Pooled Prevalence of neonatal respiratory distress syndrome and its associated factors in Ethiopia: A Systematic review and Meta-analysis

Asnake Tadesse Abate; Tsehayu Melak Siyum; Gebresilassie Tadesse Gizaw; Setegn Fentahun Shibie; Gezahagn Demsu Gedefaw

doi:10.12688/f1000research.166752.1

Home Browse Pooled Prevalence of neonatal respiratory distress syndrome and its...

ALL Metrics

-

Views

-

Downloads

Get PDF

Get XML

Export

▬

✚

Systematic Review

Pooled Prevalence of neonatal respiratory distress syndrome and its associated factors in Ethiopia: A Systematic review and Meta-analysis

[version 1; peer review: awaiting peer review]

Asnake Tadesse Abate ¹, Tsehayu Melak Siyum¹, Gebresilassie Tadesse Gizaw², Setegn Fentahun Shibie², Gezahagn Demsu Gedefaw¹

Asnake Tadesse Abate ¹, Tsehayu Melak Siyum¹, [...] Gebresilassie Tadesse Gizaw², Setegn Fentahun Shibie², Gezahagn Demsu Gedefaw¹

PUBLISHED 17 Jul 2025

Author details Author details

¹ Department of Neonatal Health Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Amhara, Ethiopia
² Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia

Asnake Tadesse Abate
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tsehayu Melak Siyum
Roles: Data Curation, Formal Analysis, Methodology, Resources, Writing – Review & Editing

Gebresilassie Tadesse Gizaw
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Setegn Fentahun Shibie
Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing

Gezahagn Demsu Gedefaw
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS AWAITING PEER REVIEW

Abstract

Background

Many primary articles in Ethiopia approach the prevalence and factors associated with respiratory distress syndrome, but discrepancies were seen among those articles. This study aimed to assess the pooled prevalence and factors associated with neonatal respiratory distress syndrome in Ethiopia.

Methods

Primary studies were searched using different data sources. Thirteen primary studies were included. The data were extracted using a Microsoft Excel spreadsheet and exported to Stata version 14 for analysis. Publication bias was confirmed using Egger’s regression test.

Results

This study included thirteen primary articles that met the inclusion criteria. The pooled prevalence of respiratory distress syndrome in Ethiopia was 30.28%. Neonates with birth weights less than 1500gm and preterm neonates had a significant factor for respiratory distress syndrome.

Conclusion

We found a high pooled prevalence of respiratory distress syndrome. Thus, to reduce this problem, the relevant body should put special emphasis on the variables mentioned above.

Keywords

Hyaline membrane disease, Newborns, Secondary research, low income country.

Corresponding author: Asnake Tadesse Abate

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Abate AT et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Abate AT, Siyum TM, Gizaw GT et al. Pooled Prevalence of neonatal respiratory distress syndrome and its associated factors in Ethiopia: A Systematic review and Meta-analysis [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:704 (https://doi.org/10.12688/f1000research.166752.1) First published: 17 Jul 2025, 14:704 (https://doi.org/10.12688/f1000research.166752.1) Latest published: 17 Jul 2025, 14:704 (https://doi.org/10.12688/f1000research.166752.1)

Introduction

Respiratory distress syndrome (RDS) is a surfactant-deficient (dysfunctional) lung disease caused mostly by lung immaturity and characterized by cyanosis, grunting, apnea, nasal flaring, poor feeding, tachypnea, and retractions in the intercostal, subcostal, or suprasternal areas. These manifestations develop either at or shortly after birth.^1–4

RDS is one of the most common health problems encountered in preterm neonates and the most frequent cause of neonatal respiratory failure and death.^5,6 It accounts for death among neonates 12.8% in Poland, 46.9% in Nigeria, and 45% in Ethiopia.^7–9 It is the leading cause of morbidity and mortality among premature neonates in Ethiopia.¹⁰

RDS is a known risk factor for intracerebral/intraventricular hemorrhage, which increases the likelihood of cerebral palsy and late epilepsy. It also often leads to morbidities such as bronchopulmonary dysplasia and requires prolonged hospitalization resulting in high costs that lead to economic burdens on the family, society, and health care systems.^11–14

According to studies conducted in Iraq, India, Nigeria, and Egypt, the prevalence of RDS was 34.7%, 57%, 26.2%, and 48.5%, respectively.^7,15–17 Many studies have suggested that prematurity, low birth weight, sepsis, perinatal asphyxia, gestational diabetes mellitus, and placental insufficiency are factors significantly associated with RDS.^1,18–22 If RDS is not identified early and treated effectively, it may cause fatal consequences or respiratory failure may result in death.^6,10 Although several primary studies on the prevalence of RDS were conducted in Ethiopia, the reports from this research revealed disparate and inconsistent findings. Furthermore, there have been no prior systematic reviews or meta-analyses of the pooled prevalence and risk factors for RDS in Ethiopian newborns. Therefore, determining the pooled prevalence and its associated factors of RDS can be used as baseline evidence for the concerned stakeholders to address the problem and the potential factors for neonatal RDS.

Research questions

What is the estimated pooled prevalence of respiratory distress syndrome among neonates in Ethiopia?

What is the pooled effect of the factors associated with respiratory distress syndrome among neonates in Ethiopia?

Methods

Protocol and registration of this study

The protocol for this study is registered with the International Prospective Register of Systematic Reviews (PROSPERO) under ID CRD42023491295. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study was conducted in Ethiopia to determine the combined prevalence of neonatal respiratory distress syndrome and its contributing factors.²³

Searching strategies and appraisal of studies

Using published studies up to December 28/2023, this systematic review and meta-analysis were carried out. Several electronic search engines, including PubMed/Medline, Google, Google Scholar, Web of Science, CINAHL, and EMBASE, were searched for the published articles. The keywords and search strategies used for the PubMed database were (“Prevalence” OR “Magnitude” OR “Epidemiology” OR “Proportion” OR “Pattern of admission” OR “Burden” OR “Incident”) AND (“associated factors” OR “risk factors” OR “determinants” OR “predictors”) AND (“respiratory distress syndrome” OR “hyaline membrane disease”) AND (“neonatal intensive care unit”) AND (“neonates” OR “newborns”) AND “Ethiopia”.

Eligibility of the study

All primary articles that reported the prevalence and associated factors of respiratory distress syndrome among neonates in various regions of Ethiopia, published between 2016 and 2023, were included. Only full-text articles in English, based on cross-sectional and retrospective follow-up study designs, were considered, without restrictions on the study area. However, this study excluded case reports, case studies, journals lacking full text, articles in other languages, and qualitative findings.

Data extraction

After a thorough examination of the titles, abstracts, and full texts of the included studies, two writers (GD and GT) independently extracted all necessary data from the primary articles using a standardized data extraction format in Microsoft Excel. This format included the first author’s name, publication year, study design, region of study, sample size, and prevalence of respiratory distress syndrome. For the second objective, the writers also extracted risk factors associated with respiratory distress syndrome, along with the 95% confidence interval and odds ratio. To any disagreements that arose during the data extraction process, the two writers discussed the issues with the third author (SF), and any conflicting data were re-extracted.

