Evaluation of neonatal mortality surveillance system, Lower River Region, The Gambia, 2020-2024

Abstract

Introduction: Neonatal mortality remains a major global health challenge, with an estimated 6,500 neonatal deaths occurring daily worldwide. Due to inadequate healthcare infrastructure and weak surveillance systems, neonatal mortality is significant. The neonatal death surveillance system in Lower River Region has never been evaluated; therefore, this study aims to assess the usefulness, attributes, and performance of the neonatal mortality surveillance system in Lower River Region. Methods: A descriptive cross-sectional study was conducted to evaluate the performance of the neonatal mortality surveillance system in the Lower River Region using semi-structured questionnaires and a checklist. Surveillance data from 2020 to 2024 were reviewed, following the CDC Guidelines for Evaluating Public Health Surveillance Systems (2001). Purposive sampling was used to select respondents from the district hospital and health centres, while random sampling was applied to three community clinics, one private facility, one NGO clinic, and one service clinic. Results: A total of 34 participants were interviewed across all districts in the Lower River Region. The system recorded 89 neonatal deaths between 2020 and 2024, but none were investigated or used for public health action. The overall performance of the surveillance system was 50.1%. Usefulness (25.9%), simplicity (39.4%), acceptability (33.8%), and timeliness (21.3%) were all low. Flexibility (86.0%) was strong, and data quality (64.1%) and stability was moderate (60.1%). The system showed moderate representativeness (66.7%) across districts, sex, and years, but had major gaps in reporting, investigating, feedback, and community engagement. Conclusion: The neonatal mortality surveillance system in the Lower River Region provides useful data but performs moderately due to weak timeliness, incomplete investigations, inconsistent reporting tools, and limited training and feedback. Strengthening supervision, resources, and data management is essential for improving its effectiveness and supporting timely interventions to reduce preventable neonatal deaths.