Abstract / Summary
Background: Differences in staffing, clinical supervision, emergency preparedness, and the organization of services outside normal working hours may be related to variations in perinatal outcomes for off-hours and weekend deliveries. Evidence from Africa is sparse and conflicting, with some studies reporting increased neonatal morbidity or mortality for births occurring at nighttime/off-hours or weekends while others have reported no significant differences. Hence, this systematic review and meta-analysis aimed to estimate the association between nighttime/off-hours or weekend births and adverse perinatal outcomes in African health facilities.
Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline. An internet-based search of noninterventional studies in Africa was performed in CINAHL, EMBASE, PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, African Index Medicus, African Journals Online, Africa-Wide Information (EBSCOhost) and Google Scholar. A total of 3430 studies were screened, and only 8 studies satisfied the inclusion criteria. The Newcastle-Ottawa Scale and Joanna Briggs Institute critical appraisal checklist were used. The random- and fixed-effects meta-analyses were done in Stata version 17, and forest plots, tests of heterogeneity, and funnel plots were all generated.
Results: Eight studies were included. The majority of single-centric studies report increasing risk of early neonatal death (OR ≈ 1.70), fresh stillbirths (OR ≈ 1.95), low Apgar scores, and neonatal intensive care unit admissions with off-hour deliveries. Meta-analyses showed the borderline relationship of fresh stillbirth (OR 1.33; 95% CI 0.99-1.67) with I² = 88.7%, early neonatal death (OR 1.62; 95% CI 1.20-2.05; I² = 0%), but not with a 5-minute Apgar score of < 7 (OR 1.13; 95% CI 0.86-1.40; I² = 0%) with night/weekend birth. No evidence for publication bias was demonstrated.
Conclusion: Off-hour delivery within African hospitals is associated with increased risk of early neonatal death and possibly fresh stillbirth, but the impact on Apgar score and other outcomes is heterogeneous. Staffing, case mix, and service organization were the explanations for differences.