Outcome measurement

There are two key results from this systematic review and meta-analysis. The primary outcome variable of the study was respiratory distress syndrome, while the secondary outcomes examined the risk factors associated with neonatal respiratory distress syndrome in Ethiopia. The prevalence reported in each primary study was used to calculate the pooled prevalence of respiratory distress syndrome, and the findings on the correlation between each risk factor and the disorder were employed to determine the pooled odds ratio (AOR).

Quality assessment

The quality of the primary studies included in this systematic review and meta-analysis was assessed using a standard critical appraisal tool. Specifically, the Joanna Briggs Institute Quality Appraisal Checklist was employed to evaluate the methodological quality of these studies²⁴ (S1 File). This checklist addresses several key aspects of study methodology, including sample representativeness, appropriate participant recruitment, comprehensive participant description, use of reliable standard measurements, adequate statistical analysis, and the identification of subgroups or confounding variables.

Studies were classified based on their appraisal scores: high quality for scores of 8 or above, moderate quality for scores between 5 and 7, and low quality for scores between 0 and 4. Only articles with quality scores of 5 or higher were included in this systematic review and meta-analysis. Any disagreements among authors regarding the quality evaluation of the included articles were resolved by the third author (TM) to reach a consensus.

Data synthesis and analysis

The data synthesis was completed by tabulation, producing a clear and thorough descriptive summary of the included studies. The results of the current study were outlined and presented using texts, forest plots, and tables. Microsoft Excel spreadsheet was used to extract the numerical data and STATA 14.0 was used for analysis. The standard I² was used to measure heterogeneity.²⁵ Because of the significant heterogeneity, a random-effect meta-analysis model was utilized to determine the pooled effect size of all the included studies at a 95% confidence interval. Additionally, subgroup analysis was done using publication year, regional state and study design to identify the possible sources of heterogeneity. Sensitivity analysis was conducted to check the effects of a single study on the pooled prevalence. By visually examining a funnel plot for symmetrical distribution, publication bias was assessed.²⁶ To further evaluate publication bias, Egger weighted regression tests were used and it was considered when the value of p was less than 0.05.²⁷

Patient and public involvement: The public and/or patients were not involved in the design, execution, reporting, or dissemination plans of this meta analysis.

Ethical consideration

Since this study is a systematic review and meta-analysis and it is registered with the International Prospective Register of Systematic Reviews (PROSPERO) under ID number of CRD42023491295.

Results

Search results

After a search on the above-listed databases and other search engines, 319 studies were found. Of those, 124 studies were excluded because of duplication. The remaining articles were further reviewed by topic and abstract, leading to exclude 171 articles conducted outside Ethiopia. Additionally, 24 studies were checked through a review of the full-text articles for eligibility using the inclusion criteria and 11 studies were excluded. Lastly, 13 articles were included in the current systematic review and meta-analysis ( Figure 1).

Figure 1. Flow chart on the article selection strategy for systematic review and meta-analysis of prevalence and associated factors of respiratory distress syndrome among neonates in Ethiopia, 2024.

Characteristics of the included studies

In the current study, nine primary studies that were published between 2016 and 2023 were included. Out of the included studies, seven studies in Amhara, two in SNNPs, one in Addis Ababa, another one in (Addis Ababa, Gondar and Jimma) and the remaining two study in Oromia were conducted with a total population of 10,015. Regarding the study designs, nine were cross-sectional designs and four were retrospective cohort study designs. From the included studies, the minimum sample size was 291 and the maximum sample size was 4919. The prevalence of respiratory distress syndrome (RDS) in the study area ranged from 8.3% to 49.83% ( Table 1). According to the Joanna Briggs Institute (JBI), 69% of the studies demonstrated high quality, while the remaining 31% were rated as medium quality.

Table 1. Characteristics of studies included in this systematic review and meta-analysis on respiratory distress syndrome among neonates in Ethiopia.

Authors	Year of publication	Study design	Study area	Sample size	Prevalence of RDS (%)
Ebissa et al.⁴⁴	2019	Cross-sectional	Oromia	341	11.9
Bogale et al.⁴⁵	2023	Cross-sectional	SNNPs	395	45.1
Yared et al.⁴⁶	2020	Retrospective follow-up study	Addis Ababa	571	43.4
Shambel et al.⁴⁷	2023	Cross-sectional	Amhara	422	26.9
Abayneh et al.⁴⁸	2017	Cross-sectional	Amhara	769	10.9
Wubet et al.⁴⁹	2023	Retrospective follow-up study	Amhara	423	47.16
Yalemtsehay Dagnaw et al.⁵⁰	2022	Retrospective follow-up study	Amhara	291	49.83
Binyam et al.⁵¹	2021	Retrospective follow-up study	Amhara	535	40
Belete et al.⁵²	2020	Cross-sectional	SNNPs	412	34
Mehretie Kokeb & Teshome Desta⁵³	2016	Cross-sectional	Amhara	335	19.7
Birtukan Assefa et al.⁵⁴	2021	Cross-sectional	Amhara	228	11.8
Zemene Tigabu et al.⁹	2020	Cross-sectional	Ethiopia	4919	45.3
Jorge Seboka et al.⁵⁵	2018	Cross-sectional	Oromia	384	8.3

Pooled prevalence of neonatal respiratory distress syndrome

In this systematic review and meta-analysis, thirteen studies were included to determine the overall prevalence of respiratory distress syndrome among neonates in Ethiopia. The pooled prevalence of RDS in Ethiopia was found to be 30.28% (95% CI: 20.54%, 40.02%) and the weighted prevalence of RDS was also determined ( Figure 2).

Figure 2. The forest plot shows the pooled prevalence of respiratory distress syndrome among neonates in Ethiopia.

Heterogeneity and bias test

The test statistic showed that there was significant heterogeneity between the included articles (I² = 99.1%, p = 0.000) ( Figure 2). To check the publication bias, two techniques were used such as funnel plot ( Figure 3) and Egger’s tests showed that there was no statistically significant evidence for the presence of publication bias (p = 0.553) ( Table 2).

Figure 3. A funnel plot shows the pooled prevalence of respiratory distress syndrome among neonates in Ethiopia.

Table 2. Egger’s test of respiratory distress syndrome among neonates in Ethiopia.

Std-Eff	Coef.	Std. Err.	T	P > t	95% Conf. Interval
Slope	37.07398	11.02237	3.36	0.006	12.81391, 61.33405
Bias	-4.314301	7.058099	0.61	0.553	-19.849, 11.221

Sub-group analysis

Because heterogeneity affected the pooled prevalence of respiratory distress syndrome, we conducted a sub-group analysis based on the year of publication, the regional state and study design. As subgroup analysis showed, the pooled prevalence of respiratory distress syndrome among neonates was found to be 39.51% (95% CI: 28.64, 50.34) in the SNNPs region, 9.95% (95% CI: 6.43%, 13.46%) in Oromia region, and 29.38% (95% CI: 17.33%, 41.44%) in Amhara region. Furthermore, the subgroup analysis indicated that the pooled prevalence of respiratory distress syndrome was greater in the studies conducted after 2021 with a prevalence of 36.74% (95% CI: 24.74%, 48.74%) than in the studies carried out before 2021 with the prevalence of 24.78% (95% CI: 10.24%, 39.31%). Based on the study design, the pooled prevalence of respiratory distress syndrome among neonates that was conducted with cross sectional study design was lower when compared to retrospective follow-up studies: 25.65% (95% CI: 13.31%, 37.98%) and 41.95% (95% CI: 38.02%, 45.89%), respectively ( Table 3).

