title: Neonatal mortality in Ethiopia: trends and determinants.
abstract: 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.
authors.affiliation: Mela Research PLC, P,O, Box 34422, Holy City Center Building, 4th Floor, Addis Ababa, Ethiopia. yared@melaresearch.com.
authors.forename: Yared
authors.initials: Y
authors.lastname: Mekonnen
authors.forename: Biruk
authors.initials: B
authors.lastname: Tensou
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Telake
authors.forename: Tedbabe
authors.initials: T
authors.lastname: Degefie
authors.forename: Abeba
authors.initials: A
authors.lastname: Bekele
mesh_terms: D000293:Adolescent; D000328:Adult; D001721:Birth Intervals; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors