Contributing Factors to Elevated Neonatal Sepsis Rates in State Hospitals: A Mixed Methods Study in Windhoek, Namibia

Background: Neonatal sepsis remains a significant contributor to infant morbidity and mortality worldwide, particularly in low- and middle-income countries. In Namibia, despite national health policies aimed at reducing neonatal deaths, sepsis rates remain high. Aim: This study aimed to investigate the factors contributing to high neonatal sepsis rates in state hospitals in Windhoek, Namibia, from the perspective of frontline nursing staff. Methods: A mixed methods triangulation design was employed, collecting both qualitative and quantitative data from nurses in two state hospitals. Stratified random sampling was used for the quantitative component, while purposive sampling guided qualitative interviews. Quantitative data (n=62) were analyzed using descriptive statistics in STATA, and qualitative data (n=15) underwent thematic analysis. Results: out of 77 total number of participants under Quantitative (62) findings showed most nurses had moderate experience with neonatal sepsis care but expressed a need for further training. High workload (39%), lack of equipment (23%), inadequate training (15%), and emotional stress (16%) were major challenges reported. 15 participants under Qualitative data revealed key themes including poor availability of equipment, overcrowding, high nurse-to-patient ratios, inadequate maternal hygiene practices, and insufficient healthcare facilities. Conclusion: Structural and resource-related challenges significantly contribute to neonatal sepsis in Windhoek’s state hospitals. Strategic interventions, including infrastructure improvements, nurse training, and maternal hygiene education, are essential to reducing infection rates.