Table 3. Sub-group analysis of respiratory distress syndrome and associated factors among neonates in Ethiopia.

Variables	Sub-groups	No of studies	Prevalence% (95%CI)	I²(%)	P-value
Region	SNNPs	2	39.51 (28.64, 50.34)	90.5	0.001
	Oromia	2	9.95 (6.43, 13.46)	62.1	0.104
	Amhara	7	29.38 (17.33, 41.44)	98.9	0.000
	Addis Ababa, Gondar and Jimma	1	45.30 (43.91, 46.69)
	Addis Ababa	1	43.40 (39.34, 47.47)
Year of publication	<2021	7	24.78 (10.24, 39.31)	86.1	0.000
Year of publication	≥2021	6	36.74 (24.74, 48.74)	80.6	0.001
Study design	Cross sectional	9	25.65 (13.31, 37.98)	98.3	0.000
Study design	Retrospective follow-up	4	41.95 (38.02, 45.89)	63.8	0.040

Sensitivity analysis

The sensitivity analysis was accomplished to determine the heterogeneity of the included studies systematically by keeping out one study to determine the impact of each study’s findings on the pooled prevalence of respiratory distress syndrome. As the analysis shows, all of the values were within the expected 95% CI, supplying that the exclusion of a single study did not significantly change the prevalence of the current study ( Table 4).

Table 4. Sensitivity analysis of respiratory distress syndrome among neonates in Ethiopia.

Authors	Estimated 95%CI	Heterogeneity
Authors	Estimated 95%CI	I²	P-value
Ebissa et al.	31.82 (21.71, 41.92)	99.1%	≤0.001
Bogale et al.	29.05 (18.82, 39.29)	99.2%	≤0.001
Yared A. et al.	29.19 (18.86, 39.51)	99.2%	≤0.001
Shambel D. et al	30.56 (20.14, 40.99)	99.2%	≤0.001
Abayneh G et al.	31.91 (22.29, 41.53)	98.9%	≤0.001
Wubet T. et al.	28.88 (18.68, 39.09)	99.2%	≤0.001
Mehretie Kokeb & Teshome Desta	31.16 (20.84, 41.49)	99.2%	≤0.001
Binyam M. et al.	29.47 (19.09, 39.86)	99.2%	≤0.001
Belete et al.	29.97 (19.58, 40.36)	99.2%	≤0.001
Birtukan Assefa et al.	31.82 (21.69, 41.95)	99.2%	≤0.001
Zemene Tigabu et al.	28.99 (20.01, 37.98)	98.5%	≤0.001
Jorge Seboka et al.	32.12 (22.45, 41.79)	99.0%	≤0.001
Yalemtsehay Dagnaw et al.	28.67 (18.53, 38.82)	99.2%	≤0.001

Risk factors associated with respiratory distress syndrome among neonates in Ethiopia

This systematic review and meta-analysis demonstrated that two risk factors were significantly associated with respiratory distress syndrome among neonates in Ethiopia. A neonate with a birth weight of less than 1500 gm was significantly associated with respiratory distress syndrome in two studies and being preterm neonate was significantly associated with respiratory distress syndrome in three studies that were included in this systematic review and meta-analysis.

Based on the findings of this systematic review and meta-analysis, the likelihood of respiratory distress syndrome occurrence was 2.92 times higher among neonates with a birth weight of less than 1500 gm than neonates with a birth weight of 1500 gm and above (AOR: 2.92; 95% CI: 1.72, 4.94). Neonate being born preterm was 3.8 times more likely to develop respiratory distress syndrome as compared to term (AOR = 3.82; 95% CI: 2.80, 5.23) ( Figure 4).

Figure 4. The forest plot shows factors significantly associated with the pooled prevalence of respiratory distress syndrome among neonates in Ethiopia.

Discussion

To mitigate neonatal respiratory distress syndrome (RDS), a comprehensive approach that emphasizes both prevention and treatment is essential. Key strategies include antenatal corticosteroid therapy, which accelerates fetal lung maturation and reduces the incidence of RDS in preterm neonates, and surfactant replacement therapy, which enhances lung function in affected infants. Non-invasive respiratory support, such as continuous positive airway pressure (CPAP), helps minimize ventilator-induced lung injury. Preventing preterm birth through proper antenatal care, tocolytics, and maternal nutrition also decreases the overall risk of RDS. Additionally, early neonatal monitoring, stringent infection control measures, and improved regionalized neonatal care and referral systems contribute to better survival outcomes. Strengthening healthcare provider training, expanding access to life-saving interventions, and enhancing neonatal transport networks are crucial for reducing RDS-related neonatal mortality, particularly in resource-limited settings such as Ethiopia.

Addressing neonatal respiratory distress syndrome (RDS) in Ethiopia necessitates improved preventive measures, standardized research designs, and additional studies. Strengthening antenatal care through the timely administration of corticosteroids, infection prevention, and enhanced maternal nutrition can mitigate critical risk factors. Utilizing standardized research methods will enhance data accuracy, while further studies should investigate region-specific determinants and refine interventions. Policymakers must implement evidence-based neonatal care guidelines to ensure equitable access to surfactant therapy, continuous positive airway pressure (CPAP), and specialized care, ultimately reducing neonatal mortality.

The current study was carried out to assess the pooled prevalence and risk factors associated with neonatal respiratory distress syndrome in Ethiopia. This is the first systematic review and meta-analysis in the study setting and it can assist program planners and policymakers in determining the best course of action to address issues affecting this vulnerable population.

In this systematic review and meta-analysis, the pooled prevalence of respiratory distress syndrome among neonates in Ethiopia was found to be 32.76% (95% CI: 22.24%, 43.27%). This finding is consistent with the primary studies conducted in Nigeria (26.2%),⁷ Iraq (34.7%),¹⁶ Nepal (34%),²⁸ and India (33.4%).²⁹ However, the pooled prevalence of respiratory distress syndrome in this study is lower than studies conducted in Egypt (45.8%),¹⁵ Saudi Arabia (54.7%),⁵ India (57%),¹⁷ Poland (54.29%),³⁰ and Cameroon (47.5%).²¹ On the other hand, the pooled prevalence of respiratory distress syndrome is higher than studies conducted in Pakistan (4.6%),³¹ Portugal (8.83%),³² Nepal (17.8%),³³ and Bulgaria (15%).³⁴ The possible reason for this disparity may be due to the differences in study design, sample size, study population, the population’s awareness of health services, health care quality and coverage. The other reason for this variation might be due to the fact that the other studies conducted in different countries had a single result while the current systematic review and meta-analysis pooled prevalence from different studies.

