Association of maternal serum magnesium with pre-eclampsia in African pregnant women: a systematic review and meta-analysis.

Pre-eclampsia (PE) is a pregnancy-related disorder characterized by hypertension and proteinuria occurring after 20 weeks of gestation. Several studies have been performed to determine the serum magnesium (Mg) level in PE, but most report inconclusive results. Consequently, this study was designed to resolve this controversy among African women. PubMed, Hinari, Google Scholar and African Journals Online electronic databases were searched for studies published in English. The qualities of included articles were appraised using the Newcastle-Ottawa quality assessment tool. Stata 14 software was utilized for analysis and serum Mg levels in cases and normotensive controls were compared through mean and standardized mean difference (SMD) at the 95% confidence interval (CI). In this review, we found that the mean serum Mg level was significantly reduced in cases (0.910±0.762 mmol/L) vs controls (1.167±1.060 mmol/L). The pooled SMD of serum Mg was significantly lower in cases (-1.20 [95% CI -1.64 to -0.75]). Therefore, since serum Mg is reduced in cases vs controls, we propose that Mg is involved in the pathophysiology of PE. Nevertheless, to know the exact mechanisms of Mg in PE development will require large-scale prospective studies.

Association of endothelial nitric oxide synthase gene variants in pre-eclampsia: an updated systematic review and meta-analysis.

INTRODUCTION: Three common endothelial nitric oxide synthase (eNOS) gene variants are existed such as; G-894T, T-786C, and variable number tandem repeats in intron-4 (VNTR intron-4) which has been proposed to be linked with PE. However, there is still debate regarding the findings. To address this, a review was conducted to assess the potential association of eNOS gene variants at these positions with the risk of PE. METHODS: PubMed, Scopus, Science Direct, Hinari, and African Journal Online databases and Google Scholar search engines were utilized to search studies published in English-language until 30 January 2023. The Joanna Briggs Institute Meta-Analysis instrument was used for data extraction process and the Newcastle-Ottawa Scale was used to appraise the quality of the included studies. Meta-regression analysis was conducted using Stata 14 statistical software. The pooled odds ratios (ORs) of fixed and random effect models were utilized to evaluate the association of eNOS gene polymorphism with the risk of PE at 95% CI. Publication bias was assessed using Egger's test and a funnel plot. RESULTS: The study included 47 observational studies involving 13,795 pregnant women (6216 cases and 7579 controls). Pregnant women carrying TT and CC genotypes of eNOS gene at 894 and 786 positions were found to have a greater probability of developing PE as compared to GG and TT genotypes (OR = 1.54 vs. 1.43 and CI: 1.12 - 2.14 vs.1.02 - 2.00 at 95% CI), respectively. However, a significant association was not observed between aa genotype of eNOS gene in VNTR intron-4 region and risk of PE as compared to bb genotype (OR =1.26, 95% CI: 0.83 - 1.89). The allelic model of eNOS gene at all positions showed nonsignificant association with the risk of PE. CONCLUSIONS: The women having eNOS gene variants at 894 and 786 positions showed a significant association with the risk of PE. Yet, the women having eNOS gene variant at intron-4 region showed nonsignificant association with the risk of PE. Thus, this study suggests that eNOS gene variants may play a role in the development of PE, but large-scale studies are required to inaugurate concrete evidence on the roles of eNOS gene variants in PE pathogenesis.

Determinants of pre-eclampsia among pregnant women attending antenatal care and delivery services at Bahir Dar public hospitals, northwest Ethiopia: A case-control study.

Background and Aims: Pre-eclampsia (PE) is a pregnancy-related syndrome that occurs after 20 weeks of pregnancy. The current study was designed to evaluate the determinants of PE in pregnant women following antenatal and delivery services. Methods: An institution-based case-control study was performed in governmental hospitals of Bahir Dar city. The data were collected using an interview-administered questionnaire and analyzed by SPSS version 20 software. Bivariate and multivariable logistic regression models were utilized for the analysis of variables. A p < 0.05 was used to declare the level of significance. Results: In this study, the mean ages (in years) of cases and controls were 28.20 ± 5.66 and 27.52 ± 4.70, respectively. Factors such as: being primiparous (adjusted odds ratio [AOR]: 3.19 at 95% confidence interval [CI]: 1.71, 5.97), family history of hypertension (HTN) (AOR: 4.14 at 95% CI: 1.71, 10.05), previous history of PE (AOR: 7.97 at 95% CI: 2.42, 26.63), number of antenatal care (ANC) visits (AOR: 5.43 at 95% CI: 2.86, 10.33), not taking iron and folic acid supplement (AOR: 4.46 at 95% CI: 1.59, 12.48), body mass index ≥25 kg/m2 (AOR: 3.47 at 95% CI: 1.78, 6.77), not consuming vegetables (AOR: 1.99 at 95% CI: 1.07, 3.69) and not consuming egg, milk and milk products (AOR: 3.00 at 95% CI: 1.47, 6.11) were the determinants of PE. Conclusion: In this study, different determinants of PE were identified. Hence, special attention should be given for primiparous women, women having previous history of PE and family history of HTN. Moreover, nutritional counseling should be given for pregnant women during ANC visits. Besides, higher officials should design an appropriate strategy to increase the number of mothers to complete their ANC visits and to take iron and folic acid supplements. Furthermore, to verify the determinants of PE, community-based cohort studies are warranted.

