Abstract
Background:Sub-Saharan Africa (SSA) has one of the highest levels of perinatal mortality globally. However, there are sub-regional and country-specific disparities in its distribution.Objective:The aim of this study was to undertake a meta-analysis of demographic and health surveys to quantify perinatal mortality rate within sub-Saharan Africa and to depict sub-regional and country-specific differences.Methods:This study used cross-sectional data from the most recent demographic and health surveys (2010–2016) conducted in 21 sub-Saharan African countries. The countries were grouped into four sub-regions (Eastern Africa, Western Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate perinatal mortality rate within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 > 50%), hence a random effect model was used. Sensitivity analysis was also performed to examine the effects of outliers. Perinatal mortality was defined as pregnancy losses occurring after seven completed months of gestation (stillbirths) and deaths to live births within the first seven days of life (early neonatal deaths).Findings:The pooled estimate for perinatal mortality rate per 1000 births across 21 countries in the four sub-regions of SSA was 34.7 (95% CI: 32.6, 36.8). Eastern Africa reported 34.5 (95% CI: 32.2, 36.8), with the highest rate observed in Tanzania [39.5 (95% CI: 35.8, 43.4)]. Western Africa reported 35.7 (95% CI: 32.2, 39.3), with the highest rate observed in Nigeria [40.9 (95% CI: 38.3, 43.2)]. Southern Africa reported 30.3 (95% CI: 26.5, 34.0), with the highest rate observed in Lesotho [49.6 (95% CI: 42.3, 57.8)]. Central Africa reported 30.7 (95% CI: 28.0, 33.3), with the highest rate observed in Equatorial Guinea [37.3 (95% CI: 30.5, 45.1)].Conclusions:To reduce mortality in the perinatal period, interventions should focus on improving access to high quality antenatal and postnatal care, as well as strengthening health care systems within countries in sub-Saharan Africa.
Highlights
Sub-Saharan Africa (SSA) has one of the highest levels of perinatal mortality globally. there are sub-regional and country-specific disparities in its distribution
Perinatal mortality occurs due to a complex interaction of individual level factors relating to maternal lifestyle and maternal obstetric complications, which could be exacerbated by underlying community-level factors, such as lack of access to good quality maternal and newborn health services, to clean water supply, to proper antenatal and postnatal nutrition for the mother and the newborn and poor environmental sanitation, as well as societal factors relating to political instability and armed conflicts [1]
The pooled rate across 21 countries in SSA was 34.7
Summary
Sub-Saharan Africa (SSA) has one of the highest levels of perinatal mortality globally. there are sub-regional and country-specific disparities in its distribution. Objective: The aim of this study was to undertake a meta-analysis of demographic and health surveys to quantify perinatal mortality rate within sub-Saharan Africa and to depict sub-regional and country-specific differences. Perinatal deaths are pregnancy losses occurring after 28 weeks of gestation (stillbirths) and deaths to live births within the first seven days of life (early neonatal deaths) [1]. These untimely deaths are a major public health problem in many developing countries and have enormous economic, social and health implications for families and society [2]. Perinatal mortality occurs due to a complex interaction of individual level factors relating to maternal lifestyle and maternal obstetric complications, which could be exacerbated by underlying community-level factors, such as lack of access to good quality maternal and newborn health services, to clean water supply, to proper antenatal and postnatal nutrition for the mother and the newborn and poor environmental sanitation, as well as societal factors relating to political instability and armed conflicts [1]
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