Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis.

Neonatal birth trauma, although it has steadily decreased in industrialized nations, constitutes a significant health burden in low-resource settings. Keeping with this, we sought to determine the pooled cumulative incidence (incidence proportion) of birth trauma and identify potential contributing factors in low and middle-income countries. Besides, we aimed to describe the temporal trend, clinical pattern, and immediate adverse neonatal outcomes of birth trauma. We searched articles published in the English language in the Excerpta Medica database, PubMed, Web of Science, Google, African Journals Online, Google Scholar, Scopus, and in the reference list of retrieved articles. Literature search strategies were developed using medical subject headings and text words related to the outcomes of the study. The Joana Briggs Institute quality assessment tool was employed and articles with appraisal scores of seven or more were deemed suitable to be included in the meta-analysis. Data were analyzed using the random-effect Dersimonian-Laird model. The full search identified a total of 827 articles about neonatal birth trauma. Of these, 37 articles involving 365,547 participants met the inclusion criteria. The weighted pooled cumulative incidence of birth trauma was estimated at 34 per 1,000 live births (95% confidence interval (CI) 30.5 to 38.5) with the highest incidence observed in Africa at 52.9 per 1,000 live births (95% CI 46.5 to 59.4). Being born to a mother from rural areas (odds ratio (OR), 1.61; 95% CI1.18 to 2.21); prolonged labor (OR, 5.45; 95% CI 2.30, 9.91); fetal malpresentation at delivery (OR, 4.70; 95% CI1.75 to 12.26); shoulder dystocia (OR, 6.11; 95% CI3.84 to 9.74); operative vaginal delivery (assisted vacuum or forceps extraction) (OR, 3.19; 95% CI 1.92 to 5.31); and macrosomia (OR, 5.06; 95% CI 2.76 to 9.29) were factors associated with neonatal birth trauma. In conclusion, we found a considerably high incidence proportion of neonatal birth trauma in low and middle-income countries. Therefore, early identification of risk factors and prompt decisions on the mode of delivery can potentially contribute to the decreased magnitude and impacts of neonatal birth trauma and promote the newborn's health.

Ethiopians' knowledge of and attitudes toward epilepsy: A systematic review and meta-analysis.

Background: Epilepsy remains one of the world's most common neurological diseases, but it appears to be widely misunderstood, particularly in under-resourced countries like Ethiopia. Improving individuals' knowledge and attitude toward epilepsy is critical for reducing the multifaceted impacts of epilepsy. Therefore, in this study, we sought to estimate the pooled levels of good knowledge and a favorable attitude toward epilepsy and also identify the associated factors using available data collected from different segments of the population. Methods: Articles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 16 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. The random-effect meta-analysis model was used to estimate Der Simonian-Laird's pooled effect. Statistical heterogeneity of the meta-analysis was checked via Higgins and Thompson's I 2 statistics (0-100%), and Cochran's Q test at P < 0.10. Subgroups, based on the study regions, and sensitivity analyses were also performed. Publication bias was examined subjectively using funnel plots and objectively using the nonparametric rank correlation test of Begg and the regression-based test of Egger for small study effects with P < 0.05 considered to indicate potential publication bias. Furthermore, the Trim-and-fill method of Duval and Tweedie was used to explore sources of publication bias for the favorable level of attitudes toward epilepsy. Result: A total of 12 studies with 6,373 study participants and 10 studies with 5,336 study participants were included to estimate the pooled level of good epilepsy knowledge and favorable attitudes respectively. The overall estimated levels of good epilepsy knowledge and favorable attitudes toward epilepsy among Ethiopians were 47.37% [(95% CI: 35.00, 59.74), I 2 = 99.2, P < 0.001] and 46.83%[(95% CI: 32.75, 60.90), I 2 = 99.2, P < 0.001] respectively. Subgroup analysis revealed that the pooled level of good epilepsy knowledge was 48.51% [(95% CI: 38.95, 58.06), I 2 = 95.6%, P < 0.001] in the Amhara region. Conclusion: In the current review, we found out that there is a huge knowledge gap and an unfavorable level of attitudes towardepilepsy, which demand immediate public health action as well as a targeted policy intervention.

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis.

Background: Episiotomy, a surgical procedure that enlarges the vaginal opening during childbirth, was common practice until the early 2000s. Other sources, including the World Health Organization (WHO), advocate for the selective use of episiotomy. Episiotomy rates, on the other hand, have remained high in developing countries, while declining in developed countries. As a result, the current study sought to determine the overall prevalence of episiotomy in Africa as well as the risk factors associated with its practice. Methods: Articles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 14 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. A random-effects meta-analysis model was used to determine the pooled prevalence of episiotomy. A heterogeneity test was conducted using I-Squared (I 2) statistics. Egger's test and funnel plots were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI). Result: A total of 21 studies with 40,831 participants were included in the systematic review and meta-analysis. The pooled prevalence of episiotomy practice was 41.7% [95% CI (36.0-47.4), I 2 = 99.3%, P < 0.001). Primiparity [OR: 6.796 (95% CI (4.862-9.498)), P < 0.001, I 2: 95.1%], medical doctors- assisted delivery [OR: 3.675 (95% CI (2.034-6.640)), P < 0.001, I 2: 72.6%], prolonged second stage of labor [OR: 5.539 (95% CI (4.252-7.199)), P < 0.001, I 2: 0.0%], using oxytocin [OR: 4.207 (95% CI (3.100-5.709)), P < 0.001, I 2: 0.0%], instrument -assisted vaginal delivery [OR: 5.578 (95% CI (4.285-7.260)), P < 0.001, I 2: 65.1%], and macrosomia [OR: 5.32 (95% CI (2.738-10.339)), P < 0.001, I 2: 95.1%] were factors associated with episiotomy practice. Conclusion: In this review, the prevalence of episiotomy among African parturients was high. A selective episiotomy practice should be implemented to reduce the high episiotomy rates. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382, identifier: CRD42021293382.