Course: - ADVANCED EPIDEMIOLOGY
Review protocol: Survival status and predictors of neonatal mortality among
neonates admitted to neonatal intensive care unit in hospitals found in Ethiopia
By: -
Wubtaye Hailu
ID number: - pgw/81255/15, Epidemiology and Biostastics (weekned)
Submitted to: Dr. Eskinder W.(PhD)
October 14, 2023
Wolaita Sodo, Ethiopia
Table of Contents
1. Background .................................................................................................................. - 1 -
2. Objective ....................................................................................................................... - 2 -
3. Review questions ........................................................................................................ - 2 -
4. Methods ......................................................................................................................... - 2 -
4.1. Search strategy ............................................................................................................. - 2 -
4.2. Criteria for considering studies for this review ............................................................- 3 -
4.3. Additional limits ...........................................................................................................- 3 -
4.4. Quality control and assessment .................................................................................... - 4 -
4.5. Data collection and management ................................................................................. - 4 -
4.6. Data extraction (selection and coding) .........................................................................- 4 -
4.7. Strategy for data synthesis ............................................................................................- 5 -
4.8. Dissemination ...............................................................................................................- 5 -
5.Time frame ........................................................................................................................- 5 -
6. Reference ..........................................................................................................................- 6 -
Survival status and predictors of neonatal mortality among neonates
admitted to NICU in hospitals found in Ethiopia: Review protocol of
systematic review and meta-analysis.
1. Background
Neonatal period is one of the most vulnerable and greatest risky periods in human life. Neonatal
mortality (NM) is defined as the death of a baby during the neonatal period (within the first 28
days of life) (1,2). The Global Health Observatory (GHO) by WHO in 2016 showed 2.6 million
neonatal deaths annually. Of these deaths, 1 million neonates died on the first day they were born,
and nearly 1 million died within the next 6 days (3). Among the 20 countries with the highest
risk of neonatal death worldwide, 15(75%) are in Africa (4). Although developing countries have
been given highest priority to achieve the global target of less than ten deaths per 1000 live births
by 2035; it is projected that the sub-Saharan Africa will have 33% of births and 60% of deaths in
2030(5,6). A decrement in neonatal death from 39 to 29 was observed between the 2005 and
2016 Ethiopian demographic health survey (EDHS) (7,8), but it has remained high since 2016
(EPHIEE, 2019).
Neonatal mortality mainly occurs as a result of preventable or treatable causes and conditions
such as; prematurity, birth asphyxia, and sepsis, are the three areas that can be mitigated by the
presence of a skilled clinicians at the time of delivery (1). The risk factors of NM greatly varied
from institution to institution in different studies, both in Ethiopia and abroad. Many literature
studies on the predictors of NM in Ethiopia also reported inconsistent results.
Thus, researches are critical to tackle it factors that predict neonatal mortality. Therefore, the
current study intended to determine the survival status and predictors of neonatal mortality
among neonates admitted in Neonatal Intensive Care Units of hospitals Ethiopia.
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2. Objective
The objective is to consolidate the factors that predict neonatal mortality among those neonates
admitted to neonatal intensive care unit in hospitals found. Besides, this review will be it
intended to determine their survival status.
3. Review questions
Survival status and predictors of neonatal mortality among neonates admitted NICU in hospitals found
in Ethiopia.
Population Include: All mothers and their neonates (newborns less 28 days of age) admitted
to neonatal intensive care unit in Ethiopia context.
Intervention Supplemented with neonatal resuscitation and other neonatal intensive care
support; including antibiotics, oxygen.
Comparison Those delivered at hospital and discharged to home without need for admission at
neonatal intensive care unit
Outcomes The survival time of neonates admitted to neonatal intensive care unit.
Factors that predict their mortality.
4. Methods
4.1. Search strategy
An appropriate and comprehensive search strategy with relevant search terms for all data sources
mentioned will be developed and pilot tested before final search.
Electronic searches: i will search PubMed, EMBASE, Web of Science, SCOPUS, CINAHL,
Ovid MEDLINE, Pro Quest, and WHO IMSEAR (WHO Index Medicus South East Asian
Region). The following search terms will be used (“predictors” OR “factors”) AND (“neonatal
death” and “survival status” OR “survival time”).
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Hand searching: Hand searching will be conducted for (a) journal volumes which are not
included in electronic databases.
Searching the grey literature: Potential sources of grey literature will include Shodhganga
(INFLIBNET) and Government of Ethiopia databases.
Reference lists: Snowballing will be performed to screen the references of identified literature
for potentially relevant studies. Additionally, experts, authors, researchers and relevant
organizations of identified studies will be contacted to suggest other existing relevant studies.
4.2. Criteria for considering studies for this review
4.2.1. Inclusion criteria
Published studies conducted on neonates admitted to neonatal intensive care unit in Ethiopia
context (irrespective of the diagnosis made during admission) will be eligible for inclusion.
