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Archives of Disease in Childhood. Fetal... Jan 2021We aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates.
DESIGN
We conducted a systematic review of non-ETS and ETS in non-vigorous infants born through meconium-stained amniotic fluid (MSAF). We searched PubMed/Medline, Scopus, Clinical Trials.gov, Cumulative Index to Nursing and Allied Health, and Cochrane Library databases from inception to November 2019, using keywords and related terms. Only non-vigorous infants born through MSAF included in randomised controlled trials, were included. We calculated overall relative risks (RRs) and mean differences with 95% CIs using a random-effects model, to determine the impact of ETS in non-vigorous infants born through MSAF.
MAIN OUTCOME MEASURES
The primary outcome was the incidence of meconium aspiration syndrome (MAS). Secondary outcomes were respiratory outcome measures (pneumothorax, persistent pulmonary hypertension of the newborn, secondary pneumonia, need for respiratory support, duration of mechanical ventilation), initial resuscitation and others including shock, perinatal asphyxia, convulsions, neonatal mortality, blood culture-positive sepsis and duration of hospital stay.
RESULTS
A total of 2085 articles were identified in the initial database search. Four studies, including 581 non-vigorous meconium-stained infants, fulfilled the inclusion criteria, comprising 292 infants in the non-ETS group and 289 in the ETS group. No statistically significant difference was found for MAS (RR 0.98; 95% CI 0.71 to 1.35).
CONCLUSIONS
Initiating ETS soon after birth in non-vigorous meconium-stained infants may not alter their neonatal outcomes.
Topics: Amniotic Fluid; Female; Humans; Infant, Newborn; Intubation, Intratracheal; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Randomized Controlled Trials as Topic; Respiratory Tract Diseases; Severity of Illness Index
PubMed: 32561566
DOI: 10.1136/archdischild-2020-318941 -
Archives of Public Health = Archives... 2020The trend of increasing caesarean deliveries in developed countries over the past three decades is now being observed in sub-Saharan African. This rise might be... (Review)
Review
BACKGROUND
The trend of increasing caesarean deliveries in developed countries over the past three decades is now being observed in sub-Saharan African. This rise might be associated with an increase in the complications that could arise from this surgical intervention. We therefore sought to assess the prevalence, indications and complications of caesarean deliveries in Cameroon.
METHODS
We systematically searched online databases: Medline; Global Health and the CINAHL from 01st January 1966 to 25th July 2019. We reviewed published cohort studies, retrospective register analysis and cross-sectional studies that described cohorts of pregnant women presenting at delivery facilities in Cameroon; and included those that had an estimate of the proportion of women who delivered by caesarean sections.
RESULTS
There were 126 articles initially identified by the search and 88 articles were retained after removal of duplicates. After screening of the titles and abstracts, and full text review, we identified 16 articles describing 22 cohorts of women presenting for delivery in health facilities in Cameroon. The overall estimate for the prevalence of caesarean deliveries was 9.9% (95% CI: 7.4, 12.8%, I = 99.68%, χ = 315.9, < 0.001). The prevalence of caesarean deliveries increased progressively from 3.4% (95% CI: 2.2, 4.8%) before the year 2000, to 9.8% (95% CI: 7.4, 12.8%) between 2000 and 2009 and 14.7% (95% CI: 8.8, 21.7%) from 2010 to 2019. The three commonest indications for caesarean deliveries were: cephalopelvic disproportion (27.5%; 95% CI: 17.5, 38.7%); previous caesarean deliveries (13.2%; 95% CI: 7.4, 20.3%) and foetal distress (11.2%; 95% CI: 4.8, 19.5%). Neonates who were born by caesarean delivery were more likely to have neonatal asphyxia when compared with neonates born from vaginal deliveries (OR: 6.5; 95% CI: 2.5, 16.5).
CONCLUSION
The rates of caesarean deliveries in Cameroon falls just within the recommended 10-15% range proposed by the World Health Organisation but have however been increasing progressively in the past decades. There is a strong need to assess the various indications of caesarean deliveries in Cameroon in order to curb its associated complications.
PubMed: 32514347
DOI: 10.1186/s13690-020-00430-1 -
Ultrasound in Obstetrics & Gynecology :... Jul 2020To evaluate the effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome by performing a systematic review of available published...
