The impact of COVID-19 mitigation measures on neonatal health outcomes in sub-Saharan Africa: A systematic review and meta-analysis

Objectives: To assess the relationship between COVID-19 mitigation measures and stillbirth, low birth weight (LBW), and preterm birth (PTB) in sub-Saharan Africa. Study design: Systematic review/meta-analysis. Methods: We searched six databases for literature indexed from January 2020 to December 2022 for studies examining COVID-19 policies and neonatal outcomes in sub-Saharan Africa. These studies were assessed for their risk of bias and described via narrative synthesis. Meta-analysis with random effects was performed to generate risk ratios (RRs) that were stratified by study scope to explore heterogeneity. Results: Our search identified 515 unique studies, sixteen of which were included. Most studies were multi-/ single-center examinations (n = 7) and national/regional investigations (n = 6). The stillbirth RR suggested a marginal increase during mitigation measures (RR: 1.13; 95 % CI: 0.97, 1.31); however, among national/regional studies, there was no increase (RR: 0.96; 95 % CI: 0.82, 1.14). Similarly, the LBW RR suggested an increase during mitigation measures (RR: 1.18; 95 % CI: 0.90, 1.56), but the RR among national/regional investigations indicated no increase (RR: 0.97; 95 % CI: 0.91, 1.04). For PTB, the RR indicated no increase during mitigation measures (RR: 1.00; 95 % CI: 0.94, 1.07); there were no differences between multi-/single-center examinations and national/regional investigations. Conclusions: Our results suggest that outcome risk did not change after mitigation measures were imposed when focusing on national/regional investigations and provide insights for both African health officials and researchers.