Meta-analysis showed that neonates with a birth weight of less than 1500 gm and preterm neonates were significantly associated with respiratory distress syndrome. The current study identified that the odds of having respiratory distress syndrome among neonates with a birth weight of less than 1500 gm were 2.9 times higher compared with those neonates with a birth weight of 1500 gm and above. This finding was supported by the study conducted in Italy.³⁵ This could be because low birth weight newborns are more likely to have immature physiological and anatomical structures, like fragile brain capillaries, a large surface area to body mass ratio, lack of subcutaneous tissue, and surfactant deficiencies end up with respiratory distress syndrome.³⁶ Furthermore, respiratory distress syndrome in low birth weight neonates is primarily caused by the immaturity of their lungs, specifically the surfactant-producing cells (type II pneumocytes). Without sufficient amounts of surfactant, the alveoli become unstable and tend to collapse, resulting in impaired oxygen exchange and respiratory distress syndrome.³⁷

This review also disclosed that preterm neonates were at higher risk of developing respiratory distress syndrome than term neonates. This is consistent with studies conducted in Poland,³⁰ India,³⁸ and China.¹ This could be because, respiratory distress syndrome occurs primarily due to the immaturity of the lungs, and premature birth interferes with the normal development of the respiratory system. As gestational age increases (during the last trimester of pregnancy), the lungs undergo a crucial stage of development where the production of surfactant begins which reduces the surface tension in the alveoli, the tiny air sacs in the lungs and keeps the alveoli open and prevents their collapse during exhalation.^39,40

Strengths and limitations of the study

Joanna Briggs Institute Quality Appraisal Checklist was used to evaluate the quality of eligible studies. Funnel plot and Egger weighted regression tests were used to assess the risk of bias of the included studies. Only quantitative observational studies were included in this systematic review and meta-analysis; case series, case reports, and qualitative data were not included. Furthermore, subgroup analysis was identified in different strata; heterogeneity was observed in specific stratified groupings. Lack of sufficient studies on prevalence and factors associated with neonatal respiratory distress syndrome in Ethiopia.

Conclusions

The result of systematic review and meta-analysis revealed that the pooled prevalence of respiratory distress syndrome among neonates in Ethiopia was found to be high. It also revealed that a neonate with a birth weight of less than 1500 gm and being preterm neonate were both significantly associated with respiratory distress syndrome. According to the findings of the subgroup analysis that was conducted using publication year, and regional state, there is a difference in the pooled prevalence of neonatal respiratory distress syndrome. As a result, to minimize the complication of respiratory distress syndrome in neonates, the concerned stakeholders should give special emphasis on neonates delivered with preterm and birth weight of less than 1500 gm. The findings of this study emphasize the urgent need for targeted interventions to reduce neonatal respiratory distress syndrome (RDS) in Ethiopia, with significant implications for both policy and clinical practice. Policymakers should prioritize integrating antenatal corticosteroid administration into routine maternal care to ensure that all eligible preterm pregnancies receive timely treatment. Additionally, the study highlights the necessity of expanding access to surfactant therapy and CPAP in neonatal intensive care units (NICUs), particularly in underserved regions. Strengthening regionalized neonatal care and referral systems can facilitate timely interventions, ultimately reducing neonatal mortality. By incorporating these evidence-based strategies into national neonatal care guidelines, Ethiopia can improve neonatal survival rates, lower healthcare costs associated with prolonged hospital stays, and enhance overall maternal and child health outcomes.

Author contribution statement

Asnake Tadesse and Gezahagn Demsu: Conceived and designed the studies, performed the studies, analyzed and interpreted the data, analysis tools or data, and wrote the report. Gebresilassie Tadesse and Setegn Fentahun: Conceived and designed the studies, performed the studies, and analyzed and interpreted the data. Tsehayu Melak: Contributed materials, analysis, tools, or data, and wrote the paper.

Data availability statement

Figshare: RDS outcome data Excel.xlsx: https://doi.org/10.6084/m9.figshare.29476340.v1⁴¹

Data are available under the terms of the: https://creativecommons.org/licenses/by/4.0/

Figshare: Online resource for PRISMA Checklist of items to be included in reports of observational studies in epidemiology Checklist for cohort, case-control, and cross-sectional studies (combined): Abate, Asnake (2025). PRISMA Checklist.docx. figshare. Journal contribution.

https://doi.org/10.6084/m9.figshare.29476388.v1⁴²

Data are available under the terms of the: https://creativecommons.org/publicdomain/zero/1.0/

Figshare: Supporting file: https://doi.org/10.6084/m9.figshare.29476475.v1⁴³

Supporting file 1: Quality assessment of the included studies.

Data are available under the terms of the: https://creativecommons.org/licenses/by/4.0/

Patient consent for publication: Not required.

Acknowledgments

We would like to express our gratitude to all authors of the articles included in this systematic review and meta-analysis.

