The result from multivariable shows that age of mother between 20-34, gestational age 37-41 weeks, SVD and delivery followed by partograph were identified as determinants of the neonatal near miss.
Age of mother between 20-34 had lower odds of experiencing Neonatal Near Miss than those mothers of age below 20 years old. This result is in line with study done in Tigray that showed that being under 18 years of age at first marriage [AOR=2.8, 95%CI:1.18–6.83], had higher odds of experience NNM than above age of 18. This is because at early age physiological and psychological they aren’t enough matured and early pregnancy in prematurity stage associated with neonatal near miss. Additionally, as most of the respondents were from the rural area and uneducated, there is still early marriage in the area.
In study done in Brazil show that advanced maternal age (>35 years old) was to be a risk factor for neonatal near miss in nulliparous (OR = 1.62; 95%CI: 1.05-2.50) and multiparous women (OR = 1.51; 95%CI: 1.20-1.91) when compared to women 20-29 years of age . There were also in study done in northeast Brazil Infants born to older mothers showed a nearly 2-fold risk of neonatal near miss, compared to mothers aged 20 to 34 (OR: 0.43; 95% CI: 0.23–0.83) . But studies done in Brazil use different age group category with a range of 10 years when compared with current study.
Other variables which significantly associate with NNM was GA. GA with 37-41 weeks had 0.16 times lower odds of experiencing neonatal near miss than neonates of <37weeks of gestational age at birth [AOR=0.16, 95% CI: (0.06-0.47)]. In line with this result, study in Ghana the most predictive elements of the NNM were gestational age >33 weeks., study in Brazil gestational age <33 weeks was identified in 85.7% of hospitalized newborns, and this was the factor that most contributed to the near miss rate . Also, a study conducted in Brazil, shows that >80% near miss case were < 30 weeks of gestational age . this is because most complication has supposed to be related with prematurity. In Ethiopia also study conducted in Ambo show that the gestational age between 36-41 weeks were protected against neonatal near miss than neonates of ≥ 42 weeks of gestational age at birth [AOR=0.13, 95% CI:(0.051, 0.32)]. this is because prematurity impose the newborn for life threating condition because of his immature organ.
Opposite to result, in study done in three African country (Benin, Burkina Faso and Morocco) most neonatal near misses occurred in babies without extreme values of gestational age (>41) . This result show opposite with current study it’s because methodological difference, study setting and use large sample size than current study.
Another variable which is determinates of NNM were mode of delivery study show that neonate SVD had less odds of experiencing NNM than delivered assisted instrumentally and CS. This result shows the similar conclusion with study done in Ambo which reveal that neonates who were given birth by instrumental delivery had higher odds of experiencing neonatal near miss than neonates gave birth by spontaneous vaginal delivery [AOR= 4.62, 95% CI: (1.78, 11.98)]. It is supposed to be a fact that instrumental delivery can cause a lot of adverse effect on neonates and mothers and increase risk of such complications is estimated to lead to NNM. Other study in Gamo Gofa show that mother who gave birth by cesarean mode of delivery were 4.89 times more likely to have NNM cases than SVD and Instrumental assisted delivery . And also in other ways, evidence from Brazil stated that neonatal near miss rate was higher among babies delivered by C/S than in those delivered through SVD. The result shows the same result with current result.
Another variable, delivery followed by partograph had less odds of developing Neonatal near miss than not followed by partograph. Even though there was no study support this finding, it is a fact that delivery not followed by partograph can lead to a lot of adverse effect on neonates and mothers. To avoid adverse outcome a chart called a partograph will help you to follow the progress of a labor that is prolonged and which may be obstructed. It will also alert you to signs of fetal distress. The partograph has been established as the “gold standard” labor monitoring tool universally. It has recommended by the World Health Organization (WHO) for use in active labor .
In this study Occupation of mother and parental, marital status, complication during labor and delivery, parity, delivery attended health worker, and presentation were insignificantly associated with neonatal near miss. And also, ethnicity, religion, sex of neonate, place of the residence had also not significate association with neonatal near-miss cases in this finding. This is because, nowadays there is an improvement in the health care delivery system, advances in technology, and seeking health information irrespective of residence, Ethnicity, religion and educational status.
Finally, the strength of this study was employing a standardized neonatal near miss identification criteria to avoid misclassification and the incomplete questionnaires were filled to got 100% response rate of the respondents. This study didn’t analysis selection criteria for case event, the criteria only to identify the neonatal near miss event and identify additional determinant factor (Partograph usage) that isn’t addressed yet in published literature.
In this study, data corresponding to sociodemographic and economic variables were collected by interviews and might be subject to recall bias. The readers should consider the limitations of this study while interpreting the finding and the other scholars will do more to overcome those limitations.