Studies should have been published in English in indexed and peer-reviewed journals between
2007- October 2016 E.C. Eligible study designs include (a) analytic study designs (case-control
studies, cohort studies, analytical cross-sectional studies) and (b) descriptive studies (cross-
sectional studies), reports of secondary data analyses, outcome studies, and fact sheets which
report a quantitative analysis of factors associated with mortality in neonates admitted to NICU.
4.2.2. Exclusion criteria
Studies will be excluded if they are letters, editorials, commentaries, reviews, meta-analysis,
qualitative research, conference papers, reports which do not include a quantitative analysis of
factors associated with neonatal mortality and the survival time. Besides, case series and case
report study designs are also excluded.
4.3. Additional limits
This review will not include case series and case reports studies on survival status and neonatal
death.
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4.4. Quality control and assessment
The methodological quality of the systematic review will be evaluated using the ‘A
Measurement Tool to Assess Systematic Reviews’ (AMSTAR) criteria. The ‘Grading of
Recommendations Assessment, Development and Evaluation’ (GRADE) assessment for the
quality of evidence produced by systematic reviews, and a summary of findings table will be
reported using GRADE Pro.
4.5. Data collection and management
Endnote (version x7) will be used for Study selection and management of searched results. Data
will be extracted on Microsoft Excel 2007. Statistical analysis will be performed using STATA
(version 14).
4.6. Data extraction (selection and coding)
Studies will be reviewed based on the exclusion and inclusion criteria, by two authors
independently in three stages. During the first stage of title screening, titles of the studies
identified from the search will be assessed for inclusion. If both authors reject a title, it will be
excluded from the review. Titles approved by either author will move to abstract screening. In
the next stage of abstract screening, abstracts of these selected titles that are approved by either
author will be included for the final stage of full text screening. If both authors reject a study at
this stage, it will be excluded from the review. In the third stage of full text screening, full texts
of abstracts selected in the previous stage will be screened for eligibility. Only those studies
approved by both authors will be included in the review. In the event of any disagreements, a
third author and senior review authors will arbitrate and a consensus will be reached on the
inclusion of the study. Rationale for exclusion will be provided for all studies which get excluded
through this process.
A final list of articles will be prepared for data extraction. A PRISMA chart will be created, to
outline and summarize this study selection process
The data to be extracted includes: details of the intervention, the study design, descriptive
statistics of the groups in the study (age, gender, etc.), the primary outcomes of the included
studies, and the results.
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4.7. Strategy for data synthesis
The data from the results of each included study will be extracted into defined data extraction
spreadsheets. The results will be synthesized in a narrative manner in the results and interpreted
in the discussion sections. Based on the included manuscripts in the final library, the plausibility
of a meta-analysis will be assessed depending on the variation of the included data presented.
4.8. Dissemination
The findings of the study will be shared with all stakeholders of this research. Knowledge
dissemination workshops will be conducted with relevant stakeholders to transfer the evidence,
tailored to the stakeholder.
5.Time frame
Activities to be done Completed date Lead reviewer
Draft protocol for internal and 2 weeks Advisors and senior researcher
external review
Searching and study selection 3 weeks Authors
Data extraction 8 weeks Authors
Quality assessment 4 weeks Authors
Draft report for peer review 2 weeks Authors
Submit for publication and 1 week Authors and advisors
Celebrate publication
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6. Reference
1. UNICEF, state of world’ children, 2009. Newyork: UNICEF;2008
2. Elias Merdassa Roro, Meseret Itana Tumtu1,, Dejene Seyoum Gebre Predictors, causes, and
trends of neonatal mortality at Nekemte Referral Hospital, east Wollega Zone, western Ethiopia
(2010–2014). Retrospective cohort study,October 9, 2019.
3. Global Health Observatory (GHO) Data, WHO, 2016. Available from
4. Mihiretu A, Negash T, Elazar T. Perinatal death and associated factors in Wolaita Sodo
referral hospital, southern Ethiopia: a facility based cross-sectional study. Prim Health Care.
2017;7(2):1-5.
5. Ndombo PK, Ekei QM, Tochie JN, Temgoua MN, Angong FTE, Ntock FN, et al. A cohort
analysis of neonatal hospital mortality rate and predictors of neonatal mortality in a sub-urban
hospital of Cameroon. Ital J Pediatr. 2017;43(1):1–8.
6. Liu L, et al. Global, regional, and national causes of child mortality in 2000- 13, with
projections to inform post-2015 priorities: an updated systematic analysis. Lancer. 2015 Jan
31;385(9966):430–40
7. ETHIOPIA Demographic and Health Survey 2016; Central Statistical Agency Addis Ababa,
Ethiopia, FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA
8. Ethiopia Mini Demographic and Health Survey 2019; Central Statistical Agency Addis Ababa,
Ethiopia, FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA
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