References

1. Jing L, Na Y, Ying L: High-risk factors of respiratory distress syndrome in term neonates: a retrospective case-control study. Balkan Med. J. 2014; 2014(1): 64–68.
2. Choudhary PK, Piparsania S, Sagar U: A study to determine the incidence of respiratory distress syndrome among neonates in a tertiary care hospital. J. Adv. Med. Dent. Sci. Res. 2020; 8(9): 173–175.
3. Rao Y, Sun X, Yang N, et al.: Neonatal respiratory distress syndrome and underlying mechanisms in cloned cattle. Mol. Reprod. Dev. 2018; 85(3): 227–235. PubMed Abstract | Publisher Full Text
4. Legesse BT, Abera NM, Alemu TG, et al.: Incidence and predictors of mortality among neonates with respiratory distress syndrome admitted at West Oromia Referral Hospitals, Ethiopia, 2022. Multi-centred institution based retrospective follow-up study. Plos one. 2023; 18(8): e0289050. PubMed Abstract | Publisher Full Text | Free Full Text
5. Qari SA, Alsufyani AA, Muathin SH, et al.: Prevalence of Respiratory Distress Syndrome in Neonates. Egypt. J. Hosp. Med. 2018; 70(2): 257–264. Publisher Full Text
6. Tochie JN, Sibetcheu AT, Arrey-Ebot PE, et al.: Global, Regional and National Trends in the Burden of Neonatal Respiratory Failure and essentials of its diagnosis and management from 1992 to 2022: a scoping review. Eur. J. Pediatr. 2023; 183: 9–50. Publisher Full Text
7. Adebami OJ, Joel-Medewase VI, Agelebe E, et al.: Determinants of outcome in newborns with respiratory distress in Osogbo, Nigeria. Int. J. Res. Med. 2017; 5(4): 1487–1493. Publisher Full Text
8. Sahoo T, Anand P, Verma A, et al.: Outcome of extremely low birth weight (ELBW) infants from a birth cohort (2013–2018) in a tertiary care unit in North India. J. Perinatol. 2020; 40(5): 743–749. PubMed Abstract | Publisher Full Text
9. Kebede ZT, Matebe YH, Demisse AG, et al.: Hematologic profiles of Ethiopian preterm infants with clinical diagnoses of early-onset sepsis, perinatal asphyxia, and respiratory distress syndrome. Glob. Pediatr. Health. 2020; 7. Publisher Full Text
10. Mitiku HD: Neonatal mortality and associated factors in Ethiopia: a cross-sectional population-based study. BMC Womens Health. 2021; 21(1): 1–9. Publisher Full Text
11. Donda K, Vijayakanthi N, Dapaah-Siakwan F, et al.: Trends in epidemiology and outcomes of respiratory distress syndrome in the United States. Pediatr. Pulmonol. 2019; 54(4): 405–414. Publisher Full Text
12. Groene S, Spekman J, Te Pas A, et al.: Respiratory distress syndrome and bronchopulmonary dysplasia after fetal growth restriction: lessons from a natural experiment in identical twins. EClinicalMedicine. 2021; 32: 100725. View Article. 2021. PubMed Abstract | Publisher Full Text | Free Full Text
13. Thygesen SK, Olsen M, Østergaard JR, et al.: Respiratory distress syndrome in moderately late and late preterm infants and risk of cerebral palsy: a population-based cohort study. BMJ Open. 2016; 6(10): e011643. PubMed Abstract | Publisher Full Text | Free Full Text
14. Thygesen SK, Olsen M, Pedersen L, et al.: Respiratory distress syndrome in preterm infants and risk of epilepsy in a Danish cohort. Eur. J. Epidemiol. 2018; 33: 313–321. PubMed Abstract | Publisher Full Text
15. Abou-Faddan HH, Abdelaziz N: Respiratory distress and its outcome among neonates admitted to neonatal intensive care unit of Assiut University Children Hospital, Egypt. Egypt The Egyptian Journal of. Community Med. 2018; 36(2): 69–78. Publisher Full Text
16. Ajeli MHA, Shukr M, Hachim BAA-H: Prevalence and Etiology of Respiratory Distress in Newborns in the Fallujah Teaching Hospital for Women and Children. Kerbala Jorunal of Medicine. 2019; 12(2).
17. Sahoo T, Anand P, Verma A, et al.: Outcome of extremely low birth weight (ELBW) infants from a birth cohort (2013-2018) in a tertiary care unit in North India. J Perinatol: Official Journal of the California Perinatal Association. 2020; 40(5): 743–749. PubMed Abstract | Publisher Full Text
18. Sweet DG, Carnielli V, Greisen G, et al.: European consensus guidelines on the management of respiratory distress syndrome–2019 update. Neonatology. 2019; 115(4): 432–450. PubMed Abstract | Publisher Full Text | Free Full Text
19. Mwita S, Jande M, Katabalo D, et al.: Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth: a scoping review on the impact of antenatal corticosteroids in low-and middle-income countries. World J. Pediatr. 2021; 17: 131–140. PubMed Abstract | Publisher Full Text
20. Hubbard RM, Choudhury KM, Lim G: Treatment patterns and clinical outcomes in neonates diagnosed with respiratory distress syndrome in a low-income country: a report from Bangladesh. Anesth. Analg. 2018; 126(5): 1684–1686. PubMed Abstract | Publisher Full Text | Free Full Text
21. Tochie JN, Choukem S-P, Langmia RN, et al.: Neonatal respiratory distress in a reference neonatal unit in Cameroon: an analysis of prevalence, predictors, etiologies and outcomes. Pan Afr. Med. J. 2016; 24(1): 152. PubMed Abstract | Publisher Full Text | Free Full Text
22. Lloreda-García JM, Sevilla-Denia S, Rodríguez-Sánchez A, et al.: Perinatal outcome of macrosomic infants born to diabetic versus non-diabetic mothers. Endocrinología y Nutrición (English Edition). 2016; 63(8): 409–413. Publisher Full Text
23. Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int. J. Surg. 2021; 88: 105906. PubMed Abstract | Publisher Full Text
24. Munn Z, Moola S, Lisy K, et al.: Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. JBI Evidence Implementation. 2015; 13(3): 147–153.
25. Rücker G, Schwarzer G, Carpenter JR, et al.: Undue reliance on I 2 in assessing heterogeneity may mislead. BMC Med. Res. Methodol. 2008; 8: 1–9.
26. Sterne JA, Egger M: Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J. Clin. Epidemiol. 2001; 54(10): 1046–1055. Publisher Full Text
27. Egger M, Smith GD, Schneider M, et al.: Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315(7109): 629–634. PubMed Abstract | Publisher Full Text | Free Full Text
28. Rijal P, Shrestha M: Scenario of neonatal respiratory distress in tertiary hospital.2018.
29. Singh S, Srivastava R, Singh A, et al.: Respiratory distress including meconium aspiration syndrome in vigorous neonates born through meconium stained amniotic fluid: incidence, onset, severity and predictors at birth. Indian J. Pediatr. 2013; 80: 538–543. PubMed Abstract | Publisher Full Text
30. Niesłuchowska-Hoxha A, Cnota W, Czuba B, et al.: A retrospective study on the risk of respiratory distress syndrome in singleton pregnancies with preterm premature rupture of membranes between 24+ 0 and 36+ 6 weeks, using regression analysis for various factors. Biomed. Res. Int. 2018; 2018: 1–6. PubMed Abstract | Publisher Full Text | Free Full Text
31. Parkash A, Haider N, Khoso ZA, et al.: Frequency, causes and outcome of neonates with respiratory distress admitted to Neonatal Intensive Care Unit, National Institute of Child Health, Karachi. J. Pak. Med. Assoc. 2015; 65(7): 771–775. PubMed Abstract
32. Correia C, Rocha G, Flor-de-Lima F, et al.: Respiratory morbidity in late preterm infants. Minerva Pediatr. 2016; 70(4): 345–354. PubMed Abstract | Publisher Full Text
33. Adhikari J, Aryal S, Gupta V: Acute respiratory distress and its risk factors among neonates admitted in a tertiary care center of Western Nepal. Journal of Nepalgunj Medical College. 2017; 15(1): 5–8. Publisher Full Text
34. Mihaylova A, Gueorguiev S, Parahuleva N, et al.: Frequency of hyaline membrane disease in preterm infants after prenatal corticosteroid prophylaxis. Frequency of hyaline membrane disease in preterm infants after prenatal corticosteroid prophylaxis. 2018.
35. Condò V, Cipriani S, Colnaghi M, et al.: Neonatal respiratory distress syndrome: are risk factors the same in preterm and term infants? J. Matern. Fetal Neonatal Med. 2017; 30(11): 1267–1272. PubMed Abstract | Publisher Full Text
36. Dhaded SM, Somannavar MS, Vernekar SS, et al.: Neonatal mortality and coverage of essential newborn interventions 2010-2013: a prospective, population-based study from low-middle income countries. Reprod. Health. 2015; 12: 1–8.
37. Bahwal SA, Jawass MA, Bahartha AS: Respiratory Distress and Its Outcome among Neonates Admitted to Neonatal Intensive Care Unit of Mukalla Maternity and Child Hospital, Yemen. Diyala J. Med. 2020; 18(1): 141–154. Publisher Full Text
38. Gagrani S, Mehrotra G, Mulye S, et al.: Effect of gender and gestational age on short term morbidities and mortality in extremely low birth neonates. Int. J. Contemp. Pediatr. 2017; 4(3): 993. Publisher Full Text
39. Course C, Chakraborty M: Management of respiratory distress syndrome in preterm infants in wales: a full audit cycle of a quality improvement project. Sci. Rep. 2020; 10(1): 3536. PubMed Abstract | Publisher Full Text | Free Full Text
40. Vardar G, Karadag N, Karatekin G: The role of lung ultrasound as an early diagnostic tool for need of surfactant therapy in preterm infants with respiratory distress syndrome. Am. J. Perinatol. 2020; 38(14): 1547–1556. PubMed Abstract | Publisher Full Text
41. Abate A: RDS outcome data Excel.xlsx. figshare. 2025.
42. Abate A: PRISMA Checklist.docx.2025.
43. Abate A: Supporting file.docx.2025.
44. Bayana E, Gela D, Gebreyohannis T, et al.: Pattern of disease & associated factors among neonates admitted to neonatal intensive care unit at jimma university medical center, jimma. Southwest Ethiopia.2019.
45. Chekole B, Fetene TT, Geze TS, et al.: Prevalence and factors associated with neonatal acute respiratory distress syndrome among neonates admitted to the neonatal intensive care units of Gurage zone public hospital, South West Ethiopia. Afr. Health Sci. 2023; 23(3): 159–167. PubMed Abstract | Publisher Full Text
46. Aynalem YA, Mekonen H, Akalu TY, et al.: Incidence of respiratory distress and its predictors among neonates admitted to the neonatal intensive care unit, Black Lion Specialized Hospital, Addis Ababa, Ethiopia. PloS one. 2020; 15(7): e0235544. PubMed Abstract | Publisher Full Text | Free Full Text
47. Asmamaw SD, Getachew S, Demeke T, et al.: Magnitude of Neonatal Admission Diagnosis and Associated Factors at Selected Hospitals in Wollo, Northeast Ethiopia. Res. Rep. Neonatol. 2023; 13: 29–44. Publisher Full Text
48. Demisse AG, Alemu F, Gizaw MA, et al.: Patterns of admission and factors associated with neonatal mortality among neonates admitted to the neonatal intensive care unit of University of Gondar Hospital, Northwest Ethiopia. Pediatr. Health Med. Ther. 2017; 8: 57–64. PubMed Abstract | Publisher Full Text | Free Full Text
49. Wondie WT, Legesse BT, Mekonnen GB, et al.: Incidence and predictors of respiratory distress syndrome among low birth weight neonates in the first seven days in Northwest Ethiopia Comprehensive Specialized Hospitals, 2023: A retrospective follow-up study. BMJ Open. 2023; 13(11): e079063. PubMed Abstract | Publisher Full Text | Free Full Text
50. Genie YD, Kebede BF, Zerihun MS, et al.: Morbidity and mortality patterns of preterm low birthweight neonates admitted to referral hospitals in the Amhara region of Ethiopia: retrospective follow-up study. BMJ Open. 2022; 12(7): e054574. PubMed Abstract | Publisher Full Text | Free Full Text
51. Minuye Birihane B, Alebachew Bayih W, Yeshambel Alemu A, et al.: The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study. Plos one. 2021; 16(3): e0249365. PubMed Abstract | Publisher Full Text | Free Full Text
52. Fenta B, Yetwale A, Biyazin T, et al.: Respiratory distress and its associated factors among preterm neonates admitted to Mizan Tepi University teaching hospital, Bench Maji Zone, South West Ethiopia, 2020. J. Neonatal Nurs. 2022; 28(4): 249–254. Publisher Full Text
53. Kokeb M, Desta T: Institution Based prospective cross-sectional study on patterns of neonatal morbidity at Gondar University Hospital Neonatal Unit, North-West Ethiopia. Ethiop. J. Health Sci. 2016; 26(1): 73–79. PubMed Abstract | Publisher Full Text | Free Full Text
54. Assefa B, Abate A, Yirga T: Magnitude of Preterm Birth Admission, Immediate Outcomes and Their Predictors in Debre Markos Referral Hospital, North West, Ethiopia.2021.
55. Seboka J, Abera AM, Rebitu AD: Pattern of admission and outcome of neonate admitted to adama hospital medical college neonatal intensive care unit, adama, Ethiopia. Int. J. Sci. Basic Appl. Res. 2018; 42(01): 59–71.

