Background
Methods
Reporting and protocol registration
Inclusion criteria
Exclusion criteria
Information sources and search strategies
Study selection
Risk of Bias assessment
Data extraction process
Data synthesis and analysis
Results
Selection of studies
Characteristics of included studies
Study ID | Author (year) | Region | Study Design | Sample Size | PMR per 1000 total births | SBR per 1000 births | ENM R per 1000 live births | IPI < 15 months with PM | IPI < 15 months without PM | IPI ≥ 15 months with PM | IPI ≥ 15 months without PM | OR [95% CI] |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Sahlemariam Y (1997) [36] | Addis Ababa | Follow up | 1606 | 106/1606 (66) | 38/1606 (23.7) | 68/1334 (50.9) | – | – | – | – | – |
2 | EDHS (2000) [32] | National | Cross sectional | 12,494 | 655/12494 (52) | 234/12494 (18.7) | 421/12260 (34) | – | – | – | – | – |
3 | EDHS (2005) [33] | National | Cross sectional | 11,280 | 420/11280 (37) | 117/11280 (10.4) | 303/10860 (27.9) | – | – | – | – | – |
4 | EDHS (2011) [2] | National | Cross sectional | 12,077 | 551/12077 (46) | 204/12077 (16.9) | 347/11873 (29) | – | – | – | – | – |
5 | Chekol A (2011) [26] | Benishangul | Cross sectional | 581 | 69/581 (118.8) | 56/581 (96.4) | 13/525 (24.8) | – | – | – | – | – |
6 | Assefa N (2012) [22] | Oromia | prospective follow up | 1438 | 27/1438 (18.8) | 27/1438 (18.8) | – | – | – | – | – | – |
7 | Wakgari N (2013) [41] | mixed (EDHS) | Cross sectional | 8651 | 343/8651 (39.6) | – | 343/8651 (39.6) | – | – | – | – | – |
8 | Andargie G (2013) [3] | Amhara | Prospective longitudinal | 1752 | 88/1752 (50.2) | 41/1752 (23.4) | 47/1711 (27.5) | 40 | 483 | 48 | 1881 | 2.04 [1.32; 3.14] |
9 | Worku A (2014) [44] | Amhara | Prospective Cohort | 727 | 36/727 (49.52) | 20/727 (27.5) | 16/707 (22.6) | – | – | – | – | – |
10 | Adane A (2014) [19] | Amhara | Cross sectional | 481 | 34/481 (70.7) | 34/481 (70.7) | – | – | – | – | – | – |
11 | Yaya Y (2014) [45] | SNNP | Cross sectional | 11,762 | 226/11762 (19.2) | 226/11762 (19.2) | – | – | – | – | – | – |
12 | Debelew G (2014) [28] | Oromia | Prospective follow up | 3510 | 123/3510 (35) | 47/3510 (13.4) | 76/3463 (21.9) | – | – | – | – | – |
13 | Abdo R (2016) [18] | SNNP | Cross sectional | 327 | 28/327 (85.6) | 28/327 (85.6) | – | – | – | – | – | – |
14 | Mengesha H (2016) [34] | Tigray | prospective cohort | 1152 | 50/1152 (43.4) | – | 50/1152 (43.4) | – | – | – | – | – |
15 | Shifa G (2016) [8] | SNNP | Cross sectional | 20,161 | 282/20161 (13.98) | – | 282/20161 (13.98) | – | – | – | – | – |
16 | Berhie K (2016) [25] | mixed | Cross sectional | 12,560 | 320/12560 (25.5) | – | 320/12560 (25.5) | – | – | – | – | – |
17 | Asefa D (2016) [21] | Oromia | Cross sectional | 9921 | 1080/9921 (108.9) | 852/9921 (85.9) | 232/9069 (25.6) | – | – | – | – | – |
18 | Aragaw Y (2016) [20] | Oromia | Cross sectional | 3786 | 372/3786 (98.3) | 268/3786 (70.8) | 104/3518 (29.6) | – | – | – | – | – |
19 | Ballard K (2016) [23] | mixed (Amhara and Oromia) | Cross sectional | 4358 | 95/4358 (21.8) | 95/4358 (21.8) | – | – | – | – | – | – |
20 | Yirgu R (2016) [12] | Amhara | Nested Case control | 4049 | 102/4049 (25.2) | 57/4049 (14.1) | 45/3992 (11.3) | 1 | 5 | 101 | 217 | 0.43 [0.05; 3.73] |
21 | Cherie N (2017) [27] | Amhara | Cross sectional | 462 | 21/462 (45.5) | 21/462 (45.5) | – | – | – | – | – | – |
