Prevalence of neonatal necrotizing enterocolitis and predictors in Ethiopia: a systematic review and meta-analysis

Abstract Neonatal death in sub-Saharan African countries accounts for 80% of the global burden. An estimated 30 deaths per 1000 live births occurred in Ethiopia in 2019. Neonatal necrotizing enterocolitis (NEC) is the most common contributing factor to these deaths. Nevertheless, there is no strong evidence of neonatal NEC in Ethiopia. Therefore, this study aimed to determine the pooled prevalence of neonatal NEC and its predictors among neonates admitted to neonatal intensive care units in Ethiopia. Databases (Scopus, CINAHL, CAB Abstract, Embase, PubMed, Web of Science, Google and Google Scholar) and lists of references were used to search literature in Ethiopia. Stata version 17 (StataCorp, College Station, TX, USA) was used for analysis and the odds ratios (ORs) of the outcome variable were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for I2 and p-values. Also, sensitivity analysis and funnel plots were used to assess the stability of pooled values to outliers and publication bias. A total of 12 studies with a sample size of 7675 were included in this study. The overall prevalence of neonatal NEC was 16% (95% confidence interval 11 to 22). Meta-analyses and sensitivity analyses showed the stability of the pooled ORs and the funnel plots did not show publication bias. Preterm birth, very low birth weight and duration of stay in a neonatal intensive care unit (NICU) were identified as predictors of neonatal NEC. In Ethiopia, one in six (16%) neonates admitted to NICUs had NEC, with preterm birth, very low birth weight and duration of stay in the NICU identified as key predictors. Moreover, these findings imply the need for targeted interventions to reduce the risk of this condition in vulnerable neonates using large-scale prevention strategies through high-quality healthcare for mothers and children.