Background: Neonatal mortality is a significant challenge that affects babies within the first 28 days of life. The issue is particularly challenging for healthcare systems in developing countries, where interventions are required. Although there has been a decline in neonatal mortality worldwide, comprehensive data on the patterns of neonatal mortality and the contributing factors in rural regions of Ethiopia is lacking. Objective: To determine neonatal mortality trends  and mortality in rural Ethiopia using 2011-2019 DHS data Methods: Ethiopian demographic health survey (EDHS) program conducted a cross-sectional community-based study in rural Ethiopia in 2011, 2016, and 2019. The study included women who gave birth within the specified timeframe and agreed to participate. Sampling was done through a multistage cluster approach, and STATA version 17 was used to analyze the data. Predictor variables were validated through multiple logistic regression analysis. Weighted estimates were used to derive population-level statistics and a p-value less than 0.05 was considered significant. Results: The study analyzed data from 22,755 women who participated in EDHS surveys between 2011 and 2019. Neonatal mortality rates decreased from 7.5% to 6.03%. Regional variations were observed, with Gambela and Tigrai having the lowest rates, and Dire Dawa and the Somali region having higher rates. Factors like mother's age, wealth index, birth order, neonate's sex, and presence of twins, immediate breastfeeding, and baby's size were associated with neonatal mortality. Conclusion and recommendation: Despite significant advancements that have been made to decrease neonatal mortality, there remain challenges that need to be addressed. Therefore, regional health bureaus should strengthen their strategies to enhance antenatal care (ANC) visits and promote birth delivery at health facilities.

The authors have declared no competing interest.

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The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

In order to utilize the data for research purposes, we obtained a formal grant from the EDHS team. We followed the ethical principle of not sharing any of the data with anyone.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

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