22 | Dejene T (2017) [38] | Oromia | Cross sectional | 413 | 33/413 (79.9) | 33/413 (79.9) | – | – | – | – | – | – |
23 | Mihiretu A (2017) [35] | SNNP | Cross sectional | 300 | 52/300 (173.3) | 52/300 (173.3) | – | – | – | – | – | – |
24 | Lakew D (2017) [31] | Amhara | Cross sectional | 2555 | 218/2555 (85.3) | 218/2555 (85.3) | – | 104 | 793 | 43 | 1009 | 3.08 [2.13; 4.44] |
25 | Tsegaye B (2018) [40] | SNNP | Cross sectional | 580 | 16/580 (27.6) | – | – | – | – | – | – | – |
26 | Roro E (2018) [11] | Oromia | Nested Case control | 4383 | 73/4383 (16.7) | 26/4383 (5.9) | 47/4357 (10.8) | 15 | 18 | 58 | 128 | 1.84 [0.87; 3.9] |
27 | Goba G (2018) [1] | Tigray | unmatched case control | 265 | – | – | – | 42 | 39 | 49 | 135 | 2.97 [1.72; 5.12] |
28 | Getiye Y (2017) [29] | Addis Ababa | unmatched case control | 395 | – | – | – | 41 | 29 | 69 | 256 | 5.25 [3.04; 9.04] |
29 | Tilahun S (2008) [39] | Addis Ababa | unmatched case control | 343 | – | – | – | 27 | 27 | 93 | 196 | 2.11 [1.17; 3.79] |
30 | Tewabe T (2018) [37] | Amhara | Cross sectional | 391 | 43/391 (109.9) | 43/391 (109.9) | – | – | – | – | – | |
31 | Haftu A (2018) [30] | Tigray | prospective cohort | 1103 | 55/1103 (49.9) | 25/1103 (22.7) | 30/1078 (27.8) | – | – | – | – | – |
32 | Woldeamanuel B (2019) [42] | Mixed (EDHS) | Cross sectional | 2738 | 170/2738 (62.09) | 59/2738 (21.55) | 111/2679 (41.43) | – | – | – | – | – |
33 | Berhe T (2019) [24] | Tigray | cross sectional | 570 | 21/570 (36.8) | 21/570 (36.8) | – | – | – | – | – | |
34 | Worede D (2019) [43] | Amhara | unmatched case control | 420 | 49 | 98 | 35 | 238 | 3.4 [2.08; 5.57] |
Quality (risk of bias) assessment for the included studies
Pooled estimate of perinatal mortality rate
Sensitivity analysis
Subgroup analysis
Variables | Characteristics | Pooled perinatal mortality rate per 1000 total births (95% CI) | Tau2 |
---|---|---|---|
Year of publication | 1997–2000 | 57.9 (45.4–71.9) | 0.0003 |
2001–2014 | 43.6 (33.9–54.4) | 0.0015 | |
2015–2019 | 54.8 (36.9–76) | 0.0083 | |
Study place | Community | 35 (27–44.1) | 0.0022 |
Institution | 75 (58.6–93.2) | 0.0035 | |
Region | National DHS | 44.9 (36.7–53.9) | 0.0003 |
Addis Ababa | 66 (54.4–78.7) | Not applicable | |
Amhara | 59.1 (37.1–85.8) | 0.0045 | |
Benishangual | 118.8 (93.6–146.4) | Not applicable | |
Oromia | 53.2 (22–96.8) | 0.0107 | |
SNNP | 46.2 (28.6–67.6) | 0.0024 | |
Tigray | 49.1 (38.6–60.8) | 0.0005 | |
Mixeda | 28.6 (19.4–39.5) | 0.0007 | |
Study design | Cross-sectional | 58 (44.2–73.6) | 0.0051 |
Follow up | 43.4 (32.3–55.9) | 0.0013 | |
Nested Case Control | 20.7 (13.1–29.9) | 0.0004 | |
Study setting | Urban | 45.5 (15.5–90) | 0.0039 |
Rural | 20.5 (17.4–23.8) | 0.0001 | |
Both | 58.6 (45.7–72.8) | 0.0049 | |
Study outcome | Stillbirth | 51.4 (36.2–29) | 0.0035 |
ENM | 44.4 (21.6–74.8) | 0.0041 | |
Both(PM) | 52.7 (39.3–68) | 0.0039 |
Publication bias
Trend of perinatal mortality
Relationship between inter-pregnancy interval and perinatal mortality
Publication bias
P
= 0.313) (Fig. 6).
Key findings of the review
Variables | Effect sizes | 95% CI |
---|---|---|
Perinatal mortality rate | 51.3 per 1000 total births | 40.8, 62.8 |
Stillbirth rate | 36.9 per 1000 births | 27.3, 47.8 |
Early neonatal mortality rate | 29.5 per live births | 23.9, 35.6 |