More than one in three newborns evaluated for suspected sepsis in sub-Saharan Africa turn out to have culture-confirmed bacterial sepsis, according to a systematic review and meta-analysis published in November 2026. The analysis pooled data from 21 observational studies covering 7,993 neonates across seven countries in the region and estimated a pooled prevalence of 35.2 percent, with a 95 percent confidence interval of 27.4 to 43.5 percent. The finding, reported in a journal focused on critical care sepsis research, quantifies a burden that has long been suspected but rarely synthesized at this scale.
The review followed PRISMA 2020 reporting guidelines and searched PubMed/MEDLINE, Embase, Scopus, and Google Scholar for English-language studies published between January 2020 and December 2025. Eligible studies were observational, conducted in countries within the United Nations geographical definition of sub-Saharan Africa, involved neonates aged 0 to 28 days, reported culture-confirmed bacterial sepsis, and provided data on bacterial isolates. After screening 325 identified records, the reviewers included 21 studies. Most of the included studies were conducted in neonatal intensive care settings, meaning the pooled estimate applies specifically to neonates evaluated for suspected sepsis rather than to all newborns in the region.
Prevalence in the analysis was defined as the proportion of neonates with culture-confirmed bacterial sepsis among all neonates evaluated for suspected neonatal sepsis in each study. Blood cultures were obtained according to the clinical criteria applied in the individual studies, and bacterial pathogens isolated from blood cultures were treated as the causative organisms of culture-confirmed sepsis. The pooled prevalence was estimated using the DerSimonian and Laird random-effects model, and statistical heterogeneity was assessed with Cochran’s Q test and the I² statistic. The result was a substantial degree of heterogeneity: I² was 98.3 percent with p < 0.001, indicating that nearly all of the variability across studies reflected true between-study differences rather than sampling error.
Subgroup analysis by publication period showed how stable the burden has been. Studies published during 2020 to 2022 yielded a pooled prevalence of 36.1 percent (95 percent CI: 26.9 to 45.7 percent), while studies from 2023 to 2025 yielded 33.8 percent (95 percent CI: 19.3 to 50.1 percent). The difference between the two periods was not statistically significant (p = 0.8129). The authors note that this suggests the burden of neonatal sepsis has remained consistently high in the region, although meta-regression was not performed because of the limited distribution of studies across countries.
Beyond prevalence, the review mapped which bacteria are actually causing these infections. Among culture-confirmed bacterial isolates, Staphylococcus aureus was the most frequently identified pathogen, appearing in 20 studies with a pooled prevalence of 23.0 percent (95 percent CI: 17.3 to 29.3 percent) among reported positive cultures, corresponding to 519 isolates. Coagulase-negative staphylococci followed, reported in 12 studies at 20.6 percent (95 percent CI: 13.8 to 28.3 percent; n = 469). Klebsiella pneumoniae ranked third, reported in 18 studies at 15.2 percent (95 percent CI: 10.5 to 20.6 percent; n = 401), then Escherichia coli in 19 studies at 9.3 percent (95 percent CI: 5.9 to 13.3 percent; n = 229), and Streptococcus spp. in 8 studies at 8.1 percent (95 percent CI: 3.1 to 14.9 percent; n = 81).
Less prominent but clinically significant organisms completed the spectrum. Enterobacter spp. were reported in 10 studies with a pooled prevalence of 7.0 percent (95 percent CI: 2.8 to 12.7 percent; n = 90), Acinetobacter spp. in 12 studies at 4.8 percent (95 percent CI: 2.5 to 7.5 percent; n = 69), Pseudomonas aeruginosa in 9 studies at 3.5 percent (95 percent CI: 1.7 to 5.8 percent; n = 42), Enterococcus spp. in 8 studies at 3.2 percent (95 percent CI: 2.2 to 4.3 percent; n = 47), and Serratia marcescens in 11 studies at 3.0 percent (95 percent CI: 1.1 to 5.7 percent; n = 54). The authors emphasize that both Gram-positive and Gram-negative bacteria contribute substantially to neonatal sepsis in the region, with the predominance of specific pathogens varying across settings.
