Introduction: Globally around 5 million children under the age of 5 years die every year. Ethiopia is one of five countries that contribute to more than half of these deaths. In the absence of a national vital registry system in Ethiopia, there is a lack of high-quality data regarding causes of death. Methods: We conducted a verbal autopsy study among under-five deceased children at the Birhan health and demographic site (HDSS) located in the North Shewa zone, Ethiopia. All deaths of under five children, which occurred in the time period from March 1, 2019 to February 29, 2020 at the Birhan HDSS, were identified. The under-five mortality rate (U5MR) was computed using a Kaplan-Meier approach. The world health organization verbal autopsy questionnaire was administered to mothers or caregivers of the deceased child after a minimum mourning period of 42 days. The causes of death were then determined by the InterVA-5 algorithm. Results: There were 90 under-five deaths resulting in an estimated U5MR of 45.3 per 1000 live births. The majority (62.2%) of deaths occurred during the neonatal period. The leading causes of death in under-five children were birth asphyxia (20, 27.0%), prematurity (19, 25.7%) and meningitis and encephalitis (8, 10.8%) while leading causes of neonatal deaths were birth asphyxia (19, 38.0%), prematurity (18, 36.0%) and neonatal sepsis (6, 12.0%). Conclusions: There is a high under-five mortality rate at the study site, with most deaths occurring in the neonatal period. Birth asphyxia and prematurity contributed to more than half of the under-five deaths suggesting that follow-up and management during pregnancy, labor and delivery should be strengthened to avert a significant proportion of under-five deaths.

The authors have declared no competing interest.

The work has been supported by the Bill & Melinda Gates Foundation (grants INV-010382 and INV-003612) and the funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication

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Ethics IRB of the Saint Paul Hospital Millennium Medical College and the Harvard T. H. Chan School of Public Health gave ethical approval for this work

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