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Background  Newborn morbidity and mortality are forecasted using the Apgar scores. Obstetricians worldwide have used the Apgar score for more than half a century for the assessment of immediate newborn conditions. It is a simple and convenient evaluation system that offers a standardized and effective assessment of newborn infants. Neonatal morbidity and mortality can be reduced if high-risk neonates are identified and managed adequately. This study aimed to assess the determinants of 5th minute low Apgar score among newborns at Public hospitals in Hawassa city, South Ethiopia.    Methods  A hospital-based unmatched case-control study was conducted at Public Hospitals in Hawassa city. Data were collected from 134 cases and 267 controls using a structured and pre-tested questionnaire by observing, interviewing, and reviewing patient cards. Newborns who delivered with a 5th minute Apgar score < 7 were considered as cases; whereas a similar group of newborns with a 5th minute Apgar score of ≥ 7 were categorized as controls. A consecutive sampling technique was employed to recruit cases, while a simple random sampling technique was used to select controls. Data entry and analysis were performed using Epi Data version 3.1 and SPSS version 20 respectively. Binary and multivariable analyses with a 95 % confidence level were performed. In the final model, variables with  P  < 0.05 were considered statistically significant.    Results  After controlling for possible confounding factors, the results showed that lack of physical and emotional support during labor and delivery [AOR = 3.5, 95 %CI:1.82–6.76], rural residence [AOR = 4, 95 %CI: 2.21–7.34], lack of antenatal care follow up [AOR = 3.5, 95 % CI: 1.91–6.33], anemia during pregnancy [AOR = 2.3,95 %CI: 1.10–4.71] and low birth weight [AOR = 6.2, 95 %CI: 2.78–14.03] were determinant factors of low Apgar scores. The area under the Apgar score ROC curve was 87.4 %.    Conclusions  Lack of physical and emotional support, rural residence, lack of ANC follow-up, low birth weight, and anemia during pregnancy were determinant factors of a low Apgar score. `Effective health education during preconception about anemia during pregnancy and ANC will help in detecting high-risk pregnancies that lead to a low Apgar score. In addition to the standard care of using electronic fetal monitoring, increasing access to compassion ships during labor and delivery is recommended.

The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia