Pooled estimates of stillbirth in Ethiopia: systematic review and meta-analysis, 2013-2024.

Background: Stillborn babies are those that are born with no signs of life at or after 28 weeks of gestation or weighing more than 1000 g. It is a public health problem that is overlooked in the global agenda. Individual studies have been conducted with different estimates across countries, making it difficult to understand the national stillbirth rate. Thus, this study aims to better understand stillbirth in Ethiopia and inform policy makers by producing pooled estimates.

Methods: A systematic review and meta-analysis were performed between 2013 and 2024 in accordance with the PRISMA guidelines. The outcomes of interest in the English language were exhaustively searched in different databases, such as PubMed/Medline, Science Direct, HINARI and Google Scholar. Data selection, extraction and quality assessment were performed by two authors independently. Zotero was used for study selection, whereas all the statistical analyses were performed with MEDCALC version 23.2.1 software.

Result: Among a total of 1007 studies found in databases and manual citation searches, 35 studies were included in the analysis. The overall pooled stillbirth rate was 68 (95% confidence interval (CI) 52-85) per 1000 births in Ethiopia. Subgroup analysis revealed discrepancies in rates across regions, study years and settings. Subgroup analysis revealed that the pooled estimate of the stillbirth rate of recent studies (2021-2024) is 72 (95% CI, 48-100) per 1000 births, which is higher than the rate of earlier studies (2013-2020), with a rate of 63 (95% CI, 38-93) per 1000 births.

Conclusion: The pooled estimate of the stillbirth rate is high in Ethiopia compared with the global target stillbirth rate of 12 per 1000 births, which is set for 2030 and is also higher than African countries. The stillbirth rate has also increased over time in Ethiopia. This might be due to poor maternal health access and utilization, including a significant rate of iodine deficiency, among pregnant women in Ethiopia. The review informs policy makers and program implementers about the burden of stillbirth in Ethiopia. All health sector actors should adjust and improve the quality of maternal health services, with attention given to stillbirth to reach the global target.