Perinatal mortality and its association with antenatal care visit, maternal tetanus toxoid immunization and partograph utilization in Ethiopia: a meta-analysis

Scientific Reports, Volume 11, No. 1, Year 2021

Ukuhunyushwa

Despite remarkable progress in the reduction of under-five mortality; perinatal mortality is the major public health problem in Africa. In Ethiopia, the study findings on perinatal mortality and its predictors were inconsistent. Therefore, this systematic review and meta-analysis estimated the pooled perinatal mortality, and its association with antenatal care visit, maternal tetanus toxoid immunization, and partograph monitoring. International databases like PubMed, SCOPUS, Google Scholar and Science Direct were systematically searched. I squared statistics was used to determine the levels of heterogeneity across studies and the pooled estimate was computed using a random-effect model. The meta-analysis showed that a pooled prevalence of perinatal mortality in Ethiopia was 6.00% (95% CI 5.00%, 7.00%). The highest proportion of perinatal mortality was a stillbirth, 5.00% (95% CI 4.00%, 7.00%). Women who had antenatal care visit [OR = 0.20 (95% CI 0.12, 0.34)], maternal tetanus toxoid immunization [OR = 0.43 (95% CI 0.24, 0.77)] and partograph monitoring [POR = 0.22 (95% CI 0.06, 0.76)] reduced the risk of perinatal mortality. Whereas, previous history of perinatal mortality [POR = 7.95 (95% CI 5.59, 11.30)] and abortion history (POR = 2.02 (95% CI 1.18, 3.46)) significantly increased the risk of perinatal mortality. Therefore, antenatal care visit, maternal tetanus toxoid vaccination uptake, and partograph utilization should be an area of improvements to reduce perinatal mortality. A systemic review and meta-analysis of published studies were conducted to estimate the prevalence of perinatal mortality and its association with antenatal care visit, maternal tetanus toxoid immunization and partograph utilization in Ethiopia. This systematic review and meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2009 statement checklist22 (Supplementary file 1). All relevant published studies were searched from the major international databases like PubMed, Cochrane Library, Web of science, science direct, and African Journals Online databases. Google Scholar and Google hand searches were also used. Additionally, a search was made for the reference list of studies already identified to retrieve additional articles. Studies identified through the systematic search were retrieved and managed using Endnote X7. The Population, Exposure, Comparison and Outcomes (PECO) search formula was used to retrieve articles. Population All births from the 28 weeks of gestation till the 7 days’ postpartum period in Ethiopia were the population of interest. Exposures Predictors of perinatal mortality included antenatal care visit, maternal toxoid injection, partograph monitoring of labour, previous perinatal death and abortion. Comparisons were defined for each predictor based on the reported reference group for each predictor in each respective variable. Outcome Perinatal mortality. For each of the selected components of PECO, electronic databases were searched using the keyword search and the medical subject heading [MeSH] words. Key words like perinatal mortality, stillbirth, predictors, determinants, antenatal care visit, maternal tetanus toxoid injection, partograph monitoring as well as Ethiopia were used. The search terms were combined by the Boolean operators “OR” and “AND. All published studies published from 2010 until the end of our search in the English language (7/4/2020) were retrieved to assess eligibility for inclusion in this review and critical assessment. The article selection underwent several steps. Two reviewers (MD and TYA) evaluated the retrieved articles for inclusion using their title, abstract and full-text review. Any disagreement during the selection process between the reviewers was resolved by consensus. Full texts of selected articles were then evaluated using the prior eligibility during the encounter of duplication; only the full-text article was retained. The included studies that were reported perinatal mortality or AND predictors, antenatal care visit, maternal tetanus toxoid injection, partograph monitoring and previous perinatal death. All prospective and retrospective cohort studies, cross-sectional studies, case–control and Demographic and Health Survey (DHS) reports were included in this review. However, this review excluded studies that were case reports of populations, abstracts of conferences, articles without full access and the outcome of interest not reported. Studies that were not fully accessed after at least two email contacts of the principal investigator were excluded. The primary outcome of this systematic review and meta-analysis was perinatal mortality in Ethiopia. The secondary outcomes were: the pooled effect of selected predictors on perinatal mortality, antenatal care visit, maternal toxoid injection, partograph monitoring of labour, previous history of perinatal death and abortion. Poor obstetric history means previous unfavorable fetal outcome in terms of those having at least one of the following two or more consecutive spontaneous abortions, history of intrauterine fetal death, intrauterine growth retardation, stillbirth, early neonatal death, and/or congenital anomalies. Maternal stress is the exposure of an expectant mother to stress, which can be caused by stressful life events like or by environmental hardships, which resulting changes to the mother’s hormonal and immune system may harm the fetus’s (and after birth, the infant’s) immune function and brain development. Thus, women who endorse life events experienced in the prior 6 months across 11 domains, including financial, legal, relationships, career, safety in the community, safety in the home, medical issues about others, medical issues about self, authority, home issues, and prejudice. Pregnant women who endorsed the event as positive, negative, or neutral. The numbers of domains with at least one negative event were summed to create a negative life events domain score, with higher scores suggesting increased maternal stress23.