The prominence of coagulase-negative staphylococci deserves particular caution. These organisms are consistent with reports from neonatal intensive care units worldwide, but they are also among the most frequent contaminants of blood cultures, especially in neonates where obtaining aseptic blood specimens is technically difficult. Some reported CoNS isolates may therefore represent contamination rather than true bloodstream infections. Nevertheless, CoNS are recognized causes of healthcare-associated and late-onset neonatal sepsis, particularly among preterm infants and neonates requiring prolonged hospitalization, invasive procedures, or indwelling vascular catheters. The observed prevalence likely reflects a combination of true infections and potential contamination, with the balance shaped by microbiological practices and diagnostic criteria in each study.
Heterogeneity was also high in the pathogen-specific estimates. Staphylococcus aureus showed I² of 91.6 percent, coagulase-negative staphylococci 92.5 percent, Klebsiella pneumoniae 91.6 percent, Escherichia coli 90.2 percent, and Enterobacter spp. 92.3 percent. The authors attribute this variability to differences in neonatal populations, healthcare settings, infection prevention practices, blood culture methods, and laboratory capacity across studies. Enterococcus spp. was the exception, with minimal heterogeneity at I² of 2.4 percent, though this estimate was based on fewer studies and should be interpreted cautiously. The authors conclude that the pooled estimates should be read as regional summary measures rather than precise values applicable to any individual hospital or country.
Publication bias was assessed using funnel plot inspection and Egger’s regression test, and no evidence of bias was detected (p = 0.827). Quality appraisal used a modified Joanna Briggs Institute checklist adapted for prevalence estimation and pathogen reporting, covering domains such as sampling frame, sample size adequacy, validity of sepsis identification including microbiological confirmation, and statistical analysis. Two reviewers independently screened and extracted data, with disagreements resolved by a third reviewer. Antimicrobial susceptibility data could not be quantitatively synthesized because reporting was inconsistent across studies, which the authors flag as a limitation for drawing conclusions about resistance patterns and empirical treatment.
The review’s authors argue that the findings highlight the need to strengthen microbiological surveillance, diagnostic capacity, and infection prevention and control measures across sub-Saharan Africa. The disproportionately high burden of Staphylococcus aureus, they suggest, may indicate increased healthcare-associated transmission, invasive neonatal care practices, and potential gaps in infection prevention within neonatal units, with direct implications for empirical antibiotic selection and the possibility of methicillin-resistant S. aureus. Given the substantial heterogeneity and the concentration of studies in intensive care settings, the pooled figures describe the scale of the problem among neonates already suspected of infection rather than a precise prediction for any single facility, but they provide the most comprehensive multicountry snapshot to date of what is causing these infections and how consistently the burden persists across the region.
Subject of Research: Pooled prevalence and bacterial causes of culture-confirmed neonatal sepsis in sub-Saharan Africa
Article Title: Prevalence and bacterial etiology of culture-confirmed neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis
Article References: Nzobokela, J., Sichone, E., Chama, J., Mwape, D., Chisompola, D., & Mwambungu, A. (2026). Prevalence and bacterial etiology of culture-confirmed neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis. Critical Care: Sepsis and Severe Infection, 1(1), Article 18. https://doi.org/10.1186/s44541-026-00021-7
Image Credits: AI Generated
DOI: 10.1186/s44541-026-00021-7
Keywords: neonatal sepsis, sub-Saharan Africa, systematic review, meta-analysis, Staphylococcus aureus, Klebsiella pneumoniae, blood culture, prevalence, bacterial pathogens, newborn health, infection prevention, antimicrobial stewardship
News Source: Harold Sullivan. (November 6, 2026). Neonatal sepsis strikes one in three babies tested in sub-Saharan Africa, review finds. Scienmag.
