NeoShield: Epidemiological Analysis of Neonatal Sepsis and Antimicrobial Resistance Dynamics to Inform Novel Detection Tools in High-Burden Settings

Neonatal healthcare-associated infections (HAIs) are a major cause of mortality and antimicrobial resistance (AMR) in healthcare facilities across sub-Saharan Africa. Of the 2.3 million neonatal deaths annually, an estimated 24% are infection-related, with many linked to outbreaks. Overstretched clinical teams, limited diagnostics, fragmented data, and critical gaps in local pathogen epidemiology and genomics often hinder outbreak detection and response. Integrated, context-appropriate solutions are urgently needed to link local microbiological surveillance to real-time, individual-level care. NeoShield will address these challenges in Malawi and Zambia by generating epidemiological and genomic data on neonatal HAIs and their associated AMR, and by developing and validating an AI-driven Clinical Decision Support Algorithm (CDSA) to support inpatient management of neonatal sepsis. The CDSA will integrate clinical signs, point-of-care diagnostics, and local microbiology trends to support antibiotic treatment decisions aligned with facility, national, and World Health Organisation (WHO) guidelines. Five workstreams will be delivered: (1) Laboratory Strengthening; (2) CDSA Development and Validation; (3) Ward-Level Outbreak Detection with Automated Alerts; (4) Sepsis and Stewardship Intervention Bundle; and (5) Pathogen Whole-Genome Sequencing. NeoShield will produce open-source digital tools, open-access learning resources, peer-reviewed publications, and policy briefs to inform national and global strategies for neonatal infection prevention and AMR surveillance.