I-AI Digest

Study Justification:

– Perinatal mortality is a major public health problem in Africa, despite progress in reducing under-five mortality.
– In Ethiopia, there is inconsistent information on perinatal mortality and its predictors.
– This systematic review and meta-analysis aims to estimate the prevalence of perinatal mortality and its association with antenatal care visit, maternal tetanus toxoid immunization, and partograph utilization in Ethiopia.

Highlights:

– The meta-analysis found that the pooled prevalence of perinatal mortality in Ethiopia was 6.00%.
– Stillbirth accounted for the highest proportion of perinatal mortality.
– Antenatal care visit, maternal tetanus toxoid immunization, and partograph monitoring were associated with a reduced risk of perinatal mortality.
– Previous history of perinatal mortality and abortion history significantly increased the risk of perinatal mortality.

Recommendations:

– Improvements in antenatal care visit, maternal tetanus toxoid vaccination uptake, and partograph utilization are needed to reduce perinatal mortality in Ethiopia.

Key Role Players:

– Ministry of Health: Responsible for implementing policies and programs related to maternal and child health.
– Health professionals: Including doctors, nurses, and midwives who provide antenatal care and delivery services.
– Community health workers: Involved in promoting and educating communities about the importance of antenatal care and immunization.
– Non-governmental organizations (NGOs): Working in partnership with the government to support maternal and child health initiatives.

Cost Items for Planning Recommendations:

– Training and capacity building for health professionals on antenatal care, immunization, and partograph utilization.
– Procurement and distribution of tetanus toxoid vaccines.
– Strengthening health facilities to ensure availability of necessary equipment and supplies for antenatal care and delivery.
– Community outreach and awareness campaigns to promote the importance of antenatal care and immunization.
– Monitoring and evaluation activities to assess the impact of interventions on perinatal mortality rates.

Amandla Obufakazi

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is rated 8 because it is based on a systematic review and meta-analysis, which are considered high-quality studies. The abstract provides information on the methods used, including the databases searched and the statistical analysis performed. It also presents the findings of the meta-analysis, including the pooled prevalence of perinatal mortality and the association with various factors. However, to improve the evidence, it would be helpful to provide more details on the inclusion and exclusion criteria for the studies included in the meta-analysis, as well as the quality assessment of the included studies. Additionally, providing information on the sample size and characteristics of the included studies would further strengthen the evidence.

Abstract

A systemic review and meta-analysis of published studies were conducted to estimate the prevalence of perinatal mortality and its association with antenatal care visit, maternal tetanus toxoid immunization and partograph utilization in Ethiopia. This systematic review and meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2009 statement checklist22 (Supplementary file 1). All relevant published studies were searched from the major international databases like PubMed, Cochrane Library, Web of science, science direct, and African Journals Online databases. Google Scholar and Google hand searches were also used. Additionally, a search was made for the reference list of studies already identified to retrieve additional articles. Studies identified through the systematic search were retrieved and managed using Endnote X7. The Population, Exposure, Comparison and Outcomes (PECO) search formula was used to retrieve articles. Population All births from the 28 weeks of gestation till the 7 days’ postpartum period in Ethiopia were the population of interest. Exposures Predictors of perinatal mortality included antenatal care visit, maternal toxoid injection, partograph monitoring of labour, previous perinatal death and abortion. Comparisons were defined for each predictor based on the reported reference group for each predictor in each respective variable. Outcome Perinatal mortality. For each of the selected components of PECO, electronic databases were searched using the keyword search and the medical subject heading [MeSH] words. Key words like perinatal mortality, stillbirth, predictors, determinants, antenatal care visit, maternal tetanus toxoid injection, partograph monitoring as well as Ethiopia were used. The search terms were combined by the Boolean operators “OR” and “AND. All published studies published from 2010 until the end of our search in the English language (7/4/2020) were retrieved to assess eligibility for inclusion in this review and critical assessment. The article selection underwent several steps. Two reviewers (MD and TYA) evaluated the retrieved articles for inclusion using their title, abstract and full-text review. Any disagreement during the selection process between the reviewers was resolved by consensus. Full texts of selected articles were then evaluated using the prior eligibility during the encounter of duplication; only the full-text article was retained. The included studies that were reported perinatal mortality or AND predictors, antenatal care visit, maternal tetanus toxoid injection, partograph monitoring and previous perinatal death. All prospective and retrospective cohort studies, cross-sectional studies, case–control and Demographic and Health Survey (DHS) reports were included in this review. However, this review excluded studies that were case reports of populations, abstracts of conferences, articles without full access and the outcome of interest not reported. Studies that were not fully accessed after at least two email contacts of the principal investigator were excluded. The primary outcome of this systematic review and meta-analysis was perinatal mortality in Ethiopia. The secondary outcomes were: the pooled effect of selected predictors on perinatal mortality, antenatal care visit, maternal toxoid injection, partograph monitoring of labour, previous history of perinatal death and abortion. Poor obstetric history means previous unfavorable fetal outcome in terms of those having at least one of the following two or more consecutive spontaneous abortions, history of intrauterine fetal death, intrauterine growth retardation, stillbirth, early neonatal death, and/or congenital anomalies. Maternal stress is the exposure of an expectant mother to stress, which can be caused by stressful life events like or by environmental hardships, which resulting changes to the mother’s hormonal and immune system may harm the fetus’s (and after birth, the infant’s) immune function and brain development. Thus, women who endorse life events experienced in the prior 6 months across 11 domains, including financial, legal, relationships, career, safety in the community, safety in the home, medical issues about others, medical issues about self, authority, home issues, and prejudice. Pregnant women who endorsed the event as positive, negative, or neutral. The numbers of domains with at least one negative event were summed to create a negative life events domain score, with higher scores suggesting increased maternal stress23.

