A decade of perinatal mortality in Pakistan: Systematic review of patterns and challenges (2013-2022)

Abstract

Background: The World Health Organization (WHO) defines perinatal mortality (PNM) as the "death of a baby between 28 weeks of gestation onwards till the first 7 days of life." PNM is a key indicator of the quality of care for newborns and directly reflects the category of prenatal, intrapartum, and postpartum care given to a newborn. According to a report published by the WHO, 2.3 million children died within their first 20 days of life in 2022. Approximately 6500 newborn deaths occur every day, accounting for 47% of all child deaths under the age of five years. PNM is a public health concern in low and middle-income countries. According to the Pakistan Health and Demographic Survey 2017-18, the PNM rate has remained consistently high in Pakistan (75 per 1000 births) during the last decade.

Aims: To observe the frequency of PNM and early neonatal mortality (ENM) among the Pakistani population within the last decade and to identify additional risk factors for PNM and ENM.

Methods: Published studies were searched using keywords comprising PNM, ENM, stillbirths, risk rate, perinatal period, and their combinations with search engines such as Science Direct, SCOPUS, PubMed, and Google Scholar. We followed Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines to filter articles and selected 18 relevant articles for systematic review. All studies reported either the PNM, ENM, stillbirth, or live birth rate.

Results: Systematic review showed that the PNM rate in Pakistan remained high from 2013 to 2022. Hypertensive disorders, antepartum hemorrhage, and neonatal infections increased the overall risk of PNM and ENM. Other factors that contributed to the high PNM rate were advanced maternal age, low birth weight, congenital abnormalities, multigravida, poor socioeconomic conditions, and other medical problems such as gestational diabetes.

Conclusion: The PNM rate in Pakistan was found to be high according to the systematic review, but discrepancies were observed when compared with the WHO figures for PNM. We recommend conducting more original research to accurately assess the PNM rate in Pakistan, which is essential for informed and effective policy making.

Keywords: Live birth; Neonatal mortality; Perinatal mortality; Stillbirth.

Figure 1

PRISMA flowchart showing the process followed to identify articles for inclusion in the review.