Prevalence of early neonatal mortality and its predictors in sub-Saharan Africa: A Systematic review and Meta-Analysis.

BackgroundAlthough early neonatal mortality (ENM) has been reported to have a greater contribution to the overall neonatal mortality compared to late neonatal mortality, no meta-analysis has studied this phenomenon in isolation. The prevalence of ENM and its predictors in sub-Saharan Africa (SSA) remains unknown. Therefore, this meta-analysis is aimed at pooling the prevalence of ENM and its predictors in SSA. MethodsGoogle Scholar, PubMed, Scopus, CINAHL, and Google were searched for studies conducted in SSA that reported the prevalence and predictors of ENM. The data were extracted using a Microsoft Excel spreadsheet and imported into R version 4.4.1 for further analysis. Publication bias, heterogeneity, sensitivity analysis, and subgroup analysis were performed. Prevalence and odds ratios were pooled using the random effects model if significant heterogeneity existed; otherwise, the fixed effects model was used. ResultsA total of 26 studies were included in this systematic review and meta-analysis. The overall pooled prevalence of ENM in SSA was 11% (95% CI: 7-15; I2=100%). Birth asphyxia (OR=3.85; 95% CI: 1.12-13.21; P = 0.0388; I2 = 86.6%), home delivery (OR=2.46; 95% CI: 1.79-3.38; p<0.001; I2 = 0.0%), prematurity (OR=4.69; 95% CI: 3.57-6.16; p<0.001; I2 = 36.8%), male gender (OR= 1.37; 95% CI: 1.28-1.46; P < 0.001; I2 = 30.7%), delivery through caesarean section (OR=1.74; 95% CI: 1.49-2.02; P < 0.001; I2 = 31.5%) and low birth weight (OR=3.00; 95% CI: 1.01-8.91; P = 0.0482; I2 = 94.4%) were associated with a significant increase in pooled odds of ENM in SSA. ConclusionThe prevalence of ENM in SSA in significantly high and it contributes greatly to the overall neonatal mortality. Therefore, tailor-made interventions that target the reduction of birth asphyxia, prematurity, home delivery, and low birth weight should be implemented in order to reduce the burden of ENM in SSA.