Neonatal mortality in neonatal intensive care unit hospitals in Ethiopia remains unacceptably high: a systematic review and meta-analysis

Magnitude and determinants of neonatal mortality in NICU


  • Gizachew Tadele Tiruneh JSI Research & Training Institute, Inc./ The Last Ten Kilometers (L10K) Project, Addis Ababa, Ethiopia
  • Tesega Mengistu Birhanu Amhara public health institute, Bahir Dar, Ethiopia
  • Abdurahaman Seid Wollo University School of Public Health, Dessie, Ethiopia
  • Mahteme Haile Workneh Amhara public health institute, Bahir Dar, Ethiopia
  • Dareskedar Getie Amhara public health institute, Bahir Dar, Ethiopia
  • Tenagnework Antefe Abebe Amhara public health institute, Bahir Dar, Ethiopia
  • Ambanesh Necho Mulat UNICEF, Bahir Dar, Ethiopia
  • Taye Zeru Tadege Amhara public health institute, Bahir Dar, Ethiopia
  • Kassahun Alemu Gelaye Institute of Public Health, College of Health Sciences, University of Gondar, Gondar, Ethiopia
  • Tadesse Awoke Ayele Institute of Public Health, College of Health Sciences, University of Gondar, Gondar, Ethiopia


neonatal mortality, neonatal intensive care unit, Ethiopia, determinants, risk factors,


Background: In Ethiopia, the neonatal mortality rate has not shown significant changes over time and is among the highest in the world. This review aimed to explore the pooled magnitude and determinates of neonatal mortality in the neonatal intensive care unit hospitals in Ethiopia.

Methods: The research team retrieved global peer-reviewed journal articles available as electronic databases including PubMed, Popline, and Scopus databases. Random-effects meta-analysis model was used to pool the estimates of the magnitude of mortality among studies. The results were presented as the pooled estimates (odds ratio and proportion) with 95% confidence intervals, at less than 0.05 significant levels. 

Results: In this review, 10 studies were included with a total of 8,729 neonates. Of these, 1,779 (20.4%) neonates died in the neonatal intensive care unit. The pooled neonatal mortality rate was 19.0% (95% CI: 14.0-25.0).  The neonatal mortality is three times higher among early age (OR: 2.80; 95% CI: 1.45-5.40) and preterm newborns (OR: 3.27; 95% CI: 2.12-5.07) than their counterparts. Early age of the newborn, prematurity, low birth weight, perinatal asphyxia, mode of delivery, hypothermia, late initiation of breastfeeding, and having antenatal care visits were the main determinants for neonatal mortality. 

Conclusion: Neonatal mortality in the intensive care unit is high. It is unacceptably high amongst early and preterm neonates. Special care for preterm and early age newborns, timely initiation of breastfeeding, exclusive breastfeeding, and appropriate mode of delivery, essential obstetric and newborn care, and promoting antenatal visits are recommended to reduce neonatal mortality.


