Neonatal sepsis in Ethiopia: unveiling the persistent burden through systematic review and meta-analysis

Neonatal sepsis remains a major cause of morbidity and mortality globally, particularly in low- and middle-income countries. Despite several studies conducted in Ethiopia, estimates of its burden remains inconsistent.

To estimate the pooled prevalence of neonatal sepsis in Ethiopia, along with its regional and temporal variations.

A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Google Scholar, Web of Science, and Science-Direct databases and grey literature were searched for observational studies published from April 2019 to September 2025. Nineteen studies with 9,242 neonates were included. Random-effects meta-analysis was used to estimate pooled prevalence, and subgroup analyses, meta-regression, and sensitivity analyses were performed. Publication bias was evaluated using funnel plots and Egger's test.

The pooled prevalence of neonatal sepsis was 44.1% (95% CI: 35.9-52.3), with high heterogeneity (I² = 98.4%). Subgroup analysis revealed the highest prevalence in Southern Ethiopia (49.2%) and the lowest in a pooled subgroup of studies from both Addis Ababa and Somali regions (36.1%). Prevalence was higher in studies before 2020 (44.9%) compared with those after 2020. Early-onset sepsis accounted for 31.0% and late-onset for 16.9%. Funnel plot asymmetry suggested potential publication bias, but none of the variables showed a statistically significant association with neonatal sepsis prevalence (p > 0.05) using meta-regression.

Nearly one in two neonates admitted to Ethiopian health facilities are affected by sepsis, a rate substantially higher than regional and global estimates. Strengthened infection prevention, improved diagnostics, and targeted interventions are urgently needed. These findings provide updated evidence about the pooled prevalence of neonatal sepsis in Ethiopia.