The Factors Associated with Stillbirths among Sub-Saharan African Deliveries: A Systematic review and Meta-analysis 

Abstract

Background Globally, more than 2.6 million stillbirths occur each year. The vast majority (98%) of stillbirths occur in low- and middle-income countries, and over fifty percent (55%) of these happen in rural sub-Saharan Africa. Methods Pertinent articles conducted in sub-Saharan Africa were evaluated using a systemic review and meta-analysis approach to determine the factors associated with stillbirths. A literature search was performed using PubMed, the Cochran Library, Google Scholar, EMBASE, Scopus, the Web of Sciences, and gray literature. Rayyan`s software was used for literature screening. A random effects meta-analysis was conducted with STATA version 17. Heterogeneity was checked by using Cochran’s Q and I2 tests. The funnel plots and Egger’s test were used to examine the risk of publication bias. The protocol was sent for registration on January 31, 2023, and the PROSPERO registration number is CRD42023391874. Results Forty-one studies gathered from eight sub-Saharan countries with a total of 192,916 sample sizes were included. Nine variables were highly linked with stillbirth. These include advanced maternal age (AOR: 1.43, 95% CI: 1.16, 1.70), high educational attainment (AOR: 0.55, 95% CI: 0.47, 0.63), antenatal care (AOR: 0.45, 95% CI: 0.35, 0.55), antepartum hemorrhage (AOR: 2.70, 95% CI: 1.91, 3.50), low birth weight (AOR: 1.72, 95% CI: 1.56–1.87), admitted by referal (AOR: 1.55, 95% CI: 1.41, 1.68), history of stillbirth (AOR: 2.43, 95% CI: 1.84, 3.03), anemia (AOR: 2.62, 95% CI: 1.93, 3.31), and hypertension (AOR: 2.22, 95% CI: 1.70, 2.75). Conclusion A significant association was found between stillbirth and maternal age, educational status, antenatal care, antepartum hemorrhage, birth weight, mode of arrival, history of previous stillbirth, anemia, and hypertension. In order to fully screen women, cooperation between experts from many fields should be created beforehand and incorporated into the screening procedure. Keywords: Africa, fetal death, intrauterine fetal death, prenatal death