Trends and determinants of early neonatal mortality in Ethiopia: evidence from the Ethiopian demographic and health survey data.

Background: Early neonatal mortality (ENM) accounts for three-fourths of all neonatal deaths and one-third of overall child mortality. While previous studies have primarily focused on neonatal and under-five mortality, ENM has received comparatively less attention. This study aims to address this gap by analyzing trends and identifying factors associated with ENM in Ethiopia.

Methods: Data from the Ethiopian Demographic and Health Survey (EDHS) conducted between 2005 and 2016 were analyzed, comprising a total weighted sample of 22,310 participants. To account for the hierarchical structure of the EDHS data, a mixed-effects binary logistic regression model was applied to identify associated factors. In the multivariable analysis, adjusted odds ratios with 95% confidence intervals (CI) were reported to demonstrate the statistical relationship between ENM and explanatory variables.

Results: The early neonatal mortality in Ethiopia increased from 20.4 per 1,000 live births (95% CI: 17.4-23.9) in 2005 to 21.4 per 1,000 live births (95% CI: 18.3-24.9) in 2011 before declining to 16.7 per 1,000 live births (95% CI: 14.0-19.9) in 2016. The multilevel analysis revealed that the odds of ENM were lower among mothers of female newborns, those who initiated breastfeeding within two days after delivery, mothers who attended antenatal care at least once to three times, and those residing in the Afar, SNNPR, and Gambela regions. In contrast, cesarean section delivery and multiple pregnancy were significantly associated with increased odds of ENM.

Conclusions: Given the slow decline in ENM, sustained efforts are essential to improve access to quality healthcare, strengthen the health system, and address key health determinants to achieve better neonatal outcomes. Implementing evidence-based strategies, including enhancing antenatal care services, promoting early initiation of breastfeeding, and providing specialized care for multiple pregnancies and cesarean deliveries, can play a crucial role in reducing ENM and ensuring healthier outcomes for newborns.