Epidemiology of preterm birth in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Globally, complications of preterm birth are among the most common cause of neonatal mortality. In Ethiopia, the neonatal mortality reduction is not worthy of attention. Hence, this study reviewed the prevalence of preterm birth and factors associated with preterm birth in Ethiopia. METHODS: The review protocol of this study has been registered in PROSPERO (CRD42017077356). The PRISMA guideline was followed for this review. Studies that assessed the prevalence and/or associated factors of preterm birth in Ethiopia and published from Jan 01, 2009 to Dec 31, 2019 were considered. Studies were searched from the PubMed and Science Direct among medical electronic databases and Google Scholar. Random-effects model was used for detected heterogeneity among studies. Publication bias and sensitivity analysis were assessed. Pooled estimates with its 95% confidence interval were reported using forest plots. The quality of evidence from the review was assessed using GRADE approach. RESULTS: Twenty-two studies involving a total of 12,279 participants were included. The overall pooled prevalence of preterm birth in Ethiopia was 10.48% (95% CI: 7.98-12.99). Pooled odds ratio showed rural residence (AOR = 2.34, 95% CI: 1.35-4.05), being anemic (AOR = 2.59, 95% CI: 1.85-3.64), < 4 antenatal care visits (AOR = 2.34, 95%CI: 1.73-3.33), pregnancy induced hypertension (AOR = 3.49, 95% CI: 2.45-4.97), prelabor rapture of membrane (AOR = 4.42, 95% CI: 2.28-8.57), antepartum hemorrhage (AOR = 5.02, 95% CI: 2.90-8.68), multiple pregnancies (AOR = 3.89, 95% CI: 2.52-5.99), past adverse birth outcomes (AOR = 3.24, 95% CI: 2.53-4.15) and chronic illness (AOR = 4.89, 95%CI: 3.12-7.66) were associated with increased likelihood of preterm birth. Further, support during pregnancy was associated with reduced occurrence of preterm birth. CONCLUSION: The pooled national level prevalence of preterm birth in Ethiopia is high. Socio demographic, nutritional, health care, obstetric and gynecologic, chronic illness and medical conditions, behavioral and lifestyle factors are the major associated factors of preterm birth in Ethiopia. This evidence is graded as low grade. Thus, efforts should be intensified to address reported risk factors to relieve the burden of preterm birth in the study setting, Ethiopia.

Prevalence and associated factors of preterm birth in Ethiopia: systematic review and meta-analysis protocol.

INTRODUCTION: Preterm birth (PTB) complications are the leading cause of death among neonates globally. The reduction in neonatal mortality is not remarkable in Ethiopia. Therefore, this review will assess the magnitude and associated factors of PTB in Ethiopia. METHODS AND ANALYSIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline will be followed during the systematic review. We will include all observational studies published from 1 January 2009 to 31 December 2019 that examined the level and/or associated factors of any type of PTB among live births in Ethiopia. Inclusion criteria will be all live births, PTB defined as delivery before 37 weeks gestation. The primary outcome will be PTB <37 weeks, and secondary outcomes including PTB <34, <32 and <28 weeks will be analysed. PubMed and Science Direct databases as well as Google search engine and Google Scholar will be searched. The pooled prevalence of preterm and effect size of association for associated factors will be analysed using the Stata software V.14. The heterogeneity between studies will be measured by I2 statistics. A random-effects model will be used to estimate if heterogeneity detected. Publication bias will be assessed using a funnel plot. Subgroup analysis will be sought based on possible characteristics of the studies, specific morbidity (like pre-eclampsia, hypertension), type of PTB (spontaneous or iotrogenic) and quality of study (high-quality or low-risk). Meta-regression will be considered for major covariates (maternal age and maternal body mass index) related to PTB. Forest plots will be used to present the combined estimate with 95% CIs. The quality of evidence of the outcomes will be assessed with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. ETHICS AND DISSEMINATION: No ethical approval is necessary for this systematic review. The findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42017077356.