Rising Burden of Preterm Birth in Sub-Saharan Africa: Current Trends and Evidence-based Interventions

Preterm birth, defined as delivery before 37 completed weeks of gestation, is the leading cause of neonatal mortality and the second leading cause of under-five mortality globally. Sub-Saharan Africa bears a disproportionate share of this burden, accounting for more than one-third of the estimated 13.4 million preterm births worldwide each year. This scoping review synthesised the available evidence on the trends, determinants, and evidence-based interventions for preterm birth across sub-Saharan Africa. Guided by the Arksey and O'Malley scoping review framework and reported in line with the PRISMA-ScR guideline, we searched PubMed, Scopus, Web of Science, CINAHL, Global Health, Google Scholar, and African Journals Online for studies published between 2000 and 2024. Fifty-five studies met the inclusion criteria. The review documented an upward trend in preterm birth prevalence across the region, with national estimates ranging from 7% to 18%, and facility-based rates exceeding 20% in several tertiary centres. The leading maternal risk factors included hypertensive disorders of pregnancy, antepartum haemorrhage, infections (malaria, HIV, syphilis, bacterial vaginosis), inadequate antenatal care, adolescent pregnancy, advanced maternal age, short birth intervals, and maternal malnutrition. Evidence-based interventions of demonstrated effectiveness included antenatal corticosteroids for foetal lung maturation, magnesium sulphate for neuroprotection, kangaroo mother care, delayed cord clamping, antenatal prophylaxis with aspirin, and comprehensive maternal and child health packages delivered through strengthened primary health care systems. Persistent gaps were identified in service coverage, quality of intrapartum care, data systems for preterm surveillance, and the implementation of cost-effective interventions at scale. The findings underscore the urgent need for sustained political commitment, domestic financing, health workforce strengthening, and multi-sectoral action to address the structural determinants of preterm birth and accelerate progress toward the Every Newborn Action Plan targets.