Prevalence of obstructive lung patterns and actual spirometric result at different workplaces in Ethiopia: A systematic review and meta-analysis.

Background and Aims: Burdens of occupational exposure like insoluble dust particles and chemicals in the respiratory tract leads to impaired clearance. This study aims to assess the prevalence of obstructive lung patterns and actual spirometric result in Ethiopia at different workplaces. Methods: Five electronic databases such as: PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online were searched in studies conducted from 2010 to 2021. In this study, we used STATA 14 software for data analysis and the quality of included studies were appraised using the New Castle Ottawa quality assessment tool. The pooled prevalence of obstructive lung patterns and actual spirometric results were estimated using effect size and standardized mean differences (SMD). Results: A total representative of 3511 participants was included in this study. The pooled prevalence of obstructive lung patterns in occupational exposure at different workplaces was found 13.04% (95% CI: 7.96, 18.12, I 2 = 89.2%). On the other hand, the pooled prevalence of obstructive lung patterns in controls was 4.10% (95% CI: 1.86, 6.34, I 2 = 76.8%). SMD of spirometric results was significantly decreased in cases as compared to the controls. The SMD of FVC in a litter (L) at 95% of CI: -0.50 (-0.70, -0.30, I 2 = 87.7%), SMD of FEV1 in (L) at 95% CI: -0.54 (-0.72, -0.36, I 2 = 84.9%), SMD of FEF25%-50% in litter per second (L/s) at 95% of CI: -0.42 (-0.67, -0.17, I 2 = 81.9%) and SMD of PEFR in L/s at 95% CI: -0.45 (-0.68, -0.21, I 2 = 78.4%) were significantly decreased in cases as compared to the controls. Conclusion: The pooled prevalence of obstructive lung pattern was higher in people who are working at different workplace that generating dusts and chemicals. The SMD of actual spirometric results were reduced in cases than controls. Therefore, to alleviate this problem appropriate preventive measure would be warranted for those people who are working in different dust and chemical generating environments.

Comparative serum lipid and immunohematological values among adult pulmonary tuberculosis and tuberculosis lymphadenitis cases and their association with sputum bacilli load and time to culture positivity in Northwestern Ethiopia.

BACKGROUND: The serum lipid and immunohematological values of tuberculosis lymphadenitis (TBLN) patients is poorly documented relative to pulmonary tuberculosis (PTB) cases. Therefore, the aim of this study was to investigate the serum lipid and immunohematological values of patients with TBLN in comparison with PTB (PTB) patients. METHODS: An institution-based comparative cross-sectional study was conducted in Northwest Ethiopia from March to December 2021. The study participants were bacteriologically confirmed PTB (n = 82) and TBLN (n = 94) cases with no known comorbidity and whose ages was greater than 18 years and with no current pregnancy. Independent sample t-test, one-way ANOVA, box plot, and correlation matrix were used to analyze the data. RESULTS: The body mass index (BMI), CD4 + T cell count, and high-density lipoprotein-Cholesterol (HDL-C) values were significantly higher among TBLN cases compared with PTB cases. Additionally, the total white blood cell (WBC) count, hemoglobin (Hb), total Cholesterol (CHO) and creatinine (Cr) values were relatively higher among TBLN than PTB (P > 0.05). On the reverse, the platelet count and triacylglycerol (TAG) values were relatively higher among PTB than in TBLN cases. While the mean days of culture positivity were 11.6 days for TBLN, the mean days of culture positivity were 14.0 days for PTB. Anemia and serum lipid values showed no correlation with sputum bacilli load and time to culture positivity. CONCLUSION: Tuberculous lymphadenitis patients were well-endowed with serum lipid, immunological and nutritional status compared with PTB cases. Hence, the high incidence rate of TBLN in Ethiopia could not be explained by low peripheral immunohematological values, malnutrition, Anemia, and dyslipidemia. Further study for identifying the predictors for TBLN in Ethiopia is highly desirable.

