Asrat DemtseKullehe Haddis2026-06-222026-06-222024-01-13https://etd.aau.edu.et/handle/123456789/8397Background According to a March 2024 WHO report, 2.3 million deaths occurred in newborns less than 28 days globally in 2022. Sub-Saharan Africa had the highest neonatal mortality rate, of 27 per 1000 live births [1]. Hypothermia is known to increase the risk of both morbidity and mortality. Thus maintaining a normal body temperature is one of the very important steps for survival of the newborns. Despite the different mechanisms proposed to prevent hypothermia, it remains a global problem especially for low-income countries like Ethiopia. Objective The objective of the study was to determine the effect of admission hypothermia on neonatal mortality across 20 Ethiopian hospitals discharged from neonatal units from January 1-December 31, 2021. Methodology This study is a secondary analysis of prospectively collected data. A total of twenty hospitals participating in the Ethiopian Neonatal Network (ENN) in the Vermont Oxford Network (VON) Global Health Database were included. All newborns whose temperature was recorded in one hour of birth were included in the study. The admission hypothermia was assessed in association with gestational age, birth weight, the environmental temperature, level of neonatal intensive care unit where the neonatal care provided, season of the year the newborn was born, and whether the newborn was born in the weekdays or weekends. Associations were tested for mode of delivery, birth weight, place of delivery and whether the newborn was term or preterm in relation to mortality. Effect modification by discharge diagnosis was considered. Associations were calculated using relative risk (RR) with a 95% CI. Data analysis was done using SAS 9.4. iii Results A total of 12,363 newborns were included in the study. The overall rate of hypothermia was 51.6%. Predictors for hypothermia and mortality included being part of a multiple birth, low birth weight and lower gestational age. The season of the month, mode of delivery or hospital environmental temperature did not have any impact in predicting hypothermia or death. In unadjusted analyses, the risk of death increased more than five times [RR 5.65 (95% CI: 4.31, 7.41)] when the admission temperature was less than 33.9°C, more than four times [RR 4.25 (95% CI: 3.30, 5.49)] when the temperature was between 34 - 34.9°C. In a multivariable analysis with other confounding factors controlled, the risk of death increased by two times for body temperatures less than 36.5°C. Admission temperature was not an effect modifier in the associations between perinatal asphyxia, respiratory distress, or meconium aspiration syndrome and mortality. However, admission temperature was an effect modifier in the association between any sepsis and mortality. Conclusion Admission hypothermia is high in Ethiopia and is associated with a twofold increased risk of death. Lower gestational ages, low birth weight infants, septic patients, newborns with congenital anomaly and multiple births were associated with increased risk of death. Measures to improve admission hypothermia through the use of intensive quality improvement projects should be undertaken to improve the situation in the country.en-USHypothermia and Neonatal MortalityBook