OBJECTIVE
To evaluate the effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome by performing a systematic review of available published literature on pregnancies affected by COVID-19.
METHODS
We performed a systematic review to evaluate the effect of COVID-19 on pregnancy, perinatal and neonatal outcome. We conducted a comprehensive literature search using PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure Database and Wan Fang Data up to and including 20 April 2020 (studies were identified through PubMed alert after that date). For the search strategy, combinations of the following keywords and medical subject heading (MeSH) terms were used: 'SARS-CoV-2', 'COVID-19', 'coronavirus disease 2019', 'pregnancy', 'gestation', 'maternal', 'mother', 'vertical transmission', 'maternal-fetal transmission', 'intrauterine transmission', 'neonate', 'infant' and 'delivery'. Eligibility criteria included laboratory-confirmed and/or clinically diagnosed COVID-19, patient being pregnant on admission and availability of clinical characteristics, including at least one maternal, perinatal or neonatal outcome. Exclusion criteria were non-peer-reviewed or unpublished reports, unspecified date and location of the study, suspicion of duplicate reporting and unreported maternal or perinatal outcomes. No language restrictions were applied.
RESULTS
We identified a high number of relevant case reports and case series, but only 24 studies, including a total of 324 pregnant women with COVID-19, met the eligibility criteria and were included in the systematic review. These comprised nine case series (eight consecutive) and 15 case reports. A total of 20 pregnant patients with laboratory-confirmed COVID-19 were included in the case reports. In the combined data from the eight consecutive case series, including 211 (71.5%) cases of laboratory-confirmed and 84 (28.5%) of clinically diagnosed COVID-19, the maternal age ranged from 20 to 44 years and the gestational age on admission ranged from 5 to 41 weeks. The most common symptoms at presentation were fever, cough, dyspnea/shortness of breath, fatigue and myalgia. The rate of severe pneumonia reported amongst the case series ranged from 0% to 14%, with the majority of the cases requiring admission to the intensive care unit. Almost all cases from the case series had positive computed tomography chest findings. All six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk samples, respectively, were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Only four cases of spontaneous miscarriage or termination were reported. In the consecutive case series, 219/295 women had delivered at the time of reporting and 78% of them had Cesarean section. The gestational age at delivery ranged from 28 to 41 weeks. Apgar scores at both 1 and 5 min ranged from 7 to 10. Only eight neonates had birth weight < 2500 g and nearly one-third of neonates were transferred to the neonatal intensive care unit. There was one case of neonatal asphyxia and death. In 155 neonates that had nucleic-acid testing in throat swab, all, except three cases, were negative for SARS-CoV-2. There were no cases of maternal death in the eight consecutive case series. Seven maternal deaths, four intrauterine fetal deaths (one with twin pregnancy) and two neonatal deaths (twin pregnancy) were reported in a non-consecutive case series of nine cases with severe COVID-19. In the case reports, two maternal deaths, one neonatal death and two cases of neonatal SARS-CoV-2 infection were reported.
CONCLUSIONS
Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good-quality data to draw unbiased conclusions with regard to the severity of the disease or specific complications of COVID-19 in pregnant women, as well as vertical transmission, perinatal and neonatal complications. In order to answer specific questions in relation to the impact of COVID-19 on pregnant women and their fetuses, through meaningful good-quality research, we urge researchers and investigators to present complete outcome data and reference previously published cases in their publications, and to record such reporting when the data of a case are entered into one or several registries. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Abortion, Spontaneous; Adult; Betacoronavirus; COVID-19; Cesarean Section; China; Coronavirus Infections; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Maternal Mortality; Pandemics; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; SARS-CoV-2
PubMed: 32430957
DOI: 10.1002/uog.22088 -
BMC Public Health May 2020Four million people living in the Indian Sundarbans region in the state of West Bengal face a particularly high risk of drowning due to rurality, presence of open water,...
BACKGROUND
Four million people living in the Indian Sundarbans region in the state of West Bengal face a particularly high risk of drowning due to rurality, presence of open water, lack of accessible health systems and poor infrastructure. Although the World Health Organization has identified several interventions that may prevent drowning in rural low-and middle-income country contexts, none are currently implemented in this region. This study aims to conduct contextual policy analysis for the development of a drowning program. Implementation of a drowning program should consider leveraging existing structures and resources, as interventions that build on policy targets or government programs are more likely to be sustainable and scalable.
