Mercy Wamunyima Monde

Background: A lot of unborn and newly born babies continue to die during pregnancy, childbirth and in the first week of life. Over 5,1 million stillbirths and neonatal deaths occur globally each year with 98% of these in low-middle-income countries. Since the Millennium Development Goals (MDG) era, global perinatal mortality reduced from 5.7 million in 2000 to 4.1 million by 2015. The global stillbirth rate which averaged 24.7 in 2000 declined to 18.4 per 1000 live births by 2015. Neonatal mortality rate equally showed a downward trend from 37 in 1990 to 19 deaths per 1000 live births by 2016. In spite of this, sub-Saharan Africa (SSA) has continued to record the highest rate as 2% of the 45% data collected is in high income countries. The average perinatal mortality rate is at 30.3 per 1000 live births with Ethiopia reportedly highest at 49. The main aim of this study is to determine the magnitude of perinatal mortality in SSA since 2000. Methods: The databases searched are EMBASE, Scopus, and CINAHIL the followed by grey literature sources including ProQuest Global Thesis, and Dissertation, and Google Scholar. The articles for the publications made from January 2000 to December, 2023. Quality of the articles check was with Joanna Briggs Institute quality assessment tool. Three reviewers screened all retrieved articles, extracted, and then critically appraised all identified studies. Stata software version 17 will be used. Discussion: The review will provide a detailed summary of the magnitude of perinatal mortality in SSA since 2000. The review will synthesis available observational studies on perinatal mortality to identify pooled estimates. Systematic review registration: PROSPERO CRD42023437432

Background: In 2023, an estimated 2.3 million newborns died globally, nearly half of all under-five deaths. Although global perinatal mortality has declined, sub-Saharan Africa continues to carry a disproportionate burden. 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 and risk of bias were appraised independently using the JBI and STROBE checklists. Data were analysed in Stata 17. Heterogeneity was assessed with I² and Q-statistics, and 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 met inclusion criteria. Most were of moderate to high quality, with confounding and incomplete follow-up being the most frequent risks of bias. Pooled odds ratios (ORs) showed 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). A history of perinatal mortality was also predictive (RR 3.37; 95% CI: 1.36–8.34). One unpooled study reported syphilis, Rhesus status, and foetal presentation as additional risks. Conclusion: Sociodemographic factors, maternal and obstetric complications, and infections emerged as key predictors of perinatal mortality in sub-Saharan Africa. While most included studies were of moderate to high quality, residual bias related to confounding and follow-up was noted. These findings underscore the multifactorial nature of perinatal mortality and highlight the need for integrated maternal and newborn health interventions to accelerate progress toward global targets. Systematic review registration: PROSPERO CRD42023437432

Barriers to successful implementation of the human papillomavirus vaccination exist. However, there is limited evidence on implementation strategies in sub-Saharan Africa (SSA). Therefore, this scoping review aimed to identify implementation strategies used in SSA to increase HPV vaccination uptake for adolescent girls. This scoping review was guided by Joanna Briggs Institute guidelines for scoping reviews and an a priori protocol and reported based on the Preferred Reporting Items for Systematic Reviews and Metanalysis for Scoping Reviews (PRISMA-ScR). We searched PubMed, EMBASE, CINAHL, Scopus, Google Scholar, and gray literature. Two independent reviewers screened article titles and abstracts for possible inclusion, reviewed the full text, and extracted data from eligible articles using a structured data charting table. We identified strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and reported their importance and feasibility. We retrieved 246 articles, included 28 of these, and identified 63 of the 73 ERIC implementation strategies with 667 individual uses, most of which were highly important and feasible. The most frequently used discrete strategies included the following: Build a coalition and change service sites 86% (24/28), distribute educational materials and conduct educational meetings 82% (23/28), develop educational materials, use mass media, involve patients/relatives and families, promote network weaving and stage implementation scale up 79% (22/28), as well as access new funding, promote adaptability, and tailor strategies 75% (21/28). This scoping review shows that implementation strategies of high feasibility and importance were frequently used, suggesting that some strategies may be cross-cutting, but should be contextualized when planned for use in any region.