Background: The first month is the most crucial period for child survival. Neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa, including Ethiopia. This region shows the least progress in reducing neonatal mortality and continues to be a significant public health issue. In this study setting, the causes and predictors of neonatal death in the neonatal intensive care units are not well documented. Hence, this study aimed to determine the causes and predictors of neonatal mortality among infants admitted to neonatal intensive care units in eastern Ethiopia.Methods: A facility-based in prospective follow-up study was conducted among neonates admitted to neonatal intensive care units of public hospitals of eastern Ethiopia from November 1 to December 30, 2018. Data were collected using a pretested structured questionnaire and a follow-up checklist. The main outcomes and causes of death were set by pediatricians and medical residents. EpiData 3.1 and Statistical Package for Social Sciences Version 25 software were used for data entry and analysis, respectively. Multivariable logistic regression was used to identify the predictors of facility-based neonatal mortality.Results: The proportion of facility-based neonatal mortality was 20% (95% CI:16.7-23.8%). The causes of death were complications of preterm birth (28.58%), birth asphyxia (22.45%), neonatal infection (18.36%), meconium aspiration syndrome (9.18%), respiratory distress syndrome (7.14%), and congenital malformation (4.08%). Low birth weight, preterm births, length of stay of the neonatal intensive care unit, low 5 min APGAR score, hyperthermia, and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units of public hospitals in eastern Ethiopia. Conclusions:The proportion of facility-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving the timing and quality of antenatal care is essential for early detection, anticipating high-risk newborns, and timely interventions. Furthermore, early initiation of feeding and better referral linkage to tertiary health facilities could lead to a reduction in neonatal death in this setting.

Background: The first month is the most crucial period for child survival. Neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa, including Ethiopia. This region shows the least progress in reducing neonatal mortality and continues to be a significant public health issue. In this study setting, the causes and predictors of neonatal death in the neonatal intensive care units are not well documented. Hence, this study aimed to determine the causes and predictors of neonatal mortality among infants admitted to neonatal intensive care units in eastern Ethiopia. Methods: A facility-based prospective follow-up study was conducted among neonates admitted to neonatal intensive care units in public hospitals in eastern Ethiopia from November 1 to December 30, 2018. Data were collected using a pre-tested structured questionnaire and a follow-up checklist. The main outcomes and causes of death were set by pediatricians and medical residents. Epi-Data 3.1 and Statistical Package for Social Sciences Version 25 software were used for data entry and analysis, respectively. Multivariable logistic regression was used to identify the predictors of facility-based neonatal mortality.Results: The proportion of facility-based neonatal mortality was 20%(95% CI:16.7-23.8%). The causes of death were complications of preterm birth (28.58%), birth asphyxia (22.45%), neonatal infection (18.36%), meconium aspiration syndrome (9.18%), respiratory distress syndrome (7.14%), and congenital malformation (4.08%). Low birth weight, preterm births, length of stay in the neonatal intensive care unit, low 5 minutes APGAR score, hyperthermia, and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units in public hospitals in eastern Ethiopia.Conclusions: The proportion of facility-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving the timing and quality of antenatal care is essential for early detection, anticipating high-risk newborns, and timely interventions. Furthermore, early initiation of feeding and better referral linkage to tertiary health facilities could lead to a reduction in neonatal death in this setting.

Background: The first month is the most crucial period for child survival and neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa including Ethiopia. This region shows the least progress to reducing this high mortality rate and it continues to be a significant public health issue. The facilities-based cause and predictors of neonatal death in the neonatal intensive care unit are not well documented in this study setting. Hence, the aim of this study was to determine the cause and predictors of neonatal mortality among infants admitted to the neonatal intensive care units in Eastern Ethiopia. Method: Facilities-based prospective follow-up study was conducted among neonates admitted to the neonatal intensive care units of public hospitals in Eastern Ethiopia from November to December 2018. Data was collected using a pre-tested, structured questionnaire and a follow-up checklist. The main outcomes and cause of death was set by pediatricians and residents. Epi-Data 3.1 and SPSS 25 Version software were used for data entry and analysis. Binary logistic regression was used to find out the predictors of facilities-based neonatal mortality. Result: The proportion of facilities-based neonatal mortality was 20%. The top five causes of death were a complication of prematurity (49%), birth asphyxia (37.8%), infection (32.6%), meconium aspiration syndrome (17.3%) and congenital malformation (6.1%). Low birth weight, preterm births, length of stay in NICU , low 5 minute Apgar score , hyperthermia and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units in public hospitals, Eastern Ethiopia. Conclusion In summary, the proportion of facilities-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving ANC and this would lead to early detection, anticipating high-risk newborns and timely intervention is very essential. Furthermore, early initiation of feeding and a better referral linkage to tertiary facilities could lead to a reduction of neonatal death in this setting.

