Abstract
BackgroundThe Ethiopian neonatal mortality rate constitutes 42% of under-5 deaths. We aimed to examine the trends and determinants of Ethiopian neonatal mortality.MethodsWe 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.ResultsThe 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.ConclusionsNeonatal 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.
Highlights
The Ethiopian neonatal mortality rate constitutes 42% of under-5 deaths
The three surveys collected data from mothers or caretakers of live-born infants in the 5 years preceding the date of the interview
1908 live births per year were reported in the three surveys between 1995 and 2011
Summary
The Ethiopian neonatal mortality rate constitutes 42% of under-5 deaths. We aimed to examine the trends and determinants of Ethiopian neonatal mortality. Neonatal mortality, accounting for an estimated 4 million deaths worldwide each year, constitutes 40% of under-5 mortality and approximately 57% of infant mortality [1]. Most neonatal deaths (99%) arise in low-income and middle-income countries, and approximately half occur at home [2]. In the past two to three decades, neonatal mortality rates have shown a slow decline in developing. With a population of nearly 83 million in 2010 [7], Ethiopia is the second most populous country in Africa after Nigeria. High fertility and low life expectancy characterize the demography, as in most subSaharan African countries. The country witnessed an unprecedented decline in under-5
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