Izinto zokwakha

Emisha

The systematic review and meta-analysis conducted in Ethiopia found that improving access to antenatal care visits, maternal tetanus toxoid immunization, and partograph utilization can significantly reduce perinatal mortality rates. These interventions have been shown to be effective in reducing the risk of perinatal mortality. Additionally, addressing previous history of perinatal mortality and abortion history is important, as these factors have been found to increase the risk of perinatal mortality. By implementing these recommendations and addressing risk factors, progress can be made in reducing perinatal mortality rates in Ethiopia. The findings of this study were published in the journal Scientific Reports in 2021.

AI Innovations Description

The recommendation based on the systematic review and meta-analysis is to focus on improving access to antenatal care visits, maternal tetanus toxoid immunization, and partograph utilization in order to reduce perinatal mortality in Ethiopia. These interventions have been found to significantly reduce the risk of perinatal mortality. Additionally, efforts should be made to address previous history of perinatal mortality and abortion history, as these factors have been found to increase the risk of perinatal mortality. By improving access to these interventions and addressing risk factors, it is possible to make progress in reducing perinatal mortality rates in Ethiopia.

AI Innovations Methodology

The methodology used to simulate the impact of the main recommendations on improving access to maternal health in Ethiopia would involve implementing interventions aimed at improving access to antenatal care visits, maternal tetanus toxoid immunization, and partograph utilization. This could be done through various strategies, such as:

1. Strengthening healthcare infrastructure: Improving access to antenatal care visits, maternal tetanus toxoid immunization, and partograph utilization would require strengthening the healthcare infrastructure in Ethiopia. This could involve increasing the number of healthcare facilities, ensuring they are adequately staffed with trained healthcare professionals, and providing necessary equipment and supplies.

2. Increasing awareness and education: Conducting awareness campaigns to educate pregnant women and their families about the importance of antenatal care visits, maternal tetanus toxoid immunization, and partograph utilization. This could be done through community outreach programs, health education sessions, and the use of mass media.

3. Removing financial barriers: Implementing policies and programs to remove financial barriers that prevent pregnant women from accessing antenatal care visits, maternal tetanus toxoid immunization, and partograph utilization. This could involve providing free or subsidized healthcare services, implementing health insurance schemes, and improving the availability of affordable transportation to healthcare facilities.

4. Training healthcare professionals: Providing training and capacity-building programs for healthcare professionals to ensure they have the necessary skills and knowledge to provide quality antenatal care, administer maternal tetanus toxoid immunization, and effectively use the partograph.

5. Monitoring and evaluation: Establishing a system for monitoring and evaluating the implementation and impact of these interventions. This could involve collecting data on the number of antenatal care visits, maternal tetanus toxoid immunization coverage, and partograph utilization rates, as well as tracking perinatal mortality rates over time.

By implementing these strategies, it is possible to improve access to antenatal care visits, maternal tetanus toxoid immunization, and partograph utilization in Ethiopia, which can ultimately lead to a reduction in perinatal mortality rates.

Umbhali

Dima Health

Identifiers:

DOI: 10.1038/s41598-021-98996-5

Research Areas:

Community Interventions, Genetics and Genomics, Health System and Policy, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cohort Study, Cross Sectional Study

Study Approach:

Mixed-methods, Quantitative, Systematic Review

Participants Gender:

Female

Yabelana ngalokhu: