Analysis of the global burden and key risk factors of neonatal sepsis and other neonatal infections in 204 countries and territories, 1990-2021

Abstract

Background: Neonatal infections, particularly neonatal sepsis, remain significant contributors to morbidity and mortality in pediatrics. This study aims to provide data support for health authorities to control neonatal infections by analyzing the burden of neonatal sepsis and other neonatal infectious (NSNIs) globally and the trends in their risk factors.

Methods: This study is based on the Global Burden of Disease (GBD) database, reviewing the burden and trends of neonatal sepsis and other infectious diseases from 1990 to 2021 at global, regional, and national levels. Descriptive statistics and Joinpoint regression analyses were employed to assess incidence rates, prevalence rates, mortality rates, and Disability-Adjusted Life Years (DALYs), with the Average Annual Percent Change (AAPC) used to quantify these trends.

Results: The findings reveal that from 1990 to 2021, the global incidence (AAPC = -0.8%, p < 0.01), prevalence (AAPC = -0.8%, p < 0.01), DALYs (AAPC = -0.9%, p < 0.01), and mortality rates (AAPC = -0.9%, p < 0.01) for neonatal sepsis and other neonatal infections showed a downward trend. The burden was notably higher in males than in females. Regional analysis indicated that the disease burden remains high in Africa and Southeast Asia, with DALYs of 367,540.10/100,000 and 180,599.79/100,000, respectively. Conversely, the burden in the Eastern Mediterranean and Western Pacific regions has been rising, with DALYs increasing from 53,165.45/100,000 in 2016 to 57,179.59/100,000 in 2021, and from 125,896.44/100,000 in 2018 to 131,698.77/100,000 in 2021. National-level data revealed that Sierra Leone, Chad, and Burkina Faso had significantly higher burdens compared to other countries, with DALYs of 534,090.25/100,000, 520,317.08/100,000, and 505,365.73/100,000 in 2021. An analysis of risk factors indicated that DALYs associated with ambient particulate matter pollution increased by 0.7% since 1990, while DALYs from Household air pollution in solid fuels decreased by 1.4%. Although the burden of diseases related to low birth weight and short gestation declined in many countries, an upward trend was observed in the Eastern Mediterranean and Western Pacific regions (DALYs increased from 88,653.41/100,000 in 2018 to 93,752.24/100,000 in the Eastern Mediterranean and from 28,813.84/100,000 in 2017 to 32,280.55/100,000 in the Western Pacific).

Conclusion: The analysis indicates that while the global burden of NSNIs has decreased, the situation remains serious in Africa and Southeast Asia, with a continuing rise in the burden of NSNIs in the Eastern Mediterranean and Western Pacific regions in recent years. Policymakers should prioritize improving healthcare facilities, increasing access to medical resources, and investing in maternal and neonatal care to effectively reduce the incidence of NSNIs.

Keywords: global disease burden; key risk factors; neonatal infections; other neonatal infections; sepsis.

Figure 1

Trends of incidence rate of NSNIs at the global and regions from 1990 to 2021. NSNIs: neonatal sepsis and other neonatal infections.

Figure 2

Distribution of NSNIs burden across 204 countries worldwide in 2021. (A) Incidence rate; (B) prevalence rate; (C) DALYs rate; and (D) death rate.

Figure 3

Trends in DALYs and mortality rates of NSNIs attributable to risk factors from 1990 to 2021. DALYs: disability-adjusted life years.