BackgroundThe Ethiopian neonatal mortality rate constitutes 42% of under-5 deaths. We aimed to examine the trends and determinants of Ethiopian neonatal mortality.MethodsWe analyzed the birth history information of live births from the 2000, 2005 and 2011 Ethiopia Demographic and Health Surveys (DHS). We used simple linear regression analyses to examine trends in neonatal mortality rates and a multivariate Cox proportional hazards regression model using a hierarchical approach to examine the associated factors.ResultsThe neonatal mortality rate declined by 1.9% per annum from 1995 to 2010, logarithmically. The early neonatal mortality rate declined by 0.9% per annum and was where 74% of the neonatal deaths occurred. Using multivariate analyses, increased neonatal mortality risk was associated with male sex (hazard ratio (HR) = 1.38; 95% confidence interval (CI), 1.23 − 1.55); neonates born to mothers aged < 18 years (HR = 1.41; 95% CI, 1.15 − 1.72); and those born within 2 years of the preceding birth (HR = 2.19; 95% CI, 1.89 − 2.51). Winter birth increased the risk of dying compared with spring births (HR = 1.28; 95% CI, 1.08 − 1.51). Giving two Tetanus Toxoid Injections (TTI) to the mothers before childbirth decreased neonatal mortality risk (HR = 0.44; 95% CI, 0.36 − 0.54). Neonates born to women with secondary or higher schooling vs. no education had a lower risk of dying (HR = 0.68; 95% CI, 0.49 − 0.95). Compared with neonates in Addis Ababa, neonates in Amhara (HR: 1.88; 95% CI: 1.26 − 2.83), Benishangul Gumuz (HR: 1.75; 95% CI: 1.15 − 2.67) and Tigray (HR: 1.54; 95% CI: 1.01 − 2.34) regions carried a significantly higher risk of death.ConclusionsNeonatal mortality must decline more rapidly to achieve the Millennium Development Goal (MDG) 4 target for under-5 mortality in Ethiopia. Strategies to address neonatal survival require a multifaceted approach that encompasses health-related and other measures. Addressing short birth interval and preventing early pregnancy must be considered as interventions. Programs must improve the coverage of TTI and prevention of hypothermia for winter births should be given greater emphasis. Strategies to improve neonatal survival must address inequalities in neonatal mortality by women's education and region.

Summary OBJECTIVE To evaluate the performance of a Verbal Autopsy (VA) expert algorithm (the InterVA model) for diagnosing AIDS mortality against a reference standard from hospital records that include HIV serostatus information in Addis Ababa, Ethiopia. METHODS Verbal autopsies were conducted for 193 individuals who visited a hospital under surveillance during terminal illness. Decedent admission diagnosis and HIV serostatus information is used to construct two reference standards (AIDS versus other causes of death and TB/AIDS versus other causes). The InterVA model is used to interpret the VA interviews, and the sensitivity, specificity, and cause-specific mortality fractions are calculated as indicators of the diagnostic accuracy of the InterVA model. RESULTS The sensitivity and specificity of the InterVA model for diagnosing AIDS are 0.82 (95%-CI: 0.74-0.89) and 0.76 (95%-CI: 0.64-0.86), respectively. The sensitivity and specificity for TB/AIDS are 0.91 (95%-CI: 0.85-0.96) and 0.78 (95%-CI: 0.63-0.89), respectively. The AIDS specific mortality fraction estimated by the model is 61.7% (95%-CI: 54%-69%), which is close to 64.7% (95%-CI: 57%-72%) in the reference standard. The TB/AIDS mortality fraction estimated by the model is 73.6% (95%-CI: 67%-80%), compared to 74.1% (95%-CI: 68%-81%) in the reference standard. CONCLUSION The InterVA model is an easy to use and cheap alternative to physician review for assessing AIDS mortality in countries without vital registration and medical certification of causes of death. The model seems to perform better when TB and AIDS are combined, but the sample is too small to statistically confirm that.

Health Extension Workers (HEWs), in general, properly provided antibiotic treatment of possible severe bacterial infections in newborns at the health post level. But only about half of newborns estimated to have infections in the intervention area received treatment by HEWs, and home visits and referrals declined in the final months of the study. Cluster-level analysis suggests a mortality reduction consistent with this level of treatment coverage, although the finding did not reach statistical significance.

Summaryobjective To determine the level of HIV-related mortality reduction after the introduction of largescale antiretroviral therapy (ART) using a burial surveillance system coupled with verbal autopsy (VA) in Addis Ababa, Ethiopia. HIV-specific mortality fractions were calculated by age, sex and year of burial to examine the mortality trends before and during the ART era.results Of the 4239 VA physician diagnoses, 1087 (25.6%) were ascribed to HIV-related deaths. HIVrelated deaths in 2009 were 33% fewer than in 2001. The proportion of HIV-related deaths was reduced from 44.0% in the pre-ART period to 20.0% in the ART era. Mortality in women (36.7%) declined more than in men (30%). A marked reduction in HIV-specific mortality was observed in the age group 30-39 years (from 69.1% pre-ART to 46.8% during ART era) compared to 20-29 (from 60.5% pre-ART to 41.0% during ART) and 40-49 year olds (49.7%) pre-ART to 34.4% during ART provision).conclusion Burial surveillance combined with VA demonstrated a significant reduction in HIV-related deaths during the provision of free ART. Replication of burial surveillance is recommended in similar settings, where a vital registration system is non-existent, to track large-scale populationlevel interventions.

Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur at home. Objective: To evaluate the accuracy of physician reviewers of verbal autopsies in diagnosing HIV and AIDS-related deaths in the adult population of Addis Ababa, the capital of Ethiopia. Methods: This study was done within the context of a burial surveillance system in Addis Ababa. Trained interviewers completed a standard verbal autopsy questionnaire and an independent panel of physicians reviewed the completed form to assign cause of death. Physicians' review was compared to a reference standard constructed based on prospectively collected HIV-serostatus and patients' hospital record. Sensitivity and specificity were calculated to validate the physicians' verbal autopsy diagnoses against reference standards. Results: Physicians accurately identified AIDS-related deaths with sensitivity and specificity of 0.88 (95% CI: 0.80 - 0.93) and 0.77 (95% CI: 0.64 - 0.87), respectively. Generally, there was high level of agreement (Cohen's Kappa Statistic (K > 0.6) between the first two physicians with some yearly variations. In 2008 and 2009 there was an almost perfect agreement (K > 0.80). Conclusion: This study demonstrated the agreement level between two independent physicians in diagnosing AIDS-related death is very high and thus using a single verbal autopsy coder is practical for programmatic purposes in countries where there is critical shortage of doctors