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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.
