Adverse perinatal outcomes and their associated determinants in Sub-Saharan Africa

Abstract

Adverse perinatal outcomes (APOs) constitute a significant concern for public health in most developing countries. APOs significantly affect perinatal and neonatal survival, with the risk of developing complications such as developmental disability and ill health throughout their lives. This review aimed to identify adverse perinatal outcomes and their associated determinants in Sub-Saharan Africa (SSA). The study conducted an electronic database search from PubMed, Embase, Medline, and African Online Journals to identify relevant literature. Studies were included if they were published in English on adverse perinatal outcomes and their determinants between 1st January 2013 and 31st March 2024. The studies’ quality was assessed by adhering to the guidelines and recommendations for reporting scoping reviews. Two authors independently screened the included studies’ titles, abstracts, and full texts. Out of the 120 studies identified through the database search, 50 met the eligibility criteria and were included in the review. The findings reveal that there were an estimated number of 2.6 million third-trimester stillbirths globally, with 41 % occurring in SSA in 2015. Most studies attributed stillbirth to lack of ANC attendance, delayed or less than four ANC attendance, maternal age, level of education, malaria, HDP, and grand multiparity. Globally, there is an estimated annual delivery of 30 million babies weighing below 2500 g, with half of these deliveries occurring in SSA. Most studies found LBW to be significantly associated with maternal age (especially adolescent pregnancies), maternal nutrition, education, and the number of ANC attendance. According to the WHO, 15 million babies are born preterm annually, with 81 % occurring in South Asia and SSA. Most studies cited maternal age and diseases such as hypertensive disorders in pregnancy (HDP) as significant predictors of preterm birth. Neonatal death was found to be one of the significant burdens faced by SSA; the region has the highest neonatal death rate of 27 per 1000 live births, making it a significant contributor to under-five mortality in the sub-region. Most studies found poor ANC attendance, HDP, and delayed obstetric emergency care significant predictors of neonatal death. The review established that the several APOs in SSA are associated with maternal age, less than four antenatal care follow-ups or non-utilization, maternal education, medical conditions, parity, rural residence, distance travel, and women’s participation in decision-making. This suggests that efforts should be geared towards improving access to healthcare and women’s empowerment.