Magnitude and Predictors of Early Neonatal Mortality in Africa:- A Systematic Review and Meta-Analysis

The first weeks of postnatal age is the most hazard time when three-quarters of neonatal death encountered. Africa is the region where most neonatal mortality is recorded and the problem is unresolved yet. Because evidence matter to have significant health improvement, this analysis aimed to generate continental based data on early neonatal death and its predictors.

PICO research question approach was used to search citations from PubMed, Research 4 life, Cochran Library, Google scholar, Epistimonikos, Scopus and Google up to February 2025. Joanna Briggs Institute (JBI) prevalence/cohort/case control studies critical appraisal tools were used to assess the quality of the included articles. All studies conducted in Africa that reported the magnitude of early neonatal mortality, its associated factors and studies that reports both were included. Data was extracted using Microsoft Excel spreadsheet and imported into STATA version 17 for analysis. Publication bias was evaluated through funnel plots and further examined using Egger's and Begg's tests. A random effects meta-analysis model with 95% CI was computed to estimate the pooled effect size.

After a comprehensive search and screening process, 18 articles encompassing 15 892 samples were identified from 2853 citations. The pooled magnitude of early neonatal mortality among neonates admitted to neonatal intensive care units found to be 14% (CI: 0.11-0.17), the highest estimate observed in Morocco 17% (CI: 14-21), followed by in Ethiopia 15% (CI: 10-19) with substantial heterogeneity (I ²) level of 96.68% and P value of .00. Because of significant publication bias, the pooled magnitude was imputed, shifting the early neonatal mortality from 14% to 10% (CI: 0.102-0.111). Prematurity, asphyxia and hypothermia were the three most commonly reported factors in the included articles. Consequently, the meta-analysis result showed that prematurity, asphyxiated and hypothermia increases the risk of early neonatal mortality with pooled adjusted odds ratio of 5.4 (CI: 2.83-8.10), 3.35 (CI: 2.07-4.62) and 4.38 (CI: 3.52-5.24), respectively.

This review reviled that early neonatal mortality in Africa is still a serious issue requiring further intervention, highlighting challenges within the region health care system. Africa needs to intensify efforts to prevent preterm birth and improve preterm care; to prevent the incidence of asphyxia and establish hypothermia free delivery and newborn care services.