Prevalence of early neonatal mortality and its predictors in sub-Saharan Africa: A Systematic review and Meta-Analysis.

Background: Although early neonatal mortality (ENM) has been reported to have a greater contribution to the overall neonatal mortality compared to late neonatal mortality, no meta-analysis has studied this phenomenon in isolation. The prevalence of ENM and its predictors in sub-Saharan Africa (SSA) remains unknown. Therefore, this meta-analysis is aimed at pooling the prevalence of ENM and its predictors in SSA. Methods: Google Scholar, PubMed, Scopus, CINAHL, and Google were searched for studies conducted in SSA that reported the prevalence and predictors of ENM. The data were extracted using a Microsoft Excel spreadsheet and imported into R version 4.4.1 for further analysis. Publication bias, heterogeneity, sensitivity analysis, and subgroup analysis were performed. Prevalence and odds ratios were pooled using the random effects model if significant heterogeneity existed; otherwise, the fixed effects model was used. Results: A total of 26 studies were included in this systematic review and meta-analysis. The overall pooled prevalence of ENM in SSA was 11% (95% CI: 7-15; I2=100%). Birth asphyxia (OR=3.85; 95% CI: 1.12-13.21; P = 0.0388; I2= 86.6%), home delivery (OR=2.46; 95% CI: 1.79-3.38; p<0.001; I2 = 0.0%), prematurity (OR=4.69; 95% CI: 3.57-6.16; p<0.001; I2 = 36.8%), male gender (OR= 1.37; 95% CI: 1.28-1.46; P < 0.001; I2 = 30.7%), delivery through caesarean section (OR=1.74; 95% CI: 1.49-2.02; P < 0.001; I2 = 31.5%) and low birth weight (OR=3.00; 95% CI: 1.01-8.91; P = 0.0482; I2 = 94.4%) were associated with a significant increase in pooled odds of ENM in SSA. Conclusion: The prevalence of ENM in SSA in significantly high and it contributes greatly to the overall neonatal mortality. Therefore, tailor-made interventions that target the reduction of birth asphyxia, prematurity, home delivery, and low birth weight should be implemented in order to reduce the burden of ENM in SSA.