Identifying factors affecting neonatal near-miss cases is fundamental to condense neonatal mortality. Some studies were conducted in assessing neonatal near-miss cases, but they failed in identifying the most determinants for near-miss cases. Therefore, this study showed the most proximate factors affecting near-miss cases in the study settings.
Of the characteristics that were assessed in this study; multiparty, antenatal care, premature rupture of membrane, non-vertex presentation, and cesarean mode of delivery had a significant association with neonatal near-miss cases.
As indicated in this finding multiparty was significantly associated with NNM. This was in line with a study done in Ethiopia [26], but inconsistent with a study done in Southeast Brazil [19]. This difference is maybe due to differences in socioeconomic status and health care delivery system. Not having ANC follow-up had a significant factor for having neonates with a life-threatening condition (near-miss) as point outed in this study. This was congruent with a study done in Southeast Brazil [19]. This is obvious that the pregnant mother avoids preventable risk factors after having ANC follow and early identification, and treatment of pre-existing conditions, and early screening of conditions that occurred during pregnancy.
Premature rupture of membrane and cesarean mode of delivery were significantly associated with NNM cases in this finding. This was in line with studies done in South Africa, and three studies in Brazil [15, 16, 19, 27]. The reason for this is that those stated conditions are one, or in another way can affect the neonates during intra-uterine as well as extra-uterine life and predispose for life-threatening conditions. In this study, the non-vertex presentation had a significant association with NNM cases. This is the fact that mal-presentation during delivery cause different complications in the mother as well as in the baby, and results for neonatal near-misses.
In this study, hemorrhage and hypertensive disorder during pregnancy were not significantly associated with neonatal near-miss cases. This was incongruent with a study done by Kale et al. [19]. The reason for this discrepancy may be methodological aspects of the study (difference in the study participant selection, study setting, and design). Educational status of the mother and father and place of the residence had also not significate association with neonatal near-miss cases as speculated 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 and educational status.
The utmost importance of this study for public health is: identifying the potential factors that predispose the newborn for life-threatening (near-miss) conditions are very important to tackle the underlining causes and to give immediate solutions. The finding of this study initiates different stakeholders in the health care system to design appropriate strategies and planning for the measurements to be taken to avoid those potential factors, both in the health care institutions as well as in the community at large. This study becomes one input for health policymakers and program developers typical regarding neonatal health in the health care delivery system.
The limitation of this study is that it does not incorporate some of the variables that are addressed in the community, such as wealth index, nutritional status, and cultural aspects. Therefore, other scholars should consider those situations and it also very important if they supplement or triangulate with a qualitative study to dig out untouched aspects.
The strength of this study was that data on exposure and confounding collected before the occurrence of cases (neonatal near-miss case) (from the follow-up study conducted in the same setting), which reduces the potential for recall bias and uncertainty regarding the temporal sequence between exposure and case onset. Besides, it was more efficient to measure the exposure status as compared to the whole cohort.
In summary, there is a gap in previous studies to show the most proximate factors that affect neonatal near-miss cases. Therefore, this study envisioned to fill the aforementioned gaps. In this study, party, antenatal care, premature rupture of membrane, presentation, and mode of delivery were significantly associated with near-miss cases. Whereas, the educational status of the mother and father, place of residence, hemorrhage, and hypertensive disorder during pregnancy had not significate association with near-miss cases. The readers should consider the limitations of this study while interpreting the finding, and the other scholars will do more to overcome those limitations. The finding of this study gives an overriding reputation to tackle factors affecting neonatal health, which leads to near-miss and predisposing factors for neonatal mortality.