1. UN IGME. Levels & Trends in Child Mortality: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. Report 2015. Geneva, Switherland: World Health Organization; 2015.
2. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet. 2016;387(10018):587-603.
3. WHO, UNICEF, UNFPA, World Bank Group, United Nations Population Division. Trends in Maternal Mortality: 1990 to 2015 Population and Development Review. Geneva: World Health Organization2015.
4. UNICEF, World Health Organization, The World Bank, United Nations DESA/Population Division. Levels & Trends in Child Mortality. Report 2015. Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York: UNICEF2015.
5. Central Statistical Agency [Ethiopia], International I. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International; 2012.
6. Central Statistical Agency [Ethiopia], Macro O. Ethiopia Demographic and Health Survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro.; 2006.
7. Central Statistical Agency (CSA) [Ethiopia], ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2016.
8. WHO. Strategies toward ending preventable maternal mortality (EPMM). Geneva, Switzerland: World Health Organization2015.
9. Chou D, Daelmans B, Jolivet RR, Kinney M, Say L. Ending preventable maternal and newborn mortality and stillbirths. BMJ. 2015;351:h4255.
10. Hogberg U. The World Health Report 2005: "make every mother and child count" - including Africans. Scandinavian journal of public health. 2005;33(6):409-11.
11. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet. 2014;384(9940):347-70.
12. Lassi ZS, Mallick D, Das JK, Mal L, Salam RA, Bhutta ZA. Essential interventions for child health. Reproductive health. 2014;11(1):S4.
13. Holmes W, Kennedy E. Reaching emergency obstetric care: overcoming the ‘second delay’. Melbourne: Burnet Institute on behalf of Compass. 2010.
14. FMoH. National Strategy for Newborn and Child Survival in Ethiopia: 2016-2020. Addis Ababa, Ethiopia: Federal Ministry of Health; 2015.
15. Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. International journal of evidence-based healthcare. 2015;13(3):179-87.
16. Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3: Systematic reviews of effectiveness: The Joanna Briggs Institute; 2017.
17. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Chapter 7: Systematic reviews of etiology and risk: The Joanna Briggs Institute; 2017.
18. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of internal medicine. 2018;169(7):467-73.
19. StataCorp. Stata: Release 15. Statistical Software. College Station, Texas: Stata Press; 2017.
20. Sterne JA, Palmer TM. Meta-analysis in Stata: an updated collection from the Stata Journal. 2 ed: StataCorp LP; 2016.
21. Farah AE, Abbas AH, Ahmed AT. Trends of admission and predictors of neonatal mortality: A hospital based retrospective cohort study in Somali region of Ethiopia. PloS one. 2018;13(9).
22. Orsido TT, Asseffa NA, Berheto TM. Predictors of Neonatal mortality in Neonatal intensive care unit at referral Hospital in Southern Ethiopia: a retrospective cohort study. BMC pregnancy and childbirth. 2019;19(1):83.
23. Worku B, Kassie A, Mekasha A, Tilahun B, Worku A. Predictors of early neonatal mortality at a neonatal intensive care unit of a specialized referral teaching hospital in Ethiopia. Ethiop J Health Dev. 2012;26(3):200-7.
24. Yismaw AE, Gelagay AA, Sisay MM. Survival and predictors among preterm neonates admitted at University of Gondar comprehensive specialized hospital neonatal intensive care unit, Northwest Ethiopia. Ital J Pediatr. 2019;45(1):4.
25. Ayalew S YS. Survival Analysis of Premature Infants Admitted to Neonatal Int ensive Care Unit (NICU) in Northwest Ethiopia using Semi-Parametric Fr ailty Model. Journal of Biometrics & Biostatistics. 2015;06(01).
26. Wesenu M, Kulkarni S, Tilahun T. Modeling Determinants of Time-To-Death in Premature Infants Admitted to Neonatal Intensive Care Unit in Jimma University Specialized Hospital. Annals of Data Science. 2017;4(3):361-81.
27. Demisse AG, Alemu F, Gizaw MA, Tigabu Z. Patterns of admission and factors associated with neonatal mortality among neonates admitted to the neonatal intensive care unit of University of Gondar Hospital, Northwest Ethiopia. Pediatric Health Med Ther. 2017;8:57-64.
28. Tewabe T, Mehariw Y, Negatie E, Yibeltal B. Neonatal mortality in the case of Felege Hiwot referral hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a one year retrospective chart review. Ital J Pediatr. 2018;44(1):57.
29. Woldu M, Guta M, Lenjisa J, Tegegne G, Tesafye G, Dinsa H. Assessment of the incidence of neonatal sepsis, its risk factors, antimicrobial use and clinical outcomes in Bishoftu General Hospital. Neonatal Intensive Care Unit, Debrezeit-Ethiopia Pediat Therapeut. 2014;4(214):2161-0665.1000214.
30. Tekleab AM, Amaru GM, Tefera YA. Reasons for admission and neonatal outcome in the neonatal care unit of a tertiary care hospital in Addis Ababa: a prospective study. Research and Reports in Neonatology. 2016.
31. Chow S, Chow R, Popovic M, Lam M, Popovic M, Merrick J, et al. A selected review of the mortality rates of neonatal intensive care units. Frontiers in public health. 2015;3:225.
32. Karimi P, Mahmudi L, Azami M, Badfar G. Mortality in Neonatal Intensive Care Units in Iran: A Systematic Review and Meta-Analysis. Iranian Journal of Neonatology IJN. 2019;10(3):70-80.
33. Weirich CF, Andrade ALS, Turchi MD, Silva SA, Morais-Neto OL, Minamisava R, et al. Neonatal mortality in intensive care units of Central Brazil. Revista de saude publica. 2005;39(5):775-81.
34. Seid SS, Ibro SA, Ahmed AA, Akuma AO, Reta EY, Haso TK, et al. Causes and factors associated with neonatal mortality in Neonatal Intensive Care Unit (NICU) of Jimma University Medical Center, Jimma, South West Ethiopia. Pediatric health, medicine and therapeutics. 2019;10:39.
35. Zhang B, Dai Y, Chen H, Yang C. Neonatal Mortality in Hospitalized Chinese Population: A Meta-Analysis. BioMed research international. 2019;2019.
36. Oza S, Lawn JE, Hogan DR, Mathers C, Cousens SN. Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000–2013. Bulletin of the World Health Organization. 2014;93:19-28.






Systematic review