Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Abstract

Background. Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined. Methods. Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and Google) were explored. 20 out of 818 studies were included in this study. The IDRs and predictors of neonatal mortality were computed from studies conducted in survival analysis. Fixed and random effect models were used to compute pooled estimates. Subgroup and sensitivity analyses were performed. Results. Neonates were followed for a total of 1,095,611 neonate-days; 67142 neonate-days for neonates treated in neonatal intensive care units and 1,028,469 neonate-days for community-based studies. The IDRs of neonatal mortalities in neonatal intensive care units and in the community were 24.53 and 1.21 per 1000 person-days, respectively. The IDRs of early and late neonatal mortalities neonatal intensive care units were 22.51 and 5.09 per 1000 neonate-days, respectively. Likewise, the IDRs of early and late neonatal mortalities in the community were 0.85 and 0.31, respectively. Not initiating breastfeeding within one hour, multiple births, rural residence, maternal illness, low Apgar score, being preterm, sepsis, asphyxia, and respiratory distress syndrome were independent predictors of time to neonatal mortality in neonatal intensive care units and male gender, perceived small size, multiple births, and ANC were predictors of neonatal mortality in the community. Conclusion. The incidence density rate of neonatal mortality in Sub-Saharan Africa is significantly high. Multiple factors (neonatal and maternal) were found to be independent predictors. Strategies must be designed to address these predictors, and prospective studies could reveal other possible factors of neonatal mortalities.

Neonatal References: Epidemiology and Prognosis in a Malian Context

“…We found a greater danger of death in newborns who were born more prematurely and or with a very low birth weight. The same observation was found in African studies [26]. The high risk of mortality in this population could be explained by their physical and physiological immaturity [27] [28] [29] [30].…”

“…On the prognostic level, we found a mortality of 40.2%. This high mortality is found in all sub-Saharan countries [26]. Factors contributing to high mortality of neonatal references observed in our study were preterm, low weight, hypothermia and fever.…”

The relationship between Apgar score and gender with the incidence of neonatal sepsis: systematic review

“…1,9,13 A low Apgar score at minute 5 has a risk of 3.47 times more likely to be infected (p value=0.000, 95% CI: 2.53-4.41, OR: 3.47) and even cause death, compared to newborns born with Apgar normal scores. 15 The 1st minute Apgar score with a value less than 7 has a 1.5 times greater risk of infection (p value=0.01, 95% CI: 5.7-0.99). 16 There is a difference in risk values between the Apgar score for values less than 7 seen at the 1 st minute and seen from the 5 th minute, this is because asphyxia causes immunological disorders and requires resuscitation intervention after birth, this tends to give time for bacteria to have the opportunity to explore self in newborns.…”

“…In the research results of Gutbir et al it is stated that an Apgar score with a low score is at risk of experiencing neonatal sepsis with a relative risk of 1.28, in line with the results of research from 9 literatures discussing Apgar scores with a low score can be 3 times greater risk to suffer from neonatal sepsis (p value<0.05, 95% CI: 1.3-7-7, OR: 3.2). 1,[9][10][11][12][13][14][15][16] Assessment of the Apgar score can be done at the same time as the examination of sex, gender is one of the risk factors for neonatal sepsis. The gender at risk for infection is higher in the male sex, this is in accordance with the results of the study of Murthy, et al that male infants are 1.3 times higher risk of infection (p value=0.03, 95% CI: 1.02-1.68, OR: 1.3) compared to female infants, this is in line with the results of 5 literature studies which state that male sex is at risk 1.31 (p value=0.003, 95% CI: 1.22-1.41, OR: 1.31) had a higher risk of infection and even death than women.…”

“…The gender at risk for infection is higher in the male sex, this is in accordance with the results of the study of Murthy, et al that male infants are 1.3 times higher risk of infection (p value=0.03, 95% CI: 1.02-1.68, OR: 1.3) compared to female infants, this is in line with the results of 5 literature studies which state that male sex is at risk 1.31 (p value=0.003, 95% CI: 1.22-1.41, OR: 1.31) had a higher risk of infection and even death than women. [13][14][15][17][18][19] Table 3 shows the results of the analysis that 10 of the 14 literatures that discuss the Apgar score, the results of research from 10 literatures that the 5th minute Apgar score value of less than seven is an independent predictor of the risk of neonatal sepsis with a p value<0.01 (95% CI: 8.31-41.45, OR: 18.56) with a mean risk of 16.9%. 1,9,13 A low Apgar score at minute 5 has a risk of 3.47 times more likely to be infected (p value=0.000, 95% CI: 2.53-4.41, OR: 3.47) and even cause death, compared to newborns born with Apgar normal scores.…”