Neonatal mortality and its association with antenatal care visits among live births in Ethiopia: a systematic review and meta-analysis

Background: Even though neonatal mortality is reduced from time to time, the problem is still prevalent in Ethiopia. Despite a few studies tried to show the extent of neonatal mortality in Ethiopia, the pooled estimation of neonatal mortality remains inconclusive and inconsistent. Thus, this systematic review and meta-analysis were intended to determine the pooled prevalence of neonatal mortality rate and its association with antenatal care visits in Ethiopia. Methods: Studies were retrieved through reputable search engines in; CINAHL, Embase, Medline, PubMed, Google Scholar, ISI Web of Science, ScienceDirect, and SCOPUS in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Newcastle-Ottawa Quality assessment tool for cross-sectional studies was used for critical appraisal of studies which were included. Risk of Bias in nonrandomized studies of Interventions (ROBINS-I) tool was also used to assess the risk of bias. Random-effects meta-analysis was used to estimate the level of pooled prevalence of neonatal mortality and its association with antenatal care visits at 95% confidence interval and with its respective odds ratio (OR). Meta-regression was also carried out to identify the potential source of heterogeneity. Begs and egger test followed by trim and fill analysis were used to determine publication bias. Subgroup analyses, based on study setting, were also carried out. Result: A total of 5839 articles were identified through searching, of which 11 articles representing participants were included in the final analysis. The average pooled prevalence of neonatal mortality in Ethiopia was 6.78% (CI: 4.45, 9.12). Subgroup analysis was undertaken and the pooled estimate of neonatal mortality among these communities based studies was 2.56% and in hospital-based study it was 11.8%. Neonatal mortality was more significant among mothers who had antenatal visits of less than three times during their pregnancy period with OR of 1.76 (95% CI: 1.42, 3.16). Conclusion: The pooled prevalence of neonatal mortality in Ethiopia was slightly low compared to the national 2016 demographic Health Survey of the country. Therefore, the government of Ethiopia should influence the health sector to give attention for increasing antenatal care visits and further research is needed to investigate further factors of neonatal mortality.