METHODS
A detailed content review of national and state policy (West Bengal) was conducted to identify policy principles and/or specific government programs that may be leveraged for drowning interventions. The enablers and barriers of these programs as well as their implementation reach were assessed through a systematic literature review. Identified policies and programs were also assessed to understand how they catered for underserved groups and their implications for equity.
RESULTS
Three programs were identified that may be leveraged for the implementation of drowning interventions such as supervised childcare, provision of home-based barriers, swim and rescue skills training and community first responder training: the Integrated Child Development Scheme (ICDS), Self-Help Group (SHG) and Accredited Social Health Activist (ASHA) programs. All three had high coverage in West Bengal and considered underserved groups such as women and rural populations. Possible barriers to using these programs were poor government monitoring, inadequate resource provision and overburdening of community-based workers.
CONCLUSIONS
This is the first systematic analysis of both policy content and execution of government programs to provide comprehensive insights into possible implementation strategies for a health intervention, in this case drowning. Programs targeting specific health outcomes should consider interventions outside of the health sector that address social determinants of health. This may enable the program to better align with relevant government agendas and increase sustainability.
Topics: Drowning; Federal Government; Government Programs; Humans; India; Policy; Rural Population; State Government; Swimming
PubMed: 32414356
DOI: 10.1186/s12889-020-08868-2 -
Archives of Public Health = Archives... 2020Adolescent deliveries (10-19 years) carry a high risk of adverse outcomes due to the biological and physiological immaturity of these mothers. They pose a significant... (Review)
Review
BACKGROUND
Adolescent deliveries (10-19 years) carry a high risk of adverse outcomes due to the biological and physiological immaturity of these mothers. They pose a significant health burden in Cameroon, as it is reported that a high proportion of women attending delivery services are teenagers. We therefore sought to systematically assess the prevalence of adolescent deliveries in the country and its maternal and neonatal outcomes.
METHODS
This was a systematic review of literature and a meta-analysis. We searched MEDLINE, CINAHL and Global Health online databases for all studies that reported the proportion of adolescent women who presented for delivery in health facilities in Cameroon. All observational studies published up to 10th July 2019, were included.
RESULTS
A total of 47 articles were identified by the search. After removal of duplicates and screening of the titles and abstracts, 11 eligible studies were retained with ten articles meeting the inclusion criteria. These ten studies finally retained reported on nine different cohorts with a total of 99,653 women. The pooled prevalence of adolescent deliveries from the nine cohorts in Cameroon was 14.4% (95% CI: 10.7-18.6%), the prevalence for early adolescent deliveries was 2.8% (95% CI: 0.4-7.2%), meanwhile that for late adolescent deliveries was 12.5% (95% CI: 6.7-19.8%). The prevalence of adolescent deliveries in urban areas - 13.1% (95% CI: 7.8-19.6%) was similar to that in semi-urban areas- 14.1% (95% CI: 6.7-23.5%). Adolescents were more likely than adults (> 19 years) to have low birth weight babies (OR: 1.8; 95% CI: 1.6, 2.1); babies born with asphyxia (OR: 1.7; 95% CI: 1.3, 2.1); babies born before term (OR: 1.5; 95% CI: 1.1, 1.9) and babies who die in the neonatal period (OR: 2.1; 95% CI: 1.2, 3.8).
CONCLUSION
The prevalence of adolescent deliveries in Cameroon is high. Implementation of adolescent-friendly policies is necessary to reduce the proportion of adolescents who become pregnant in Cameroon.
PubMed: 32391147
DOI: 10.1186/s13690-020-00406-1 -
Heliyon Apr 2020Birth asphyxia leads to about 4 million neonatal deaths every year around the globe. But, the pooled prevalence of asphyxia was not yet collated in East and Central... (Review)
Review
BACKGROUND
Birth asphyxia leads to about 4 million neonatal deaths every year around the globe. But, the pooled prevalence of asphyxia was not yet collated in East and Central African countries. Hence, this systematic review and meta-analysis aimed to determine the pooled prevalence of perinatal asphyxia in Central and East Africa.
