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Impact of Neonatal Sepsis Screening on Neonatal Sepsis Detection in Nigerian Hospitals

Abstract

Neonatal sepsis remains a significant cause of illness and death among newborns in Nigeria, particularly among preterm, low-birth-weight, and otherwise vulnerable infants. The condition may progress rapidly and can be difficult to recognize because its early clinical manifestations are often nonspecific. Delayed identification and treatment of neonatal sepsis may result in severe complications, prolonged hospitalization, neurological injury, or death. Neonatal sepsis screening provides an important opportunity for the early identification of newborns who may have sepsis or who require further clinical and laboratory evaluation. Screening may involve systematic assessment of clinical signs, maternal and neonatal risk factors, vital signs, laboratory investigations, and other appropriate diagnostic procedures according to established clinical protocols. Neonatal sepsis detection refers to the identification of newborns with suspected or confirmed sepsis through appropriate clinical and diagnostic assessment. In Nigeria, effective screening may be particularly important because limited laboratory capacity, inadequate staffing, delayed presentation, shortages of essential supplies, and weaknesses in infection prevention and referral systems may contribute to delayed diagnosis. Against this background, this study investigates the impact of neonatal sepsis screening on neonatal sepsis detection in Nigerian hospitals. The study will be anchored on the Health Systems Framework, the Donabedian Model of Healthcare Quality, and the Three Delays Model. The Health Systems Framework emphasizes service delivery, health workforce, health information, essential medicines and technologies, financing, and accessibility as important components of effective healthcare delivery. The Donabedian Model evaluates healthcare quality through structure, process, and outcome and provides a framework for examining how the availability and implementation of neonatal sepsis screening services influence detection outcomes. The Three Delays Model provides a framework for understanding delays in recognizing illness, reaching appropriate healthcare, and receiving adequate care after arrival at a healthcare facility. Collectively, these theoretical perspectives provide a suitable framework for explaining how neonatal sepsis screening may influence neonatal sepsis detection in Nigerian hospitals. The study will adopt a quantitative cross-sectional or retrospective hospital-based research design. The study population will comprise newborns receiving care in selected secondary and tertiary hospitals in Nigeria, particularly those admitted to neonatal units and special-care baby units. A multistage sampling technique will be used to select states, hospitals, neonatal units, and eligible newborns or medical records. Neonatal sepsis screening will be assessed using indicators such as availability of standardized screening protocols, routine assessment of newborns for sepsis risk factors and clinical signs, availability of trained healthcare personnel, availability of functional diagnostic equipment, availability of laboratory investigations, screening frequency, documentation of screening results, and adherence to screening guidelines. Neonatal sepsis detection will be assessed using indicators such as identification of suspected cases, laboratory-confirmed cases where appropriate, time from admission to identification, completion of diagnostic assessment, and appropriate referral or treatment initiation following detection. Data will be collected from structured questionnaires, neonatal medical records, admission registers, laboratory records, screening forms, and hospital programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening practices, and neonatal sepsis detection patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic regression, will be used to determine the impact of neonatal sepsis screening on neonatal sepsis detection. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that effective implementation of neonatal sepsis screening has a significant positive impact on neonatal sepsis detection in Nigerian hospitals. Hospitals with standardized screening protocols, trained healthcare personnel, appropriate diagnostic equipment, and consistent screening practices are expected to identify suspected and confirmed cases of neonatal sepsis more effectively than hospitals with limited screening capacity. Early screening may facilitate prompt clinical assessment and initiation of appropriate management, thereby reducing delays in treatment. Routine screening of newborns at increased risk may also improve the identification of cases that might otherwise remain undetected because of nonspecific clinical manifestations. Conversely, inadequate staffing, limited laboratory capacity, shortages of diagnostic supplies, poor adherence to screening protocols, inadequate documentation, and delayed laboratory results may reduce the effectiveness of neonatal sepsis screening. The study may also demonstrate that screening effectiveness depends on the availability of appropriate confirmatory diagnostic and treatment services within hospitals.

The study is expected to contribute to the literature on neonatal sepsis screening, neonatal sepsis detection, newborn health, neonatal mortality, paediatrics, infection prevention and control, epidemiology, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospital administrators, paediatricians, neonatologists, neonatal nurses, laboratory scientists, infection prevention and control teams, maternal and child health programme managers, development partners, and policymakers regarding strategies for strengthening early detection of neonatal sepsis. The study will also provide evidence-based recommendations for standardizing neonatal sepsis screening protocols, strengthening neonatal healthcare-worker training, improving laboratory capacity, ensuring adequate availability of diagnostic supplies and equipment, improving documentation and monitoring of screening activities, strengthening infection prevention and control measures, and integrating effective neonatal sepsis screening into routine newborn care services across Nigerian hospitals.

Keywords: Neonatal sepsis screening, neonatal sepsis detection, Nigeria, newborn health, neonatal infection, neonatal mortality, paediatrics, infection prevention and control, neonatal care, early detection, epidemiology, public health.