Maternal serum uric acid, creatinine and blood urea levels in the prediction of pre-eclampsia among pregnant women attending ANC and delivery services at Bahir Dar city public hospitals, northwest Ethiopia: A case-control study.

Background: Pre-eclampsia (PE) is a metabolic disorder that adversely affects the lives of mother and their infants. Even though, several studies have been conducted on PE, no effective diagnostic and therapeutic agents were developed so far. Hence, this study was designed to evaluate serum uric acid, blood urea and creatinine levels in the prediction of PE. Methods: A hospital-based case-control study was conducted among pregnant women. A simple random sampling technique was applied to select study participants. The socio-demographic and clinical data were collected using an interview-administered questionnaire. Serum samples were used to determine the maternal uric acid, urea and creatinine levels via an automated chemistry analyzer. Independent sample t-test, Pearson correlation test and receiver operating characteristic (ROC) curve analysis were performed to check the association and diagnostic accuracy of variables to PE. Results: The mean ages (in years) of the case and control groups were 27.98 ± 5.64 and 27.33 ± 4.45, respectively. The mean serum uric acid and blood urea levels were significantly higher in pre-eclamptic women than in normotensive pregnant women (6.27 ± 0.20 vs 4.43 ± 0.15, and 8.50 ± 3.99 vs 5.67 ± 2.19), respectively but the serum creatinine level is non-significantly increased in cases as compared to controls (0.70 ± 0.05 vs 0.50 ± 0.01). The areas under the ROC curve of serum uric acid, creatinine and blood urea levels were 0.785, 0.735 and 0.764 (sensitivity: 69%, 60.7%, 67.9%; specificity: 73.8%, 75%, 71.4%) with the cutoff points of ≥5.25 mg/dL, ≥0.565 mg/dL and ≥6.5 mg/dL, respectively. Conclusion: In this study, we observed a significantly higher concentration of serum uric acid and blood urea values in pre-eclampsia as compared with normotensive pregnant women. Therefore, this suggested that serum uric acid; blood urea and creatinine values can be associated with PE. Moreover, serum uric acid, blood urea and creatinine levels could be carefully utilized as a diagnostic marker for PE, but their inclusion in routine diagnostic test to PE requires large-scale multi-center prospective studies that corroborate our findings.

Prevalence and risk factors of type-2 diabetes mellitus in Ethiopia: systematic review and meta-analysis.

Diabetes mellitus (DM) is a public health problem in developing as well as developed nations. DM leads to many complications that are associated with higher morbidity and mortality worldwide. Therefore, the current study was planned to assess the prevalence and risk factors of type-2 DM in Ethiopian population. Six electronic databases such as: PubMed, Scopus, Hinari, Web of science, Google Scholar, and African Journals Online were searched for studies published in English up December 30, 2020. Newcastle-Ottawa Scale was used for quality assessment of the included studies. The data was extracted by Microsoft excel and analyzed through Stata version 16 software. The random effect meta-regression analysis was computed at 95% CI to assess the pooled prevalence and risk factors of type-2 DM. Forty observational studies were included in this systematic review and meta-analysis. The pooled prevalence of DM in Ethiopia was 6.5% (95% CI (5.8, 7.3)). The sub-group analysis revealed that the highest prevalence of DM was found in Dire Dawa city administration (14%), and the lowest prevalence was observed in Tigray region (2%). The pooled prevalence of DM was higher (8%) in studies conducted in health facility. Factors like: Age ≥ 40 years ((Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.05, 3.49)), Illiterate (AOR: 2.74 (95% CI: 1.18, 6.34)), Cigarette smoking (AOR: 1.97 (95% CI: 1.17, 3.32)), Body mass index (BMI) ≥ 25 kg/m2 (AOR: 2.01 (95 CI: 1.46, 2.27)), family history of DM (AOR: 6.14 (95% CI: 2.80, 13.46)), history of hypertension (AOR: 3.00 (95% CI: 1.13, 7.95)) and physical inactivity (AOR: 5.79 (95% CI: 2.12, 15.77)) were significantly associated with type-2 DM in Ethiopian population. In this review, the prevalence of type-2 DM was high. Factors like: Older age, illiteracy, cigarette smoking, MBI ≥ 25, family history of DM, history of hypertension and physical inactivity were an identified risk factors of type-2 DM. Therefore, health education and promotion will be warranted. Further, large scale prospective studies will be recommended to address possible risk factors of type-2 DM in Ethiopian population.

