Determinants of Neonatal Near Miss Among Newborns Admitted to SOS Mother & Child Hospital, Benadir Region, Somalia: A Case-Control Study

Abstract BackgroundWhile the birth of a newborn is often a moment of great joy, it can be overshadowed by life-threatening complications that endanger survival in the early days of life. Neonatal near-miss (NNM) cases—infants who narrowly survive severe complications—offer a valuable lens for evaluating the quality of neonatal care. Somalia continues to experience one of the world’s highest neonatal mortality rates, reflecting major gaps in maternal and child health services. This study aimed to identify the determinants of neonatal near miss among neonates admitted to SOS Mother & Child Hospital, Benadir-Somalia.MethodsAn unmatched case-control study was conducted at SOS Mother and Child Hospital in Benadir region from December 2024 to April, 2025. A total of 243 NNM cases and 730 healthy neonate controls were included. Cases were identified using pragmatic and management criteria from the CLAP criteria. For each case, three controls were randomly selected. Data were collected using structured interviews and record reviews, and analyzed using SPSS v25. Logistic regression was employed to identify independent predictors of neonatal near miss.ResultsSignificant predictors of neonatal near miss included lack of maternal (AOR: 2.61) and paternal education (AOR: 3.64), monthly household income below 100 USD (AOR: 2.82), short birth interval under 24 months (AOR: 1.97), lack of antenatal care (ANC) attendance (AOR: 6.25), history of stillbirth (AOR: 4.35), obstetric complications (AOR: 4.46), preterm or post-term birth (AOR: 1.89), prolonged labor (AOR: 3.58), home delivery (AOR: 4.76), maternal chronic illness (AOR: 3.37), male sex of the newborn (AOR: 1.86), and low birth weight (AOR: 9.34).Conclusion & recommendationNeonatal near miss remains a pressing public health concern in Somalia, influenced by socio-demographic, obstetric, and neonatal factors. Strengthening maternal education, promoting antenatal care, ensuring skilled birth attendance, and improving facility-based delivery services are essential to reducing neonatal complications and improving outcomes. Policymakers and humanitarian partners must prioritize investments in maternal and newborn health to address these preventable risks.