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Impact of antenatal care on neonatal mortality among neonates in Ethiopia: a systematic review and meta-analysis.

ABSTRACT: Background: As compared to other regions of the world, Sub Saharan Africa (SSA) is the region with the highest neonatal mortality and is the region showing the least progress in the reduction of newborn death. Despite better progress made in reducing neonatal mortality, Ethiopia contributes the highest rate of neonatal death in Africa. In Ethiopia, findings from few studies were inconsistent and there is a need to systematically pool existing data to determine the impact of antenatal care on neonatal mortality among mother-neonate pairs in Ethiopia.

Methods: Published articles from various electronic databases such as Medline, Hinari, Pub Med, Cochrane library, the Web of Science, and Google Scholar were accessed. Also, unpublished studies from library catalogs were identified. All observational studies that were conducted on the association between antenatal care follow-up and neonatal mortality among neonates in Ethiopia were included. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). Forest plots were used to visualize the presence of heterogeneity and estimate the pooled impact on antenatal care on neonatal mortality. The presence of publication bias was assessed by funnel plots and Egger's statistical tests.

Results: Initially, a total of 345 studies were accessed. Finally, 28 full-text studies were reviewed and fourteen studies fulfilled inclusion criteria and included in the final meta-analysis. The overall pooled estimate indicates the odds of neonatal death among neonates from women with antenatal care were 65% lower than those neonates from women who had no antenatal care follow-up (OR: 0.35, 95% CI: 0.24, 0.51).

Conclusions: In this systematic review and meta-analysis, lack of ANC follow-up increase the probability of neonatal mortality as compared to having ANC follow-up. Thus, we will recommend for more coverages of appropriate antenatal care where risk groups can best be identified and managed.

SUBMITTER: Tolossa T

PROVIDER: S-EPMC7653817 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Impact of antenatal care on neonatal mortality among neonates in Ethiopia: a systematic review and meta-analysis.

Tolossa Tadesse T Fekadu Ginenus G Mengist Belayneh B Mulisa Diriba D Fetensa Getahun G Bekele Daniel D

Archives of public health = Archives belges de sante publique 20201110 1

<h4>Background</h4>As compared to other regions of the world, Sub Saharan Africa (SSA) is the region with the highest neonatal mortality and is the region showing the least progress in the reduction of newborn death. Despite better progress made in reducing neonatal mortality, Ethiopia contributes the highest rate of neonatal death in Africa. In Ethiopia, findings from few studies were inconsistent and there is a need to systematically pool existing data to determine the impact of antenatal care ...[more]

PMID: 33292564

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Project description:BackgroundNeonatal mortality is one of the major public health problems throughout the world and most notably in developing countries. There exist inconclusive findings on the effect of antenatal care visits on neonatal death worldwide. Thus, the aim of this systematic review and meta-analysis was to reveal the pooled effect of antenatal care visits on neonatal death.MethodsThe present systematic review and meta-analysis was performed using published literature, which was accessed from national and international databases such as, Medline/PubMed, EMBASE, CINAHL, Cochrane Central library, Google Scholar, and HINARI. STATA/SE for windows version 13 software was used to calculate the pooled effect size with 95% confidence intervals (95% CI) of maternal antenatal care visits on neonatal death using the DerSimonian and Laird random effects meta-analysis (random effects model), and results were displayed using forest plot. Statistical heterogeneity was checked using the Cochran Q test (chi-squared statistic) and I2 test statistic and by visual examination of the forest plot.ResultsA total of 18 studies, which fulfilled the inclusion criteria, were included in the present systematic review and meta-analysis. The finding of the present systematic review and meta-analysis revealed that antenatal care visits decrease the risk of neonatal mortality [pooled effect size 0.66 (95% CI, 0.54, 0.80)]. Cochrane Q test (P?<?0.001) revealed no significant heterogeneity among included studies, but I2 statistic revealed sizeable heterogeneity up to 80.5% (I2?=?80.5%). In the present meta-analysis traditional funnel plot, Egger’s weighted regression (P?=?0.48) as well as Begg’s rank correlation statistic (P?=?0.47) revealed no evidence of publication bias.ConclusionsThe present systematic review and meta-analysis revealed that antenatal care visits were significantly associated with lower rates of neonatal death. The risk of neonatal death was significantly reduced by 34% among newborns delivered from mothers who had antenatal care visits. Thus, visiting antenatal care clinics during pregnancy is strongly recommended especially in resource-limited settings like countries of sub-Saharan Africa.Electronic supplementary materialThe online version of this article (10.1186/s40985-018-0110-y) contains supplementary material, which is available to authorized users.

