According to the World Health Organization (WHO) report, around 4 million newborns die each year within the first four weeks of life, with 75% of these deaths occurring during the first week. Neonatal sepsis represents a major global public health challenge due to its significant impact on neonatal mortality and morbidity. Neonatal sepsis ranks as the third leading cause of neonatal deaths globally, accounting for nearly 26% of these fatalities. It is the primary cause of neonatal mortality in low- and middle-income countries like Mali, responsible for over half of all neonatal fatalities.
Neonatal sepsis is a systemic infection that occurs within the first 28 days of life. Based on onset time, it is classified into 2 subtypes: early-onset sepsis (EOS) and late-onset sepsis (LOS). EOS occurs within the first 72 hours after birth and is typically affected by microorganisms acquired before or during delivery, often during maternal-fetal infection. In contrast, LOS develops after 72 hours and results from organisms acquired postnatally from the healthcare settings or community.
The occurrence of neonatal sepsis varies significantly across countries. In East Africa, the estimated prevalence was 29.7%, while in other African nations, it ranged from 55% in Nigeria to 49.8% in Tanzania, 79% in Ethiopia, 20% in South Africa, and 21.8% in Uganda. In sub-Saharan Africa, many risk factors are associated with neonatal sepsis such as male neonates, pre-term rupture of membranes, intrapartum maternal fever, a low appearance, pulse, grimace, activity, and respiration (APGAR) score at 1 min, meconium-stained amniotic fluid, prolonged labor, need for resuscitation, low birth weight, multiple digital vaginal examinations.
In 2017, Mali joined the global maternal sepsis study (GLOSS), a WHO program across 52 countries aimed at developing diagnostic criteria, evaluating maternal sepsis prevalence, and estimating newborn management. However, the study did not recognize risk factors for neonatal sepsis in Mali. Since 2012, Mali’s politico-security crisis has reduced healthcare access and compromised the quality of maternal and neonatal care, leading to a significant increase in neonatal sepsis rates. With a portion of the national health budget redirected to security, identifying neonatal sepsis risk factors is necessary to guide preventive measures.
Fatoumata Bintou Traoré et al. conducted a prospective cross-sectional study to estimate the prevalence and risk factors of neonatal sepsis among neonates admitted to 4 health facilities in the Bamako district and Koulikoro region in Mali. This study was carried out from December 2022 to January 2023 in two hospitals and two reference health centers. A total of 795 neonates with a mean age of 3.95 ± 5.82 days, and 86.67% of neonates were 2.5 kg birth weight were included in this study. The mothers predominantly belonged to the 25–34 age group, and 96.6% were married. Neonatal sepsis was clinically diagnosed in 21% (167/795) of neonates, including 25.75% identified with LOS and 74.25% with EOS.
Neonates aged 0 to 7 days were 2.8 times more likely to develop neonatal sepsis compared to those aged 8 to 28 days (Adjusted odds ratio [AOR] = 2.79, 95% confidence interval [CI]: 1.59–4.89). Also, neonates with birth weight below 2.5 kg had a 2.9-fold greater chance of developing sepsis compared to those weighing over 2.5 kg (AOR = 2.88, 95% CI: 1.41–5.86). Moreover, neonates with APGAR score at 5 min <7 were 4 times more likely to the occurrence of neonatal sepsis compared to those with APGAR score ≥7 (AOR = 4.03, 95% CI: 3.09–5.24).
Several statistically significant risk factors are identified for neonatal sepsis by bivariate logistic analysis. These involved gestity >3 (OR = 1.87, 95% CI: 1.30 to 2.68, p = 0.001), maternal age ≥35 years (OR = 1.84, 95% CI: 1.12 to 3.03, p = 0.01), parity >3 (OR = 1.77, 95% CI: 1.25 to 2.50, p = 0.000), multiple pregnancy (OR = 1.87, 95% CI: 1.1 to 3.21, p = 0.02), mothers with no formal education (OR = 3.41, 95% CI: 1.86 to 6.23, p = 0.000), intrapartum fever (OR = 2.69; 95% CI: 1.86 to 3.88, p = 0.000),  urinary tract infection (UTI) (OR = 1.66, 95% CI: 1.13 to 2.44, p = 0.009), hand washing with soap before handling baby (OR = 0.46, 95% CI: 0.29 to 0.73, p = 0.001), prolonged labor (OR = 3.98, 95% CI: 2.50 to 6.34, p = 0.000), prolonged rupture of membranes (OR = 4.07, 95% CI: 2.51 to 6.60; p = 0.000), and bleeding during pregnancy (OR = 2.28, 95% CI: 1.18 to 4.42, p = 0.014).
Logistic regression analysis was used to adjust for variables with p value of <0.20. After adjustment, the analysis showed that neonates of mothers with no formal education were twice as likely to develop sepsis (AOR = 2.24, 95% CI: 1.15 to 4.33). Similarly, maternal fever during labor (AOR = 2.31, 95% CI: 1.52 to 3.53), prolonged rupture of membranes (AOR = 1.87, 95% CI: 1.01 to 3.54), and prolonged labor (AOR=2, 95% CI: 1.03 to 3.88) were significant risk factors.
The authors concluded that neonatal sepsis continues to pose a significant health burden in Mali. Given the country’s constrained security resources and ongoing challenges, this study provides valuable insights to inform targeted prevention strategies. Prioritizing antenatal and postnatal care, encouraging facility-based deliveries, and closely monitoring high-risk neonates are essential steps toward reducing sepsis prevalence. Additionally, future research should prioritize the inclusion of home-born neonates to ensure comprehensive understanding and intervention.
Reference: Traoré FB, Camara BS, Diallo EM, et al. Prevalence and factors associated with neonatal sepsis in Mali: a cross-sectional study. BMJ Open. 2025;15(1):e082066. doi:10.1136/bmjopen-2023-082066
