BackgroundNeonatal mortality accounts for an estimated 2.8 million deaths worldwide, which constitutes 44 % of under-5-mortality and 60 % of infant mortality. Neonatal mortality predictors vary by country with the availability and quality of health care. Therefore, aim of this study was to estimate survival time and identify predictors of neonatal mortality in Tigray region, northern Ethiopia.MethodA prospective cohort study design was carried out among a cohort of neonates delivered in seven hospitals of Tigray from April to July, 2014 and followed up for a total of 28 days. Data were collected by interviewing mothers using structured questionnaires and assessments of the neonate and mothers by midwives. Kaplan-Meier, Log rank test and Cox-proportional hazard regressions were used. STATA V-11 program was used for data entry, cleaning and analysis.ResultsFrom 1152 neonates, 68 died (neonatal mortality rate 62.5/1000 live births), 73.52 % of the neonates died within 7 days, 60 were lost to follow-up and the percentage of survival at 28 days was 93.96 % (95 % CI: 92.4, 95.2 %). Predictors of neonatal mortality were: normal birth weight (AHR: 0.45, 95 % CI: 0.24, 0.84), not initiating exclusive breastfeeding (AHR: 7.5, 95 % CI: 3.77, 15.05), neonatal complications (AHR: 0.14, 95 % CI 0.07, 0.29), maternal complications (AHR: 0.37, 95 % CI: 0.22, 0.63) and proximity (AHR: 2.5, 95 % CI: 1.29, 4.91).ConclusionNeonatal mortality is unacceptably very high. Managing complications and low birth weight, initiating exclusive breast feeding, improving quality of services and ensuring a continuum of care are recommended to increase survival of neonates.

BackgroundDespite the significant reduction in childhood mortality, neonatal mortality has shown little or no concomitant decline worldwide. The dilemma arises in that the lack of documentation of cause of death in developing countries, where registration of vital events is virtually nonexistent. Understanding of the causes of death in neonates is important to guide public health interventions. The present study identifies the common causes of neonatal death in Ethiopia.MethodsA prospective cohort study was conducted among neonates born between April 2014 and July 2014 in seven hospitals, in Tigray region, Ethiopia. Mothers were interviewed by midwifes respecting risk factors and infant survival. For neonates who died in hospital, causes of death were extracted from medical records, whereas a verbal autopsy method provided presumptive assignment of cause of death for those infants who died at home.ResultsOf the1152 live births, there were 68 deaths (63 per 1000 live births). Two thirds of deaths were attributable to prematurity 23 (34%) or asphyxia 21 (31%). Slight variance was seen between the morality patterns in early and late neonatal periods. In the early neonatal period, 37% were due to prematurity, while asphyxia (35%) was more common in the late neonatal period. All infection-related deaths occurred in neonate-mother dyads from rural areas.ConclusionPrematurity, asphyxia, and infections were the leading causes of neonatal deaths in Tigray region during the study period. Causes of deaths identified during early and late neonatal mortality differed, which clearly indicates the need for responsive and evidence-based interventions and policies.

BackgroundInfant birth weight, which is classified into low birth weight, normal birth weight and macrosomia, is associated with short and long-term health consequences, such as neonatal mortality and chronic disease in life. Macrosomia and low birth weight are double burden problems in developing counties, such as Ethiopia, but the paucity of evidence has made it difficult to assess the extent of this situation. As a result there has been inconsistency in the reported prevalence of low birth weight and macrosomia in Ethiopia. This study aimed to determine the incidence and predictors of low birth weight and macrosomia in Tigray, Northern Ethiopia.MethodWe conducted a cross-sectional survey among a cohort of 1152 neonates delivered in Tigray Region at randomly selected hospitals between April and July 2014. We used the birth weight category described previously as an outcome variable. Data were collected using structured questionnaire by midwives. We entered and analyzed data using STATA™ Version 11.0. Data were described using a frequency, percentage, relative risk ratio, and 95% confidence interval. Multinomial logistic regression was conducted to identify independent predictors of low birth weight and macrosomia.ResultIn this study, we found a 10.5% and 6.68% incidence of low birth weight and macrosomia, respectively. Seventy (57.8%) of all low birth weight neonates were term births. The predictors for low birth weight were: early marriage (<18 year) (RRR: 0.59, CI: 0.35–0.97); rural residence (RRR: 0.53, CI: 0.32–0.9); prematurity (RRR: 15.4, CI: 9.18–25.9); no antenatal follow-up (RRR: 6.78, CI: 2.39–19.25); and female sex (RRR: 1.77, CI: 1.13–2.77). Predictors for macrosomia were: female gender (RRR: 0.58, CI: 0.35–0.9); high body mass index (RRR: 5.0, CI: 1.56–16); post-maturity (RRR: 2.23, CI: 1.06–4.6); and no maternal complication (RRR: 0.46, CI: 0.27–0.8).ConclusionIn this study, we found gestational age and gender of the neonate to be common risk factors for both low birth weight and macrosomia. Strengthening antenatal follow up, prevention of pre and post maturity, controlling body mass index, and improving socioeconomic status of mothers are recommendations to prevent the double burden (low birth weight and macrosomia) and associated short and long-term consequences.

Background: Pre-term and post-term births are major determinants of neonatal mortality, including short-and long-term morbidity. In developing countries, where pre-term and post-term births are disproportionately common, the magnitude and underlying causes are not well understood, and evidence is required to design appropriate interventions. This study measured the incidence and identified risk factors of pre-term birth and post-term births in Ethiopia. In addition, it examined the effects of pre-term and post-term birth on neonatal mortality. Method: This study is a portion of prospective cohort study conducted on 1152 live births born between April and July 2014 in seven hospitals in Tigray region, Northern Ethiopia. Neonatal mortality and birth outcomes were considered as dependent variables. Data were collected using a structured questionnaire and weekly neonatal follow up directed at midwives. Data were described using frequency, percentage, ratio of relative risk (RRR), and 95 % confidence interval (CI). We used multinomial and binary logistic regression to identify independent predictors of birth outcome and neonatal mortality respectively. Result: The prevalence of pre-term and post term births was 8.1 % and 6.0 % respectively. Underweight maternal body mass index (RRR: 0.47, CI: 0.22-0.99), medium reported income (RRR: 0.26, CI: 0.12-0.5), length of neonate (RRR: 0.05, CI: 0.01-0.41), and multiple births (RRR: 2.86, CI: 1.4-5.650) were associated with pre-term birth. Predictors for post-term birth were overweight maternal body mass index (RRR: 3.88, CI: 1.01-15.05), high reported income mothers (RRR: 2.17, CI:1.1-4.3), as well as unmarried, widowed and divorced marital status (RRR:2.43, CI:1.02-5.80). With regards to binary logistic regression, pre-term birth (RR: 2.45, CI: 1.45-4.04) was an independent predictor for neonatal mortality, but this was not true for post-term births (RR: 0.45, CI: 0.07-2.96). Conclusion: Socioeconomic and proximate factors are important predictors for pre-term and post-term births. Empowering women in terms of income status and controlling body mass index within the normal range are recommended. In addition, early detection and close antenatal follow-ups for mothers, who are at risk before and during pregnancy, are necessary to prevent both pre-term and post-term births.