Study selection and data extraction
A total of 434 studies were identified using electronic searches (through Database searching (n = 426)) and other sources (n =8)) that was conducted from August 30, 2019, up to September 30, 2019. Of these, 238 studies were excluded due to duplication. From the remaining 196 studies, after reviewing the title and abstract 180 studies were excluded as they were irrelevant for this systematic review and meta-analysis. The remaining 16 full-text articles were assessed for eligibility criteria based on the pre-defined criteria. Among these five articles were further excluded due to they are not inline to the preset criteria, three studies from Ethiopia [20-22], one study from Nepal  and one study from Himalayas . Finally, 11 studies were fulfilled the eligibility criteria and included in this systematic review and meta-analysis (Fig.1).
Characteristics of the studies
A total of 5416 Study participants included in his systematic review with a range of 296 in Tigray  to 845 in Amhara  in individual studies, and studies were carried out from 2015 to 2019.
Utilization of Essential Newborn Care Services in Ethiopia
The utilization of essential newborn care services from included studies ranged between 23.1 % and 96.1 % (Table 1). As indicated in the forest plot, the pooled estimate for utilization of essential newborn care services from 11 studies in Ethiopia was 48.768% (95% CI: 27.891, 69.645) (Fig. 2). We identified a high and significant heterogeneity between studies (I2= 99.8%%; p-value=0.000), indicating great variability in utilization across studies, random effect analysis model was used to estimate the pooled prevalence of the utilization of essential newborn care service in Ethiopia (Fig. 2). We performed a subgroup analysis based on Study Area and study setting to identify the source of heterogeneity (Table 2). Beyond subgroup analysis, meta-regression for the included studies was conducted to identify factors for heterogeneity. However, there was no statistical significance value from the meta-regression (Table 3).
We observed publication bias using both Begg's and Egger's tests [18, 19] and these tests showed that there was statistical evidence of publication bias at a p-value less than 0.05 and the funnel plot was asymmetry. By considering publication bias trim and fill meta-analysis was done . However, based on this analysis, the prevalence of essential newborn care utilization was 48.77 and no significant change was showed as compared with the main meta-analysis.
Sensitivity and Subgroup analysis
Due to considerable heterogeneity in this review, Subgroup analysis was done by setting of studies and regions. Based on Subgroup analysis report the pooled prevalence of essential Newborn care utilization was higher in Tigray region (66.93 %) followed by Amhara region (59.62 %). Subgroup analysis was also carried out based on the study setting, according to this analyses the prevalence rate of 51.41% and 36.82% were revealed from community Based and institution-based respectively (Table 2). A sensitivity analysis was done to identify outlier studies. According to the analysis, no influential studies were detected so that all of the studies were included in the final analysis.
Associated Factors of Newborn Care Service Utilization
A total of 11 studies were included for analysis of an associated factor of newborn care
services utilization. We identified five main associated factors with the pooled odds ratio ranging
from 1.63 to 6.84. These associated factors were a place of residence, Immediate PNC, counseling during delivery, ANC follows up and educational status of mothers. The analysis of 11 studies showed that counseling about ENBC practices was showed statistically significant association with ENBC practice of mothers as compared with those mothers who had not got counseling about ENBC practices during ANC and PNC follow up [OR=4.39, 95% CI: (2.99, 6.45] (Fig. 3a). Similarly, this study showed that living in urban was strongly associated with essential newborn care utilization [ OR = 2.50 (95% CI: 1.64, 3.88)] (Fig. 3b). Furthermore, the PNC visit was showed statistically significant association with ENBC practice of mothers when compared with those who had not to go immediate PNC visits after delivery [OR=5.53, 95% CI: (3.02, 10.13] (Fig. 3c). Moreover, utilization of newborn care services showed statistically significant association with ENBC among mothers who had two or more ANC visits compared to mothers making none visits (OR=6.84; 95% CI: 1.15, 4.70) (Fig. 3d). Mothers who had formal educational status were 1.63 times more likely to practice essential newborn care as compared to those who had no formal education [OR = 1.63 (95% CI: 1.12, 2.37)] (Fig. 3e).