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. 2025 Jul 15:13:1458871.
doi: 10.3389/fped.2025.1458871. eCollection 2025.

Incidence and predictors of mortality among low birth weight neonates in Africa: a systematic review and meta-analysis

Leweyehu Alemaw Mengstie #  1 , Wegayehu Zeneb Teklehaimanot #  1 , Mohammed Tesema Gebeyehu #  1 , Worku Abemie #  1 , Abatwoy Ayfokru #  1 , Yihenew Ayehu Dessie #  2 , Mitiku Tefera #  1 , Bekahegn Girma #  1
Affiliations

Incidence and predictors of mortality among low birth weight neonates in Africa: a systematic review and meta-analysis

Leweyehu Alemaw Mengstie et al. Front Pediatr. .

Abstract

Background: In Africa, the burden of low birth weight (LBW) neonatal mortality remains substantial, yet comprehensive evidence is lacking, with varied and inconclusive findings from primary studies. This systematic review and meta-analysis aimed to assess the pooled incidence and predictors of LBW neonatal mortality in Africa.

Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, EMBASE, Cochrane Library, African Journals Online, Web of Science, Google Scholar, and Google for relevant studies. The Newcastle Ottawa Scale was used to assess study quality. Heterogeneity and publication bias were evaluated using the I 2 statistic and Egger's test. A random-effects model was applied due to significant heterogeneity, with pooled incidence and 95% confidence intervals (CIs) calculated. Subgroup and sensitivity analyses explored sources of heterogeneity.

Results: This meta-analysis included 28 studies involving 56,775 LBW neonates. The pooled incidence of LBW neonatal mortality in Africa was 33.1% per 100 person-years (95% CI: 19.54-46.65), with substantial heterogeneity (I 2 = 99.9%, P < 0.001). Predictors associated with LBW neonatal mortality included extremely low birth weight (PHR = 4.37, 95% CI: 2.62-7.29), lack of antenatal care follow-up (PHR = 2.84, 95% CI: 1.21-6.67), perinatal asphyxia (PHR = 1.73, 95% CI: 1.38-2.16), necrotizing enterocolitis (PHR = 2.80, 95% CI: 2.03-3.86), preterm birth (PHR = 3.17, 95% CI: 1.88-5.35), respiratory distress syndrome (PHR = 1.87, 95% CI: 1.57-2.23), sepsis (PHR = 2.04, 95% CI: 1.59-2.63), lack of kangaroo mother care (PHR = 5.29, 95% CI: 2.76-10.16), maternal diabetes mellitus (PHR = 2.74, 95% CI: 1.87-4.01), and maternal HIV infection (PHR = 4.47, 95% CI: 2.06-9.67).

Conclusions: This study highlights a concerning high incidence of LBW neonatal mortality in Africa. Strategies targeting these predictors, such as improving antenatal care, promoting kangaroo mother care, and managing maternal health conditions like diabetes and HIV, could substantially reduce LBW neonatal mortality in the region. Policymakers and healthcare providers should prioritize these interventions to mitigate the high burden of LBW neonatal mortality and improve neonatal health outcomes across Africa.

Systematic review registration: identifier, CRD42024560375.

Keywords: Africa; incidence; low birth weight; meta-analysis; mortality; neonates; predictors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart diagram of the study selection.
Figure 2
Figure 2
Forest plot for the incidence of low birth weight neonatal mortality in Africa, 2024 (n = 28).
Figure 3
Figure 3
Forest plot for the overall prevalence of low birth weight neonatal mortality.
Figure 4
Figure 4
Funnel plot for the incidence of low birth weight neonatal mortality and its predictor in Africa.
Figure 5
Figure 5
Subgroup analysis by countries for the included studies to investigate the source of heterogeneity among studies conducted in Africa, 2024 (n = 28).
Figure 6
Figure 6
Sub group analysis by study design for the included studies to investigate the source of heterogeneity among studies conducted in Africa, 2024 (n = 28).
Figure 7
Figure 7
Sub group analysis by sampling technique for the included studies to investigate the source of heterogeneity among studies conducted in Africa, 2024 (n = 28).
Figure 8
Figure 8
Sensitivity analysis for studies included to estimate the pooled incidence of low birth weight neonatal mortality in Africa.
See this image and copyright information in PMC

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