INTRODUCTION:
Reducing preventable neonatal deaths is central to Sustainable Development Goal (SDG) 3.2, yet neonatal sepsis remains a leading cause of mortality in low- and middle-income countries (LMICs). Global maternal, newborn, and child health strategies emphasize timely care-seeking and family engagement, but public health narratives often frame delays as caregiver knowledge deficits or cultural resistance. This study explores how caregivers in Zimbabwe navigate neonatal sepsis risk amid uncertainty, gendered power relations, and under-resourced health systems.

METHODS:
We conducted a qualitative study comprising five focus group discussions and 24 semi-structured interviews with caregivers of neonates with suspected or diagnosed sepsis across ten rural, peri-urban, and urban health facility catchment areas in Zimbabwe, to examine how caregivers make decisions and engage with health services. Data were collected in Shona, transcribed, translated, and analysed thematically, with attention to decision points, communication experiences, and interactions with care.

RESULTS:
Caregivers reported limited understanding of neonatal sepsis, early danger signs, and treatment rationales, compounded by poor communication and hierarchical care environments. In the absence of clear information, families drew on overlapping biomedical, religious, and traditional explanations. Decisions to delay care, observe at home, or decline referral were shaped by uncertainty, fear, financial and transport constraints, and restricted maternal decision-making autonomy. Caregivers also highlighted missed opportunities for early intervention due to inadequate counselling, lack of structured education, and limited involvement in care decisions.

CONCLUSIONS:
Achieving SDG 3.2 requires re-framing neonatal sepsis care-seeking as a relational and system-mediated process, not failure of caregiver compliance. Ministries of Health should embed caregiver-centred communication, shared decision-making, and culturally responsive education on neonatal danger signs into MNCH policy, facility standards, and frontline training. Strengthening respectful, family-centred care and aligning care pathways with socio-economic realities are low-cost, scalable strategies to promote equity, improve timely presentation, and sustainably reduce preventable neonatal deaths in LMICs.