title: Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990-2013: findings from the Global Burden of Disease Study 2013.
abstract: Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990-2013.
  
  
  
  We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used.
  
  
  
  Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1-4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013. Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n= 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap.
  
  
  
  LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya ; Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK ; St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
authors.forename: Amare
authors.initials: A
authors.lastname: Deribew
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, Australia ; Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
authors.forename: Gizachew Assefa
authors.initials: GA
authors.lastname: Tessema
authors.affiliation: Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK ; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Kebede
authors.initials: K
authors.lastname: Deribe
authors.affiliation: School of Public Health, Mekelle University, Mekelle, Ethiopia ; School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Yohannes Adama
authors.initials: YA
authors.lastname: Melaku
authors.affiliation: Ethiopian Public Health Association, Addis Ababa, Ethiopia.
authors.forename: Yihunie
authors.initials: Y
authors.lastname: Lakew
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, Australia ; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia ; Department of Epidemiology, University of Groningen, Groningen, The Netherlands.
authors.forename: Azmeraw T
authors.initials: AT
authors.lastname: Amare
authors.affiliation: School of Public Health, Mekelle University, Mekelle, Ethiopia ; Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Ethiopia ; Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany.
authors.forename: Semaw F
authors.initials: SF
authors.lastname: Abera
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Mesoud
authors.initials: M
authors.lastname: Mohammed
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Abiy
authors.initials: A
authors.lastname: Hiruye
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Efrem
authors.initials: E
authors.lastname: Teklay
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
authors.forename: Awoke
authors.initials: A
authors.lastname: Misganaw
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kassebaum
mesh_terms: D002423:Cause of Death; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology / Q000401:mortality; D005002:Ethiopia / Q000453:epidemiology; D000071219:Global Burden of Disease; D006801:Humans; D007223:Infant; D066088:Infant Death / Q000209:etiology*; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality; D009748:Nutrition Disorders / Q000401:mortality; D066087:Perinatal Death / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000209:etiology / Q000401:mortality; D012307:Risk Factors