Magnitude and causes of under-five mortality in the North Shewa Zone, Ethiopia

Introduction Globally around 5 million children under the age of 5 years die every year. Ethiopia is one of five countries that contribute to more than half of these deaths. In the absence of a national vital registry system in Ethiopia, there is a lack of high-quality data regarding causes of death. Methods We conducted a verbal autopsy study among under-five deceased children at the Birhan health and demographic site (HDSS) located in the North Shewa zone, Ethiopia. All deaths of under five children, which occurred in the time period from March 1, 2019 to February 29, 2020 at the Birhan HDSS, were identified. The under-five mortality rate (U5MR) was computed using a Kaplan-Meier approach. The world health organization verbal autopsy questionnaire was administered to mothers or caregivers of the deceased child after a minimum mourning period of 42 days. The causes of death were then determined by the InterVA-5 algorithm. Results There were 90 under-five deaths resulting in an estimated U5MR of 45.3 per 1000 live births. The majority (62.2%) of deaths occurred during the neonatal period. The leading causes of death in under-five children were birth asphyxia (20, 27.0%), prematurity (19, 25.7%) and meningitis and encephalitis (8, 10.8%) while leading causes of neonatal deaths were birth asphyxia (19, 38.0%), prematurity (18, 36.0%) and neonatal sepsis (6, 12.0%). Conclusions There is a high under-five mortality rate at the study site, with most deaths occurring in the neonatal period. Birth asphyxia and prematurity contributed to more than half of the under-five deaths suggesting that follow-up and management during pregnancy, labor and delivery should be strengthened to avert a significant proportion of under-five deaths. What is already known on this topic What this study adds How this study might affect research, practice or policy ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The work has been supported by the Bill & Melinda Gates Foundation (grants INV-010382 and INV-003612) and the funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics IRB of the Saint Paul Hospital Millennium Medical College and the Harvard T. H. Chan School of Public Health gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors