Determinants of Neonatal Mortality in Sub-Saharan Africa: A Scoping Review

Background: Neonatal deaths are considered one of the primary health issues worldwide, and one of the leading causes of death amongst children under 5 is what is referred to as neonatal mortality, with the highest prevalence being recorded in Sub-Saharan Africa. Although there is global development, the average neonatal mortality rate of 27 deaths per 1,000 live births in the region is significantly higher than the Sustainable Development Goal (SDG) 3.2 target of less than 12 deaths by 2030. It is crucial to know the multifactorial determinants of neonatal survival to guide evidence-based interventions and policy changes. The goal of this scoping review was to identify, map, and synthesise the most recent literature on determinants of neonatal mortality in Sub-Saharan Africa (2020-2025), and to categorise them in thematic domains and identify gaps of interest to the nursing, policy, and research. Methods: The review used the framework by Arksey and O'Malley (2005), modified by Levac et al. (2010), and followed the PRISMA-ScR guidelines. PubMed, Scopus, CINAHL, and Cochrane Library, as well as WHO and UNICEF repositories, were searched to retrieve peer-reviewed and grey literature. Articles were included when they investigated the determinants of neonatal death in live-born infants in Sub-Saharan Africa aged 0-28 days. The standardised charting table was used to extract the data and analyse thematically in four domains, namely neonatal, maternal, health-system, and socio-economic factors. Results: A total of 27 articles were found to fit the inclusion criteria. There were major risk factors such as low birth weight, prematurity, birth asphyxia, sepsis, poor access to skilled birth attendants, and insufficient neonatal intensive care. Maternal factors that were contributing to risk included being young (below 20 years), short inter-pregnancy intervals, and inadequate antenatal care. Vulnerability was also worsened by poverty, maternal low education, and rural status, and prevented by early breastfeeding, facility birth, and postpartum follow-up. Conclusion: Neonatal mortality in Sub-Saharan Africa is caused by complex biological determinants, maternal determinants, systemic determinants, and socio-economic determinants. Recommendation: To realise SDG 3.2 and to enhance neonatal survival in the region, it is important to strengthen skilled care, neonatal infrastructure, and empower women.