Factors Associated with Neonatal Mortality in the Neonatology Department of the Regional Hospital Center, AGADIR, MOROCCO

Document Type : Original Article


1 Research team in congenital anomalies, Training in clinical epidemiology and medical-surgical sciences, Faculty of Medicine and Pharmacy Rabat-University Mohammed V – Rabat Morocco

2 Research team in congenital anomalies, Training in clinical epidemiology and medical-surgical sciences, Faculty of Medicine and Pharmacy Rabat-University Mohammed V – Rabat MoroccoUnit of Dysmorphology and Developmental Anomalies,

3 Research team in congenital anomalies, Training in clinical epidemiology and medical-surgical sciences, Faculty of Medicine and Pharmacy Rabat-University Mohammed V – Rabat MoroccoCentre


Background: Neonatal mortality is a major public health problem and concern worldwide. Despite significant improvement, the neonatal mortality rate is still high. The present study aimed to determine the factors associated with neonatal mortality in the Neonatology Department of the regional hospital center, Agadir, Morocco.
Methods: This is a retrospective case-control study in which the records of newborns admitted during 2019 (from January 1 to December 31), in the neonatal department of the regional hospital of AGADIR were studied. Neonatal and maternal characteristics were collected from the medical record using a pre-established exploitation form. A total of 760 mother-infant pairs were selected. The association between death and study variables was evaluated using the bivariate analysis conducted by the Chi-square test. Subsequently, multivariate analysis was performed using binary logistic regression to assess the effect of each factor.
Results: Significant associations were found between the onset of neonatal death and several factors such as distance traveled to the hospital facility (AOR = 3.588, 95% CI:1.952-6.594); multiparity (AOR = 3.301,95% CI: 1.919-5.680); the number of prenatal visits (AOR = 3.608,95% CI: 2.293-5.678); low birth weight (AOR = 0.314, 95% CI: 0.184-0.535); referral act  (AOR = 0.368, 95%CI: 0.208-0.652); 5-min Apgar Score (AOR = 0.104, 95%CI: 0.42- 0.257) and gestational age (AOR = 1.788,  95%CI: 0.608- 5.257).
Conclusion: Neonatal mortality is associated with several preventable factors. Further preventive measures for these risk factors are required, especially in terms of pregnancy monitoring, delivery conditions, and infant management at birth.


  1. Gondwe MJ, Mhango JM, Desmond N, Aminu M, Allen S. Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: A systematic review. BMJ Open Qual. 2021; 10(1):1–10.

    1. Ouahid H, Adarmouch L, Belouali R, Mouwafaq S, Soummani A. Factors associated with intrapartum and very early neonatal mortality at the maternity of University hospital Mohamedd VI, Marrakech, Morocco. Case-control study. Rev Epidemiol Sante Publique. 2019; 67(4):233–8.
    2. Paulson KR, Kamath AM, Alam T, Bienhoff K, Abady GG, Abbas J, et al. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet. 2021; 398(10303):870–905.
    3. UNICEF. Levels & trends in child mortality estimation child mortality. Un Igme. 2020. Available from: https://www.unicef.org/media/79371/file/
    4. Moroccan Ministry of Health Strategy 2017-2021 «Every mother and newborn baby counts». 2021;1–46.
    5. WHO. Global strategy for women's, children's and adolescents' health (2016-2030): early childhood. Development Report of the Director General; 2018.
    6. MMH. Directorate of population. Maternal and Child Health (report). Rabat; 2015.
    7. Al-Assadi AF, Al-Haroon DS, Al-Rubaye A, Abdul-Rahman BA. Risk Factors and neonatal outcome among preterm birth at Basrah central hospitals. Med J Basrah 2018; 36(2):87–96.
    8. Séjourné N, Sanchez-Rodriguez R, Leboullenger A, Callahan S. Maternal burn-out: an exploratory study. J Reprod Infant Psychol. 2018; 36(3):276–88.
    9. Batista CB, Carvalho ML, Vasconcelos AG. Access to and use of health services as factors associated with neonatal mortality in the North, Northeast, and Vale do Jequitinhonha regions, Brazil. J Pediatr. 2018; 94(3):293–9.
    10. Demitto MO, Gravena AA, Dell’Agnolo CM, Antunes MB, Pelloso SM. High risk pregnancies and factors associated with neonatal death. Rev Esc Enferm USP. 2017; 51:1–7.
    11. Jahani MA, Rad ZA, Naghavian M, Salmanian T, Mojaveri MH. Factors affecting stillbirth rate in the hospitals affiliated to Babol University of Medical Sciences. Iran J Neonatol. 2015; 6(3):22–7.


