Factors contributing to increased Neonatal Mortality in Grand Kru County, Liberia, January 2017-December 2021

Author: Jimmy Lawubah


Jimmy Lawubah, Chukwuma David Umeokonkwo, Himiede Wede Sesay, Babalola Joseph Obafemi, Faith Tina Whesseh, Leroy Maximore, Francis Bobway, Boye Nuyelleh, Lily Marie Sanvee-Blebo, Maame Amo-Addae

Journal details:

Journal of Interventional Epidemiology and Public Health

Journal of Interventional Epidemiology and Public Health. 2023;6:17. [doi: https://www.doi.org/10.37432/jieph.2023.6.4.89]

Publication Date: October 20, 2023



Introduction: The average global neonatal mortality rate is 17 deaths per 1,000 live births, while in Liberia, the neonatal mortality rate is 30.6 deaths per 1,000 live births as of 2020. Liberia is among the countries in the world with the highest neonatal mortality rate. In 2016, the former president of Liberia declared neonatal mortality as a public health emergency due to the high neonatal mortality rate which was recorded as 42 deaths per 1,000 live births. Grand Kru County is one of the counties in Liberia where neonatal death is reported nearly every month. The aim of this study is to describe the burden of neonatal death in Grand Kru from 2017-2021 and identify direct causes and contributory factors.

Methods: A cross-sectional study was conducted at 24 health facilities in Grand Kru We reviewed neonatal death investigation forms, health management information system (HMIS) monthly reports, weekly surveillance reporting ledgers and the county’s integrated disease surveillance and response (IDSR) line list to obtain the total neonatal deaths, its causes, and contributory factors. We determined the number of live births by reviewing the labour and delivery ledgers from January 2017 to December 2021. Data was cleaned and analyzed in Excel, we calculated the proportion for each socio-demographic variable, direct causes of death and contributory factors.

Results: There were 126 neonatal deaths and 3,714 live births reported from 2017-2021. Sixty-seven (53.2%) of the neonatal deaths were females, 82.5% (104/126) occurred in the health facilities, the median age was 2 days (interquartile range [IQR]: 1 – 4) days. Barclayville district accounted for 49.2% (62/126), followed by Jroah district 30.1% (38/126). The main direct causes of neonatal death were birth asphyxia 39.6% (50/126) and neonatal sepsis 25.3% (32/126), while contributing factors include: late community referral 58.7% (74/126), lack of functional incubators 28.6% (36/126) and delayed ambulance services for patient referral 16.7% (21/126). The average neonatal death rate in Grand Kru from 2017-2021 was 33.9 deaths per 1,000 live births.

Conclusion: Neonatal rate in Grand Kru was high. Birth asphyxia and neonatal sepsis were the leading causes of neonatal deaths, while late community referral, lack of functional incubators and delayed ambulance services for patients’ referral were leading factors contributing to neonatal mortality in Grand Kru County.