Predictors of birth asphyxia in Ethiopia: an updated systematic review with meta-analysis
Mulugeta Dile Worke1, Benyam Seifu2, Belete Belgu3
1Department of Midwifery, College of Health Sciences, Debre Tabor University, Debra Tabor, Ethiopia.
Insights
Birth asphyxia affects nearly one in four newborns in Ethiopia, highlighting the critical need for improved care. Identifying and addressing intrapartum, maternal, and neonatal risk factors is essential to reduce neonatal mortality.
Area of Science:
- Neonatal Health
- Public Health
- Epidemiology
Background:
- Birth asphyxia is a primary cause of neonatal mortality globally.
- Effective care during and immediately after birth is vital for infant survival.
- Ethiopia faces significant challenges with birth asphyxia, necessitating updated research on its predictors.
Purpose of the Study:
- To conduct an updated systematic review and meta-analysis.
- To determine the key predictors of birth asphyxia in Ethiopia.
Main Methods:
- Systematic review and meta-analysis of observational studies from Ethiopia.
- Searched multiple databases (CINAHL, PubMed, Embase, Web of Science, Cochrane Library) and grey literature.
- Utilized a random-effect model for analysis and assessed heterogeneity and publication bias.
Main Results:
- Included 38 studies with 13,593 participants; pooled prevalence of birth asphyxia was 23.07%.
- Significant predictors included intrapartum events (e.g., prolonged labor, cord issues), obstetric procedures (e.g., cesarean sections), neonatal factors (e.g., low birth weight, male sex), and maternal conditions (e.g., hypertension, anemia).
Conclusions:
- Approximately 23% of newborns in Ethiopia experience birth asphyxia.
- Tailored interventions targeting intrapartum, maternal, neonatal, and obstetric procedural factors are crucial.
- Public health initiatives, early detection, and multidisciplinary approaches are needed to reduce neonatal mortality and achieve Sustainable Development Goals.
Background:
Birth asphyxia is one of the leading causes of most neonatal deaths. Hence, strengthening and investing in care is crucial, particularly around birth and the first week of life. As a result, several studies, including an umbrella review, were conducted even though significant variations were observed among those investigations. Thus, this is an updated systematic review and meta-analysis aimed to determine predictors of birth asphyxia in Ethiopia.
Methods:
Online databases such as CINAHL, PubMed, Embase, Web of Science, and Cochrane Library were searched. Online searches turned up pertinent grey literature, and repositories of several universities were also searched. Observational studies carried out in Ethiopia were included. The authors conducted an independent search, quality check, and data extraction. The Newcastle Ottawa Scale checklist was used to evaluate the quality of articles. STATA version 17 was used for both data entry and statistical analysis. Since there were variations among studies, a random-effect model was employed for analysis. Egger's regression test and funnel plot were utilized to assess publication bias, and the I-squared test was performed to verify the studies' heterogeneity.
Results:
This analysis comprised 38 studies with 13,593 sample sizes. The pooled prevalence of birth asphyxia was 23.07% (95% CI: 19.96, 26.18). An intrapartum (i.e., prolonged labor, blood- or meconium-stained amniotic fluid, tight nuchal cord, cord prolapse, intrapartum fetal distress, malposition/malpresentation, and premature rupture of membrane) and obstetric procedure (i.e., labor induction, emergency cesarean sections, instrumental deliveries, and night time deliveries) factors were significantly associated with birth asphyxia. Moreover; neonatal (i.e., low birth weight, premature birth, and the male sex of the neonate), and maternal (i.e., place of residence, primigravida, mother's age, chronic hypertension, pregnancy-induced hypertension, anemia throughout pregnancy, antepartum hemorrhage, absence of antenatal care follow-up) were also significantly associated with birth asphyxia.
Conclusions:
This meta-analysis indicates nearly one in four newborns suffered from birth asphyxia in Ethiopia. It implicates tailored interventions for an intrapartum, maternal, neonatal, and an obstetrics procedure-related associated factors are needed to reduce birth asphyxia, thereby enhancing achievement of the sustainable development goal that aimed to reduce neonatal mortality to less than 12 per 1000 live births. Therefore, advocacy for public health initiatives aimed at increasing awareness of birth asphyxia and promoting early detection and intervention strategies, multidisciplinary approaches, and interventional studies are crucial.
