Profiles of Neonatal Deaths at a Rural Hospital in the Eastern Cape, South Africa: A Retrospective Descriptive Study

Abstract

<ns3:p> Background Neonatal mortality remains a significant public health challenge in South Africa, particularly in rural settings where health outcomes continue to reflect structural inequities rooted in the apartheid era. This study aimed to describe maternal and neonatal characteristics among neonatal deaths at a rural hospital in the Eastern Cape from 2019 to 2025. Methods This retrospective descriptive study used data extracted from routinely collected maternal and neonatal records and analysed using IBM SPSS version 30. During the study period, 28,107 live births and 252 neonatal deaths were recorded, corresponding to a neonatal mortality rate (NMR) of 9.0 per 1,000 live births. Of the identified neonatal deaths, 200 records contained sufficient information for analysis. Results Most neonatal deaths occurred among preterm neonates (64.8%), low birth weight infants, and male neonates (58.1%). Most deaths occurred during the early neonatal period, particularly within the first three days of life in this facility. Birth asphyxia (49.7%), hypothermia (33.3%), and neonatal infection or sepsis (17.1%) were among the most frequently documented clinical conditions. Among mothers with available records, late antenatal booking and infrequent antenatal care attendance were commonly documented. Conclusion These findings provide a descriptive profile of neonatal deaths at a rural district hospital and highlight patterns requiring further investigation and quality improvement initiatives. The study also demonstrates the importance of improving data completeness and routine neonatal surveillance in rural healthcare settings. <ns3:bold>Ethics</ns3:bold> approval was obtained from Walter Sisulu University (WSU HREC 110/2025) and the Eastern Cape Health Research Committee (EC_202507_061). </ns3:p>