Magnitude of neonatal mortality and its association with maternal and child health care in sub-Saharan africa: a systematic review and meta-analysis.

Abstract

Background: Neonatal mortality remains a problem in sub-Saharan Africa (SSA). Findings of primary studies varied in magnitude of neonatal mortality, characteristics of the study population, and association of maternal and child health care with neonatal mortality. Thus, this review was aimed at estimating the pooled magnitude of neonatal mortality and its association with maternal and child health care in SSA.

Methods: Databases (PubMed, ScienceDirect, and Hinari for health via Research4Life) and gray literature sources were accessed. Relevant studies were retrieved from related studies via snowballing. A combination of medical subject headings (MeSH terms) using Boolean operators and key words related to neonatal mortality were used to search studies. Full-text articles published from observational studies in SSA included. Heterogeneity was assessed using a forest plot and Higgins's I² test. When heterogeneity was evident, a sensitivity and subgroup analysis were done. A weighted inverse variance random-effects model was applied to estimate the pooled effect sizes. Publication bias was assessed using a funnel plot and Egger's regression test. A trim and fill analysis was considered when publication bias exists.

Results: A total of 57 studies were included to answer the review questions. The pooled neonatal mortality rate among live births was 32 per 1,000 live births (95% CI: 25, 42), and among neonates admitted to neonatal intensive care units was 16.5% (95% CI: 13.9, 19.5%) in SSA. Lack of antenatal care visits [Odds ratio (OR) = 2.19, 95% CI: 1.61, 2.98], giving childbirth outside of a health institution or home [OR = 1.44, 95% CI: 1.13, 1.84], and late initiation of breastfeeding [OR = 3.49, 95% CI: 1.98, 6.15] increased the odds of neonatal mortality.

Conclusions: Neonatal mortality in SSA remains high. Maternal health services such as exposure to antenatal care and institutional delivery and child health services such as early initiation of breastfeeding were related to reducing the burden of neonatal mortality. Thus, much effort and commitment are needed to achieve the United Nations' sustainable development goal of reducing neonatal mortality.