Project description:Antenatal care uptake is among the key indicators for monitoring the progress of maternal outcomes. Early initiation of antenatal care facilitates the timely management and treatment of pregnancy complications to reduce maternal deaths. In Ethiopia, antenatal care utilization is generally low, and delayed initiation of care is very common. We aimed to systematically identify and synthesize available evidence on delayed initiation of antenatal care and the associated factors in Ethiopia.Studies published in English from 1 January 2002 to 30 April 2017 were systematically searched from PubMed, Medline, EMBASE, CINAHL and other relevant sources. Two authors independently reviewed the identified studies against the eligibility criteria. The included studies were critically appraised using the Joanna Briggs-MAStARI instrument for observational studies. Meta-analysis was conducted in RevMan v5.3 for Windows using a Mantel-Haenszel random effects model. The presence of statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the I2 statistics. Pooled estimate of the proportion of the outcome variable was calculated. Pooled Odd Ratios with 95% CI were calculated to measure the effect sizes.The pooled magnitude of delayed antenatal care in Ethiopia was 64% (95% CI: 57%, 70%). Maternal age (OR?=?0.70; 95% CI: 0.53, 0.93), place of residence (OR?=?0.29, 95% CI: 0.16, 0.50), maternal education (OR?=?0.49; 95% CI: 0.38, 0.63), husband's education (OR?=?0.44; 95% CI: 0.23, 0.85), maternal occupation (OR?=?0.75; 95% CI: 0.61, 0.93), monthly income (OR?=?2.06; 95% CI: 1.23, 3.45), pregnancy intention (OR?=?0.49; 95% CI: 0.40, 0.60), parity (OR?=?0.46; 95% CI: 0.36, 0.58), knowledge of antenatal care (OR?=?0.40; 95% CI: 0.32, 0.51), women's autonomy (OR?=?0.38; 95% CI: 0.15, 0.94), partner involvement (OR?=?0.24; 95% CI: 0.07, 0.75), pregnancy complications (OR?=?0.23; 95% CI: 0.06, 0.95), and means of identifying pregnancy (OR?=?0.50; 95% CI: 0.36, 0.69) were significantly associated with delayed antenatal care.Improving female education and women's empowerment through economic reforms, strengthening family planning programs to reduce unintended pregnancy and promoting partner involvement in pregnancy care could reduce the very high magnitude of delayed antenatal care in Ethiopia.CRD42017064585 .

Project description:BackgroundAntenatal care service satisfaction is a measure of the degree to which a woman seeking care is happy with the antenatal care service provided to her. Thus, this systematic review and meta-analysis aims to identify factors that determine antenatal care service satisfaction among women in Ethiopia.MethodsPubMed, Hinari, and Google Scholar were systematically searched for eligible studies. In addition, national university digital libraries were also searched. The Joanna Briggs Institute's (JBI) critical appraisal tools were used to assess the quality of the included articles. The Cochrane Q-statistics and I2 tests were used to assess heterogeneity among the included studies. Publication bias was assessed using Egger's test. Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The extracted data were analyzed using STATA version 14 software and the results were presented using the forest plot.ResultsOf the 274 articles identified through the systematic search of the literature, 13 studies fulfilling the inclusion criteria were included in this meta-analysis. First antenatal care visit (AOR: 0.62 and 95% CI: 0.40, 0.96), women waited <60 min (AOR: 1.87 and 95% CI: 1.40-2.50), women whose privacy was maintained (AOR: 3.91 and 95% CI: 1.97-7.77), women treated respectfully (AOR: 5.07 and 95% CI: 2.34-10.96), and unplanned pregnancies (AOR = 0.28 and 95% CI: 0.10-0.77) were significantly associated with antenatal care service satisfaction.ConclusionThe study assessed the determinants of antenatal care service satisfaction in Ethiopia. First antenatal care visit, waiting time (<60 min) to see the care provider, maintenance of privacy, respectful treatment, and pregnancy unplanned were found to be determinants of antenatal care service satisfaction. Counseling a woman to comply with a minimum required antenatal care visits and compassionate and respectful maternity care will increase maternal satisfaction with the antenatal care services.

Project description:BackgroundAlthough neonatal death is a global burden, it is the highest in sub-Saharan African countries such as Ethiopia. Moreover, there is disparity in the prevalence and associated factors of studies. Therefore, this study was aimed at providing pooled national prevalence and predictors of neonatal mortality in Ethiopia.MethodsThe following databases were systematically explored to search for articles: Boolean operator, Cochrane Library, PubMed, EMBASE, Hinari, and Google Scholar. Selection, screening, reviewing, and data extraction were done by two reviewers independently using Microsoft Excel spreadsheet. The modified Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute Prevalence Critical Appraisal tools were used to assess the quality of evidence. All studies conducted in Ethiopia and reporting the prevalence and predictors of neonatal mortality were included. Data were extracted using Microsoft Excel spreadsheet software and imported into Stata version 14s for further analysis. Publication bias was checked using funnel plots and Egger's and Begg's tests. Heterogeneity was also checked by Higgins's method. A random effects meta-analysis model with 95% confidence interval was computed to estimate the pooled effect size (i.e., prevalence and odds ratio). Moreover, subgroup analysis based on region, sample size, and study design was done.ResultsAfter reviewing 88 studies, 12 studies fulfilled the inclusion criteria and were included in the meta-analysis. Pooled national prevalence of neonatal mortality in Ethiopia was 16.3% (95% CI: 12.1, 20.6, I 2 = 98.8%). The subgroup analysis indicated that the highest prevalence was observed in the Amhara region, 20.3% (95% CI: 9.6, 31.1), followed by Oromia, 18.8% (95% CI: 11.9, 49.4). Gestational age [AOR: 1.32 (95% CI: 1.07, 1.58)], neonatal sepsis [AOR: 1.23 (95% CI: 1.05, 1.4)], respiratory distress syndromes (RDS) [AOR: 1.18 (95% CI: 0.87, 1.49)], and place of residency [AOR: 1.93 (95% CI: 1.13, 2.73)] were the most important predictors.ConclusionsNeonatal mortality in Ethiopia was significantly decreased. There was evidence that neonatal sepsis, gestational age, and place of residency were the significant predictors. RDS were also a main predictor of mortality even if not statistically significant. We strongly recommended that health care workers should give a priority for preterm neonates with diagnosis with sepsis and RDS.

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Impact of antenatal care on neonatal mortality among neonates in Ethiopia: a systematic review and meta-analysis.

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Impact of antenatal care on neonatal mortality among neonates in Ethiopia: a systematic review and meta-analysis.

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