Newborn examination practices and congenital anomaly detection in public health facilities in Addis Ababa, Ethiopia: a qualitative exploratory study

Background: Congenital anomalies are a leading cause of infant morbidity and mortality, particularly in low-resource settings. Early detection through standardized newborn examinations is critical but remains underexplored in Ethiopia. Objective: This qualitative study systematically assesses neonatal examination practices in major public hospitals in Addis Ababa, Ethiopia, identifying gaps and proposing recommendations for standardized protocols. Methods: We conducted twelve key informant interviews from November 2024 to January 2025 with pediatricians, obstetrician-gynecologists, and midwives from four large public hospitals using purposive sampling based on role and neonatal care experience. Interviews were transcribed verbatim and analyzed thematically following Braun & Clarke's framework. Coding was performed by two researchers; discrepancies were resolved by consensus. Trustworthiness was enhanced through member checking, peer debriefing, triangulation, and an audit trail. Results: Examination practices are fragmented, with inconsistent use of structured checklists and inadequate documentation. Training gaps among clinicians and non-physician staff were evident. There is strong interest in adopting checklist-based approaches to improve anomaly detection. Conclusions: The findings highlight critical gaps in neonatal examination and documentation practices across the study sites. Developing a national checklist, comprehensive training programs, and mandatory protocols could strengthen early detection and management of congenital anomalies.