Determinants and causes of neonatal mortality in Jimma Zone, Southwest Ethiopia: a multilevel analysis of prospective follow up study

PLoS One. 2014 Sep 18;9(9):e107184. doi: 10.1371/journal.pone.0107184. eCollection 2014.

Abstract

Background: Ethiopia is among the countries with the highest neonatal mortality with the rate of 37 deaths per 1000 live births. In spite of many efforts by the government and other partners, non-significant decline has been achieved in the last 15 years. Thus, identifying the determinants and causes are very crucial for policy and program improvement. However, studies are scarce in the country in general and in Jimma zone in particular.

Objective: To identify the determinants and causes of neonatal mortality in Jimma Zone, Southwest Ethiopia.

Methods: A prospective follow-up study was conducted among 3463 neonates from September 2012 to December 2013. The data were collected by interviewer-administered structured questionnaire and analyzed by SPSS V.20.0 and STATA 13. Verbal autopsies were conducted to identify causes of neonatal death. Mixed-effects multilevel logistic regression model was used to identify determinants of neonatal mortality.

Results: The status of neonatal mortality rate was 35.5 (95%CI: 28.3, 42.6) per 1000 live births. Though significant variation existed between clusters in relation to neonatal mortality, cluster-level variables were found to have non-significant effect on neonatal mortality. Individual-level variables such as birth order, frequency of antenatal care use, delivery place, gestation age at birth, premature rupture of membrane, complication during labor, twin births, size of neonate at birth and neonatal care practice were identified as determinants of neonatal mortality. Birth asphyxia (47.5%), neonatal infections (34.3%) and prematurity (11.1%) were the three leading causes of neonatal mortality accounting for 93%.

Conclusions: This study revealed high status of neonatal mortality in the study area. Higher-level variables had less importance in determining neonatal mortality. Individual level variables related to care during pregnancy, intra-partum complications and care, neonatal conditions and the immediate neonatal care practices were identified as determinant factors. Improving antenatal care, intra-partum care and immediate neonatal care are recommended.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asphyxia Neonatorum / epidemiology
  • Cause of Death
  • Data Collection
  • Delivery, Obstetric
  • Ethiopia / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant Mortality*
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Perinatal Mortality*
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology
  • Premature Birth / epidemiology
  • Prenatal Care
  • Prospective Studies
  • Stillbirth / epidemiology
  • Surveys and Questionnaires

Grants and funding

This study was partially funded by Addis Ababa University from the SPH/JHU collaboration fund for strengthening graduate training and research in Reproductive health and partially by The African Doctoral Dissertation Research Fellowship award offered by the African Population and Health Research Center (APHRC) in partnership with the International Development Research Centre (IDRC). The funders had no role in study design, data collection and analysis, or preparation of the manuscript.