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The annual average rate of reduction under-five mortality has accelerated in the past 15 years. In Ethiopia, under-five mortality declined by 47% in the period between 2000 and 2011, from 166 to 88 deaths per 1000 live births. The analysis of trends and causes of under-five mortality generated by Health and Demographic Surveillance System (HDSS) from six networked Ethiopian Universities Research Centers indicates under-five mortality inequalities and difference in causes of death in rural and urban areas and a general decline in mortality rate in the past five years.