Research Article Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis Zebenay Workneh Bitew , 1 Ayinalem Alemu, 2 Ermias Getaneh Ayele, 1 Desalegn Abebaw Jember, 1 Michael Tamene Haile, 1 and Teshager Worku 3 1 St. Paul’s Hospital Millennium Medical College, Nursing Education Directorate, Addis Ababa, Ethiopia 2 Ethiopian Public Health Institute, Addis Ababa, Ethiopia 3 College of Health and Medical Sciences, School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia Correspondence should be addressed to Zebenay Workneh Bitew; zedo2015@gmail.com Received 14 July 2020; Accepted 26 September 2020; Published 17 October 2020 Academic Editor: Asirvatham Alwin Robert Copyright © 2020 Zebenay Workneh Bitew et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined. Methods. Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and Google) were explored. 20 out of 818 studies were included in this study. The IDRs and predictors of neonatal mortality were computed from studies conducted in survival analysis. Fixed and random effect models were used to compute pooled estimates. Subgroup and sensitivity analyses were performed. Results. Neonates were followed for a total of 1,095,611 neonate-days; 67142 neonate-days for neonates treated in neonatal intensive care units and 1,028,469 neonate-days for community-based studies. The IDRs of neonatal mortalities in neonatal intensive care units and in the community were 24.53 and 1.21 per 1000 person- days, respectively. The IDRs of early and late neonatal mortalities neonatal intensive care units were 22.51 and 5.09 per 1000 neonate-days, respectively. Likewise, the IDRs of early and late neonatal mortalities in the community were 0.85 and 0.31, respectively. Not initiating breastfeeding within one hour, multiple births, rural residence, maternal illness, low Apgar score, being preterm, sepsis, asphyxia, and respiratory distress syndrome were independent predictors of time to neonatal mortality in neonatal intensive care units and male gender, perceived small size, multiple births, and ANC were predictors of neonatal mortality in the community. Conclusion. The incidence density rate of neonatal mortality in Sub-Saharan Africa is significantly high. Multiple factors (neonatal and maternal) were found to be independent predictors. Strategies must be designed to address these predictors, and prospective studies could reveal other possible factors of neonatal mortalities. 1. Background Neonatal mortality rate (NMR) is defined as the death of a newborn within 28 days of birth, and it is expressed per 1000 live births [1]. It is also classified as early (the first 7 days) and late (7 to 28 days) neonatal mortality rates [2, 3]. It is the most vulnerable period in which around one million newborns die in the early neonatal period and 2.8 million die in the late neonatal period [4]. Neonatal mortality rate in the least developed countries (26 per 1000 live births) is signifi- cantly lower than NMR in the globe (19 per 1000 live births) [5]. In Sub-Saharan Africa (SSA), NMR was found to be 29 per 1000 live births that accounted for 36% of under-five mortalities [6]. Neonatal mortality (NM) is a major public health prob- lem that endangers the survival of children with a remarkable variation between developed (4 to 46%) and developing countries (0.2 to 64.4%) [7]. It contributes to 44% of under- five mortalities throughout the world and more than 99% of NM took place in low- and middle-income countries, including SSA [2, 3, 8], with a slow progress in decreasing of NM being seen in African and Asian countries [9]. The Hindawi International Journal of Pediatrics Volume 2020, Article ID 3894026, 14 pages https://doi.org/10.1155/2020/3894026