Preterm Neonatal Mortality and Its Associated Factors in Ethiopia: A Systematic Review and Meta‐Analysis

Background: Preterm neonatal mortality is the leading cause of death among children under 5 years of age globally, with the highest burden in low- and middle-income countries. Evidence on the national pooled prevalence of preterm neonatal mortality and its determinants in Ethiopia is limited. This study aimed to estimate the pooled prevalence of preterm neonatal mortality and identify its associated factors in Ethiopia. Methods: A comprehensive search was carried out in Web of Science, Scopus, PubMed, Google Scholar, and African Journals Online. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines were followed to report the review findings. Data were extracted using a standardized Excel spreadsheet, and the quality of the included studies was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis model was used to estimate the pooled prevalence with a 95% confidence interval (CI). Heterogeneity across studies was assessed using I² statistic, and subgroup analyzes were performed to explore potential sources of heterogeneity. Results: Thirty-one eligible articles were included in the analysis. The pooled prevalence of preterm neonatal mortality was 28.58% (95% CI: 23.08%-34.08%). Male sex (AHR = 1.26, 95% CI: 1.05-1.47), gestational age ≤ 32 weeks (AHR = 1.59, 95% CI: 1.02-2.16), lack of kangaroo mother care (AHR = 1.86, 95% CI: 1.05-2.67), asphyxia (AHR = 1.92, 95% CI: 1.48-2.35), a fifth-minute APGAR score < 7 (AHR = 1.78, 95% CI: 1.25-2.32), respiratory distress (AHR = 1.69, 95% CI: 1.50-1.87), hypothermia (AHR = 1.28, 95% CI: 1.01-1.55), and sepsis (AOR = 1.60, 95% CI: 1.07-2.14) were identified as risk factors for preterm neonatal mortality. In contrast, antenatal care utilization (AHR = 0.65, 95% CI: 0.36-0.94) and antenatal steroid exposure (AHR = 0.65, 95% CI: 0.31-0.99) were protective factors against preterm neonatal mortality. Conclusion: More than one in four preterm neonates died in Ethiopia. Several neonatal and clinical factors, including male sex, very low gestational age of 32 weeks or less, lack of kangaroo mother care, asphyxia, a low fifth-minute APGAR score, respiratory distress, hypothermia, and sepsis, were identified as significant predictors of preterm neonatal mortality and require timely intervention, appropriate medication, and close follow-up. Conversely, antenatal care utilization and antenatal steroid exposure were found to be protective factors, highlighting the importance of quality maternal and newborn care services.