Prevalence of and risk factors for hypertension in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: A number of epidemiological studies were performed to know the prevalence of and the risk factors for hypertension. However, these studies reported inconsistent results. As a result, this systematic review and meta-analysis were planned to generate representative data on the prevalence of and risk factors for hypertension among the Ethiopian adult population. METHODS: Five electronic databases, namely, PubMed, Science Direct, Google Scholar, Hinari, and African Journals Online, were searched for studies published in English from 1 January 2010 to 31 August 2020. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa scale were used for data extraction and quality assessment for this review. Stata version 14 statistical software was used for the analysis, and due to high heterogeneity a random effects model was used for meta-analysis at 95% confidence interval (CI). RESULTS: In this review, 35 observational studies were included. The pooled prevalence of hypertension in Ethiopia was 20.63% (95% CI [18.70, 22.55]) with the I 2 value of 96.1%. Older age (≥40 years) (adjusted odds ratio [AOR]: 3.46 [95% CI: 2.67, 4.49]), urban residence (AOR: 1.47 [95% CI: 1.28, 1.70]), educational status less than grade 12 (AOR: 1.67 [95% CI: 1.38, 2.01]), family history of hypertension (AOR: 4.33 [95% CI: 2.95, 6.34]), diabetes mellitus (DM) (AOR: 5.18 [95% CI: 3.01, 8.88]), body mass index (BMI) ≥25 (AOR: 3.79 [95% CI: 2.61, 5.50]), central obesity (AOR: 1.91 [95% CI: 1.09, 3.36]), and alcohol consumption (AOR: 1.72 [95% CI: 1.26, 2.34]) were the identified risk factors for hypertension. CONCLUSION: The pooled prevalence of hypertension is relatively higher as compared to the previous reports in Ethiopia. Older age, urban residence, lower educational coverage, family history of hypertension, DM, BMI ≥25, alcohol consumption, and central obesity were the risk factors for hypertension. The governments and stakeholders should design an appropriate strategy to prevent and control the disease in the Ethiopian population.

Maternal Serum Zinc Level and Pre-eclampsia Risk in African Women: a Systematic Review and Meta-analysis.

Some studies have reported the association between maternal serum zinc (Zn) levels and pre-eclampsia. However, many studies have reported controversial results. Hence, this systematic review and meta-analysis was planned to generate summarized evidence on the association between maternal serum Zn levels and pre-eclampsia in African women. Four electronic databases such as PubMed, Hinari, Google Scholar, and African Journals Online were searched for studies published in English. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument, and Newcastle-Ottawa Scale were used for data extraction and quality assessment of the included studies. The meta-regression analysis was performed by the Stata 14 software. The standardized mean difference (SMD) values of lipid profiles were computed to assess their association with pre-eclampsia at 95% CI. A total of 12 observational studies were included. The mean values of serum Zn level were significantly lower in pre-eclamptic women as compared with normotensive pregnant women (Zn = 59.40 ± 22.80 µg/dL and 80.24 ± 16.04 µg/dL), respectively. The pooled SMD of Zn was significantly reduced in pre-eclamptic women as compared with normotensive pregnant women with the SMD of -1.45 (95% CI -2.26, -0.65) at 95% CI. In this review, we found that the maternal Zn serum level was significantly reduced in pre-eclamptic women than normotensive pregnant women. This suggests that Zn could be involved in the etio-pathogenesis of pre-eclampsia. However, the specific functions of Zn in pre-eclampsia pathogenesis should be proved in large-scale clinical trial studies.

Maternal lipid profile and risk of pre-eclampsia in African pregnant women: A systematic review and meta-analysis.

