Prevalence of neonatal near miss in Africa: a systematic review and meta-analysis

BACKGROUND Neonatal near miss (NNM) applies to cases where newborns almost died during the first 28 d of life but survived life-threatening conditions following birth. The most vulnerable time for infant survival is the neonatal stage, corresponding to almost 50% of deaths occurring at <5 y of age. No study indicates the overall pooled prevalence of NNM in Africa. Thus this review aimed to estimate the overall pooled prevalence of NNMs in Africa. METHODS Articles were retrieved through a comprehensive search strategy using PubMed/MEDLINE, Embase, Health InterNetwork Access to Research Initiative, Cochrane Library and Google Search. Data extraction was done independently by all authors. Forest plots and tables were used to represent the original data. The statistical heterogeneity was evaluated using I2 statistics. There was heterogeneity between the included articles. Therefore the authors used a meta-analysis of random effects to estimate the aggregate pooled prevalence of NNM in Africa. Funnel plot and Egger regression test methods were used to assess possible publication bias. R software version 3.5.3 and R studio version 1.2.5003 were used to analyse the data. The guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to publish this article. The review was registered on the International Prospective Register of Systematic Reviews (registration ID: CRD42021290223). RESULTS Through an exhaustive search, we found 835 articles. However, we considered only eight full-text articles to be included in this meta-analysis. The analysis of included studies showed that the overall pooled prevalence of NNM in Africa was 30% (95% confidence interval [CI] 16 to 44). The subgroup analysis by study year showed that the prevalence of NNM from 2012-2015 and 2018-2019 was 36% (95% CI 23 to 49) and 20% (95% CI 1 to 39), respectively. CONCLUSION This finding suggests that the pooled prevalence of NNM is high in Africa as compared with other studies. Therefore the government and other stakeholders working on maternal and child health should assist in the design of interventions and strategies for improving the quality of neonatal care.

[1]  E. Mayo-Wilson,et al.  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews , 2021, BMJ.

[2]  K. Jain,et al.  Near miss: determinants of maternal near miss and perinatal outcomes: a prospective case control study from a tertiary care center of India , 2021, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[3]  J. Browne,et al.  Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname , 2020, Journal of global health.

[4]  Mirella Bezerra Rodrigues Vilela,et al.  EARLY NEONATAL NEAR MISS IN A UNIVERSITY HOSPITAL: COMPARATIVE CROSS-SECTIONAL STUDY , 2020, Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo.

[5]  T. Tekelab,et al.  Incidence and determinants of neonatal near miss in south Ethiopia: a prospective cohort study , 2020, BMC Pregnancy and Childbirth.

[6]  C. Moyer,et al.  Neonatal near-misses in Ghana: a prospective, observational, multi-center study , 2019, BMC Pediatrics.

[7]  Mirella Bezerra Rodrigues Vilela,et al.  NEONATAL MORBIDITY NEAR MISS IN TERTIARY HOSPITALS IN A CAPITAL OF NORTHEAST BRAZIL , 2019, Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo.

[8]  L. Katz,et al.  Neonatal near miss determinants at a maternity hospital for high-risk pregnancy in Northeastern Brazil: a prospective study , 2018, BMC Pregnancy and Childbirth.

[9]  O. K. Ezeh.  Trends and population-attributable risk estimates for predictors of early neonatal mortality in Nigeria, 2003–2013: a cross-sectional analysis , 2017, BMJ Open.

[10]  E. Henning,et al.  A populational based study on the prevalence of neonatal near miss in a city located in the South of Brazil: prevalence and associated factors , 2017 .

[11]  K. Christensson,et al.  Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India , 2017, Global health action.

[12]  V. Filippi,et al.  Characteristics of neonatal near miss in hospitals in Benin, Burkina Faso and Morocco in 2012–2013 , 2016, Tropical medicine & international health : TM & IH.

[13]  Patrick Gerland,et al.  Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation , 2015, The Lancet.

[14]  A. Silva,et al.  Neonatal near miss: a systematic review , 2015, BMC Pregnancy and Childbirth.

[15]  A. Nakimuli,et al.  Still births, neonatal deaths and neonatal near miss cases attributable to severe obstetric complications: a prospective cohort study in two referral hospitals in Uganda , 2015, BMC Pediatrics.

[16]  Z. Bhutta,et al.  The post-2015 agenda: staying the course in maternal and child survival , 2015, Archives of Disease in Childhood.

[17]  E. Ota,et al.  Risk Factors and Adverse Perinatal Outcomes among Term and Preterm Infants Born Small-for-Gestational-Age: Secondary Analyses of the WHO Multi-Country Survey on Maternal and Newborn Health , 2014, PloS one.

[18]  A. Silva,et al.  Neonatal near miss in the Birth in Brazil survey. , 2014, Cadernos de saude publica.

[19]  C. Lockwood,et al.  JBI's Systematic Reviews: Study selection and critical appraisal. , 2014, The American journal of nursing.

[20]  R. Mori,et al.  Development of criteria for identifying neonatal near‐miss cases: analysis of two WHO multicountry cross‐sectional studies , 2014, BJOG : an international journal of obstetrics and gynaecology.

[21]  E. Abalos,et al.  Pre‐eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health , 2014, BJOG : an international journal of obstetrics and gynaecology.

[22]  L. Katz,et al.  Factors associated with severe maternal morbidity and near miss in the São Francisco Valley, Brazil: a retrospective, cohort study , 2014, BMC Pregnancy and Childbirth.

[23]  Strategies toward ending preventable maternal mortality ( EPMM ) , 2014 .

[24]  Millennium Development Goals report 2014. , 2014, Midwifery.

[25]  P. Tugwell,et al.  The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses , 2014 .

[26]  J. Bryce,et al.  The unfinished agenda in child survival , 2013, The Lancet.

[27]  Jan J Barendregt,et al.  Meta-analysis of prevalence , 2013, Journal of Epidemiology & Community Health.

[28]  C. Mathers,et al.  Levels and trends in child mortality. Report 2012. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. , 2012 .

[29]  J. Cecatti,et al.  Neonatal near miss approach in the 2005 WHO Global Survey Brazil. , 2010, Jornal de pediatria.

[30]  L. Say.  Neonatal near miss: a potentially useful approach to assess quality of newborn care. , 2010, Jornal de pediatria.

[31]  T. Avenant.  Neonatal near miss: a measure of the quality of obstetric care. , 2009, Best practice & research. Clinical obstetrics & gynaecology.

[32]  ASM Nawshad Uddin Ahmed,et al.  Clinical signs that predict severe illness in children under age 2 months: a multicentre study , 2008, The Lancet.

[33]  S. Cousens,et al.  4 million neonatal deaths: When? Where? Why? , 2005, The Lancet.

[34]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[35]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.