Perinatal mortality in eastern Africa: A systematic review and meta-analysis

Every day, over 5000 stillbirths and more than 6000 newborn deaths are estimated to occur worldwide, the majority in sub-Saharan Africa and South Asia. Estimates, however, rely on data that might underestimate these deaths. Further, outside major categories such as preterm birth, infection, and complications at delivery, little is known about the causes of death for newborns and even less for stillbirths.

This systematic review and meta-analysis aimed to synthesize evidence on the incidence, causes, and risk factors for perinatal mortality in East Africa to inform public health policy.

We searched major databases: Medline, Web of Science, EMBASE, Global Health, SCOPUS, Cochrane Library, CINAHL, HINARI, African Index Medicus, African Journals Online (AJOL), DHS website, and the World Health Organization African Regional Office (AFRO) Library. The search was conducted without imposing any language restrictions. Studies published 2010-2022 reporting perinatal mortality (incidence/causes/risk factors) in East African countries were included. We included all observational studies (cross-sectional, case-control, prospective cohort, and retrospective studies) and community-based trials. We performed meta-analyses with random effects to estimate pooled perinatal mortality rates for the population and health facility settings. We investigated and reduced heterogeneity where appropriate. We summarized causes of death descriptively and synthesized risk factors narratively.

We included 99 out of 22 889 studies. The pooled population-based perinatal mortality rate was 33.1/1000 births (95% confidence interval [CI]: 29.3-37.1, I² = 96.9%), and for health facility settings 67.1/1000 (95% CI: 47.5, 89.7, I² = 98.9%). The major reported causes of perinatal deaths were infections and intrapartum-related events. However, our understanding of the specific causes of death was limited by the lack of detailed information necessary for diagnosing specific causes. Risk factors for perinatal mortality were demographic (low socioeconomic status), related to care (lack of antenatal care, obstetric complications), and maternal comorbidities. Protective factors included women's empowerment and supporting access to care through maternity waiting homes.

Perinatal mortality remains high in East Africa. Many deaths were preventable through addressing modifiable risk factors and strengthening health systems to provide quality antenatal and intrapartum care. Consistent use of standardized cause-of-death classification and improved data quality are needed to enhance the understanding of specific causes of death and target interventions.