Monitoring System Gaps and Neonatal Mortality in Six Health Facilities in Jimma Zone, Ethiopia

Monitoring System Gaps and Neonatal Mortality in Six Health Facilities in Jimma Zone, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Monitoring System Gaps and Neonatal Mortality in Six Health Facilities in Jimma Zone, Ethiopia Derartu Dereje Tekela, Johan Stiens, Kinde Anlay Fante, Bruno da Silva This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9124595/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Neonatal mortality remains a major public health challenge in low- and middle-income countries, where access to continuous physiological monitoring is often limited. Monitoring devices such as pulse oximeters and thermometers are essential for early detection of neonatal complications, yet gaps in device availability, functionality, and trained workforce capacity remain common. Few studies have simultaneously examined neonatal outcomes, monitoring device functionality, and staffing capacity within the same healthcare facilities. Methods A mixed-methods study was conducted across six public health facilities in Jimma Zone, Ethiopia. Retrospective neonatal admission records collected between June 2024 and June 2025 were reviewed to assess neonatal outcomes and causes of admission. Facility assessments were performed to evaluate the availability and functionality of monitoring devices. Focus group discussions with healthcare providers explored challenges related to monitoring practices, device functionality, and maintenance systems. Results Facility assessments revealed substantial gaps in monitoring infrastructure. Across the six facilities, 15 pulse oximeters were identified, of which only 6 were functional, while 9 were non-functional. Eleven thermometers were reported, with 7 functional and 4 non-functional. Only one functional neonatal patient monitoring system was identified. Qualitative findings highlighted recurring challenges related to equipment malfunction, lack of preventive maintenance, limited biomedical engineering support, and insufficient staff training. Conclusions Strengthening neonatal monitoring systems requires not only increasing device availability but also improving equipment maintenance systems, biomedical engineering support, and workforce training in resource-constrained healthcare settings. Neonatal mortality Vital signs monitoring Pulse oximetry Medical device functionality Neonatal care Health workforce capacity Low-resource settings Ethiopia Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 01 May, 2026 Reviewers agreed at journal 27 Apr, 2026 Reviews received at journal 23 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviewers invited by journal 22 Apr, 2026 Editor assigned by journal 20 Apr, 2026 Editor invited by journal 26 Mar, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 26 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9124595","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":630647947,"identity":"75d1e4ac-b367-466d-bb9a-ca657d0fb424","order_by":0,"name":"Derartu Dereje Tekela","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYDCCA2CSGUQkMHwAkmzspGhhnAHSwkyCFgZmHgQbN+A73vtM4geDtZx5e8PDxza/tsnzMTMwfviYg1uL5JnjZpI9DOnGMmcOJBvn9t02bGNmYJacuQ23FoMbaWwSPAyHE2dIJKRJ5/bcZgRqYWPmxafl/jM2yT8Mh+tnyD9I/23Zc9uesJYbbGzSQFsSJCQY0pgZftxOJKhF8kwas7WMQbrhDJ6EZMnehtvJbcyMzXj9wnf8GOPNNxXW8hLsZxI//Phz23Z+e/PBDx/xaAECFgkGAxDNk8DA2AZiMDbgVQ8EzB8gNPsBBoY/hBSPglEwCkbBSAQAhvdNRzY4dBAAAAAASUVORK5CYII=","orcid":"","institution":"Jimma University","correspondingAuthor":true,"prefix":"","firstName":"Derartu","middleName":"Dereje","lastName":"Tekela","suffix":""},{"id":630647948,"identity":"dac9310a-339f-4b56-a9e3-f894a68c2cd6","order_by":1,"name":"Johan Stiens","email":"","orcid":"","institution":"Vrije Universiteit Brussel","correspondingAuthor":false,"prefix":"","firstName":"Johan","middleName":"","lastName":"Stiens","suffix":""},{"id":630647949,"identity":"d17e0577-23fe-4a9c-8aa5-1cb1dc3a0ec0","order_by":2,"name":"Kinde Anlay Fante","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"prefix":"","firstName":"Kinde","middleName":"Anlay","lastName":"Fante","suffix":""},{"id":630647950,"identity":"6c13dc78-26b4-4668-be96-bb0b3c309add","order_by":3,"name":"Bruno da Silva","email":"","orcid":"","institution":"Vrije Universiteit Brussel","correspondingAuthor":false,"prefix":"","firstName":"Bruno","middleName":"da","lastName":"Silva","suffix":""}],"badges":[],"createdAt":"2026-03-14 19:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9124595/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9124595/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108491341,"identity":"911865f0-c5f3-485f-9d05-87845b5d5462","added_by":"auto","created_at":"2026-05-05 09:53:23","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":667573,"visible":true,"origin":"","legend":"","description":"","filename":"V13NeonatalMortalityCausesofDeathandDeviceAvailabilityinSixNICUsofJimmaZoneEthiopiaAMixedMethodsStudyCopyCopy.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9124595/v1_covered_e5872446-7ebf-4b31-b91c-926b4322e8eb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Monitoring System Gaps and Neonatal Mortality in Six Health Facilities in Jimma Zone, Ethiopia","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Neonatal mortality, Vital signs monitoring, Pulse oximetry, Medical device functionality, Neonatal care, Health workforce capacity, Low-resource settings, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-9124595/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9124595/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eNeonatal mortality remains a major public health challenge in low- and middle-income countries, where access to continuous physiological monitoring is often limited. Monitoring devices such as pulse oximeters and thermometers are essential for early detection of neonatal complications, yet gaps in device availability, functionality, and trained workforce capacity remain common. Few studies have simultaneously examined neonatal outcomes, monitoring device functionality, and staffing capacity within the same healthcare facilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA mixed-methods study was conducted across six public health facilities in Jimma Zone, Ethiopia. Retrospective neonatal admission records collected between June 2024 and June 2025 were reviewed to assess neonatal outcomes and causes of admission. Facility assessments were performed to evaluate the availability and functionality of monitoring devices. Focus group discussions with healthcare providers explored challenges related to monitoring practices, device functionality, and maintenance systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eFacility assessments revealed substantial gaps in monitoring infrastructure. Across the six facilities, 15 pulse oximeters were identified, of which only 6 were functional, while 9 were non-functional. Eleven thermometers were reported, with 7 functional and 4 non-functional. Only one functional neonatal patient monitoring system was identified. Qualitative findings highlighted recurring challenges related to equipment malfunction, lack of preventive maintenance, limited biomedical engineering support, and insufficient staff training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eStrengthening neonatal monitoring systems requires not only increasing device availability but also improving equipment maintenance systems, biomedical engineering support, and workforce training in resource-constrained healthcare settings.\u003c/p\u003e","manuscriptTitle":"Monitoring System Gaps and Neonatal Mortality in Six Health Facilities in Jimma Zone, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 12:34:53","doi":"10.21203/rs.3.rs-9124595/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-01T15:29:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326745762354189568953090333537273157492","date":"2026-04-28T00:01:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T08:44:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246210297056145174800017721920788303110","date":"2026-04-23T07:27:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T07:35:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-20T11:27:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-26T17:42:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-26T11:28:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-03-26T11:24:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d4fe1b5b-d206-4df0-b7a5-f0d140a1f62c","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-01T15:29:49+00:00","index":53,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T12:34:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 12:34:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9124595","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9124595","identity":"rs-9124595","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}