METHODS
PubMed, Google Scholar, Science Direct, Africa Index Medicus, Africa Journal Online, Excerpta Medica Database, and Cochrane Library databases were searched. All necessary data were extracted using a standardized data extraction format. Data were analyzed using STATA 14 statistical software. A heterogeneity of studies was assessed using the I statistics. Publication bias was checked by using a funnel plot and Egger's regression test. A random-effect model was computed to estimate the pooled prevalence of perinatal asphyxia.
RESULTS
Thirteen full-text studies were included in the present meta-analysis. The pooled prevalence of perinatal asphyxia in this study was 15.9% (95%CI: 10.8, 21.0% [I = 94.6, p = 0.000]). Regional subgroup analysis indicated that the pooled prevalence of perinatal asphyxia was 18.0 % (95%CI:11.4, 26.7% [I = 96.00, p = 0.000]) and 9.1 % (95%CI:2.0, 16.2% [I = 90.80, P = 0.000]) in East and Central African countries respectively. Similarly, the level of perinatal asphyxia was varied based on asphyxia measuring tools. But the trim fill analysis pointed that there was no difference in the pooled prevalence of perinatal asphyxia in this study.
CONCLUSION
The pooled prevalence of perinatal asphyxia was high in the current study. It had also substantial variation across the regions and measuring tools. Therefore, there is a call to reduce the high burden of this problem in the region.
PubMed: 32368646
DOI: 10.1016/j.heliyon.2020.e03793 -
American Journal of Obstetrics &... May 2020The aim of this systematic review was to report pregnancy and perinatal outcomes of coronavirus spectrum infections, and particularly coronavirus 2019 (COVID-19) disease... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this systematic review was to report pregnancy and perinatal outcomes of coronavirus spectrum infections, and particularly coronavirus 2019 (COVID-19) disease because of severe acute respiratory syndrome-coronavirus-2 infection during pregnancy.
DATA SOURCES
Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched electronically utilizing combinations of word variants for coronavirus or severe acute respiratory syndrome or SARS or Middle East respiratory syndrome or MERS or COVID-19 and pregnancy. The search and selection criteria were restricted to English language.
STUDY ELIGIBILITY CRITERIA
Inclusion criteria were hospitalized pregnant women with a confirmed coronavirus related-illness, defined as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), or COVID-19.
STUDY APPRAISAL AND SYNTHESIS METHODS
We used meta-analyses of proportions to combine data and reported pooled proportions, so that a pooled proportion may not coincide with the actual raw proportion in the results. The pregnancy outcomes observed included miscarriage, preterm birth, preeclampsia, preterm prelabor rupture of membranes, fetal growth restriction, and mode of delivery. The perinatal outcomes observed were fetal distress, Apgar score <7 at 5 minutes, neonatal asphyxia, admission to a neonatal intensive care unit, perinatal death, and evidence of vertical transmission.
RESULTS
Nineteen studies including 79 hospitalized women were eligible for this systematic review: 41 pregnancies (51.9%) affected by COVID-19, 12 (15.2%) by MERS, and 26 (32.9%) by SARS. An overt diagnosis of pneumonia was made in 91.8%, and the most common symptoms were fever (82.6%), cough (57.1%), and dyspnea (27.0%). For all coronavirus infections, the pooled proportion of miscarriage was 64.7% (8/12; 95% confidence interval, 37.9-87.3), although reported only for women affected by SARS in two studies with no control group; the pooled proportion of preterm birth <37 weeks was 24.3% (14/56; 95% confidence interval, 12.5-38.6); premature prelabor rupture of membranes occurred in 20.7% (6/34; 95% confidence interval, 9.5-34.9), preeclampsia in 16.2% (2/19; 95% confidence interval, 4.2-34.1), and fetal growth restriction in 11.7% (2/29; 95% confidence interval, 3.2-24.4), although reported only for women affected by SARS; 84% (50/58) were delivered by cesarean; the pooled proportion of perinatal death was 11.1% (5/60; 95% confidence interval, 84.8-19.6), and 57.2% of newborns (3/12; 95% confidence interval, 3.6-99.8) were admitted to the neonatal intensive care unit. When focusing on COVID-19, the most common adverse pregnancy outcome was preterm birth <37 weeks, occurring in 41.1% of cases (14/32; 95% confidence interval, 25.6-57.6), while the pooled proportion of perinatal death was 7.0% (2/41; 95% confidence interval, 1.4-16.3). None of the 41 newborns assessed showed clinical signs of vertical transmission.
