Neonatal Mortality in Low-Birth-Weight Infants in Southern Ethiopia: A Multicenter Cohort Study With Multilevel Analysis

Background: Low-birth-weight (LBW) remains a leading cause of neonatal mortality in Ethiopia. This study aimed to identify individual and institutional determinants of mortality among LBW infants in Southern Ethiopia. Methods: A hospital-based prospective cohort study was conducted among 768 LBW neonates admitted to 8 public hospitals in South Ethiopia from September 2023 to February 2024. Data were collected using a structured questionnaire and analyzed using STATA 16. Multilevel logistic regression was applied to identify predictors of mortality. Results: Overall mortality was 28.3%. Key individual-level predictors included lower birth weight, respiratory distress syndrome, necrotizing enterocolitis, and perinatal asphyxia. Institutionally, absence of isolated preterm rooms, inadequate physician staffing and distant NICU location significantly increased mortality risk. Conclusions: LBW mortality in Southern Ethiopia is alarmingly high. Both clinical comorbidities and modifiable institutional factors, especially infrastructure and staffing, are critical determinants. Urgent improvements in neonatal care facilities and human resources are needed.