BACKGROUND:
Neonatal sepsis is one of the major causes of neonatal morbidity and mortality worldwide. Knowledge of risk factors helps in prevention and management of neonatal sepsis. However, there is a knowledge gap on prevalence and risk factors associated with neonatal sepsis in Malawi. We aimed to determine the prevalence and risk factors associated with neonatal sepsis at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi.

METHODS:
This was a hospital-based cross-sectional study that was conducted at KCH. We reviewed 397 records of neonate using consecutive sampling from 1 January 2021 to 31 March 2021.Data was extracted using a structured data extraction tool from the patients’ case notes and Sick Neonatal Ward register. Key variables such as neonatal age, birth weight, neonatal sex and maternal age, were collected. Extracted data were entered into a Microsoft Excel spreadsheet and analysed using STATA 17. Binary and multi-variate logistic regression was used to determine factors associated with neonatal sepsis.

RESULTS:
Out of 397 records reviewed, 122 (30.7%) were diagnosed with neonatal sepsis. In multivariate analysis, the following factors were associated with increased odds of neonatal sepsis; older neonates aged 8 days above (OR 3.13, CI.1.21-8.12), Female gender (OR 0.47, CI.0.26-0.86), birth weight of 2500g -3900g (OR 2.89, CI. 1.46-5.73), length of stay of 4-7 days (OR 5.00, CI. 2.14-11.71) and length of stay of more than 7 days (OR 3.62, CI. 1.48-8.82). Conclusion and Recommendation The prevalence of neonatal sepsis was at 30.7%. Neonatal factors: neonatal age, neonatal sex, birth weight and length of stay of more than 7 days were significantly associated with neonatal sepsis. We suggest that caregivers ensure safe newborn care, early detection of sepsis with special focus on female neonates aged 3 days and above with a birth weight range of 2500g-3900g and with more than 7 days hospital stay.