|Neonatal mortality in Ethiopia: trends and Determinants|
||Yared Mekonnen, Biruk Tensou, Daniel S Telake, Tedbabe Degefie and Abeba Bekele
||BMC Public Health, 13: 483; DOI:10.1186/1471-2458-13-483
||Background: The Ethiopian neonatal mortality rate constitutes 42% of under-5 deaths. We aimed to examine the
trends and determinants of Ethiopian neonatal mortality.
Methods: We analyzed the birth history information of live births from the 2000, 2005 and 2011 Ethiopia
Demographic and Health Surveys (DHS). We used simple linear regression analyses to examine trends in neonatal
mortality rates and a multivariate Cox proportional hazards regression model using a hierarchical approach to
examine the associated factors.
Results: The neonatal mortality rate declined by 1.9% per annum from 1995 to 2010, logarithmically. The early
neonatal mortality rate declined by 0.9% per annum and was where 74% of the neonatal deaths occurred. Using
multivariate analyses, increased neonatal mortality risk was associated with male sex (hazard ratio (HR) = 1.38; 95%
confidence interval (CI), 1.23 - 1.55); neonates born to mothers aged < 18 years (HR = 1.41; 95% CI, 1.15 - 1.72); and
those born within 2 years of the preceding birth (HR = 2.19; 95% CI, 1.89 - 2.51). Winter birth increased the risk of
dying compared with spring births (HR = 1.28; 95% CI, 1.08 - 1.51). Giving two Tetanus Toxoid Injections (TTI) to the
mothers before childbirth decreased neonatal mortality risk (HR = 0.44; 95% CI, 0.36 - 0.54). Neonates born to women
with secondary or higher schooling vs. no education had a lower risk of dying (HR = 0.68; 95% CI, 0.49 - 0.95).
Compared with neonates in Addis Ababa, neonates in Amhara (HR: 1.88; 95% CI: 1.26 - 2.83), Benishangul Gumuz
(HR: 1.75; 95% CI: 1.15 - 2.67) and Tigray (HR: 1.54; 95% CI: 1.01 - 2.34) regions carried a significantly higher risk of death.
Conclusions: Neonatal mortality must decline more rapidly to achieve the Millennium Development Goal (MDG) 4
target for under-5 mortality in Ethiopia. Strategies to address neonatal survival require a multifaceted approach that
encompasses health-related and other measures. Addressing short birth interval and preventing early pregnancy must
be considered as interventions. Programs must improve the coverage of TTI and prevention of hypothermia for winter
births should be given greater emphasis. Strategies to improve neonatal survival must address inequalities in neonatal
mortality by women's education and region.