Magnitude of Perinatal Mortality in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Observational Studies

Background

In 2023, an estimated 2.3 million newborns died globally, nearly half of all under-five deaths. Although global perinatal mortality has declined, sub-Saharan Africa continues to carry a disproportionate burden. This study aimed to determine the magnitude and synthesize pooled estimates of predictors of perinatal mortality in sub-Saharan Africa.

Methods

We systematically searched PubMed, EMBASE, Scopus, CINAHL, ProQuest Global, IRIS, and Google Scholar for observational studies published in English between January 2000 and December 2024. Study quality and risk of bias were appraised independently using the JBI and STROBE checklists. Data were analysed in Stata 17. Heterogeneity was assessed with I² and Q-statistics, and random-effects models generated pooled estimates with 95% confidence intervals (CI). Publication bias could not be formally assessed due to the small number of studies per predictor.

Results

Fourteen studies met inclusion criteria. Most were of moderate to high quality, with confounding and incomplete follow-up being the most frequent risks of bias. Pooled odds ratios (ORs) showed significant associations between perinatal mortality and parity (3.96; 95% CI: 2.10– 7.47), rural residence (2.56; 95% CI: 1.68–3.91), referral status (6.90; 95% CI: 2.71–17.52), antepartum haemorrhage (7.28; 95% CI: 2.70–19.65), congenital anomalies (9.70; 95% CI: 3.50– 27.00), induced labour (2.19; 95% CI: 1.46–3.29), dystocia (3.86; 95% CI: 2.26–6.60), non-use of the partograph (3.86; 95% CI: 2.26–6.60), prematurity (2.77; 95% CI: 1.81–4.26), and low birthweight (3.04; 95% CI: 0.98–9.46). A history of perinatal mortality was also predictive (RR 3.37; 95% CI: 1.36–8.34). One unpooled study reported syphilis, Rhesus status, and foetal presentation as additional risks.

Conclusion

Sociodemographic factors, maternal and obstetric complications, and infections emerged as key predictors of perinatal mortality in sub-Saharan Africa. While most included studies were of moderate to high quality, residual bias related to confounding and follow-up was noted. These findings underscore the multifactorial nature of perinatal mortality and highlight the need for integrated maternal and newborn health interventions to accelerate progress toward global targets.

Systematic review registration: PROSPERO CRD42023437432