Antenatal Care Predicts Neonatal Mortality in Eastern Africa: A Systematic Review and Meta-analysis of Observational Studies

Abstract

Background Sub-Saharan African countries, especially the Eastern region, present the dismal picture of neonatal mortality (NM) in the globe. The majority of these deaths could be avoided if effective health measures are provided throughout pregnancy and childbirth. Although antenatal care (ANC) is assumed as one of the viable interventions that contribute to neonatal survival, the effect of ANC on NM was not systematically analyzed in Eastern Africa. Thus, the study aimed to determine the pooled effect of ANC on NM in Eastern Africa. Methods PubMed, EMBASE, CINAHL, and HINARI databases were searched using appropriate keywords from January 1, 1990 to February 12, 2021. Independent authors selected eligible articles and extracted data. The risk of a bias assessment tool for nonrandomized studies was used to assess the quality of the study. Comprehensive meta-analysis version 2 was used for meta-analysis. The random-effect model was employed, and the outcome is expressed as a risk ratio with 95% confidence interval (CI). Results In total, 1149 studies were identified through database search, and only 27 studies were included in the meta-analysis. Having at least 1 ANC visit during pregnancy reduced the risk of neonatal death by 42% compared to their counterparts (RR = 0.58, 95% CI [0.47, 0.71]). The pooled prevalence of NM was 8.5% (95% CI [7.3, 9.6]), with NM rate of 46.3/1000 live births. Conclusion The study indicated that NM might be decreased even with a single ANC visit when compared to no visits. Scaling up ANC services through ANC promotion and tackling service-related barriers could potentially reduce NM in Eastern Africa.

Factors Associated with Vaccination Coverage among 0–59-Month-Old Children: A Multilevel Analysis of the 2020 Somaliland Demographic and Health Survey

“…Mothers who had at least one ANC visit were twice as likely to vaccinate their children than those with no ANC visit. This finding is consistent with other literature indicating the importance of maternal ANC utilization in childhood vaccination [46][47][48][49]. Although four ANC visits are considered standard in Somaliland, we observed that having only one ANC visit increased the odds of their children being vaccinated compared to children of mothers who did not visit ANC at all.…”

Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020

“…Adequate and quality ANC has been documented to contribute towards reduction of maternal and neonatal mortality. Tiruye et al showed that attending at least one ANC contact can decrease the risk of neonatal death by 42% [ 10 ]. However, SSA regions such as East Africa continue to share some of the poorest ANC utilization statistics and a significant share of global maternal and newborn mortality [ 10 , 11 ].…”

“…Tiruye et al showed that attending at least one ANC contact can decrease the risk of neonatal death by 42% [ 10 ]. However, SSA regions such as East Africa continue to share some of the poorest ANC utilization statistics and a significant share of global maternal and newborn mortality [ 10 , 11 ]. This may be related to the quality of ANC care that is provided, which has been criticized in several studies from SSA [ 12 ].…”

Predictors of neonatal mortality in Ethiopia: Cross sectional study using 2005, 2010 and 2016 Ethiopian demographic health survey datasets

“…The possible mechanism for this finding is that mothers who had ANC visits received health information from health care providers about healthy behaviors and possible medical complications during and after pregnancy, including newborn care. Also, the mothers are screened for health problems and receive curative and preventive health care services, such as tetanus immunization and iron and folic acid supplementation, to improve newborn health [ 33 ].…”