Magnitude of Perinatal Mortality in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Observational Studies

Background : In 2023, an estimated 2.3 million newborns died globally, accounting for nearly half of all under-five deaths. Global estimates reveal a gradual reduction in perinatal mortality; however, sub-Saharan Africa continues to bear a disproportionate burden compared to other regions. This study aimed to determine the magnitude and synthesize pooled estimates of predictors of perinatal mortality in sub-Saharan Africa. Methods: We systematically searched PubMed, EMBASE, Scopus, CINAHL, ProQuest Global, IRIS, and Google Scholar for observational studies published in English between January 2000 and December 2024. Study quality was appraised using STROBE and JBI checklists. Data were analysed in Stata 17, with heterogeneity assessed using I² and Q-statistics. Random-effects models generated pooled estimates with 95% confidence intervals (CI). Publication bias could not be formally assessed due to the small number of studies per predictor. Results: Fourteen studies were included. Pooled odds ratios (ORs) indicated significant associations between perinatal mortality and parity (3.96; 95% CI: 2.10–7.47), rural residence (2.56; 95% CI: 1.68–3.91), referral status (6.90; 95% CI: 2.71–17.52), antepartum haemorrhage (7.28; 95% CI: 2.70–19.65), congenital anomalies (9.70; 95% CI: 3.50–27.00), induced labour (2.19; 95% CI: 1.46–3.29), dystocia (3.86; 95% CI: 2.26–6.60), non-use of the partograph (3.86; 95% CI: 2.26–6.60), prematurity (2.77; 95% CI: 1.81–4.26), and low birthweight (3.04; 95% CI: 0.98–9.46). History of perinatal mortality was also strongly predictive (RR 3.37; 95% CI: 1.36–8.34). One study not pooled identified additional risks including syphilis, Rhesus status, and foetal presentation. Conclusion: This review identified sociodemographic factors, maternal and obstetric complications, and infections as key predictors of perinatal mortality in sub-Saharan Africa. The findings underscore the multifactorial nature of perinatal mortality and highlight the need for integrated interventions—spanning antenatal, intrapartum, and neonatal care, together with efforts to address underlying social determinants—to reduce preventable deaths and accelerate progress toward global maternal and newborn health targets.