Risk factor of neonatal mortality in Ethiopia: multilevel analysis of 2016 Demographic and Health Survey

BACKGROUND: In sub-Saharan African countries, neonatal mortality rates remain unacceptably high. Ethiopia is one of the countries in Sub-Saharan Africa with the highest death rates of newborn children. Therefore, this study aimed to identify the risk factors associated with neonatal mortality in Ethiopia at the individual and community level. METHODS: The 2016 Ethiopian Demographic and Health Survey data was accessed and used for the analysis. A total of 2449 newborn children were included in the analysis. The multilevel logistic regression model was used to identify the significant factor of neonatal mortality. Adjusted odds ratio with a 95% confidence interval and p-value < 0.05 in the multilevel model was reported. RESULTS: A total of 2449 newborn children were included in this study. Multiple birth type (AOR = 3.18; 95% CI 2.78, 3.63), birth order of ≥ 5 (AOR = 2.15; 95% CI 1.75, 2.64), pre-term birth (AOR = 5.97; 95% CI 4.96, 7.20), no antenatal care (ANC) visit during pregnancy (AOR = 2.33; 95% CI 2.09, 2.61), not received TT injection during pregnancy (AOR = 2.28; 95% CI 1.92, 2.71), delivered at home (AOR = 1.99; 95% CI 1.48, 2.69), less than 24 months of preceding birth interval (AOR = 1.51; 95% CI 1.35,1.68), smaller birth size (AOR = 1.58; 95% CI 1.46, 1.71), never breastfeeding (AOR = 2.43; 95% CI 2.17, 2.72), poor wealth index (AOR = 1.29; 95% CI 1.17,1.41), non-educated mothers (AOR = 1.58; 95% CI 1.46, 1.71), non-educated fathers (AOR = 1.32; 95% CI 1.12, 1.54), rural residence (AOR = 2.71; 95% CI 2.23, 3.29), unprotected water source (AOR = 1.35; 95% CI 1.16, 1.58), and have no latrine facility (AOR = 1.78; 95% CI 1.50, 2.12) were associated with a higher risk of neonatal mortality. Neonates living in Amhara, Oromia, Somali, Harari, and Dire Dawa had a higher risk of neonatal mortality compared to Tigray. Moreover, the random effects result showed that about 85.57% of the variation in neonatal mortality was explained by individual- and community-level factors. CONCLUSIONS: The findings suggest that attention be paid to education-based programs for mothers that would highlight the benefits of delivery care services, such as ANC visits, TT injections, and facility births. Meanwhile, public health initiatives should focus on expanding access to quality sanitation facilities, especially for latrines and drinking water that could improve neonatal health at the community-level as a whole.