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 17 Jul 2025

Author details Author details

¹ Department of Neonatal Health Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Amhara, Ethiopia
² Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia

Asnake Tadesse Abate
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tsehayu Melak Siyum
Roles: Data Curation, Formal Analysis, Methodology, Resources, Writing – Review & Editing

Gebresilassie Tadesse Gizaw
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Setegn Fentahun Shibie
Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing

Gezahagn Demsu Gedefaw
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

version 1

Published: 17 Jul 2025, 14:704

https://doi.org/10.12688/f1000research.166752.1

Copyright

© 2025 Abate AT et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download

Export To

metrics

	Views	Downloads
F1000Research	-	-
PubMed Central Data from PMC are received and updated monthly.	-	-

Citations

0

SEE MORE DETAILS

CITE

how to cite this article

Abate AT, Siyum TM, Gizaw GT et al. Pooled Prevalence of neonatal respiratory distress syndrome and its associated factors in Ethiopia: A Systematic review and Meta-analysis [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:704 (https://doi.org/10.12688/f1000research.166752.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

track

receive updates on this article

Track an article to receive email alerts on any updates to this article.

Open Peer Review

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 17 Jul 2025

Open Peer Review

Reviewer Status

AWAITING PEER REVIEW

Comments on this article

All Comments(0)

Add a comment

Sign up for content alerts

Browse by related subjects

[1] 1. Jing L, Na Y, Ying L: High-risk factors of respiratory distress syndrome in term neonates: a retrospective case-control study. Balkan Med. J. 2014; 2014(1): 64–68.

[2] 2. Choudhary PK, Piparsania S, Sagar U: A study to determine the incidence of respiratory distress syndrome among neonates in a tertiary care hospital. J. Adv. Med. Dent. Sci. Res. 2020; 8(9): 173–175.

[3] 3. Rao Y, Sun X, Yang N, et al.: Neonatal respiratory distress syndrome and underlying mechanisms in cloned cattle. Mol. Reprod. Dev. 2018; 85(3): 227–235. PubMed Abstract | Publisher Full Text

[4] 4. Legesse BT, Abera NM, Alemu TG, et al.: Incidence and predictors of mortality among neonates with respiratory distress syndrome admitted at West Oromia Referral Hospitals, Ethiopia, 2022. Multi-centred institution based retrospective follow-up study. Plos one. 2023; 18(8): e0289050. PubMed Abstract | Publisher Full Text | Free Full Text

[5] 5. Qari SA, Alsufyani AA, Muathin SH, et al.: Prevalence of Respiratory Distress Syndrome in Neonates. Egypt. J. Hosp. Med. 2018; 70(2): 257–264. Publisher Full Text

[6] 6. Tochie JN, Sibetcheu AT, Arrey-Ebot PE, et al.: Global, Regional and National Trends in the Burden of Neonatal Respiratory Failure and essentials of its diagnosis and management from 1992 to 2022: a scoping review. Eur. J. Pediatr. 2023; 183: 9–50. Publisher Full Text

[7] 7. Adebami OJ, Joel-Medewase VI, Agelebe E, et al.: Determinants of outcome in newborns with respiratory distress in Osogbo, Nigeria. Int. J. Res. Med. 2017; 5(4): 1487–1493. Publisher Full Text

