Journal of Neonatal Biology

Estimating the stillbirth rate and early neonatal mortality rate in Sub-Saharan region: a systematic review and meta-analysis

International Conference and Expo on Neonatology and Perinatology - June 06, 2022 | Webinar

June 06, 2022 | Webinar

Dawit Tiruneh Arega

Department of Midwifery, Debre Tabor University, Ethiopia

Scientific Tracks Abstracts: J Neonatal Biology

Abstract:

Recent technological advances as well as longitudinal monitoring not only have the potential to improve the treatment of Stillbirth and neonatal death are major global health issues with emotional, social, and economic consequences. In 2019, an estimated 1.9 million babies were stillborn at 28 weeks or later, resulting in a global stillbirth rate of 13.9 stillbirths per 1,000 total births. The majority of stillbirths occurred in a few nations, with India having the highest number, followed by Pakistan, Nigeria, the Democratic Republic of the Congo, China, and Ethiopia. These six countries accounted for half of the estimated global stillbirths and 44% of global live births. Alarmingly, Sub-Saharan Africa's share of worldwide stillbirths has risen from 27 percent in 2000 to 42 percent in 2019, as population expansion has outpaced improvements in stillbirth rates. Every year, 1.2 million newborns die in SSA alone, equating to 13,000 deaths per day, or nearly nine deaths every minute. According to a communitybased study in Uganda, 21.1% of study participants had probable depressive symptoms. Postpartum depressive symptoms were prevalent in 62.3% and 72.6% of women who had experienced stillbirth or END, respectively. Evidence suggests that if mothers and newborns had access to cost-effective interventions during pregnancy and childbirth, nearly two-thirds of neonatal deaths could be avoided. This study aimed to estimate stillbirth rate and early neonatal mortality rate, compare variation among groups, and determine level of heterogeneity between studies in Sub-Saharan African regions. Through an electronic search in Sub-Sahara region, studies were found in Non-Cochrane, PubMed, EMBASE, Medline, HINARI, WHO information Library Google Scholar, and Google datasets. In the random effect model, the event rate was estimated using Comprehensive Meta-Analysis software at 95% CI (P <0.05). I2 and Q-statistical values were used to determine the degree of heterogeneity. For detecting publication biases, Begg's correlation and Egger's regression tests were used (P <0.05). Trim and fill analysis was used to determine the observed and adjusted effect sizes. Eligible studies published in English between January 1, 2000, and December 30, 2020 were included, using the PRISMA, STROBE, and JBI tools. The observed estimates are primary outcomes and adjusted estimates are secondary outcomes. The observed estimate of SR and ENMR was 40.45 (P <0.001) per 1000 total births and 24.75 (P <0.001) per 1000 live births. The adjusted estimate of SR was found to be 30.33 per 1000 total births and ENMR found to be 13.68 per 1000 live births. A high level of heterogeneity between total studies for SR (I2: 99.99, P <0.001) and ENMR (I2: 99.99, P <0.001) were observed in the SSA. An I2 of 99.99 means that all variability in effects size estimates is related to differences in the primary studies' population mixes and intervention implementation, rather than sampling error within studies. But they were not evident by subgroup analyses in the region. Stillbirth and early neonatal mortality rates showed a slow reduction rate. We conducted a series of sensitivity analyses to reduce the level of heterogeneity between studies. Each primary study had an equally weighted mean (6.25 percent) for the overall effect size in the random effect analysis. This means we shouldn't be concerned that no single study dominated the analysis of mean effect size and heterogeneity. When we performed removing one study in the analysis, the CI of each became narrower. It indicates the mean effect size did not shift to the left or right of the mean effect. The overall conclusions remain the same with any one study removed, indicating that the results were robust. Despite the slow reduction rate, variation among the groups, a high heterogeneity within and between studies, special attention is not given to perinatal health in African counties. Importance of the study: Still birth and neonatal death are major global health issues with emotional, social, and economic consequences (Lawn et al., 2016). Postpartum depressive symptoms were prevalent in women who had experienced stillbirth or END, respectively. Women who had a perinatal death were three times more likely to experience postpartum depression symptoms than those who had a live birth (Arach et al., 2020). Despite relatively improved access to maternal health services over time, the reduction of stillbirth and early neonatal mortality rates in most African countries is slow and remain high as compared to high income countries (WHO, 2022). Evidence suggests that if mothers and newborns had access to cost-effective interventions during pregnancy and childbirth, nearly two-thirds of neonatal deaths could be avoided (Tekelab, Chojenta, Smith, & Loxton, 2019). Therefore, the findings of the study can be used to develop independent interventions package for stillbirth and early neonatal mortality in the SSA region, informing proper allocation of health resources under separate umbrellas. These findings will also help them implement public health interventions aimed at improving maternal health and lowering infant mortality rates in the region to achieve the goal of SDG by 2030.

Biography :

Dawit Tiruneh has completed his Master’s degree at the age of 25 years in Reproductive Health and maternal health from Addis Ababa University in 2011 GC. He is a Ph.D. candidate in Public Health at Haramaya University with a research interest in perinatal health, completing the required courses with great distinction. Now, he is in a position to get Ethical clearance for starting field work for data collection after he has defended the dissertation proposal in April, 2021. He has published one review and 5 original articles in reputable journals. He has also more than five research works which are not yet sent for publication. One systematic review is under revision to be published in BMJ open access journal. Furthermore, I am looking for attending your conference which will be held in the 1st week of June, 2022.