title: Survival of neonates and predictors of their mortality in Tigray region, Northern Ethiopia: prospective cohort study.
abstract: Neonatal mortality accounts for an estimated 2.8 million deaths worldwide, which constitutes 44 % of under-5-mortality and 60 % of infant mortality. Neonatal mortality predictors vary by country with the availability and quality of health care. Therefore, aim of this study was to estimate survival time and identify predictors of neonatal mortality in Tigray region, northern Ethiopia.
  
  
  
  A prospective cohort study design was carried out among a cohort of neonates delivered in seven hospitals of Tigray from April to July, 2014 and followed up for a total of 28 days. Data were collected by interviewing mothers using structured questionnaires and assessments of the neonate and mothers by midwives. Kaplan-Meier, Log rank test and Cox-proportional hazard regressions were used. STATA V-11 program was used for data entry, cleaning and analysis.
  
  
  
  From 1152 neonates, 68 died (neonatal mortality rate 62.5/1000 live births), 73.52 % of the neonates died within 7 days, 60 were lost to follow-up and the percentage of survival at 28 days was 93.96 % (95 % CI: 92.4, 95.2 %). Predictors of neonatal mortality were: normal birth weight (AHR: 0.45, 95 % CI: 0.24, 0.84), not initiating exclusive breastfeeding (AHR: 7.5, 95 % CI: 3.77, 15.05), neonatal complications (AHR: 0.14, 95 % CI 0.07, 0.29), maternal complications (AHR: 0.37, 95 % CI: 0.22, 0.63) and proximity (AHR: 2.5, 95 % CI: 1.29, 4.91).
  
  
  
  Neonatal mortality is unacceptably very high. Managing complications and low birth weight, initiating exclusive breast feeding, improving quality of services and ensuring a continuum of care are recommended to increase survival of neonates.
authors.affiliation: Adigrat University, College of Medicine and Health science, Adigrat, Ethiopia. hayetgeb@gmail.com.|Mekelle University, College of Health Science, Mekelle, Ethiopia. hayetgeb@gmail.com.
authors.forename: Hayelom Gebrekirstos
authors.initials: HG
authors.lastname: Mengesha
authors.affiliation: Mekelle University, College of Health Science, Mekelle, Ethiopia.
authors.forename: Alem Desta
authors.initials: AD
authors.lastname: Wuneh
authors.affiliation: Mekelle University, College of Health Science, Mekelle, Ethiopia.
authors.forename: Wondwossen Terefe
authors.initials: WT
authors.lastname: Lerebo
authors.affiliation: Mekelle University, College of Health Science, Mekelle, Ethiopia.
authors.forename: Tesfay Hailu
authors.initials: TH
authors.lastname: Tekle
mesh_terms: D001942:Breast Feeding; D005002:Ethiopia; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D018743:Perinatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Ethiopia; Neonatal mortality; Survival analysis; Tigray region