Maternal Anemia Prevalence and Neonatal Mortality: Evidence from Ecological Cross-National Regression Analysis

This study uses cross-national ecological data to examine the relationship between maternal anemia prevalence and neonatal mortality rates. Our regression analysis isolates the independent effect of anemia while controlling for the proportion of skilled health workers and neural tube defects (NTDs). After adjusting for NTDs (β = 0.037) and skilled health workers (β = -0.014), the multiple linear regression model revealed a statistically significant and positive correlation between maternal anemia and neonatal mortality rate (β = 0.448). The inclusion of control variables for NTDs further clarified that anemia extends beyond folate-related congenital anomalies, including a direct association with neonatal resilience and fetal growth. The negative coefficient for skilled health workers affirms their role in mitigating mortality risks. The findings in our study align with biological mechanisms linking anemia to preterm birth, intrauterine hypoxia, and immune compromise, which are consistent with prior epidemiological evidence. Additionally, the persistence of the association between the variables across robustness checks underscores the non-proximal status of maternal anemia, while confirming its independent risk factor position. The study presents a significant policy implication on the subject, advocating for scaled-up interventions and antenatal care expansion, particularly in low-and middle-income countries where anemia prevalence is highest.