Dear Editor,
We read with great interest the comprehensive systematic review and meta-analysis by Matakone et al. on “Bloodstream infections in Cameroon: a systematic review and meta-analysis”. Their findings reveal a concerning 25.2% prevalence of bacterial bloodstream infections in Cameroon, with significant antimicrobial resistance patterns, particularly among World Health Organisation priority pathogens [1]. While this study provides valuable insights into the broader landscape of bloodstream infections, it underscores a critical gap that demands immediate attention and action: the urgent need for specialized national sepsis surveillance and registry system in Cameroon. As mentioned by the authors, “… the included studies investigated only two of the ten regions and included data from a few tertiary hospitals.” underreporting precludes our understanding of the current burden of sepsis in the country. Since high-quality and contextualised data enable policymakers and stakeholders to develop tailored strategies, it is critical for such information to be standardised nationally and compliant international guidelines.
While focusing on general bloodstream infections, Matakone et al. (2025) highlighted an alarming reality that affects the most vulnerable population, newborns. Neonatal sepsis represents a distinct clinical and epidemiological entity with unique pathogens, transmission patterns, and treatment challenges that require dedicated surveillance infrastructure [2]. The high prevalence of antimicrobial-resistant pathogens documented in their study including Escherichia coli, Klebsiella species, and Staphylococcus aureus are precisely the organisms that cause life-threatening neonatal infections, often with case fatality rates exceeding 20 % in low-resource settings [3]. The authors' conclusion that “further epidemiological studies are needed to enhance our understanding and to enable policymakers and healthcare stakeholders to develop more targeted strategies” resonates strongly with the neonatal sepsis landscape.
However, we argue that such studies must be embedded within a systematic, national surveillance and registry system specifically designed for neonatal populations. Recent evidence from the country revealed (i) high and heterogeneous burden, (ii) evolving antimicrobial resistance patterns, and (iii) diagnostic uncertainty [4]. National surveillance system established across the ten regions of the country could identify, in near real-time, etiological pathogens, trends of antimicrobial resistance prevalence, emerging antibiotic resistance patterns or genes in neonatal sepsis-causing high-risk bacteria, and guide the national empiric treatment guidelines [3]. Further, even with combined culture and molecular testing approaches, most neonatal sepsis cases lack an attributable pathogen, indicating that coordinated surveillance will help in the development of improved diagnostics that are essential for informing prevention and treatment strategies.
Given that Cameroon is currently out of pace to meet the United Nations Sustainable Development Goal (SDG) of less 12 deaths/1000 livebirths, and that the country needs to make three to five time more efforts to meet this target by 2050, establishing its first national neonatal sepsis surveillance system and registry will allow better monitoring of progress and targeted interventions [5].
Rather than creating a standalone system, the registry should be integrated within existing maternal-newborn health platforms to ensure sustainability and reduce implementation barriers. This approach has proven successful for Cancer and HIV in Cameroon. The registry must capture both hospital-acquired and community-acquired neonatal sepsis through facility-based surveillance, community health worker networks and birth registration integration. Critical to the registry's success is the embedding of standardised blood culture protocols and, where feasible, molecular diagnostic capacity to improve pathogen identification and antimicrobial resistance detection, addressing the diagnostic gaps highlighted in the country. Finally, visual dashboards and run charts could provide community-, hospital- and national-level trend monitoring while enabling (i) early outbreak detection and infection prevention responses, (ii) quality improvement cycles in neonatal units, (iii) evidence-based updates to empiric treatment guidelines, and (iv) heightened awareness and sensibilisation.
Despite the fact neonatal sepsis is the leading cause of death in the first 28-days of life and that surveillance data is vital in detecting and tracking neonatal infection outbreaks, there is currently no standardised neonatal infection surveillance system in Cameroon or any other African country. The scarcity of published data from Cameroon mentioned in Matakone et al. study exemplifies the challenge of translating research findings into actionable public health interventions. The time for action is now. Every day of delay represents preventable neonatal deaths and missed opportunities for targeted interventions. Cameroon has the opportunity to become a regional leader in neonatal sepsis surveillance an opportunity that aligns with both global health security priorities and the fundamental right of every newborn to survive and thrive.
CRediT authorship contribution statement
Luria Founou: Writing – original draft, Project administration, Investigation, Formal analysis, Data curation, Conceptualization. Raspail Founou: Writing – review & editing, Supervision, Project administration.
Ethical approval and patients’ consent
As the information used in this study does not include any identifying information from the patients, written consent from the patients was not required.
Funding
No specific funding was received for this letter.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Handling Editor: Patricia Schlagenhauf
References
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