Background: Neonatal mortality remains a critical public health challenge, particularly in low-resource settings. This study investigates maternal and neonatal factors influencing neonatal mortality at Zabzugu District Hospital in Northern Ghana. Despite various interventions aimed at reducing neonatal deaths, the mortality rate in this region remains alarmingly high. The study seeks to identify the key maternal and neonatal determinants contributing to this high mortality rate and to provide evidence-based recommendations for improving neonatal outcomes.

Methodology: The study employed a retrospective unmatched case-control design, reviewing hospital records from January 2018 to December 2022. A total of 517 singleton live-born neonates were included in the study, consisting of 136 neonatal deaths (cases) and 381 postnatal survivors (controls). Data were collected on maternal age, parity, gestational age, birth weight, Apgar scores, the individual conducting the delivery, and the number of antenatal care (ANC) visits. Univariate, bivariate, and multivariate logistic regression analyses were performed to identify significant factors associated with neonatal mortality.

Results: The results revealed that neonatal mortality in Zabzugu District Hospital was significantly influenced by low birth weight, preterm birth, low Apgar scores, and deliveries conducted by unskilled personnel. High parity, advanced maternal age, and inadequate ANC visits were also significant maternal factors contributing to increased neonatal mortality risk. Neonates with a birth weight below 2500 grams were 13 times more likely to die compared to those with normal birth weight. Preterm neonates exhibited a higher mortality risk, with a significant proportion of deaths occurring within the first 24 hours of life. Additionally, neonates with low Apgar scores at 5 minutes had a substantially increased risk of mortality.

Findings: The presence of skilled birth attendants was associated with improved neonatal outcomes, emphasizing the critical role of professional obstetric care in reducing neonatal deaths. Despite interventions such as Kangaroo Mother Care (KMC) and integrated management of neonatal and childhood illnesses (IMNCI), the neonatal mortality rate at Zabzugu District Hospital remains high. The study highlights the need for enhanced ANC services, improved training for healthcare providers, and increased community awareness regarding the importance of skilled birth attendance and early neonatal care.

Conclusion and Recommendation: The study concludes that neonatal mortality in Zabzugu District Hospital is predominantly influenced by both maternal and neonatal factors. Low birth weight, preterm birth, low Apgar scores, high parity, advanced maternal age, and inadequate ANC visits are significant contributors to the high neonatal mortality rate. Addressing these factors through targeted interventions is crucial for reducing neonatal deaths in the region. the study recommends targeted interventions to address the identified risk factors. These include strengthening ANC services to ensure early detection and management of high-risk pregnancies, enhancing training programs for healthcare providers, and promoting community-based health education campaigns.