Abstract:
Background: With nearly 15 million annual preterm births globally, preterm birth is the most common cause
of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality.
As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in
preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution
to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study.
Methods: This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal
factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be
identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on
management of preterm infants including required investigations to reach final diagnoses. The study will document
the clinical and management protocols followed in these settings. The approach consists of clinical examinations and
monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both
clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and
contributory causes of mortality.
To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in
three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are
either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual
period, physical examination using the New Ballard Score, and ultrasound) will be used to determine
gestational age.
All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or
caretakers prior to their participation in the study as well as for autopsy if the infant dies.
Discussion: This study will determine the major causes of death and illness among hospitalized preterm infants in a
low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to
contribute to a significant reduction in neonatal mortality.
Keywords: Neonatal mortality, Preterm birth, Low-middle income countries, Cause of death