[8] 8. Sahoo T, Anand P, Verma A, et al.: Outcome of extremely low birth weight (ELBW) infants from a birth cohort (2013–2018) in a tertiary care unit in North India. J. Perinatol. 2020; 40(5): 743–749. PubMed Abstract | Publisher Full Text

[9] 9. Kebede ZT, Matebe YH, Demisse AG, et al.: Hematologic profiles of Ethiopian preterm infants with clinical diagnoses of early-onset sepsis, perinatal asphyxia, and respiratory distress syndrome. Glob. Pediatr. Health. 2020; 7. Publisher Full Text

[10] 10. Mitiku HD: Neonatal mortality and associated factors in Ethiopia: a cross-sectional population-based study. BMC Womens Health. 2021; 21(1): 1–9. Publisher Full Text

[11] 11. Donda K, Vijayakanthi N, Dapaah-Siakwan F, et al.: Trends in epidemiology and outcomes of respiratory distress syndrome in the United States. Pediatr. Pulmonol. 2019; 54(4): 405–414. Publisher Full Text

[12] 12. Groene S, Spekman J, Te Pas A, et al.: Respiratory distress syndrome and bronchopulmonary dysplasia after fetal growth restriction: lessons from a natural experiment in identical twins. EClinicalMedicine. 2021; 32: 100725. View Article. 2021. PubMed Abstract | Publisher Full Text | Free Full Text

[13] 13. Thygesen SK, Olsen M, Østergaard JR, et al.: Respiratory distress syndrome in moderately late and late preterm infants and risk of cerebral palsy: a population-based cohort study. BMJ Open. 2016; 6(10): e011643. PubMed Abstract | Publisher Full Text | Free Full Text

[14] 14. Thygesen SK, Olsen M, Pedersen L, et al.: Respiratory distress syndrome in preterm infants and risk of epilepsy in a Danish cohort. Eur. J. Epidemiol. 2018; 33: 313–321. PubMed Abstract | Publisher Full Text

[15] 15. Abou-Faddan HH, Abdelaziz N: Respiratory distress and its outcome among neonates admitted to neonatal intensive care unit of Assiut University Children Hospital, Egypt. Egypt The Egyptian Journal of. Community Med. 2018; 36(2): 69–78. Publisher Full Text

[16] 16. Ajeli MHA, Shukr M, Hachim BAA-H: Prevalence and Etiology of Respiratory Distress in Newborns in the Fallujah Teaching Hospital for Women and Children. Kerbala Jorunal of Medicine. 2019; 12(2).

[17] 17. Sahoo T, Anand P, Verma A, et al.: Outcome of extremely low birth weight (ELBW) infants from a birth cohort (2013-2018) in a tertiary care unit in North India. J Perinatol: Official Journal of the California Perinatal Association. 2020; 40(5): 743–749. PubMed Abstract | Publisher Full Text

[18] 18. Sweet DG, Carnielli V, Greisen G, et al.: European consensus guidelines on the management of respiratory distress syndrome–2019 update. Neonatology. 2019; 115(4): 432–450. PubMed Abstract | Publisher Full Text | Free Full Text

[19] 19. Mwita S, Jande M, Katabalo D, et al.: Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth: a scoping review on the impact of antenatal corticosteroids in low-and middle-income countries. World J. Pediatr. 2021; 17: 131–140. PubMed Abstract | Publisher Full Text

[20] 20. Hubbard RM, Choudhury KM, Lim G: Treatment patterns and clinical outcomes in neonates diagnosed with respiratory distress syndrome in a low-income country: a report from Bangladesh. Anesth. Analg. 2018; 126(5): 1684–1686. PubMed Abstract | Publisher Full Text | Free Full Text

[21] 21. Tochie JN, Choukem S-P, Langmia RN, et al.: Neonatal respiratory distress in a reference neonatal unit in Cameroon: an analysis of prevalence, predictors, etiologies and outcomes. Pan Afr. Med. J. 2016; 24(1): 152. PubMed Abstract | Publisher Full Text | Free Full Text

[22] 22. Lloreda-García JM, Sevilla-Denia S, Rodríguez-Sánchez A, et al.: Perinatal outcome of macrosomic infants born to diabetic versus non-diabetic mothers. Endocrinología y Nutrición (English Edition). 2016; 63(8): 409–413. Publisher Full Text

[23] 23. Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int. J. Surg. 2021; 88: 105906. PubMed Abstract | Publisher Full Text

[24] 24. Munn Z, Moola S, Lisy K, et al.: Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. JBI Evidence Implementation. 2015; 13(3): 147–153.

[25] 25. Rücker G, Schwarzer G, Carpenter JR, et al.: Undue reliance on I 2 in assessing heterogeneity may mislead. BMC Med. Res. Methodol. 2008; 8: 1–9.

[26] 26. Sterne JA, Egger M: Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J. Clin. Epidemiol. 2001; 54(10): 1046–1055. Publisher Full Text

[27] 27. Egger M, Smith GD, Schneider M, et al.: Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315(7109): 629–634. PubMed Abstract | Publisher Full Text | Free Full Text

[28] 28. Rijal P, Shrestha M: Scenario of neonatal respiratory distress in tertiary hospital.2018.

[29] 29. Singh S, Srivastava R, Singh A, et al.: Respiratory distress including meconium aspiration syndrome in vigorous neonates born through meconium stained amniotic fluid: incidence, onset, severity and predictors at birth. Indian J. Pediatr. 2013; 80: 538–543. PubMed Abstract | Publisher Full Text

[30] 30. Niesłuchowska-Hoxha A, Cnota W, Czuba B, et al.: A retrospective study on the risk of respiratory distress syndrome in singleton pregnancies with preterm premature rupture of membranes between 24+ 0 and 36+ 6 weeks, using regression analysis for various factors. Biomed. Res. Int. 2018; 2018: 1–6. PubMed Abstract | Publisher Full Text | Free Full Text

[31] 31. Parkash A, Haider N, Khoso ZA, et al.: Frequency, causes and outcome of neonates with respiratory distress admitted to Neonatal Intensive Care Unit, National Institute of Child Health, Karachi. J. Pak. Med. Assoc. 2015; 65(7): 771–775. PubMed Abstract

[32] 32. Correia C, Rocha G, Flor-de-Lima F, et al.: Respiratory morbidity in late preterm infants. Minerva Pediatr. 2016; 70(4): 345–354. PubMed Abstract | Publisher Full Text

[33] 33. Adhikari J, Aryal S, Gupta V: Acute respiratory distress and its risk factors among neonates admitted in a tertiary care center of Western Nepal. Journal of Nepalgunj Medical College. 2017; 15(1): 5–8. Publisher Full Text

[34] 34. Mihaylova A, Gueorguiev S, Parahuleva N, et al.: Frequency of hyaline membrane disease in preterm infants after prenatal corticosteroid prophylaxis. Frequency of hyaline membrane disease in preterm infants after prenatal corticosteroid prophylaxis. 2018.

