Background: Worldwide, approximately 14 million mothers aged 15 – 19 years give birth annually. The number of teenage births in Sub Saharan Africa (SSA) is particularly high with an estimated 50% of mothers under the age of 20. Adolescent mothers have a significantly higher risk of neonatal mortality in comparison to adults. The objective of this review was to compare perinatal/neonatal mortality in Sub Saharan Africa and it’s associated risk factors between adolescents and adults. Results: We systematically searched six databases to determine risk factors for perinatal/neonatal mortality, and pregnancy outcomes, between adolescent and adults in SSA. Article’s quality was assessed and synthesized as a narrative. Being single and having a single parent household is more prevalent amongst adolescents than adults. Nearly all the adolescent mothers (97%) were raised in single parent households. These single life factors could be interconnected and catalyze other risky behaviors. Accordingly, having co-morbidities such as Sexually Transmitted Infections, or not going to school was more prevalent in younger mothers. Conclusions: Inter-generational support for single mothers in SSA communities appears essential in preventing both early pregnancies and ensuring healthy outcomes when they occur during adolescence. Future studies should test related hypothesis and seek to unpack the processes that underpin the relationships between being single and other risk indicators for neonatal mortality in young mothers. Current policy initiatives should account for the context of single African women’s lives, low opportunity, status and little access to supportive relationships, or practical help.
Focusing on quantitative data measuring neonatal mortality between adolescents <20 years and mothers older than 20 years in SSA, we reviewed literature to determine risk of neonatal mortality stratified by maternal age. There was no existing prior review protocol.Studies were systematically screened from PubMed, Cochrane database, Adolec, Popline, Google Scholar and Global Health Archive on adolescent and adult pregnancy in SSA until February 2013 (Figure 1). Flow chart for literature screening & selection. The studies were selected based on the main inclusion criteria: Any quantitative study measuring the association between risk factors for perinatal/neonatal mortality (PNM) and pregnancy outcome between adolescent and adults in SSA either comparing directly or as stratified groups. Due to the changing African developing context, we excluded publications prior to 1994. Also excluded were analyses that focused on older mothers, because neonatal mortality risk increases in mothers over 35 years of age, suggesting a potentially different set of risk indicators in this age category (Additional file 1: Appendix 3) [9–12]. Articles were graded using the Quality Assessment Tool for Quantitative Studies [13]. Randomized control trials and cohort studies were viewed as providing more robust findings, although cross-sectional studies were also examined. Risk factors for neonatal mortality were significant if p ≤ 0.05 and 95% Confidence Interval (95% CI) ≠ 0 were met. Articles were graded on the following scale: strong +++, moderate ++ and weak + by AR. In order to calculate perinatal/neonatal mortality ratio (PNMR), data was extracted for adolescents and adults from individual studies and calculated using the formula: PNM cases/total number of adolescent or adult population*1000. A proportion of the rates was reported in the results. Prevalence rate of risk factors was calculated through the extraction of data from individual studies, using the formula: total cases/total population of adolescent or adult population. If there were multiple studies reporting the same risk factor, the cases and population was totaled stratified by adolescent and adults. A proportion was determined for adolescents and adults in addition to the 95% CI and then a z score was calculated to determine the p-value. Some studies reported odds ratios (OR) and hazard ratios (HR); these were reported to provide additional statistics. We report a narrative review comparing perinatal/neonatal mortality in SSA and it’s associated risk factors between mothers 15–19 years and 20–35 years of age.