Title : Assessing neonatal mortality using CBHMIS: Causes, distribution, and implications for public health interventions in Northern Nigeria
Abstract:
Nigeria accounts for approximately 274,000 neonatal deaths annually, representing the world's second-highest burden, with most of these deaths being preventable. However, the current hospital-based reporting system fails to capture many of these events because they occur outside health facilities. This study aimed to determine the causes and distribution of neonatal deaths in Katsina State, Nigeria, where most events occur within the communities. The study was conducted in five communities with a combined estimated population of 1.6 million. Neonatal deaths were identified through the Community-Based Health Management Information System (CBHMIS), which engaged trained community informants to report vital events. A total of 751 verbal autopsies were conducted for neonatal deaths reported between December 2023 and November 2024 using the WHO 2022 Verbal Autopsy tools. The underlying causes of death were determined by trained physicians using the WHO DORIS tool, with causes assigned to ICD-11. Data were analyzed using the Analyzing Mortality and Causes of Death 3 (ANACoD-3) software, and descriptive statistics were used to determine mortality distribution. Ethical clearance was obtained from the Katsina State Health Research Ethics Committee under the State Ministry of Health. The majority of neonatal deaths (67%) occurred within the first seven days of life (early neonatal period), and 71% of all neonatal deaths took place outside health facilities. Male neonates accounted for a slightly higher proportion of deaths (53.3%). The leading causes of neonatal deaths were neonatal sepsis (40.0%), birth asphyxia and birth trauma (34.2%), neonatal jaundice (10.6%), congenital anomalies (5.3%), prematurity and low birth weight (4.9%) and other conditions (5.0%). Alarmingly, neonatal tetanus, a condition targeted for elimination by the WHO, still accounted for 1.5% of all neonatal deaths in the study area. The high proportion of community-based births likely contributed to the high incidence of neonatal sepsis and tetanus, surpassing global neonatal mortality trends for these conditions. These findings underscore the urgent need for scalable interventions to promote clean and safe delivery practices, particularly in communities with high rates of home births and neonatal deaths. Strengthening community-based interventions, awareness campaigns, and grassroots maternal and neonatal health policies is critical for improving child survival outcomes in Nigeria.
