Journal of General Practice

Stillbirth and its Association with Early Rupture of Membranes in Sub-Saharan Africa: Systematic Review and Meta-Analysis

Abstract

Telksew Yelma Yezengaw*, Tariku Dingeta Amante, Tesfaye Assebe Yadeta and Biruk Shalmeno Tusa

Background: Stillbirth rate is an important indicator of access to quality antenatal and delivery care services. Many previous pocket studies were conducted to assess the magnitude of stillbirth and its association with premature rupture of membrane. However, the level of stillbirth, as well as its relationship with Premature Rupture of Membrane (PROM) varies from study to study. Objectives: This systematic review and meta-analysis was conducted to estimate the pooled prevalence of stillbirth and its association with the early rupture of membranes in sub-Saharan Africa. Search strategy: Electronic databases such as PubMed Central PMC, Cochrane library, Medline via Virtual Health Library (VHL), HINARI (Health Inter Network Access to Research Initiative) portal, and Google scholar were used for searching for original articles. Selection criteria: All Published and unpublished observational studies (prospective and retrospective cohort studies, case-control studies, and cross-sectional studies) that deal with stillbirth and their association with early rupture of membranes in sub-Saharan African women were included. Data collection and analysis: The extracted data analyses were done using STATA (version.16.0) software. Texts, figures, and tables were used to describe the included original articles. The heterogeneity of the studies was checked by I-squared statistics. A Random-effects method was applied to estimate the pooled prevalence of stillbirth and the effect size of the early rupture of membranes in sub-Saharan Africa. Subgroup analysis was performed based on region (East, West, Central, and Southern Africa) and year of study (before 2015 and after 2015). A funnel plot and Egger’s regression test was used to see publication bias. Main result: Pooled prevalence of stillbirth in sub-Saharan Africa was 6.4% (95% CI: 5.5-7.3). In sub-group analysis, Southern African regions had a higher stillbirth prevalence and the western African regions had a lower than East and Southern Africa. The prevalence of stillbirth in the region is increased from 4.1% (95% CI: 2.2–6.0) before 2015 to 7.1%(95% CI: 5.8-8.3) after 2015. The pooled odds ratio results from seven studies showed the non-significant effect of early rupture of membrane on stillbirth (pooled OR=1.54, 95% CI: 0.26-2.82). According to the regression test (Egger test), there was no small study effects or publication bias (P=0.108). Conclusions: The pooled prevalence of stillbirth in sub-Saharan Africa was relativity high. The analysis establishes the minimal effects of early rupture of membrane on stillbirth. Therefore, we recommend that strengthening the testing intervention is crucial to reduce the still relatively high stillbirths. Funding: No fund was received for this work.