BMJ open · 2026
Causes of and risk factors for asphyxia neonatorum in sub-Saharan Africa: a study protocol for systematic review and meta-analysis.
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Otile Jacob, Atwebembere Raymond, Tukakira John, Kizito Benjamin Birungi, Ditai James
Аннотация
INTRODUCTION: Asphyxia neonatorum (AN) is a leading cause of neonatal morbidity and mortality worldwide, accounting for nearly one quarter of the 2.3 million neonatal deaths reported in 2023. The burden is disproportionately high in sub-Saharan Africa (SSA), where neonatal mortality rates linked to AN exceed global averages. Despite numerous studies, evidence on the underlying causes and risk factors of AN in SSA remains fragmented and inconsistently reported. A clear distinction between causes and risk factors is essential to inform prevention, diagnosis and management strategies for AN in this region.
METHODS: We will conduct a systematic review and meta-analysis to identify and synthesise evidence on the causes of and risk factors for AN in SSA. Eligible studies will include observational (cross-sectional, case-control, cohort) and interventional designs, and programme evaluation studies that report primary data on neonates with AN, as well as relevant maternal, perinatal and health system determinants. Searches will be conducted in electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL, CENTRAL, Hinari, Global Index Medicus, African Journals Online) supplemented by grey literature from 1990 to June 2025. No language restriction will be applied. More than two reviewers will independently screen studies, extract data and assess methodological quality using the Mixed Methods Appraisal Tool (MMAT). Where at least two studies report comparable data on the same outcome or risk factor, we will perform meta-analyses to estimate pooled prevalence, effect sizes for risk factors and the relative contribution of different causes. We will explore heterogeneity using subgroup analyses and sensitivity testing, and assess the certainty of evidence with Grading of Recommendations Assessment, Development and Evaluation.
ETHICS AND DISSEMINATION: Ethical approval is not required as this review will synthesise published data. Findings will be disseminated through peer-reviewed publications, conference presentations and engagement with policymakers and neonatal health stakeholders in SSA, including at the planned Birth Asphyxia Symposium in Kigali, Rwanda 2027.
TRIAL REGISTRATION NUMBER: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251118757) and reported in accordance with the ‘Preferred Reporting of Items for Systematic Reviews and Meta-Analyses Protocols’ (PRISMA-P) 2015 guidelines.
METHODS: We will conduct a systematic review and meta-analysis to identify and synthesise evidence on the causes of and risk factors for AN in SSA. Eligible studies will include observational (cross-sectional, case-control, cohort) and interventional designs, and programme evaluation studies that report primary data on neonates with AN, as well as relevant maternal, perinatal and health system determinants. Searches will be conducted in electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL, CENTRAL, Hinari, Global Index Medicus, African Journals Online) supplemented by grey literature from 1990 to June 2025. No language restriction will be applied. More than two reviewers will independently screen studies, extract data and assess methodological quality using the Mixed Methods Appraisal Tool (MMAT). Where at least two studies report comparable data on the same outcome or risk factor, we will perform meta-analyses to estimate pooled prevalence, effect sizes for risk factors and the relative contribution of different causes. We will explore heterogeneity using subgroup analyses and sensitivity testing, and assess the certainty of evidence with Grading of Recommendations Assessment, Development and Evaluation.
ETHICS AND DISSEMINATION: Ethical approval is not required as this review will synthesise published data. Findings will be disseminated through peer-reviewed publications, conference presentations and engagement with policymakers and neonatal health stakeholders in SSA, including at the planned Birth Asphyxia Symposium in Kigali, Rwanda 2027.
TRIAL REGISTRATION NUMBER: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251118757) and reported in accordance with the ‘Preferred Reporting of Items for Systematic Reviews and Meta-Analyses Protocols’ (PRISMA-P) 2015 guidelines.