Determinants of Birth Asphyxia Among Newborns Delivered in Public Health Facilities in Dire Dawa, Eastern Ethiopia, 2025:

Unmatched Case- Control Study

Abstract

Background: Birth asphyxia is a major cause of neonatal morbidity and mortality worldwide and remains a significant public health problem in Ethiopia. Despite the implementation of various maternal and neonatal health interventions, including the expansion of antenatal care (ANC) contacts to eight visits, birth asphyxia continues to contribute substantially to neonatal deaths. This study aimed to identify the determinants of birth asphyxia in public health facilities of Dire Dawa City Administration, Eastern Ethiopia.

Methods: A facility-based unmatched case–control study was conducted in four health centers and two hospitals in Dire Dawa City Administration from February 20 to April 30, 2025. A total of 308 newborns, comprising 103 cases and 205 controls, were included. Data were collected using structured questionnaires and checklists through the KoboCollect application and analyzed using SPSS version 26. Variables with a p-value less than 0.25 in bivariate analysis were entered into a multivariable logistic regression model. Determinants of birth asphyxia were identified using adjusted odds ratios with 95% confidence intervals, and statistical significance was declared at p-value less than 0.05.

Results: Newborns born to mothers who had fewer than four ANC visits were five times more likely to develop birth asphyxia compared to those whose mothers had four or more visits (AOR = 5.00; 95% CI: 2.57, 9.66). Prolonged labor significantly increased the likelihood of birth asphyxia by more than fourfold (AOR = 4.25; 95% CI: 2.12, 7.79). Neonates delivered through instrumental methods had nearly three times higher odds of experiencing birth asphyxia than those delivered spontaneously (AOR = 2.70; 95% CI: 1.11, 7.36). Additionally, neonates born at non-term gestational age were more than five times more likely to develop birth asphyxia (AOR = 5.58; 95% CI: 1.91, 19.63). Low birth weight was also a significant determinant, with affected neonates having more than four times higher odds of birth asphyxia (AOR = 4.51; 95% CI: 2.07, 11.67).

Conclusion: This study identified fewer than four ANC visits, prolonged labor, instrumental delivery, non-term gestational age, and low birth weight as significant determinants of birth asphyxia. Strengthening the quality and continuity of antenatal, intrapartum, and immediate newborn care is essential to reduce the burden of birth asphyxia in public health facilities.