Neonatal Necrotizing enterocolitis is the most critical and recurrent gastrointestinal disorder in neonatal intensive care units. Although the overall mortality extends to 50 % related to necrotizing enterocolitis, it can approach 100 % with perforation, peritonitis and sepsis complications. It is the first step to planning management approaches that can contribute to decreasing long term morbidity and mortality. The aim of this systematic review and meta-analysis was to assess the prevalence and its determinant factors of necrotizing enterocolitis among admitted neonates in Ethiopia. The procedure of this systematic review and meta-analysis was registered at the Prospero with a registration number of CRD42023409175. Universal online databases such as PubMed, Cochrane, Google, Google Scholar, SCOPUS, and Web of science and Global health were used to search for articles. Data extraction was commenced with Microsoft Excel and STATA17 was used to conduct the Meta-Analysis. Random effect model analysis was considered when there was evidence of heterogeneity among the studies. The overall pooled prevalence of neonatal necrotizing enterocolitis was 14.4 % (95 % CI; 7.04, 21.85, I2 = 95.80 %, p = 0.000). The pooled odds ratio of Birth weight (AOR = 3.75 (95 % CI; 1.72, 5.79), Apgar score (AOR = 2.37 (95 % CI; 1.83, 2.91), maternal infection (AOR = 5.24 (95 % CI; 4.04, 6.45) and prolonged labor (AOR = 2.70 (95 % CI; 1.65, 3.74) had significant statistical association with neonatal necrotizing enterocolitis. This finding concluded that high prevalence and multiple determinant factors of neonatal necrotizing enterocolitis in Ethiopia. This finding recommend that neonatal care programs prioritize targeting maternal infection prevention, improved labor management, and enhanced care for low birth weight neonates and those with low Apgar scores to decrease the unacceptably high burden of neonatal necrotizing enterocolitis and its devastating consequences.
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