Spatial variation, pooled prevalence, and its associated factor of perinatal mortality in Sub-Saharan Africa: Evidence from Demographic and Health Survey 2015-2023

Abstract

Introduction: Perinatal mortality is defined as stillbirths and deaths of newborn within the first week of life per 1,000 total births. Perinatal mortality remains a major public health challenge in Sub-Saharan Africa and its magnitude of the problem varies based on geographical location. However, there is limited study that describes spatial distribution and its determinants of perinatal mortality in Sub-Saharan Africa; as well as they have not incorporated all SSA countries. Hence, assessing pooled prevalence, spatial variation, and factors contributing to perinatal mortality is essential to identify the most affected community and for designing evidence-based health policies and programs. Objective: To assess pooled prevalence, geospatial variations, and its associated factor of perinatal mortality in Sub-Saharan Africa using Demographic and Health Survey data from 2015 to 2023. Method: A cross sectional study using Demographic and Health Survey datasets of 25 SubSaharan Africa countries with a total of 201,566 weighted women’s was used for this study. The analysis was performed by STATA17, GeoDa 1.14, SatScan 9.7 and ArcGIS Pro 3.1. The global spatial autocorrelation was explored using global Moran’s-I, and its spatial variation of perinatal mortality was examined using hot spot analysis (Local Getis-OrdGi* statistic). Spatial regression analyses (ordinary least squares, spatial error model, spatial lag model, geographically weighted regression and multiscale geographically weighted regression) were conducted. Models were assessed using AICc and adjusted R². A p-value threshold of 0.05 was set to identify statistically significant spatial predictors, and the corresponding local coefficients were illustrated on a map. Results: The pooled prevalence of perinatal mortality in SSA was 46.63 per 1000 total births (95% CI: 42.48, 51.17), and its spatial distribution was found to be clustered (Global Moran’s I = 0.18, P-value <0.01). Significant hotspot areas were located in Nigeria, Madagascar, Rwanda, Malawi, Burundi, Gambia, Uganda, Cotedvoir, Angola, Ethiopia, Burkina Faso, and Senegal, while significant cold spots were located in Kenya, Gabon, South Africa, Ghana, Mali, and Mauritania. The multiscale geographic weighted regression model explained 85% of the spatial variation of perinatal mortality in SSA. No antenatal care visit, birth interval less than 15 month, women undergoing cesarean section delivery, unemployed women and households without children were significant spatial predictors of perinatal mortality in SSA. Conclusion and Recommendation: Perinatal mortality in Sub-Saharan Africa was high and varied across regions. No antenatal care visit, birth interval less than 15 months, women undergoing cesarean section delivery, unemployed women and households without children were significant spatial predictors of perinatal mortality in Sub-Saharan Africa. Policymakers and other stakeholders, such as maternity and child health programs like World Health Organization, World Bank and other Non-Governmental Organizations could hold a geographic-based intervention, enhance antenatal care and family planning services, and empower women through employment opportunities to decrease perinatal mortality in the region.