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Burden of early neonatal mortality in Sub-Saharan Africa. A systematic review and meta-analysis
Natnael Moges1, Anteneh Mengist Dessie2, Denekew Tenaw Anley2
1Department of Pediatrics and Child Health Nursing, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia.
Insights
Sub-Saharan Africa faces a high early neonatal mortality rate, with over 80 deaths per 1000 live births. Urgent strategies are needed to reduce this significant public health challenge.
Area of Science:
- Global Health
- Neonatal Health
- Sub-Saharan Africa Public Health
Background:
- Sub-Saharan Africa (SSA) bears the highest global neonatal mortality rate (27/1000 live births), contributing 43% of infant fatalities.
- Nearly three-fourths of neonatal deaths occur within the first week of life, with approximately one million infant deaths on the first day.
- Existing research lacks a conclusive pooled estimate for early neonatal mortality (ENM) in SSA.
Purpose of the Study:
- To conduct a systematic review and meta-analysis to determine the pooled magnitude of early neonatal mortality in Sub-Saharan Africa.
- To synthesize existing evidence on ENM rates across various studies in the region.
Main Methods:
- A comprehensive literature search was conducted across multiple databases up to June 8, 2023.
- Fourteen studies with 278,173 participants were included after evaluation using the JBI checklist.
- Data analysis involved STATA 17, employing random-effects modeling, heterogeneity testing (I2), and publication bias assessment (Egger's test).
Main Results:
- The pooled magnitude of early neonatal mortality in SSA was 80.3 per 1000 live births (95% CI 66 to 94.6).
- Significant heterogeneity was observed among studies (I2 = 99.80%, p <0.001), with publication bias detected.
- Ethiopia reported the highest ENM rate (20.1%), while Cameroon had the lowest (0.5%).
Conclusions:
- The pooled magnitude of early neonatal mortality in Sub-Saharan Africa is substantial, highlighting a critical public health issue.
- Governmental, non-governmental, international, healthcare, and academic institutions must prioritize and develop targeted strategies to reduce ENM in SSA.
Background:
Globally, with a neonatal mortality rate of 27/1000 live births, Sub-Saharan Africa has the highest rate in the world and is responsible for 43% of all infant fatalities. In the first week of life, almost three-fourths of neonatal deaths occur and about one million babies died on their first day of life. Previous studies lack conclusive evidence regarding the overall estimate of early neonatal mortality in Sub-Saharan Africa. Therefore, this review aimed to pool findings reported in the literature on magnitude of early neonatal mortality in Sub-Saharan Africa.
Methods:
This review's output is the aggregate of magnitude of early neonatal mortality in sub-Saharan Africa. Up until June 8, 2023, we performed a comprehensive search of the databases PubMed/Medline, PubMed Central, Hinary, Google, Cochrane Library, African Journals Online, Web of Science, and Google Scholar. The studies were evaluated using the JBI appraisal check list. STATA 17 was employed for the analysis. Measures of study heterogeneity and publication bias were conducted using the I2 test and the Eggers and Beggs tests, respectively. The Der Simonian and Laird random-effect model was used to calculate the combined magnitude of early neonatal mortality. Besides, subgroup analysis, sensitivity analysis, and meta regression were carried out to identify the source of heterogeneity.
Results:
Fourteen studies were included from a total of 311 articles identified by the search with a total of 278,173 participants. The pooled magnitude of early neonatal mortality in sub-Saharan Africa was 80.3 (95% CI 66 to 94.6) per 1000 livebirths. Ethiopia had the highest pooled estimate of early neonatal mortality rate, at 20.1%, and Cameroon had the lowest rate, at 0.5%. Among the included studies, both the Cochrane Q test statistic (χ2 = 6432.46, P <0.001) and I2 test statistic (I2 = 99.80%, p <0.001) revealed statistically significant heterogeneity. Egger's weighted regression (p <0.001) and funnel plot show evidence of publication bias in this meta-analysis.
Conclusion:
This review demonstrated that the pooled magnitude of early neonatal mortality in sub-Saharan Africa is substantial. Therefore, governmental and nongovernmental agencies, international organizations, healthcare providers and institutions and academic and research institutions should give a due attention and design strategies to reduce early neonatal mortality in Sub-Saharan Africa.
