Neonatal Mortality and Its Associated Factors Among Neonates in Ethiopia: A Systematic Review and Meta-Analysis

Despite global declines in neonatal mortality, Sub-Saharan Africa continues to bear a disproportionate burden. In Ethiopia, available evidence is largely derived from facility-based studies, yet pooled evidence from these studies remains limited. Therefore, this study aimed to estimate the pooled proportion of neonatal deaths among admitted neonates and identify associated factors in Ethiopia.

We searched major databases, including Web of Science, Scopus, PubMed, Google Scholar, and African Journals Online. Data were extracted using standardized Microsoft Excel spreadsheet. Study quality was assessed using the Joanna Briggs Institute appraisal checklist. A random-effects meta-analysis estimated pooled proportion of neonatal deaths, with heterogeneity measured by I ² and publication bias assessed using a funnel plot and Egger's test.

The pooled proportion of admitted neonatal deaths in Ethiopia was 14.31% (95% confidence interval [CI]: 12.59-16.03), indicating a high burden of neonatal deaths within healthcare facilities, with substantial heterogeneity across studies (I ² = 98.93%). Given this extreme heterogeneity, the pooled estimate should be interpreted cautiously and should not be considered a fixed national figure. Lack of antenatal care (ANC) (adjusted odds ratio [AOR] = 2.7, 95% CI: 1.5-3.96), birth asphyxia (AOR = 5.1, 95% CI: 3.0-7.1), low-birth weight (AOR = 4.1, 95% CI: 1.6-6.6), preterm birth (AOR = 2.2, 95% CI: 1.3-3.1), and hypothermia (AOR = 2.4, 95% CI: 1.2-3.7) were identified as significant risk factors for neonatal deaths.

A considerable proportion of neonatal deaths occurred among admitted neonates in Ethiopia, indicating a high burden of neonatal mortality within healthcare facilities. The major risk factors for neonatal deaths were lack of ANC, asphyxia, low-birth weight, preterm birth, and hypothermia. As the evidence was derived predominantly from facility-based studies, the findings mainly reflect the proportion of deaths among neonates receiving care in health facilities and should not be considered nationally representative of all neonates in Ethiopia.