Predictors of Neonatal Mortality in Ethiopia: Cross-Sectional Study Using 2005, 2010, and 2016 Ethiopian Demographic Health Survey Datasets. 

Abstract Background Ethiopia has the highest neonatal mortality rate in the world. Although the country has taken measures to reduce neonatal mortality, it has not been able to achieve a significant change in neonatal mortality in the last two decades. The study aims to determine the trends and predictors of change in neonatal mortality in Ethiopia for the past 15 years.Methods The study used Ethiopian Demographic Health Survey Datasets (EDHS) from 2005, 2011, and 2016. All live births of reproductive-age women in Ethiopia were included in the study. Multivariate decomposition analysis for the nonlinear response variable (MVDCMP) based on the logit link function was employed to determine the relative contribution of each independent variable to the change in neonatal mortality over the last 15 years.Result The neonatal mortality rate has decreased by 11 per 1,000 live births, with an annual reduction rate of 2.8% during the survey period. The mortality rate increased in the pastoralist regions of the country from 31 per 1,000 live births to 36 per 1,000 live births, compared to the city and agrarian regions. Maternal ANC visits in 2005 and 2016 (AOR [95%CI] = 0.10 [0.01, 0.81]; 0.01 [0.02, 0.60]) were significantly associated with neonatal mortality. In addition, the decomposition analysis revealed that changes in composition in the preceding birth intervals of more than 24 months and early breastfeeding initiation contributed to the reduction of neonatal mortality by 26% and 10%, respectively, during the survey period.Conclusion The study found that neonatal mortality is a public health problem in the country, particularly in pastoralist communities. Tailor made maternal and child healthcare interventions that promote early breastfeeding initiation, birth intervals and ANC utilization should be implemented to reduce neonatal mortality, particularly in pastoralist communities.