The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis

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Abstract

Background

Newborns are at greatest risk of dying at and shortly after the time of birth. Newborn mortality remains an urgent concern and is an important indicator of child health, development and well-being. Studies examining the effectiveness of antenatal care on maternal and newborn health outcomes have provided conflicting results. The aim of this review and meta-analysis was to determine the pooled effect of antenatal care on neonatal mortality in sub-Saharan Africa.

Methods

We searched PubMed, Medline, EMBASE, CINAHL and Google Scholar from September to November 2016 and then updated our search on April 13, 2019. Two independent reviewers extracted data from eligible studies. The quality of each included study was assessed using the Risk of Bias Assessment tool for Non-Randomized Studies (RoBANS). The results were reported based on risk ratio (RR) with 95% confidence intervals (CI) using a random-effects model.

Results

Eight hundred and ninety eight studies were initially identified. During screening, 23 studies were found to be relevant for data extraction. Of these, only twelve studies fulfilled the inclusion criteria and were included in the analysis. In five of the twelve studies included in the analysis, antenatal care service utilization had a significant association with neonatal mortality. The pooled risk ratio by the random-effects model was 0.61 (95% CI: 0.43, 0.86) for neonates born to women who received at least one antenatal care visit by a skilled provider as compared to neonates born to women who did not receive antenatal care.

Conclusion

This review indicates that utilization of at least one antenatal care visit by a skilled provider during pregnancy reduces the risk of neonatal mortality by 39% in sub-Saharan African countries. Thus, in order to accelerate progress towards the reduction of newborn deaths, all pregnant women should receive antenatal care during pregnancy.

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Most cited references 30

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Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity.

Soo Young Kim, Ji Eun Park, Yoon Lee … (2013)

To develop and validate a new risk-of-bias tool for nonrandomized studies (NRSs). We developed the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). A validation process with 39 NRSs examined the reliability (interrater agreement), validity (the degree of correlation between the overall assessments of RoBANS and Methodological Index for Nonrandomized Studies [MINORS], obtained by plotting the overall risk of bias relative to effect size and funding source), face validity with eight experts, and completion time for the RoBANS approach. RoBANS contains six domains: the selection of participants, confounding variables, the measurement of exposure, the blinding of the outcome assessments, incomplete outcome data, and selective outcome reporting. The interrater agreement of the RoBANS tool except the measurement of exposure and selective outcome reporting domains ranged from fair to substantial. There was a moderate correlation between the overall risks of bias determined using RoBANS and MINORS. The observed differences in effect sizes and funding sources among the assessed studies were not correlated with the overall risk of bias in these studies. The mean time required to complete RoBANS was approximately 10 min. The external experts who were interviewed evaluated RoBANS as a "fair" assessment tool. RoBANS shows moderate reliability, promising feasibility, and validity. The further refinement of this tool and larger validation studies are required. Copyright © 2013 Elsevier Inc. All rights reserved.

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3.6 million neonatal deaths--what is progressing and what is not?

Joy E. Lawn, Kate Kerber, Christabel Enweronu-Laryea … (2010)

Each year 3.6 million infants are estimated to die in the first 4 weeks of life (neonatal period)--but the majority continue to die at home, uncounted. This article reviews progress for newborn health globally, with a focus on the countries in which most deaths occur--what data do we have to guide accelerated efforts? All regions are advancing, but the level of decrease in neonatal mortality differs by region, country, and within countries. Progress also differs by the main causes of neonatal death. Three major causes of neonatal deaths (infections, complications of preterm birth, and intrapartum-related neonatal deaths or "birth asphyxia") account for more than 80% of all neonatal deaths globally. The most rapid reductions have been made in reducing neonatal tetanus, and there has been apparent progress towards reducing neonatal infections. Limited, if any, reduction has been made in reducing global deaths from preterm birth and for intrapartum-related neonatal deaths. High-impact, feasible interventions to address these 3 causes are summarized in this article, along with estimates of potential for lives saved. A major gap is reaching mothers and babies at birth and in the early postnatal period. There are promising community-based service delivery models that have been tested mainly in research studies in Asia that are now being adapted and evaluated at scale and also being tested through a network of African implementation research trials. To meet Millennium Development Goal 4, more can and must be done to address neonatal deaths. A critical step is improving the quantity, quality and use of data to select and implement the most effective interventions and strengthen existing programs, especially at district level. Copyright © 2010 Elsevier Inc. All rights reserved.

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Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries.

Taghreed Adam, Stephen Lim, Sumi Mehta … (2005)

To determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals. Cost effectiveness analysis. Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, comprising countries in South East Asia with high adult and high child mortality. Effectiveness data from several sources, including trials, observational studies, and expert opinion. For resource inputs, quantities came from WHO guidelines, literature, and expert opinion, and prices from the WHO choosing interventions that are cost effective database. Cost per disability adjusted life year (DALY) averted in year 2000 international dollars. The most cost effective mix of interventions was similar in Afr-E and Sear-D. These were the community based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency obstetric and neonatal care around and after birth. Screening and treatment of maternal syphilis, community based management of neonatal pneumonia, and steroids given during the antenatal period were relatively less cost effective in Sear-D. Scaling up all of the included interventions to 95% coverage would halve neonatal and maternal deaths. Preventive interventions at the community level for newborn babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well.

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Author and article information

Contributors

Tesfalidet Tekelab:

ORCID: http://orcid.org/0000-0003-0774-7708

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – original draft

Catherine Chojenta: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing

Roger Smith: Role: MethodologyRole: SupervisionRole: Writing – review & editing

Deborah Loxton:

ORCID: http://orcid.org/0000-0002-4745-8612

Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing

Umberto Simeoni: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 13 September 2019

Publication date Collection: 2019

Volume: 14

Issue: 9

Electronic Location Identifier: e0222566

Affiliations

[1 ] Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia

[2 ] College of Medical and Health sciences, Wollega University, Nekemte, Oromia, Ethiopia

[3 ] The Mothers and Babies Research Centre at the Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia

Centre Hospitalier Universitaire Vaudois, FRANCE

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: ttesfalove@ 123456gmail.com

Author information

Tesfalidet Tekelab http://orcid.org/0000-0003-0774-7708

Deborah Loxton http://orcid.org/0000-0002-4745-8612

Article

Publisher ID: PONE-D-18-16070

DOI: 10.1371/journal.pone.0222566

PMC ID: 6743758

PubMed ID: 31518365

SO-VID: 41223fbb-779f-48bf-8251-caf96db1c07b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 29 May 2018

Date accepted : 3 September 2019

Page count

Figures: 3, Tables: 3, Pages: 15

Funding

The authors received no specific funding for this work.

Custom metadata

Data Availability All relevant data are within the manuscript and Supporting Information files.

The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis

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Most cited references 30

Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity.

3.6 million neonatal deaths--what is progressing and what is not?

Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries.

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