This review was considered to evaluate the combined prevalence and associated factors of essential newborn care utilization in Ethiopia. In this review, we searched databases without limit to date of publication and study design. TO confirm the scientific accuracy, the Preferred Reporting Items of Systematic Reviews and Meta-Analysis Protocol (PRISMA- P) guideline was used . The international databases include MEDLINE/PubMed, EMBASE, Web of Sciences, Scopus, and Grey literature databases, Google Scholar, Science Direct and Cochrane library were scientifically explored. Also, we assessed reference lists of identified studies to retrieve additional articles. Unpublished studies were retrieved from the official websites of international and local organizations and universities. The search was performed by keywords, medical subject headings (MeSH) terms. We used the search terms independently and/or in combination using “OR”, “AND” or “NOT”. Keywords/search terms were “Prevalence” OR “Epidemiology” AND “essential” AND/OR “essential newborn” OR “essential neonatal” AND/OR “essential newborn care” AND/OR “essential neonatal care” AND “utilization” AND/OR “services” AND “factors” AND/OR “associated factors” AND/OR “risk factors” AND/OR “determinants” AND/OR “predictors” AND” Ethiopia”. All articles were conducted from August 30, 2019, up to September 30, 2019, and all accessible studies up to September 30, 2019, were incorporated in our meta-analysis and systematic review.
Identification and selection of studies:
This meta-analysis and systematic review included the studies that were conducted in both institution and community-based studies that reported the essential newborn care utilization and associated factors in Ethiopia. This review included all articles published in peer-reviewed journals, that were written in English and Studies comprised of any published articles that assess associated factors affecting essential newborn care utilization in Ethiopia. We excluded the primary studies, inaccessible of full-text article after contact the primary author two times through email and in case of our outcome of interest did no reported. All studies that reported the prevalence of essential newborn care services utilization and its determinants in Ethiopia were included.
Outcome of measurement
The main outcome of this study was to estimate the pooled prevalence and to identify associated factors of essential neonatal care utilization in Ethiopia.
Data extraction and synthesis
Data were retrieved by two independent reviewers (YM and TY) by using a standardized data extraction spreadsheet format. The data abstraction format includes author, the study year, region of study setting (region and rural or urban), study design, sample size, prevalence, and associated factors. Any disagreements during the extraction process were solved by consensus between the reviewers. If we got incomplete data, we excluded the study after two attempts were made to contact the corresponding author by email. Also, the two authors (YM and TY) performed the quality assessment of studies independently. Any discrepancy was resolved by discussion and agreement.
Quality Assessment of the Studies and risk of bias assessment
To assess the quality of each study, we applied Newcastle-Ottawa quality assessment tool scale adopted for cross-sectional studies . The modified Newcastle—Ottawa scales consists of three sections. The first section tool is rated from five stars for methodological evaluation. The second section tool is ranked from three stars for comparability assessment. The third section tool is evaluated from two points that deal with the statistical analysis and the outcome of each study. The original study was assessed by two reviewers independently and any disagreement between the reviewers was solved by taking the mean score of the two reviewers. Finally, the original studies with the scale of >_ 6 out of 10 were considered as high quality after reviewing different literature.
Data synthesis and statistical analysis
For farther analysis, we imported the data to STATA version 14.0 statistical software after extracting the data using Microsoft Excel format. Using the binomial distribution formula, Standard error was calculated for each study. We identify the heterogeneity between the studies using Cochrane’s Q statistics (Chi-square), inverse variance (I2) and p-values . The statistical output showed that there was significant heterogeneity among the studies (I2 = 99.8%, p = 0.000) so that we used a random-effects meta-analysis model to estimate the pooled prevalence and associated factors of essential neonatal care utilization in Ethiopia. Also, we used a forest plot to detect the presence of heterogeneity. Furthermore, subgroup analysis and meta-regression were used to identify the possible source of heterogeneity. The evidence of publication bias was checked using funnel plot symmetry. Besides, the statistical significance of publication bias was assessed using both Egger’s and Beggar’s test, subsequently, a trim-and-fill analysis was performed, with the p-value, less than 5% was used to declare the presence of publication bias [17, 18].