Spatiotemporal dynamics, factors associated with neonatal mortality and health interventions in Mali: a modeling study

Background Neonatal mortality in Sub-Saharan Africa remains high, accounting for approximately 46% of all neonatal deaths worldwide. In Mali, neonatal mortality stands at 29 deaths per 1,000 live births, with marked subnational disparities. This study aimed to assess the spatiotemporal dynamics of neonatal mortality in Mali from 2012 to 2023 and to project potential reductions in neonatal mortality by 2035 under different scenarios of scaling up three high-impact interventions. Methods We analyzed data from the 2012-2013, 2018, and 2023-2024 Demographic and Health Surveys to assess spatiotemporal patterns in neonatal mortality across Mali. Multilevel mixed-effects logistic regression identified factors associated with neonatal mortality. Global Moran's I and Local Indicators of Spatial Association assessed spatial dependence and identified high-high clusters. The Lives Saved Tool estimated potential reductions in neonatal deaths under alternative intervention scale-up scenarios through 2035. Results National neonatal mortality declined from 34 deaths per 1,000 live births (95% CI: 31-38) in 2012 to 29 (95% CI: 26-32) in 2023. Significant spatial clustering persisted across all survey rounds (Global Moran's I, all p<0.001), with recurrent high-high clusters in Sikasso, Mopti, Segou and Tombouctou. Male neonates had higher odds of death (AOR, 1.66; 95% CI, 1.26-2.19), whereas birth intervals of at least 2 years (AOR range, 0.42-0.48), postnatal care (AOR, 0.42; 95% CI, 0.19-0.94), and improved sanitation (AOR, 0.42; 95% CI, 0.27-0.67) were associated with lower odds. LiST projections indicated that scaling up thermal care, neonatal resuscitation, and clean cord care could avert more than half of preventable neonatal deaths by 2035. Conclusions Persistent clusters of high neonatal mortality were identified in Sikasso, Segou, Mopti, and Tombouctou, highlighting the need for geographically targeted strategies. Scaling up high-impact neonatal interventions could substantially reduce preventable neonatal deaths in Mali.