The magnitude of neonatal mortality and its predictors in Ethiopia: a systematic review and meta-analysis.

Background: Although neonatal death is a global burden, it is the highest in Sub Saharan Africa countries such as Ethiopia. This study was aimed to provide pooled national prevalence and predictors of neonatal mortality in Ethiopia. Objective: To assess the pooled prevalence and predictors of neonatal mortality in Ethiopia. Search Strategy: global databases were systematically explored. Systematically searched using the following databases:Boolean operator, Cochrane library, PubMed, and Google Scholar. Selection, screening, reviewing and data extraction was done by two reviewers independently using Microsoft excel spread sheet. The modified Newcastle Ottawa Scale and the Joanna Briggs Institute Prevalence Critical Appraisal tools were used to assess the quality of evidence. Selection criteria: All studies conducted in Ethiopia and reporting the prevalence and predictors of neonatal mortality were included. Data Collection and Analysis: Data were extracted using a Microsoft Excel spreadsheet software and imported into STATA Version 14 for further analysis. The pooled effect size with 95% confidence interval of neonatal mortality rate was determined using a weighted inverse variance random effects model. Publication bias was checked using funnel plots, Egger and bagger regression test. Heterogeneity also checked by Higgins method. A random effects meta-analysis model was computed to estimate the pooled effect size. Moreover, sub-group analysis based on region, sample size and study design were done. Results: After reviewing 88 studies, 12 studies fulfilled the inclusion criteria and were included in the meta analysis. The pooled national prevalence of neonatal mortality in Ethiopia was 16.3%. The subgroup analysis indicated that the highest prevalence was observed in Amhara region with a prevalence of 20.3%,followed by Oromia, 18.8%. Gestational age wth AOR,1.14 (95% CI: 0.94 ,1.3), neonatal sepsis (AOR:1.2(95% CI: 0.8, 1.5), respiratory distros (AOR: 1.2(95% CI: 0.8, 1.5) and place of residency (AOR:1.93 (95% CI:1.1,2.7) were the most important predictor. Conclusions: neonatal mortality in Ethiopia was significantly decreased than the national report. There was evidence that neonatal sepsis, gestational age, respiratory distress were the significant predictors. We strongly recommended that health care workers should give a priority for the identified predictors.