Neonatal mortality and its determinates in public hospitals of Gamo and Gofa zones, southern Ethiopia: prospective follow up study Abera Mersha* , Agegnehu Bante and Shitaye Shibiru Abstract Background: The neonatal period is the most vulnerable time for child survival. The declines in the neonatal mortality rate have been slower than the post-neonatal under-five mortality rate in the majority of countries. This trend is also similar in Ethiopia, that neonatal mortality was high as compared to the post-neonatal mortality rate. A large proportion of neonatal deaths occur during the 48 h after delivery. Different studies were conducted in assessing determinates for neonatal mortality but there is a need to assess the immediate postnatal (within 2 days following delivery) cause of neonatal mortality that the majority of deaths occurred at that time. So, this study is to fill those gaps of the aforementioned studies, in assessing the determinate factors affecting neonatal mortality in public hospitals of Gamo and Gofa Zones, Southern Ethiopia. Methods: A prospective follow up study was conducted among 6769 study participants from April 5, 2018, to March 5, 2019. All live births at the hospitals during the study period were included in this study. A structured verbal autopsy questionnaire was used to collect the data on the causes of neonatal death. Data were entered into Epi data version 3.1 and exported to Stata version 15 for analysis. Crude and adjusted estimate β with 95%CI was calculated in the binary logistic regression model. A log-likelihood ratio (LR) was tested for goodness of fit. In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results: In this study, neonatal mortality incidence ratio was 9.6 (95%CI: 7.5, 12.2) per 1000 live births. Age of the mother, number of antenatal care visits, sex of the neonate, presentation, and gestational age were identified as the significant determinates for neonatal mortality cases. Prematurity, infection, and birth asphyxia were the most common causes of neonatal mortality cases. Conclusions: This study indicated that a significant number of neonates died during the neonatal period. Both maternal and neonatal factors were identified. Therefore, early identification of obstetric complications and immediate interventions, strengthening the provision of quality antenatal and postnatal care services are recommended. Keywords: Neonatal mortality, Neonatal deaths, Gamo and Gofa zones © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License /), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ) applies to the data made available in this article, unless otherwise stated. * Correspondence: mershaabera@gmail.com Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia Mersha et al. BMC Pediatrics (2019) 19:499 1-0 Background Globally, there is impressive advancements have been made on many health fronts from 2000 to 2017. However, to meet the Sustainable Development Goals’ health targets by 2030, progress must be accelerated, in particular regions with the highest burden of disease [1]. The third Sustainable Development Goals (SDG3) aimed to end preventable deaths of newborns and reduce neonatal mortality to at least as low as 12 per 1000 live births in all countries [2]. Despite all efforts to decrease neonatal mortality, recent data show that neonatal mortality has declined at a slower rate than overall childhood mortality, which has resulted in neonatal mortality now accounting for 46% of overall under-five childhood deaths [3]. The neonatal mortality is 18 globally, and 26.7 in Africa in 2017, and 30 in Ethiopia per 1000 live births in 2019 [4, 5]. Ethiopia Mini-Demographic Health Survey, 2019 indicated that there is a slight increase in neonatal mortality, and it was high as compare to the post-neonatal mortality rate. A large proportion of neonatal deaths occur during the 48 h after delivery, and these first 2 days following delivery are critical for monitoring complications arising from the delivery [4, 6]. World Health Organization (WHO) recommended that after uncomplicated spontaneous vaginal delivery in the health care institution, both the mother and newborn should receive care for 24 h. For home delivery, both the mother and newborn must receive postnatal examination as soon as possible within 24 h if occur at home [7, 8]. The period around birth constitutes a