Abstract
BACKGROUND: Primary studies conducted in sub-Saharan Africa (SSA) reported an inconsistent association between adverse newborn conditions and neonatal mortality. Thus, this review was aimed at assessing the association of adverse newborn conditions with neonatal mortality and generating a pooled estimate of the association using a large sample size from primary studies conducted in SSA. METHODS: Databases (PubMed, ScienceDirect, and Hinari for health via Research4Life) and gray literature sources were accessed. Relevant studies were retrieved from related studies via snowballing. To search the studies, a combination of medical subject headings (MeSH terms) using Boolean operators and key words related to neonatal mortality were considered. Full-text articles published from observational studies in SSA were included. Higgins's I(2) test and forest plot were used to assess heterogeneity among the studies. When heterogeneity exists, sensitivity and subgroup analyses are done. A weighted inverse variance random-effects model was applied to estimate the pooled effect sizes. Publication bias was assessed using a funnel plot and Egger's regression test. When publication bias exists, a trim and fill analysis is done. RESULTS: A total of 36 studies were included to answer the review questions. The pooled odds ratios (OR) indicated that adverse newborn conditions: preterm birth [(OR = 3.76, 95% CI 2.92, 4.84), I(2) = 87%, Egger's test = 0.317] low birth weight [(OR = 3.10, 95% CI 2.40, 4.00), I(2) = 89%, Egger's test = 0.072], birth asphyxia [(OR = 2.94, 95% CI 2.14, 4.05), I(2) = 80%, Egger's test = 0.396], respiratory distress syndrome [(OR = 4.29, 95% CI 2.53, 7.26), I(2) = 95%, Egger's test = 0.257], hypothermia [(OR = 2.04, 95% CI 1.38, 3.03), I(2) = 83%, Egger's test = 0.356], hypoglycemia [(OR = 2.00, 95% CI 1.03, 3.90), I(2) = 88%, Egger's test = 0.016], and neonatal sepsis [(OR = 1.65, 95% CI 1.20, 2.28), I(2) = 89%, Egger's test = 0.004] were determinants of neonatal mortality in SSA. CONCLUSIONS: Neonatal mortality in sub-Saharan Africa was significantly associated with adverse newborn conditions, highlighting the need to strengthen essential newborn care practices. Maternal health services such as good antenatal care services, nutrition during pregnancy, quality intrapartum care, and infection prevention are also fundamental to reducing the risk of neonatal mortality in SSA.