[35] 35. Condò V, Cipriani S, Colnaghi M, et al.: Neonatal respiratory distress syndrome: are risk factors the same in preterm and term infants? J. Matern. Fetal Neonatal Med. 2017; 30(11): 1267–1272. PubMed Abstract | Publisher Full Text

[36] 36. Dhaded SM, Somannavar MS, Vernekar SS, et al.: Neonatal mortality and coverage of essential newborn interventions 2010-2013: a prospective, population-based study from low-middle income countries. Reprod. Health. 2015; 12: 1–8.

[37] 37. Bahwal SA, Jawass MA, Bahartha AS: Respiratory Distress and Its Outcome among Neonates Admitted to Neonatal Intensive Care Unit of Mukalla Maternity and Child Hospital, Yemen. Diyala J. Med. 2020; 18(1): 141–154. Publisher Full Text

[38] 38. Gagrani S, Mehrotra G, Mulye S, et al.: Effect of gender and gestational age on short term morbidities and mortality in extremely low birth neonates. Int. J. Contemp. Pediatr. 2017; 4(3): 993. Publisher Full Text

[39] 39. Course C, Chakraborty M: Management of respiratory distress syndrome in preterm infants in wales: a full audit cycle of a quality improvement project. Sci. Rep. 2020; 10(1): 3536. PubMed Abstract | Publisher Full Text | Free Full Text

[40] 40. Vardar G, Karadag N, Karatekin G: The role of lung ultrasound as an early diagnostic tool for need of surfactant therapy in preterm infants with respiratory distress syndrome. Am. J. Perinatol. 2020; 38(14): 1547–1556. PubMed Abstract | Publisher Full Text

[41] 41. Abate A: RDS outcome data Excel.xlsx. figshare. 2025.

[42] 42. Abate A: PRISMA Checklist.docx.2025.

[43] 43. Abate A: Supporting file.docx.2025.

[44] 44. Bayana E, Gela D, Gebreyohannis T, et al.: Pattern of disease & associated factors among neonates admitted to neonatal intensive care unit at jimma university medical center, jimma. Southwest Ethiopia.2019.

[45] 45. Chekole B, Fetene TT, Geze TS, et al.: Prevalence and factors associated with neonatal acute respiratory distress syndrome among neonates admitted to the neonatal intensive care units of Gurage zone public hospital, South West Ethiopia. Afr. Health Sci. 2023; 23(3): 159–167. PubMed Abstract | Publisher Full Text

[46] 46. Aynalem YA, Mekonen H, Akalu TY, et al.: Incidence of respiratory distress and its predictors among neonates admitted to the neonatal intensive care unit, Black Lion Specialized Hospital, Addis Ababa, Ethiopia. PloS one. 2020; 15(7): e0235544. PubMed Abstract | Publisher Full Text | Free Full Text

[47] 47. Asmamaw SD, Getachew S, Demeke T, et al.: Magnitude of Neonatal Admission Diagnosis and Associated Factors at Selected Hospitals in Wollo, Northeast Ethiopia. Res. Rep. Neonatol. 2023; 13: 29–44. Publisher Full Text

[48] 48. Demisse AG, Alemu F, Gizaw MA, et al.: Patterns of admission and factors associated with neonatal mortality among neonates admitted to the neonatal intensive care unit of University of Gondar Hospital, Northwest Ethiopia. Pediatr. Health Med. Ther. 2017; 8: 57–64. PubMed Abstract | Publisher Full Text | Free Full Text

[49] 49. Wondie WT, Legesse BT, Mekonnen GB, et al.: Incidence and predictors of respiratory distress syndrome among low birth weight neonates in the first seven days in Northwest Ethiopia Comprehensive Specialized Hospitals, 2023: A retrospective follow-up study. BMJ Open. 2023; 13(11): e079063. PubMed Abstract | Publisher Full Text | Free Full Text

[50] 50. Genie YD, Kebede BF, Zerihun MS, et al.: Morbidity and mortality patterns of preterm low birthweight neonates admitted to referral hospitals in the Amhara region of Ethiopia: retrospective follow-up study. BMJ Open. 2022; 12(7): e054574. PubMed Abstract | Publisher Full Text | Free Full Text

[51] 51. Minuye Birihane B, Alebachew Bayih W, Yeshambel Alemu A, et al.: The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study. Plos one. 2021; 16(3): e0249365. PubMed Abstract | Publisher Full Text | Free Full Text

[52] 52. Fenta B, Yetwale A, Biyazin T, et al.: Respiratory distress and its associated factors among preterm neonates admitted to Mizan Tepi University teaching hospital, Bench Maji Zone, South West Ethiopia, 2020. J. Neonatal Nurs. 2022; 28(4): 249–254. Publisher Full Text

[53] 53. Kokeb M, Desta T: Institution Based prospective cross-sectional study on patterns of neonatal morbidity at Gondar University Hospital Neonatal Unit, North-West Ethiopia. Ethiop. J. Health Sci. 2016; 26(1): 73–79. PubMed Abstract | Publisher Full Text | Free Full Text

[54] 54. Assefa B, Abate A, Yirga T: Magnitude of Preterm Birth Admission, Immediate Outcomes and Their Predictors in Debre Markos Referral Hospital, North West, Ethiopia.2021.

[55] 55. Seboka J, Abera AM, Rebitu AD: Pattern of admission and outcome of neonate admitted to adama hospital medical college neonatal intensive care unit, adama, Ethiopia. Int. J. Sci. Basic Appl. Res. 2018; 42(01): 59–71.

Pooled Prevalence of neonatal respiratory distress syndrome and its associated factors in Ethiopia: A Systematic review and Meta-analysis

Abstract

Background

Methods

Results

Conclusion

Keywords

Introduction

Research questions

Methods

Protocol and registration of this study

Searching strategies and appraisal of studies

Eligibility of the study

Data extraction

Outcome measurement

Quality assessment

Data synthesis and analysis

Ethical consideration

Results

Search results

Figure 1. Flow chart on the article selection strategy for systematic review and meta-analysis of prevalence and associated factors of respiratory distress syndrome among neonates in Ethiopia, 2024.

Characteristics of the included studies

Table 1. Characteristics of studies included in this systematic review and meta-analysis on respiratory distress syndrome among neonates in Ethiopia.

Pooled prevalence of neonatal respiratory distress syndrome

Figure 2. The forest plot shows the pooled prevalence of respiratory distress syndrome among neonates in Ethiopia.

Heterogeneity and bias test

Figure 3. A funnel plot shows the pooled prevalence of respiratory distress syndrome among neonates in Ethiopia.

Table 2. Egger’s test of respiratory distress syndrome among neonates in Ethiopia.

Sub-group analysis

Table 3. Sub-group analysis of respiratory distress syndrome and associated factors among neonates in Ethiopia.

Sensitivity analysis

Table 4. Sensitivity analysis of respiratory distress syndrome among neonates in Ethiopia.

Risk factors associated with respiratory distress syndrome among neonates in Ethiopia

Figure 4. The forest plot shows factors significantly associated with the pooled prevalence of respiratory distress syndrome among neonates in Ethiopia.

Discussion

Strengths and limitations of the study

Conclusions

Author contribution statement

Data availability statement

Acknowledgments

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Comments on this article

Browse by related subjects

Competing Interests Policy

Stay Updated