Background: Perinatal asphyxia (PNA) is lack of blood flow or gas exchange to or from the infant in the period immediately during or after the birth process. Perinatal asphyxia is a severe health problem and a major cause of neonatal morbidity and mortality worldwide. In Ethiopia, despite many studies conducted, the reported findings are inconsistent. The aim of this study is to ascertain pooled estimates of key reports to enhance the quality and consistency of the evidence.

Method: Systematic review and meta-analysis using computer databases searches were performed to locate all articles on the prevalence of PNA. Databases included were PubMed/MEDLINE, Cochrane Library, Scopus and Science Direct. Two authors screened and extracted the data independent. A random-effects model was used to calculate pooled estimates. The I² tests were used to assess the heterogeneity of the studies.

Result: The prevalence of PNA ranges 3.1% to 32.9%. The pooled estimate of 16 articles with a sample size of 9,816 was 20.02% (95% CI: 14.93, 23.90). The highest prevalence (24%) observed in Southern Nations, Nationalities and People’s Region and the lowest (8%) in Dire Dawa City Administration. Pooled odds ratio estimates from included studies revealed prolonged labor (OR=1.38, 95% CI: 1.01, 1.75), low birth weight (OR=1.73, 95% CI: 1.31, 2.15), meconium stained liquor (OR=1.76, 95% CI: 1.46, 2.06), pre-term (OR=1.71, 95% CI: 1.19, 2.23), and caesarian delivery (OR=1.9, 95% CI: 1.54, 2.26)   as significant risk factors of PNA.

Conclusion: In this review, pooled prevalence of PNA in Ethiopia was found high at 20.02%. Maternal antepartum related, maternal and fetal intrapartum related factors were risk factors for PNA. This information may be useful in guiding improvement of facility-based maternal intra-partal care, fetal intrapartum factor and inform programs on enhancement of nutritional status of pregnant mother to manage the low weight of neonates.