Introduction: Child mortality is an important indicator of a countryâ€™s developmental status.rnNeonatal mortality and stillbirth shared a higher percentage of child mortality. However, inrndeveloping countries where most deliveries occur at home and there is no civil registration, it isrndifficult to measure the magnitude of neonatal mortality. In such set-ups, the use of data fromrncontinous demographic survillance systems provided a valid result. Therefore, this study wasrnconducted in rural Butajira using a 22 years dataset with the aim of assessing trends of neonatalrnmortality and assessment of associated risk factors.rnMethods: The Butajira Rural Health Programme was launched in 1987 with an objective ofrndeveloping and evaluating a system for a continuous registration of vital events. The surveillancernsystem operates an open cohort system. An event history analysis was carried out to calculate thernyearly neonatal mortality and magnitude of death along different covariates. Poisson regressionrnmodel was used to elicit neonatal mortality risk factors.rnResults: The trends of neonatal mortality did not show a change over the study period (Pvalue=rn0.099). There was a high burden of early neonatal mortality with the highest risk of deathrnon the first day of life (incidence rate ratios 4.84 [4.5 5.2] and 18 [16.6 19.4] respectively).rnSignificant risk factors for all-cause neonatal mortality were being male 1.65(1.4-1.9), distancernto hospital 1.5(1.11- 2.0), born to follower of Islam 1.2[1.01 1.50], born to mothers with no oxenrn1.16(1.01- 1.34) and neonates were born to mothers living in thatched house 2.9(2.4-3.5).rnConculussion:- Despite there is an urgent need of reducing neonatal mortality at national level ,rnno significant change observed in neonatal mortality in Butajira. The death was significantlyrnassociated with sex of the child, socio economic variables, and physical access to hospital.rnTherefore, comprehensive prevention strategies directed at reducing neonatal death shouldrnaddress community, household and individual level factors, which significantly influencernneonatal mortality in Butajira.