Background: The first month is the most crucial period for child survival. Neonatal mortality is stagnated in sub-Saharan Africa including Ethiopia. And the trend in reduction is slower than infant and child mortality. The facilities-based cause and predictor of neonatal death in the neonatal intensive care unit were not well documented in this study setting. Hence the aim of this study was to determine the cause and predictors of neonatal mortality among neonates admitted in neonatal intensive care units in eastern Ethiopia. Method: Facilities-based prospective follow-up study was conducted among neonates admitted in neonatal intensive care units of public hospitals in eastern Ethiopia from November to December 2018. Data were collected using pre-tested, structured questionnaire and follow-up checklist. The main outcomes, cause of death was set by senior pediatricians and residents. Epi-Data 3.1 and SPSS 25 version software were used for entry and analysis. Binary logistic regression was used to find out the predictors of facilities-based neonatal mortality.Result: The proportion of facilities-based neonatal mortality was 20%. The top five cause of death was a complication of prematurity 49%, birth asphyxia 37.8%, infection 32.6%, meconium aspiration syndrome 17.3% and congenital malformation 6.1%. Low birth weight, preterm births, length of stay, low 5thminutes Apgar score, hyperthermia and initiation of feeding were predictors of neonatal death among Neonates admitted in neonatal intensive care units in public hospitals, eastern Ethiopia.ConclusionIn summary, the proportion of facilities-based Neonatal death was unacceptably high. The main causes of death were preventable and treatable. Hence, early detection, anticipating high-risk newborns and timely intervention is very essential. Furthermore, early initiation of feeding and a better referral linkage to tertiary facilities could contribute for reduction of neonatal death in this setting.

Background: The first month is the most crucial period for child survival. Neonatal mortality is stagnated in sub-Saharan Africa including Ethiopia. And the trend in reduction is slower than infant and child mortality. The facilities-based cause and predictor of neonatal death in the neonatal intensive care unit were not well documented in this study setting. Hence the aim of this study was to determine the cause and predictors of neonatal mortality among neonates admitted in neonatal intensive care units in eastern Ethiopia. Method: Facilities-based prospective follow-up study was conducted among neonates admitted in neonatal intensive care units of public hospitals in eastern Ethiopia from November to December 2018. Data were collected using pre-tested, structured questionnaire and follow-up checklist. The main outcomes, cause of death was set by senior pediatricians and residents. Epi-Data 3.1 and SPSS 25 version software were used for entry and analysis. Binary logistic regression was used to find out the predictors of facilities-based neonatal mortality. Result: The proportion of facilities-based neonatal mortality was 20%. The top five cause of death was a complication of prematurity 49%, birth asphyxia 37.8%, infection 32.6%, meconium aspiration syndrome 17.3% and congenital malformation 6.1%. Low birth weight, preterm births, length of stay, low 5 th minutes Apgar score, hyperthermia and initiation of feeding were predictors of neonatal death among Neonates admitted in neonatal intensive care units in public hospitals, eastern Ethiopia. Conclusion In summary, the proportion of facilities-based Neonatal death was unacceptably high. The main causes of death were preventable and treatable. Hence, early detection, anticipating high-risk newborns and timely intervention is very essential. Furthermore, early initiation of feeding and a better referral linkage to tertiary facilities could contribute for reduction of neonatal death in this setting. Keywords: Facilities based study, Neonatal mortality, predictors, NICU, Ethiopia