INTRODUCTION: Some studies have reported the association between maternal serum lipid profile abnormalities and pre-eclampsia. However, many studies have reported controversial results. Hence, this systematic review and meta-analysis was planned to generate summarized evidence on the association between maternal serum lipid profiles and pre-eclampsia in African women. METHODS: Four electronic databases such as; PubMed, Hinari, Google Scholar, and African Journals Online were searched for studies published in English. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa Scale were used for data extraction and quality assessment of the included studies. The meta- regression analysis was performed by Stata 14 software. The standardized mean difference (SMD) values of lipid profiles were computed to assess their association with pre-eclampsia at 95% CI. RESULTS: In this review a total of 15 observational studies were included. The mean values of triglyceride (TG), total cholesterol (TC), low density lipoprotein- cholesterol (LDL-c) and very low density lipoprotein- cholesterol (VLDL-c) were significantly higher in pre-eclamptic women as compared with normotensive pregnant women (TG = 229.61±88.27 and 147.00 ± 40.47, TC = 221.46 ± 45.90 and 189.67 ± 39.18, LDL = 133.92 ± 38.77 and 112.41 ± 36.08, VLDL = 41.44 ± 19.68 and 26.64 ± 7.87), respectively. The serum high density lipoprotein cholesterol (HDL-c) level was lower, but it is not statistically significant (HDL-c = 51.02 ± 16.01 and 61.80 ± 25.63) in pre-eclamptic women as compared with controls. The pooled standardized mean difference (SMD) of TG, TC, LDL-C and VLDL-C were significantly increased in pre-eclamptic women as compared with normotensive pregnant women with the SMD of (TG = 1.65 (1.10, 2.21), TC = 0.84 (0.40, 1.29), LDL-C = 0.95 (0.46, 1.45) and VLDL-C = 1.27 (0.72, 1.81)) at 95% CI, respectively, but the pooled SMD of HDL-cholesterol was decreased in pre-eclamptic women as compared with normotensive pregnant women (SMD = -0.91 (95% CI: -1.43, -0.39). CONCLUSIONS: In this review, the maternal serum levels of TG, TC, LDL-c and VLDL-c were significantly associated with the risk of preeclampsia. However, HDL- cholesterol was not significantly associated but it was lower in pre-eclamptic women. Further, large scale prospective studies should verify these outcomes and it is recommended that lipid profiles should be included as a routine diagnostic test for pre-eclamptic women.

Prevalence and determinants of hypertensive disorders of pregnancy in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Hypertensive disorder of pregnancy is the second commonest causes of maternal death globally. Different public health studies were conducted on hypertensive disorder of pregnancy which presented inconsistent result. Therefore, this systematic review and meta-analysis was commenced to summarize the findings conducted in several parts of the country and to generate the nationwide representative data on the prevalence and risk factors of hypertensive disorder of pregnancy in Ethiopia. METHODS AND MATERIALS: Electronic databases such as PubMed, Scopus, Google Scholar, Hinari, and African Journals Online were searched for studies published in English up to March, 2020. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa Scale were used for data extraction and quality assessment of the included studies. The meta- regression analysis was computed at 95% CI to present the pooled prevalence and risk factors of hypertensive disorder of pregnancy. RESULTS: Thirty four studies were included in this systematic review and meta-analysis. The pooled prevalence of hypertensive disorder of pregnancy and preeclampsia in Ethiopia were 6.82% (95% CI (5.90, 7.74)) and 4.74% (95% CI (3.99, 5.49)) respectively. Maternal age ≥35 years (Adjusted Odds Ratio (AOR): 2.91 (95% CI: 1.60, 5.26)), twin pregnancy (AOR: 3.04 (95% CI: 1.89, 4.87)), previous history of preeclampsia (AOR: 5.36 (95% CI: 3.37, 8.53)), family history of hypertension (AOR: 4.01 (95% CI: 2.65, 6.07)), family history of diabetes mellitus (AOR: 3.07 (95% CI: 1.66, 7.70)), body mass index ≥25 (AOR: 3.92 (95% CI: 1.82, 8.42)), alcohol consumption (AOR: 1.77 (95% CI: 1.11, 2.83)), urinary tract infection (AOR: 4.57 (95% CI: 3.47, 6.02)), lack of nutritional counseling during antenatal period (AOR: 4.87 (95% CI: 3.36, 7.06)), lack of fruits (AOR: 3.49 (95% CI: 2.29, 5.30)), and vegetables consumption (AOR: 2.94 (95% CI: 2.01, 4.31)) were the risk factors of hypertensive disorder of pregnancy in Ethiopia. CONCLUSIONS: The pooled prevalence of hypertensive disorder of pregnancy is relatively higher compared with the previous reports. Maternal age ≥35 years, twin pregnancy, previous history of preeclampsia, family history of hypertension, family history of diabetes mellitus, body mass index ≥25, alcohol consumption, urinary tract infection, lack of fruits and vegetables during pregnancy were risk factors of hypertensive disorder of pregnancy. The governments and stakeholders should work to strengthen the antenatal care practice to include the possible risk factors of hypertensive disorders of pregnancy.

