Mekonnen,Wubegzier (PhD, Associate Professor)Emyu,Solomon(MD, MPH, Assistant Professor)Shibre,Gebretsadik (MPH, PhD Candidate)Negash,Hailemariam2025-08-132025-08-132024-10https://etd.aau.edu.et/handle/123456789/6616Background: Nearly, 0.9 million children aged 5-14 died globally in 2020. The death is especially unacceptable since the majority died of preventable or treatable causes. Although communicable diseases are still the leading causes, non-communicable diseases, and external causes account for half of all deaths, posing a triple burden. Objective: To assess the trend, disease burden, and determinants of mortality among children 5-14 years in Butajira, south-central Ethiopia from 1987 through 2022. Methods: The Butajira Health and Demographic Surveillance System open prospective cohort (1987-2022) and cause of death data acquired via verbal autopsy procedures (2007- 2022) were analyzed. Event history analysis was used to study mortality trends and the incidence of child death by covariates. The broad and specific causes of death burden for children aged 5-14 years were measured. The adjusted Incidence rate ratio (aIRR) with its 95% confidence interval in the Poisson regression model was used to measure strength, direction, and significance of the association between child mortality and exposure variables. Results: A declining trend in the incidence child mortality was observed (Kendall’s tau = - 0.83; P-value < 0.0001). The overall incidence of child mortality was 6.31 (5.99, 6.64) deaths per 1000 person-years. Communicable diseases (39.2%) were the major causes of death followed by non-communicable diseases (35.4%) and external causes (23.4%). HIV/AIDS (14.6%), severe malnutrition (13.1%), accidental drowning & submersion (8.5%) and RTA (8.5%) were the leading specific causes of death. The incidence of child mortality was higher among males with aIRR/95% CI (1.27 (1.15, 1.41)), older children (2.06 (1.84, 2.29)), ruralists (2.42 (1.88, 3.12)), lowlanders (1.37 (1.17, 1.60)), owned house (3.98 (2.33, 6.79)), small households (1.18 (1.05, 1.32)), uneducated mother (2.03 (1.80, 2.29)), lived 10 KMs away from hospital (1.34 (1.11, 1.63)), used unprotected water source (1.35 (1.18, 1.55)), had at least one ox [(1.36 (1.19, 1.54), or 2+ oxen (1.54 (1.32, 1.79))] and with a house without window (1.38 (1.18, 1.62)), latrine (1.96 (1.60, 2.40)) and media exposure (1.87 (1.60, 2.19)). Conclusion: During the 36 years of study periods in Butajira HDSS, a significant declining trend in the incidence of child mortality was found. Older children and young adolescents are suffering from triple burden of diseases. A comprehensive targeted interventions needs to be delivered at societal, household and personal level to avert the mortality burden.en-USButajira HDSSChild mortalityCauses of deathDisease burdenTrendThesis