Background The first month is the most crucial period for child survival. Neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa including Ethiopia. This region shows the least progress to reducing neonatal mortality and it continues to be a significant public health issue. The facilities-based causes and predictors of neonatal death in the neonatal intensive care unit are not well documented in this study setting. Hence, the aim of this study was to determine the causes and predictors of neonatal mortality among infants admitted to the neonatal intensive care units in Eastern Ethiopia. Methods Facilities-based prospective follow-up study was conducted among neonates admitted to the neonatal intensive care units of public hospitals in Eastern Ethiopia from November to December 2018. Data were collected using a pre-tested, structured questionnaire and a follow-up checklist. The main outcomes and causes of death were set by pediatricians and medical residents. Epi-Data 3.1 and Statistical Package for Social Sciences Version 25 software were used for data entry and analysis respectively. Multivariable logistic regression was used to find out the predictors of facilities-based neonatal mortality. Results The proportion of facilities-based neonatal mortality was 20%(95% CI: 16.7-23.8%) The causes of death were complications of preterm birth 28.58%, birth asphyxia 22.45%, infection 18.36%, meconium aspiration syndrome 9.18%, respiratory distress syndrome 7.14% and congenital malformation 4.08%. Low birth weight, preterm births, length of stay in NICU, low 5 minute Apgar score, hyperthermia and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units in public hospitals, Eastern Ethiopia. Conclusion The proportion of facilities-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving timing and quality of ANC is essential for early detection, anticipating high-risk newborns and timely interventions. Furthermore, early initiation of feeding and a better referral linkage to tertiary facilities could lead to a reduction of neonatal death in this setting.

Background: Mortality rates for children under five years of age, and stillbirth risks, remain high in parts of sub-Saharan Africa and South Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to ascertain causes of child death in high child mortality settings (>50 deaths/1000 live-births). We aimed to develop a “greenfield” site for CHAMPS, based in Harar and Kersa, in Eastern Ethiopia. This very high mortality setting (>100 deaths/1000 live-births in Kersa) had limited previous surveillance capacity, weak infrastructure and political instability. Here we describe site development, from conception in 2015 to the end of the first year of recruitment. Methods: We formed a collaboration between Haramaya University and the London School of Hygiene & Tropical Medicine and engaged community, national and international partners to support a new CHAMPS programme. We developed laboratory infrastructure and recruited and trained staff. We established project specific procedures to implement CHAMPS network protocols including; death notifications, clinical and demographic data collection, post-mortem minimally invasive tissue sampling, microbiology and pathology testing, and verbal autopsy. We convened an expert local panel to determine cause-of-death. In partnership with the Ethiopian Public Health Institute we developed strategies to improve child and maternal health. Results: Despite considerable challenge, with financial support, personal commitment and effective partnership, we successfully initiated CHAMPS. One year into recruitment (February 2020), we had received 1173 unique death notifications, investigated 59/99 MITS-eligible cases within the demographic surveillance site, and assigned an underlying and immediate cause of death to 53 children. Conclusions: The most valuable data for global health policy are from high mortality settings, but initiating CHAMPS has required considerable resource. To further leverage this investment, we need strong local research capacity and to broaden the scientific remit. To support this, we have set up a new collaboration, the “Hararghe Health Research Partnership”.

Background: Mortality rates for children under five years of age, and stillbirth risks, remain high in parts of sub-Saharan Africa and South Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to ascertain causes of child death in high child mortality settings (>50 deaths/1000 live-births). We aimed to develop a “greenfield” site for CHAMPS, based in Harar and Kersa, in Eastern Ethiopia. This very high mortality setting (>100 deaths/1000 live-births in Kersa) had limited previous surveillance capacity, weak infrastructure and political instability. Here we describe site development, from conception in 2015 to the end of the first year of recruitment. Methods: We formed a collaboration between Haramaya University and the London School of Hygiene & Tropical Medicine and engaged community, national and international partners to support a new CHAMPS programme. We developed laboratory infrastructure and recruited and trained staff. We established project specific procedures to implement CHAMPS network protocols including; death notifications, clinical and demographic data collection, post-mortem minimally invasive tissue sampling, microbiology and pathology testing, and verbal autopsy. We convened an expert local panel to determine cause-of-death. In partnership with the Ethiopian Public Health Institute we developed strategies to improve child and maternal health. Results: Despite considerable challenge, with financial support, personal commitment, and effective partnership, we successfully initiated CHAMPS. One year into recruitment (February 2020), we had received 1173 unique death notifications, investigated 59/99 MITS-eligible cases within the demographic surveillance site, and assigned an underlying and immediate cause of death to 53 children. Conclusions: The most valuable data for global health policy are from high-mortality settings, but initiating CHAMPS has required considerable resource. To further leverage this investment, we need strong, sustained, local research leadership, and to broaden the scientific remit. To support this, we have set up a new collaboration, the “Hararghe Health Research Partnership”.