Jena Belayneh Hamdela, Jaldo Mesfin Menza, Demesa Yohannes Yirga, Kebede Biruk Assefa, Melaku Lamesginew Mossie
Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
Department of Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
Arch Public Health. 2025 Aug 28;83(1):219. doi: 10.1186/s13690-025-01710-4.
Neonatal mortality remains a problem in sub-Saharan Africa (SSA). Findings of primary studies varied in magnitude of neonatal mortality, characteristics of the study population, and association of maternal and child health care with neonatal mortality. Thus, this review was aimed at estimating the pooled magnitude of neonatal mortality and its association with maternal and child health care in SSA.
Databases (PubMed, ScienceDirect, and Hinari for health via Research4Life) and gray literature sources were accessed. Relevant studies were retrieved from related studies via snowballing. A combination of medical subject headings (MeSH terms) using Boolean operators and key words related to neonatal mortality were used to search studies. Full-text articles published from observational studies in SSA included. Heterogeneity was assessed using a forest plot and Higgins's I test. When heterogeneity was evident, a sensitivity and subgroup analysis were 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. A trim and fill analysis was considered when publication bias exists.
A total of 57 studies were included to answer the review questions. The pooled neonatal mortality rate among live births was 32 per 1,000 live births (95% CI: 25, 42), and among neonates admitted to neonatal intensive care units was 16.5% (95% CI: 13.9, 19.5%) in SSA. Lack of antenatal care visits [Odds ratio (OR) = 2.19, 95% CI: 1.61, 2.98], giving childbirth outside of a health institution or home [OR = 1.44, 95% CI: 1.13, 1.84], and late initiation of breastfeeding [OR = 3.49, 95% CI: 1.98, 6.15] increased the odds of neonatal mortality.
Neonatal mortality in SSA remains high. Maternal health services such as exposure to antenatal care and institutional delivery and child health services such as early initiation of breastfeeding were related to reducing the burden of neonatal mortality. Thus, much effort and commitment are needed to achieve the United Nations' sustainable development goal of reducing neonatal mortality.
在撒哈拉以南非洲地区（SSA），新生儿死亡率仍然是一个问题。初步研究的结果在新生儿死亡率的幅度、研究人群的特征以及母婴保健与新生儿死亡率的关联方面存在差异。因此，本综述旨在估计SSA地区新生儿死亡率的汇总幅度及其与母婴保健的关联。
检索了数据库（PubMed、ScienceDirect以及通过Research4Life获取健康信息的Hinari）和灰色文献来源。通过滚雪球法从相关研究中检索了相关研究。使用布尔运算符组合医学主题词（MeSH词）以及与新生儿死亡率相关的关键词来搜索研究。纳入了SSA地区观察性研究发表的全文文章。使用森林图和希金斯I检验评估异质性。当异质性明显时，进行敏感性分析和亚组分析。应用加权逆方差随机效应模型来估计汇总效应大小。使用漏斗图和埃格回归检验评估发表偏倚。当存在发表偏倚时，考虑进行剪补分析。
总共纳入了57项研究来回答综述问题。在SSA地区，活产儿中的汇总新生儿死亡率为每1000例活产儿中有32例（95%置信区间：25，42），新生儿重症监护病房收治的新生儿中的死亡率为16.5%（95%置信区间：13.9，19.5%）。未进行产前检查[比值比（OR）=2.
