Factors associated with mortality among neonates admitted with esophageal atresia at a tertiary hospital in Uganda: A retrospective study

• EA/TEF mortality at MNRH reached 71.9%, underscoring a severe survival disparity. • Gross types A and D were independent predictors of poor neonatal EA/TEF outcomes. • Surgical intervention conferred a 24% reduction in mortality risk among neonates. : Esophageal atresia (EA), often associated with tracheoesophageal fistula (TEF), is a complex congenital condition and a major cause of neonatal morbidity and mortality in low-resource setting. Survival for neonates with EA/TEF remains markedly low in Africa, in contrast to the near 100% survival rates reported in high-income countries. There is particular lack of context specific data for the Ugandan setting. This study therefore aimed to determine mortality rate and its predictors among neonates with EA/TEF admitted at Mulago National Referral Hospital (MNRH) in Uganda. : We conducted a retrospective records review of 57 neonates admitted with EA/TEF at MNRH from January 2018 to December 2023. Data were extracted using a standardized tool. Predictors of mortality were assessed using modified Poisson regression with robust error variance at 95% confidence. : Among 57 neonates, 41 (71.9%) died. The majority 50 (87.7%) had Gross type C EA/TEF. Multivariate analysis revealed that type A (aRR = 1.38, p < 0.01) and type D (aRR = 1.25, p = 0.01) were significant factors associated with mortality and undergoing surgical intervention reduced the risk to mortality by 24%. (.aRR = 0.76, p < 0.01). Other factors such as prematurity, birth weight, and pneumonia were not independently predictive as initially hypothesized. : EA/TEF mortality in Uganda is high, with Gross types A and D predicting poorer outcomes while surgery improves survival.