CONCLUSION
In hospitalized mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, preterm birth is the most common adverse pregnancy outcome. COVID-19 infection was associated with higher rate (and pooled proportions) of preterm birth, preeclampsia, cesarean, and perinatal death. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy, although they should be interpreted with caution in view of the very small number of included cases.
Topics: Abortion, Spontaneous; COVID-19; Cesarean Section; Coronavirus Infections; Female; Fetal Growth Retardation; Fetal Membranes, Premature Rupture; Hospitalization; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Intensive Care Units, Neonatal; Middle East Respiratory Syndrome Coronavirus; Perinatal Death; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; Severe acute respiratory syndrome-related coronavirus; SARS-CoV-2; Severe Acute Respiratory Syndrome
PubMed: 32292902
DOI: 10.1016/j.ajogmf.2020.100107 -
Patient Safety in Surgery 2020Caesarean section rates have increased worldwide in recent decades. Caesarean section is an essential maternal healthcare service. However, it has both maternal and...
BACKGROUND
Caesarean section rates have increased worldwide in recent decades. Caesarean section is an essential maternal healthcare service. However, it has both maternal and neonatal adverse outcomes. Therefore this systematic review and meta-analysis aimed to estimate the prevalence, indication, and outcomes of caesarean section in Ethiopia.
METHODS
Twenty three cross-sectional studies with a total population of 36,705 were included. Online databases (PubMed/Medline, Hinari, Web of Science, and Google Scholar) and online university repository was used. All the included papers were extracted and appraised using the standard extraction sheet format and Joanna Briggs Institute respectively. The pooled prevalence of the caesarean section, indications, and outcomes was calculated using the random-effect model.
RESULT
The overall pooled prevalence of Caesarean section was 29.55% (95% CI: 25.46-33.65). Caesarean section is associated with both maternal and neonatal complications. Cephalopelvic disproportion [18.13%(95%CI: 12.72-23.53] was the most common indication of Caesarean section followed by non-reassuring fetal heart rate pattern [19.57% (95%CI: 16.06-23.08]. The common neonatal complications following Caesarean section included low APGAR score, perinatal asphyxia, neonatal sepsis, meconium aspiration syndrome, early neonatal death, stillbirth, and prematurity whereas febrile morbidity, surgical site infection, maternal mortality, severe anemia, and postpartum hemorrhage were the most common maternal complications following Caesarean section.
CONCLUSION
In this systematic review and meta-analysis, the rate of Cesarean section was high. Cephalopelvic disproportion, low Apgar score, and febrile morbidity were the most common indication of Caesarean section, neonatal outcome and maternal morbidity following Caesarean section respectively. Increasing unjustified Caesarean section deliveries as a way to increase different neonatal and maternal complications, then several interventions needed to target both the education of professionals and the public.
PubMed: 32292491
DOI: 10.1186/s13037-020-00236-8 -
BMC Pregnancy and Childbirth Apr 2020Gestational diabetes mellitus (GDM) is now a global health problem. Poor blood glucose control during pregnancy may lead to maternal and neonatal/foetal complications.... (Meta-Analysis)
Meta-Analysis
Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis.
BACKGROUND
Gestational diabetes mellitus (GDM) is now a global health problem. Poor blood glucose control during pregnancy may lead to maternal and neonatal/foetal complications. Recently, the development of information and communication technology has resulted in new technical support for the clinical care of GDM. Telemedicine is defined as health services and medical activities provided by healthcare professionals through remote communication technologies. This study aimed to update the systematic review of the effectiveness of telemedicine interventions on glycaemic control and pregnancy outcomes in pregnant women with GDM.
METHODS
We searched the Web of Science, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Wan-fang Database, China Biology Medicine and VIP Database for randomized controlled trials (RCTs) related to the effectiveness of telemedicine interventions for GDM from database inception to July 31st, 2019. Languages were limited to English and Chinese. Literature screening, data extraction and assessment of the risk of bias were completed independently by two reviewers. Meta-analysis and trial sequential analysis were conducted in Stata 14.0 and TSA v0.9.5.10 beta, respectively.
