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Background Globally, neonatal and child mortality remains still high. Under-five mortality accounts for four-fifth of child and young adolescent deaths. In Ethiopia, though there has been a remarkable progress over the past years, under-five mortality is still high. Evidence from population-based longitudinal studies on under-five mortality is limited. Thus, this study aims to investigate the magnitude, trend, and causes of under-five mortality in the Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia. Methods Kilite-Awlaelo health and demographic surveillance system was established in 2009 in the northern part of Ethiopia. Population-based longitudinal study design was carried out through extracting data for nine consecutive years (2009–2017). After smoothing the data revealed a visually decreasing trend. Linear, quadratic, exponential, and autoregressive time-series models were checked. Accordingly, the exponential trend model provided the best fit with the lowest standard error of estimate, lowest sum square error and highest adjusted R2 value. Cause-specific mortality was determined by cross tabulating cause of death with specific age death. Results The overall under-five mortality rate was 35.62 per 1000 livebirths. The under-five mortality rate of rural and urban residents was 37.58 and 12.99 deaths per 1000 livebirths respectively. The exponential trend model showed the under-five mortality rate was declining exponentially. Bacterial sepsis 67(20.6%), prematurity 37(11.08%), intestinal infection disease 30(8.98%), acute lower respiratory infections 26(7.78%), and birth asphyxia 24(7.19%) were the major causes of under-five mortality. Conclusion The overall under-five mortality rate for the surveillance period was comparatively lower. A statistically significant difference in under-five mortality rate was observed between urban and rural residents. A statistically significant declining trend in the under-five mortality rate was observed. Bacterial sepsis, prematurity, intestinal infection disease, acute lower respiratory infections, and birth asphyxia were the major causes of under-five mortality. We recommend the huge discrepancy in under-five mortality rate between urban and rural dwellers could be narrowed to some level by increasing healthcare access for rural residents.

Background The fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia. Method Population-based longitudinal study design was conducted by extracting data for nine consecutive years (2009–2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009–2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. Results The skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014–2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014–2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86–196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30–3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33–4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18–3.74). Conclusion Regardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women’s attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.