Background: With the rate of 33 per 1000 births, Ethiopia has one of the highest levels of perinatal mortality in the world. Hence, identifying the predictors in the local context is very crucial for giving special emphasis to improving access to high quality services during pregnancy and child birth as well as strengthening the health care delivery system. This will facilitate the attainment of the global suitable development goal (SDG-3) and the International Conference on Population and Development (ICPD) targets related to neonatal and child mortality reduction.

Objective: To determine the magnitude of perinatal mortality and identify predictors in Southwest Ethiopia.

Methods: Community-based prospective follow-up study was conducted among randomly selected 3474 pregnant women to determine the magnitude of perinatal mortality and then, case control study was conducted to identify the predictors among 120 cases and 360 controls.  Data were collected by using structured interviewer administered questionnaire and analyzed by using SPSS V.20. Binary logistic regression analysis was used to identify the predictors of perinatal mortality.

Results: Out of 3474 pregnancies followed, 120 ended in perinatal deaths with perinatal mortality rate of 34.5 per 1000 births (95%CI: 28.5, 40.5). From this, stillbirth rate and early neonatal mortality rate were 13.5 and 21 per 1000 births, respectively.  Using ANC4+ (AOR=0.46; 95%CI: 0.23, 0.91), having good knowledge on key danger signs (AOR=0.27; 95%CI: 0.10, 0.75) and having skilled attendant at birth (AOR=0.34; 95%CI: 0.19, 0.61) predicted significant reduction of perinatal mortality. Being primipara (AOR=2.36; 95%CI: 1.13, 4.93), twin births (AOR=5.29; 95%CI: 1.46, 19.21), previous history of perinatal mortality (AOR=3.33; 95%CI: 1.27, 8.72), and existence of complication during labor (AOR=4.27; 95%CI: 2.40, 7.59) predicted significantly higher perinatal mortality.

Conclusion: The magnitude of the perinatal morality is comparable with the national figure form EDHS 2016 (33 per 1000births) but still high to achieve the HSTP targets. Care during pregnancy and child birth as well as condition of pregnancy and labor were significant predictors of perinatal mortality.

Recommendations: Interventions has to focus on increasing knowledge of key danger signs and improving utilization of skilled care during pregnancy and delivery. Special emphasis and care needs to be given to primgravida mothers, mothers with previous history of perinatal mortality, twin pregnancies and mothers having any form of complication during labor to significantly avert the risk for perinatal deaths.