Neonatal and Maternal Sepsis in Gulf Cooperation Council Countries, 1990–2023: A Global Burden of Disease Analysis and Forecast to 2050

Introduction: Sepsis remains an important cause of preventable morbidity and mortality, but long-term trends in neonatal and maternal sepsis across the Gulf Cooperation Council (GCC) have not been well characterized. Methods: We analysed Global Burden of Disease (GBD) 2023 estimates for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates from 1990 to 2023. Absolute counts and age-standardised death and incidence rates (ASDRs and ASIRs) were evaluated. Temporal trends were summarized using estimated annual percentage change (EAPC) from log-linear regression, with model fit assessed by R2. Between-country differences in temporal slopes were evaluated using pairwise tests with Holm adjustment. ARIMA and ETS models were used for exploratory projections to 2050. Results: Absolute neonatal sepsis deaths declined by 88.9% (1786 to 198) and maternal sepsis deaths by 53.6% (13 to 6). The unweighted mean of the six country-specific neonatal ASDRs declined by 76.6%, and the corresponding maternal ASDR mean declined by 85.1%. The unweighted mean neonatal ASIR declined by 21.4% (63.32 to 49.74 per 100,000), while maternal ASIR declined by 69.7% (571.73 to 173.09 per 100,000 females). Neonatal incidence declined in five countries but showed a small positive EAPC in Kuwait (+0.384% per year; 95% CI 0.053% to 0.715%); this estimate had poor fit (R2 = 0.132) and therefore should be interpreted cautiously. Formal comparisons showed between-country heterogeneity in neonatal mortality, neonatal incidence, and maternal incidence trends, whereas maternal mortality slopes did not differ significantly after multiplicity correction. The first 28 days of life contained the highest neonatal burden. Long-range forecasts were highly uncertain in several strata, with wide prediction intervals and occasional disagreement between ARIMA and ETS models. Conclusions: Neonatal and maternal sepsis mortality rates declined substantially across GCC countries over 1990–2023, but incidence trajectories were less uniform. Age-standardised rates should be prioritized for cross-country comparison, and the 2050 projections should be regarded as exploratory scenarios rather than precise targets. Continued surveillance, infection prevention, antimicrobial stewardship, and harmonized GCC reporting are warranted.