The impact of neonatal mortality on subsequent survival in rural Ethiopia.

In countries where most deliveries occur at home and most available information is hospital-based, accurate information on neonatal mortality is difficult to obtain. This study was conducted in a rural community in Ethiopia that has been under monthly demographic surveillance since 1987. The analysis in this paper was based on data collected in the 1st decade (1987-96) and this database was used to calculate mortality incidence rates and analyse survival. The overall neonatal mortality rate was 27/1000 live births (95% CI 24.5-29.5). The rates in the early and late neonatal periods were 20 and 8/1000 live births, respectively (95% CIs 18.0-22.9 and 6.6-9.4). The mortality incidence rates show that, every day, three of every 1000 newborns die in their 1st week of life. Neonatal mortality accounted for 43% of infant mortality. If all neonates survived the 1st week of life, life expectancy would increase by 1 year. Increased risk of neonatal mortality was found to be associated with living in a rural lowland area, twin births and male gender. This paper also addresses the need for further identification of the complex environmental and behavioural risk factors for neonatal mortality and for instituting appropriate and affordable interventions to reduce neonatal mortality.