RESULTS
A total of 32 RCTs were identified, with a total of 5108 patients. The meta-analysis showed that telemedicine group had significant improvements in controlling glycated haemoglobin (HbA1c) [mean difference (MD) = - 0.70, P < 0.01], fasting blood glucose (FBG) (MD = -0.52, P < 0.01) and 2-h postprandial blood glucose (2hBG) (MD = -1.03, P = 0.01) compared to the corresponding parameters in the standard care group. In the telemedicine group, lower incidences of caesarean section [relative risk (RR) = 0.82, P = 0.02], neonatal hypoglycaemia (RR = 0.67, P < 0.01), premature rupture of membranes (RR = 0.61, P < 0.01), macrosomia (RR = 0.49, P < 0.01), pregnancy-induced hypertension or preeclampsia (RR = 0.48, P < 0.01), preterm birth (RR = 0.27, P < 0.01), neonatal asphyxia (RR = 0.17, P < 0.01), and polyhydramnios (RR = 0.16, P < 0.01) were found. The trial sequential analyses conclusively demonstrated that the meta-analytic results of the change in HbA1c, the change in 2hBG, the change in FBG, the incidence rates of caesarean section, pregnancy-induced hypertension or preeclampsia, premature rupture of membranes, premature birth, neonatal asphyxia, and polyhydramnios were stable.
CONCLUSIONS
Compared to standard care, telemedicine interventions can decrease the glycaemic levels of patients with GDM more effectively and reduce the risk of maternal and neonatal/foetal complications.
Topics: Adult; Blood Glucose; Cesarean Section; Diabetes, Gestational; Female; Fetal Macrosomia; Glycated Hemoglobin; Humans; Hypoglycemia; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Prenatal Care; Randomized Controlled Trials as Topic; Telemedicine
PubMed: 32252676
DOI: 10.1186/s12884-020-02892-1 -
BMC Pediatrics Mar 2020Despite different preventive strategies that have been implemented in different health institutions in the country, neonatal mortality and morbidity are still... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite different preventive strategies that have been implemented in different health institutions in the country, neonatal mortality and morbidity are still significantly increasing in Ethiopia. Perinatal asphyxia is the leading cause of neonatal morbidity and mortality worldwide. As a result, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of perinatal asphyxia in Ethiopia.
METHODS
Online databases (PubMed, HINARI, EMBASE, Google Scholar and African Journals), other gray and online repository accessed studies were searched using different search engines. Newcastle-Ottawa Quality Assessment Scale (NOS) was used for critical appraisal of studies. The analysis was done using STATA 11 software. The Cochran Q test and I test statistics were used to test the heterogeneity of studies. The funnel plot and Egger's test were used to detect publication bias of the studies. The pooled prevalence of perinatal asphyxia and the odds ratio (OR) with a 95% confidence interval was presented using forest plots.
RESULT
Nine studies were included in this review, with a total of 12,249 live births in Ethiopia. The overall pooled prevalence of perinatal asphyxia in Ethiopia was 24.06% (95 95%CI: 18.11-30.01). Associated factors of perinatal asphyxia included prolonged labor (OR = 2.79, 95% CI: 1.98, 3.93), low birth weight (OR = 6.52, 95% CI: 4.40, 9.65), meconium-stained amniotic fluid (OR = 5.91, 95% CI: 3.95, 8.83) and instrumental delivery (OR = 4.04, 95% CI: 2.48, 6.60) were the determinant factors of perinatal asphyxia in Ethiopia.
CONCLUSIONS
The overall pooled prevalence of perinatal asphyxia was remarkably high. Duration of labor, meconium-stained amniotic fluid, instrumental deliveries, and birth weight were the associated factors of perinatal asphyxia in Ethiopia. Therefore, efforts should be made to improve the quality of intrapartum care service to prevent prolonged labor and fetal complications and to identify and make a strict follow up of mothers with meconium-stained amniotic fluid. This finding is important to early recognition and management of its contributing factors, might modify hypoxic-ischemic encephalopathy and may improve the implementation of the standard guideline effectively and consistently.
Topics: Asphyxia Neonatorum; Cross-Sectional Studies; Ethiopia; Female; Humans; Infant, Newborn; Pregnancy; Prenatal Care
PubMed: 32209083
DOI: 10.1186/s12887-020-02039-3