Liver enzyme elevation in patients taking HAART compared with treatment naïve controls at Debre Berhan Referral Hospital: a comparative cross-sectional study, Northeast Ethiopia.

OBJECTIVE: HAART had significantly improved the quality of life of HIV patients. However, it results different adverse effects such as: hepatotoxicity, nephrotoxicity, lipodystrophy, anemia, diarrhea, psychiatric disorder and others. Therefore, this comparative cross sectional study was designed to investigate liver enzyme elevation in patients taking HAART compared with treatment naïve controls at Debre Berhan Referral Hospital. RESULT: A total of 152 individuals (76 cases and 76 controls) were included in this study. The mean ages of treatment and control groups were 37.37 and 36.38 respectively. The mean values of liver enzymes (ALT, AST and ALP), total bilirubin and direct bilirubin were significantly higher (p < 0.05) while, total protein and creatinine were significantly lower in patients taking HAART compared with treatment naïve controls. In this study, about 19 (25%) of clients in HAART treated groups and 7 (9.2%) of treatment naïve controls had showed liver enzyme changes. Moreover, 23.7% and 1.3% of the HAART treated groups developed mild and moderate liver enzyme elevation or hepatotoxicity, respectively. In this study, significant difference was observed in liver enzyme elevation between ART and pre-ART patients. As a result, regular clinical and laboratory monitoring of liver function will be necessary to prevent severe form of liver injury.

Factors associated with utilization of long term family planning methods among women of reproductive age attending Bahir Dar health facilities, Northwest Ethiopia.

OBJECTIVE: This health institution based cross section study was designed to determine factors associated with utilization of long term family planning methods among women reproductive age attending Bahir Dar health facilities. RESULT: A total of 406 women were interviewed in this study. The mean age (standard deviation) of the study participants was 26.96 ± 6.31. About 99% of the study participants were consisted from Amhara ethnic group and 60.6% of them urban dwellers. In this study about 90.9% of the study participants had information about LTFP methods and 26.4% of them utilizing the methods. Factors like; knowledge of the women towards LTFP, spousal discussion on FP and occupation of the women affects LTFP utilization (6 times, 3 times and 4 times, respectively) when compared with their counter parts. In addition monthly income of the household was also associated to LTFP methods. In this study less percentage (26.4%) of women's utilizing LTFP methods that were significantly associated with the knowledge of women on LTFP, spousal discussion on FP, occupation of the women and monthly income of the household. As result continuous health education will be recommended.

Determinants of Neonatal Mortality in North Shoa Zone, Amhara Regional State, Ethiopia.

In Ethiopia, neonatal mortality has been declined since the declaration of Millennium Developmental Goals, but the rate was slower since 2006. Thus, this study was designed to assess the determinants of neonatal mortality (NM) in North Shoa Zone. A community based case-control study was conducted on 84 cases and 252 controls. Cases were deceased new-borns within 28 days of birth while controls were infants survived beyond the first 28 days. Data were collected from mothers of the cases and controls using interviewer administered questionnaires. Multivariate analysis was done to examine determinants of NM. Variables significantly associated with NM in bivariate analysis were selected for multivariate analysis. Neonates whose mothers not attended antenatal care (AOR: 3.47; 95%CI: 1.44-8.32), delivered at home (AOR: 2.86; 95%CI: 1.56-5.26), and not received postnatal care services (AOR: 3.09; 95%CI: 1.73-5.51) were more likely to die. The odds of neonatal death was higher among neonates not breastfed within the first hour of delivery than those who breastfed within the first hour of delivery (AOR: 23.48; 95%CI: 8.43-65.37). Likewise, no-colostrum intake was positively associated with neonatal death. Neonates born to mothers who not received or received a single dose of tetanus toxoid injection (TTI) were more likely to experience death than those neonates born to mothers who received two or more doses of TTI (AOR: 2.05; 95%CI: 1.14-3.70). Furthermore, being small in size at birth (AOR: 2.66; 95%CI: 1.33-5.33) and male in sex (AOR: 1.85; 95% CI: 1.06-3.26) were risk factors for NM. In conclusion, neonatal mortality was significantly associated with factors that are modifiable through addressing the continuum-of-care approach in healthcare services in North Shoa. This implies that ensuring a continuity of health care services for maternal and new-borns from antenatal to postnatal care will improve neonatal survival.