    1. Akinyemi JO, Bamgboye EA, Ayeni O. Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics. BMC Pediatr. 2015; 15(1):1–12.
    2. de Oliveira LL, Gonçalves A de C, da Costa JSD, Bonilha AL de L. Maternal and neonatal factors related to prematurity. Rev Esc Enferm USP. 2016; 50(3):382–9.
    3. WHO. WHO recommendations on antenatal care to make pregnancy a positive experience. 2016. Available from: http://apps.who.int/bookorders.%0A http://apps.who.int/iris/bitstream/10665/25080/1/WHO-RHR-16.12-fre.pdf?ua=1
    4. Haute Autorité de Santé. Suivi Et Orientation Des Femmes Enceintes. High Authority for Health; 2016
    5. Simula N, Brown R, Butt K, Morency AM, Demers S, Grigoriu A, et al. Committee Opinion No. 418: The Complete 11-14 week prenatal sonographic examination. J Obstet Gynaecol Can. 2021; 43(8):1022-31.
    6. Nair AT. Morbidity and mortality profile of newborns admitted to the neonatal intensive care unit of a tertiary care teaching hospital of Assam. J Med Sci Clin Res. 2020; 8(01):11689–95.
    7. Rahman K, Begum R. Morbidity and mortality profile of neonates admitted in a special care newborn unit of a tertiary care teaching hospital of Assam, India. New Indian J OBGYN. 2020; 7(1):82–7.
    8. Chen WH, Su CH, Lin LC, Lin HC, Lin YJ, Hsieh HY, et al. Neonatal mortality among outborn versus inborn babies. Pediatr Neonatol. 2021; 62(4):412–8.
    9. Sauvegrain P, Rico-Berrocal R, Zeitlin J. What are the causes of high perinatal and infant mortality in Seine-Saint-Denis? Consultation of professionals in the department through a Delphi processEur. J Obstet Gynecol. 2016; 45(8):908-17.
    10. Howell EA, Zeitlin J. Quality of care and disparities in obstetrics. Obstet Gynecol Clin North Am. 2017; 44(1):13–25.
    11. Mahar PS, Manzar N. The study of etiological and demographic characteristics of pterygium recurrence: A consecutive case series study from Pakistan. Int Ophthalmol. 2014; 34(1):69–74.
    12. Helenius K, Longford N, Lehtonen L, Modi N, Gale C. Association of early postnatal transfer and birth outside a tertiary hospital with mortality and severe brain injury in extremely preterm infants: observational cohort study with propensity score matching. BMJ. 2019; 367:1–11.
    13. Tran KH, Vo-Van NL, Nguyen-Thi KH, Le-Thy PA, Nguyen HS. Neonatal morbidity and mortality in a neonatal unit in a Vietnamese hospital. Iran J Neonatol. 2022; 13(2):65-71.
    14. Tajalli S, Fallahi M, Bashardoust MH, Kazemian M, Heshmatpanah J. Neonatal mortality in an Iranian referral level III neonatal intensive care unit: A cross-sectional study. Iran J Neonatol. 2021; 12(3):68–75.
    15. Garba M, Kamaye M, Alido S, Zoubeirou H, Oumarou Z, Amadou A. Determinants of early neonatal mortality at the Issaka-Gazobi maternity hospital in Niamey. J Pediatrie Pueric. 2017; 30(4):156-61
    16. Brizuela V, Leslie HH, Sharma J, Langer A, Tunçalp Ö. Measuring quality of care for all women and newborns: how do we know if we are doing it right? A review of facility assessment tools. Lancet Glob Health. 2019; 7(5):e624–32.
    17. Fawole AO, Shah A, Tongo O, Dara K, El-Ladan AM, Umezulike AC, et al. Determinants of perinatal mortality in Nigeria. Int J Gynaecol Obstet. 2011; 114(1):37–42.
    18. Chen HY, Chauhan SP. Apgar score at 10 minutes and adverse outcomes among low-risk pregnancies. J Matern Fetal Neonatal Med. 2022; 35(25):7109-18.
    19. Kaboré R, Meda IB, Koulidiati JLE, Millogo T, Kouanda S. Factors associated with very early neonatal mortality in Burkina Faso: A matched case–control study. Int J Gynaecol Obstet. 2016; 135:93–7.
    20. Takramah WK, Aheto JM. Predictive model and determinants of odds of neonates dying within 28 days of life in Ghana. Health Sci Rep. 2021; 4(1):1–11.
    21. Migoto MT, Oliveira RP de, Silva AMR, Freire MH de S. Early neonatal mortality and risk factors: a case-control study in Paraná State. Rev Bras Enferm. 2018; 71(5):2527–34.
    22. Veloso FCS, Kassar L de ML, Oliveira MJC, Lima THB de, Bueno NB, Gurgel RQ, et al. Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies. J Pediatr. 2019; 95(5):519–30.
    23. Thakur N, Saili A, Kumar A, Kumar V. Predictors of mortality of extremely low birthweight babies in a tertiary care center of a developing country. Postgrad Med J. 2013; 89(1058):679–84.
    24. Izugbara C. Single motherhood and neonatal and infant mortality in Sierra Leone, Burkina Faso and Burundi. Public Health. 2016; 135:122–30.
    25. Noble C, Mooney C, Makasi R, Ntozini R, Majo FD, Church JA, et al. Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial. BMC Pregnancy Childbirth. 2022; 22(1):1–9.
    26. Berhie KA, Gebresilassie HG. Logistic regression analysis on the determinants of stillbirth in Ethiopia. Matern Health Neonatol Perinatol. 2016; 2(1):1–10.
    27. Ogbo FA, Ezeh OK, Awosemo AO, Ifegwu IK, Tan L, Jessa E, et al. Determinants of trends in neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016. BMC Public Health. 2019; 19(1):1–12.
    28. Srivastava S, Rashmi, Paul R. Urban-rural differential in neonatal and post-neonatal mortality clustering among Indian siblings: Evidence from national family health survey 2015–16. Child Youth Serv Rev. 2021; 121(2020):105822.
    29. Kedy Koum D, Exhenry C, Penda CI, Pfister RE. Neonatal morbidity and mortality in a low-resource urban district hospital of Douala, Cameroon. Arch Pediatr. 2013; 21(2):147-56.
    30. Zhao D, Zou L, Lei X, Zhang Y. Gender Differences in infant mortality and neonatal morbidity in mixed-gender twins. Sci Rep. 2017; 7(1):3–8.