Published in PLOS One on 2026-07-23, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. HealthSignal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Josephine Shabani, Nahya Salim, Lucas Malla, James H. Cross, Rebecca E. Penzias, Audêncio Victor, Christine Bohne, Ahmad Mohamed Makuwani, Habib Ismail, Felix Bundala, Claud Kumalija, Morris Ondieki, Prosper Mshana, Jacqueline Minja, Irabi Kassim, Jennie Jaribu, Honorati Masanja, Eric O. Ohuma, Joy E. Lawn
Source: PLOS One • DOI 10.1371/journal.pone.0348874
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The Sustainable Development Goal 3.2 targets reducing the neonatal mortality rate (NMR) to <12 per 1,000 live births by 2030; however, 65 countries, including Tanzania, remain off track. The 2022/23 Tanzania Demographic and Health Survey (TDHS) reported an NMR of 24 per 1,000 live births, equivalent to 48,000 neonatal deaths annually.
Neonatal deaths were extracted from the District Health Information System (DHIS2) for 28 Regional Referral Hospitals (RRHs) and seven tertiary hospitals from 2015 to 2024. Data quality was assessed by: (1) completeness, as the proportion of months each hospital reported neonatal deaths; (2) internal consistency, comparing mean NMR for 2021–2023 with 2024 following WHO guidance; and (3) external plausibility, comparing DHIS2 with DHS and UN estimates. For seven hospitals implementing NEST360 program, NMRs from DHIS2 were compared with the Neonatal Inpatient Dataset (NID) for 2021 and 2024.
Between 2015 and 2024, DHIS2 recorded an average of >8,500 neonatal deaths annually versus 48,000 expected. RRHs accounted for 30–40% of reported deaths, and tertiary hospitals for 4–11%. Overall monthly reporting completeness was 58.3%, higher in RRHs (median 61.7%, IQR 8.3–95.0%) than in tertiary hospitals (median 50%, IQR 0.8–73.3%), with only 8 RRHs (28.5%) and no tertiary hospital achieving >75% reporting. Only 28.6% of hospitals had internal consistency (NMR within ±33% of the mean) for 2021–2023. The DHIS2 NMR for 2024 was 5.9 per 1,000 (adjusted for ~20% home births), compared to 24 per 1,000 in DHS 2022/23. Compared with NEST360 NID, one tertiary hospital reported lower DHIS2 NMRs, and three RRHs reported higher (ratio >1).
Neonatal mortality reporting in Tanzania’s DHIS2 remains substantially under-captured, with notable variations across facilities. Although RRHs perform better than tertiary hospitals, overall data quality remains low. Improving reporting in underperforming facilities and leveraging high-performing RRHs can strengthen national neonatal mortality monitoring.
Introduction
Newborn deaths remain a major public health concern, with an estimated 2.3 million newborn deaths worldwide in 2023 [1–5]. While the global community has made remarkable steps in reducing under-five mortality between 1990 and 2023, the pace of decline in newborn deaths has consistently lagged behind that of post-neonatal child mortality, making newborns an increasingly dominant share of all child deaths [2,6]. The 2022/23 Tanzania Demographic and Health Survey (TDHS) reported a Neonatal Mortality Rate (NMR) of 24 per 1,000 live births, translating to approximately 48,000 neonatal deaths annually [7]. Tanzania has committed to achieving Sustainable Development Goal (SDG) 3.2, to reduce the NMR to less than 12 per 1,000 live births by 2030 [2]. This SDG commitment is reflected in the Tanzania Development Vision 2050, the Health Sector Strategic Plan (HSSP V 2021–2025), and the National Plan for Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition, 2021–2026 (One Plan III) [8–11].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Josephine Shabani, Nahya Salim, Lucas Malla, James H. Cross, Rebecca E. Penzias, Audêncio Victor, Christine Bohne, Ahmad Mohamed Makuwani, Habib Ismail, Felix Bundala, Claud Kumalija, Morris Ondieki, Prosper Mshana, Jacqueline Minja, Irabi Kassim, Jennie Jaribu, Honorati Masanja, Eric O. Ohuma, Joy E. Lawn. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by HealthSignal. The researchers are the authors of the source study, not members of HealthSignal’s staff.
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