The aim of this study was to determine the combined prevalence and related factors of the ENBC utilization in Ethiopia. We checked databases in this analysis without restricting on the date of publishing and designing the report. The Recommended Reporting Items of the Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) guidelines have been used to validate scientific accuracy . The international databases included MEDLINE/PubMed, EMBASE, Web of Sciences, Scopus, and Grey literature databases, Google Scholar, Science Direct and Cochrane Library were scientifically explored.
Additionally, to obtain additional articles, we checked reference lists of established studies. Unpublished studies were retrieved from the official websites of international and local organizations and universities. Keywords, medical subject headings (MeSH) terms were used to conduct the search. 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 care” OR “essential newborn” AND/OR “essential newborn care” AND/OR “essential newborn 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, 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 studies in both institutional and community-based studies that reported the use of ENBC and related factors in Ethiopia. This review included all articles published in peer-reviewed journals, that were written in English We excluded any primary studies considered, inaccessible for full-text article after contacting the primary author twice via email, and in case of our outcome of interest did not respond. All studies that reported the prevalence of ENBC services utilization and its determinants in Ethiopia were included.
Data extraction and synthesis
Data were retrieved by two independent reviewers using a standardized data extraction spreadsheet format. The data abstraction format includes author, 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 resolved by consensus between the reviewers. In instances of incomplete data, we excluded the study after two attempts were made to contact the corresponding author by email. Also, the two authors 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 the Newcastle-Ottawa quality assessment tool scale adopted for cross-sectional studies . The modified the Newcastle – Ottawa scales consists of three sections. The first section tool is rated up to five stars for methodological evaluation. The second section tool is ranked up to three stars for comparability assessment. The third section tool is evaluated up to 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 resolved 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 further analysis, we imported the data into STATA Version 14.0 statistical software after extracting the data using MicrosoftMT 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 a random-effects meta-analysis model was used to estimate the pooled prevalence and associated factors of ENBC utilization in Ethiopia. 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% used to declare the presence of publication bias [18, 19].