survive VA was conducted. Study variables Neonatal mortality case was the dependent variable and socio-demographic and economic characteristics, maternal factors, maternal and child health services and obstetric factors were independent variables for this study. Data quality control To ensure quality, the questionnaire was initially drafted in the English language and then translated into the local language, “Gammogna and Amharic” by verified translators. Finally, before data collection again re-translated back to English. The questionnaires were pre-tested in another hospital with a similar status to maintain the reliability and standard VA tool and the abstraction checklist was used to ensure the validity. Besides, extensive training was given for data collectors and supervisors. Data were checked for completeness, accuracy, clarity, and consistency before data entry into the software. Proper coding and categorization of data were maintained for the quality of the data to be analyzed. Double data entry was done for its validity and compare to the original data. Data analysis and processing Data were coded, cleaned, edited and entered into Epi data version 3.1 and then exported to Stata version 15 for analysis. Binary logistic regression was done to see the association between each independent variable and outcome variable. A log-likelihood ratio (LR) was tested for the goodness of fit. All variables with P < 0.25 in the bivariate analysis were included in the final model of multivariable analysis to control all possible confounders. Variance inflation factor (VIF) > 10 and Tolerance (T) < 0.1 were considered as suggestive of the existence of multi co-linearity. A crude and adjusted Beta (β) coefficient with 95%CI was estimated to identify determinates for the neonatal mortality cases. In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results The overall process of the study In this study, 6986 study participants were interviewed in the baseline after excluding 131 twin deliveries from total live births in three selected public hospitals from two zones of Southern Ethiopia. During follow up for 28 days 153 study participants became lost to follow up and 64 were excluded from the study because of inconsistent and incomplete information. At the end of follow up, 6769 study participants stayed in the cohort and interviewed the end line which gave a response rate of 96.9%. During follow up 6704 neonates were survived and 65 died. A verbal autopsy had conducted among 52 died neonates and the rest were refused (Fig. 1). Socio-demographic and economic characteristics of the respondents Of the neonate’s mother, 3384 (50.0%) were age ranged 25–34 years old and with mean and standard deviation (SD) of 25.3 ± 5.02. The majority (95.0%) were married and 3727 (55.0%) had from the Gamo ethnicity group. Regarding the educational status of neonates mother, 1439 (21.3) had no formal education and 2069 (30.6%), 1822 (26.9%) and 1439 (21.3%) had primary (grade 1–8), secondary (grade 9–12) and college and above respectively. Two thousand eighty (30.7%) of the neonate’s father had the educational status of college and above and 2497 (36.9%) had merchant. Out of neonates mother 2885 (42.6%) had Orthodox religion follower and 420 (6.2%), 2966 (43.8%), 451 (6.7%) and 47 (0.7%) were Catholic, Protestant, Muslim and traditional respectively. More than half (57.7%) of the neonates mother was housewife and 1057 (15.6%), 1403 (20.7%), 123 (1.8%) and 283 (4.2) were merchant, government employer, Mersha et al. BMC Pediatrics (2019) 19:499 Page 3 of 8 daily labor and student respectively and 4067 (60.1%) had urban residents (Table 1). Maternal and child health, and obstetric factors Out of the neonate’s mother, 3900 (57.6%) had multipara (birth order ≥2), only 350 (9.0%) had a history of the stillbirth and 434 (11.1%) encountered loss of conceptus. Two thousand eight hundred (71.8%) of the mothers of the neonates were birth inter of 24– 48 month and 329 (8.4%) had a history of neonatal death. Of the neonate’s mothers, 6004 (88.7%) had antenatal care (ANC) and 6674 (98.6%) had immediate postnatal care. Regarding mode of delivery 4943 (73.0%) gave birth by spontaneous vaginal delivery, 243 (3.6%) were instrumental and 1583 (23.4) were by caesarean section. One thousand two hundred sixtytwo (18.6%) encountered prelabour rupture of membrane and 524 (7.7%) developed hypertension (HTN) during pregnancy. Out of the neonate’s mothers, 193 (2.9%) had anemic and 682 (10.1%) faced dystocia. From those who faced labor dystocia, 24 (3.5%) had due to uterine pre-rupture, 465 (68.2%) had due to prolonged labor and 193 (28.3%) had due to fetopelvic disproportion. Two hundred thirty (3.4%) of the neonate’s mothers encountered infection and 130(1.9%) had developed other pathologies. Of the mothers who developed infection 33 (14.4%) had an unspecified infection and 50 (21.7%), 100 (43.5%) and 47 (20.4%) had puerperal endometritis, pyelonephritis and others (syphilis and malaria) respectively. From the mothers who developed other pathologies 33 (25.4%) had HIV/AIDS, 58 (44.6%) had heart diseases and 39 (0.3%) had others (DM, thyroid disorder, embolism, and DIC). Regarding the presentation of neonates, 5818 (86.0%) delivered with vertex and 3606 (53.3%) were