likely to die than those have APGAR score more than 5 (AOR, of 2.68(1.28, 5.60)), with 95% CI. Children born with congenital anomalies and admitted to NICU are 9 times more likely to die than those with no congenital anomaly (AOR, of 9.37(3.29, 26.71)), with 95% CI; and Neonates born from mothers having no ANC visit and admitted to NICU are 3 times more likely to die than those having ANC visit (AOR, of 2.79(1.53, 5.08)), with 95% CI. (Table 5)

DISCUSSION:

The findings of the study showed that 18.9 % neonates were died after admission in NICU of BuleHora general hospital. This indicates that only four out of five neonates surpass the 1^st 28 days of life after admission to NICU. However, this institutional neonatal death varied by age of neonatal life, neonate age less than 14 days, place of birth, APGAR score at the first minute birth, presence or absence of congenital anomalies, and maternal ANC visit.

The findings of the current study is in line with the study conducted at Harare Central hospital (19.3%).¹⁵The study at St. Luke Wolisso hospital (16.9)¹¹, and the study done at Ayider Hospital 16.7%, in Tigray¹⁸.However, the findings is higher than the study done in Jimma Medical Center 13.3%, South West Oromia¹⁶in Gondar University hospital 14.3%, in Amhararegion³⁷, Public Hospitals in pastoralist areas of Afar, (14.6%)²⁴and Northern Ghana (13.4%)¹⁷.Even much lower prevalence were reported from Pakistan (4.8%)¹⁸. and Pediatrics department of Tertiary hospital in Phnom Penh (9.3%), Cambodia¹⁹, at Jordan, Princess Rahma Pediatric Hospital (8.1%) a²², and at YaoundeGynaeco-Obstetric and Pediatric Hospital (9.83%)²³. The implication of this finding is a high proportion of mothers didn’t attend their ANC follow ups and many of they had home delivery that leads to delayed care.

Some studies have shown a much higher mortality rates among neonates admitted at NICU. The studies conducted at Mauritania (34.7%)²⁰, and Asmara, Eritrea (59.9%)²⁵ shows the same fact. The overall disparity may be justified by variation in awareness of community up on use of available health services including service delivery at health facilities for sick neonates and socio-cultural elements: like health service use and the difference hospital setting (equipment available and skilled persons).

The analysis showed neonates with age of less than 14 days and admitted to NICU had 4.3 times more likely to die than those of their counter parts older than 14 days. This is similar to the study done in Jimma¹⁶, in this could be due to the fact more than 80% of the deaths occurred during early neonatal age and the neonatal mortality is associated with early neonatal age.

The finding of this study showed, neonate born at home and admitted at NICU had 4.6 times more likely to die than those born at health facilities. This finding may be justified by a high proportion of mothers had home delivery that leads to delayed care and the neonatal mortality would be high in this group of new born. The Study conducted at Yaounde Gynaeco-Obstetric and Pediatric showed neonates born at hospital is found to be a factor protecting neonates from death and this finding is in line with the finding of this study.

This study found that neonatal mortality is 2.6 times more common on neonates with Apgar score at the first minute of birth less than 5 than those neonates with APGAR score five and more, unlike other study a low at fifth minute APGAR score didn’t have an effect on neonatal mortality; rather this study found a low at first minute APGAR score was associated with increased risk of neonatal mortality, it could be an indication for the absence of proper and effective resuscitation measures the neonatal mortality would be high in this group of newborn, the study at Asmara, Eritrea, and at Brazil ²²supports the finding of this study.

As it is found in this study, newborn with congenital anomalies were 9 times more vulnerable for neonatal mortality than those with no congenital anomalies. This finding is in agreement with the study conducted at Jimma¹⁹and Ayider Hospital, Mekelle¹. The study is also in line with study conducted at Asmara²¹, andGhana²³.‘

This study found out that neonates born from mothers having no ANC visit and admitted to NICU are 2.7 times more likely to die than those mothers having ANC visit. The reason behind higher neonatal mortality with neonates born from mother having no ANC visit could be for obstructing preventable factors during pregnancy; the failure of having a proper ANC care is associated with an increased. This finding revealed the same result as 2016 EDHS indicating neonate born to mothers who didn’t utilize ANC had higher odd of neonatal mortality in Ethiopia.²³The study conducted at Afar²⁴ also supports the finding of this study.

This study has some important strength: such as data collection was done by health professional and data was rechecked for data consistency and quality. Even though this study addressed major predictors of neonatal mortality among neonates admitted to NICU, there was difficulty of getting important socio demographic predictors like maternal educational, maternal age and occupational status due to missing data on documents. This study shares the limitation of cross sectional study and data used for this study was inferior to prospective study, finally the study was limited to documented cases and may under represent death of newborns, thus it needs conducting additional longitudinal studies and qualitative studies for further investigation of factors associated with neonatal mortality at NICU.

CONCLUSION:

This study reported high proportion of neonatal mortality among neonates admitted in neonatal intensive care unit of BuleHora general hospital when we compare with national level of prevalence. neonates age less than fourteen days of age particularly at very early ages of life, neonates born at home, neonates whose APGAR score at the first minutes of birth less than 5, newborn with congenital anomalies and neonates born from mothers having no ANC visit had significant association with neonatal mortality.

ABBREVIATIONS:

ANC Antenatal Care

APGAR Appearance, Pulse, Grimace, Activity and

Respiration

AOR Adjusted Odd Ratio

CMR Child Mortality Rate

EDHS Ethiopia Demographic Health Survey

EMOH Ethiopia Ministry of Health

IMR Infant Mortality Rate

NICU Neonatal Intensive Care Unit

NMR Neonatal Mortality Rate

WHO World Health Organization

ACKNOWLEDGMENTS:

The researcher would like to thank all the participants and everyone who contributed directly or indirectly in the progress of research work.

AUTHORS CONTRIBUTIONS:

ATC the principal investigator was involved in proposing, designing, and implementation the study and also undertook analysis and drafted the manuscript.GN gave critical comments and approved the manuscript. GD and BLS were involved in preparing the manuscript, and rectified the paper. All authors approved the final work.

COMPETING INTERESTS:

No competitive financial interest declaration by any individual or entity or non-financial competing interests, such as political, economic, religious, ideological, scholarly, scientific and commercial or any other competing interests are related in this manuscript.

DATA AVAILABILITY:

Data utilized and assessed in the present study can be availed through the corresponding author on request.

ETHICAL APPROVAL:

All studies were conducted in conjunction with the standards for human research as set out in the Helsinki Declaration and the recommendations for the International Conference on Harmonization of Good Clinical Practice. BuleHora University, institutional review board gave ethical clearance to conduct the study. Respondents were told of the study's intent and goals. After receiving verbal consent from each individual, the data was obtained.

FUNDING ACKNOWLEDGEMENTS:

The author(s) obtained financial assistance from BuleHora University for conducting this research while no financial assistance is provided for, authorship, and/or publishing

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Received on 09.01.2024 Modified on 01.03.2024

Asian J. Nursing Education and Research. 2024; 14(2):149-156.

DOI: 10.52711/2349-2996.2024.00030

S. No	Significant factors variable	CI	Power	AOR	Proportions of exposed group	Proportions of non-exposed group	Sample size	Reference
1	Multiple birth	95	80	6.71	11.8	88.2	448	(10)
2	APGAR at 5^th	95	80	2.12	39.7	60.3	298	(15)
3	Prematurity	95	80	0.39	37.037	62.96	170	(13)
4	Asphyxia	95	80	3.84	32	68	147	(15)
5	Male sex	95	80	2.8	51.7	48.3	145	(12)