Trends, Distribution and Variations in Neonatal Sepsis Rates in Tanzania Health Facilities based on DHIS2 Data from 2021 to 2025

Abstract Background Tanzania is among Sub Saharan African (SSA), countries with a higher neonatal mortality rate of 24 per 1,000 live births, whereby neonatal sepsis contributes more than 20% of total neonatal deaths. Despite the national efforts to integrate the neonatal sepsis rate indicator into District Health Information System 2 (DHIS2) in order to create national, regional, council, and facility data for decision-making and services improvement, there are a limited number of analyses that have been done to assess the trends and variations of this indicator. Therefore, this study aimed to assess the trends, distribution, and regional variations in neonatal sepsis rates in Tanzania health facilities using routine DHIS 2 data from 2021 to 2025. Methodology: This study was a descriptive cross-sectional study conducted among 138 health facilities reporting neonatal sepsis data in Tanzania. Permission to conduct this study was obtained from the Ministry of Health, and ethical clearances were obtained from the National Institute of Medical Research. The validated data was retrospectively extracted from the DHIS2 database, cleaned, and analyzed using R version 4.5.0. The neonatal sepsis variations in trend were analyzed using the ordinary least squares method, and significant changes/variations were measured at ≤ 0.05 p-values and presented in tables, graphs, and figures. Results The overall neonatal sepsis rate trend increased from 12.9 per 1,000 live births in the year 2021 to 20.9 per 1,000 live births in the year 2025. Male neonates reported consistent decreases of neonatal sepsis rate trends from 6.4 per 1,000 live births in the year 2021 to 5.7 per 1,000 live births in the year 2025. The secondary health facilities reported a higher and decreased neonatal sepsis rate from 64.1 per 1,000 live births in the year 2021 to 41.9 per 1,000 live births in the year 2025. The urban health facilities reported a higher and decreased neonatal sepsis rate from 21.5 per 1,000 live births to 14.5 per 1,000 live births, and the neonatal sepsis rate reported in private health facilities was very high but decreased from 18.4 per 1,000 live births in the year 2021 to 14.3 per 1,000 live births in the year 2025. The coastal zone reported the highest rate of neonatal sepsis of 17.8 per 1,000 live births, and the Lindi region (21.3 per 1,000 live births), reported the highest neonatal sepsis rate. There were substantial variations in the either increases or decreases in the trends of neonatal sepsis across different subgroups, although these variations were not statistically significant. Conclusion Overall neonatal sepsis rates trends increased from 2021 to 2025 but remained variable across the sub-facility level, ownerships, neonates' sexes, zones, and locations. Clinical trial registration This study was not a clinical trial