A Methodological Framework for Assessing the Unintended Impact of COVID-19 Infection Prevention Protocols on Neonatal Sepsis in Ethiopian Hospitals (2021–2026)

This methodology article presents a structured framework for assessing the unintended consequences of COVID-19 infection prevention and control (IPC) protocols on neonatal sepsis rates within Ethiopian hospitals from 2021–2026. The central research problem is the potential for stringent pandemic measures—including restricted parental access, altered healthcare worker practices, and resource reallocation—to inadvertently elevate neonatal sepsis incidence, a leading cause of child mortality in Africa. To address this, we propose a rigorous, mixed-methods longitudinal framework employing a convergent design. Quantitatively, the study analyses retrospective and prospective hospital data, comparing pre-pandemic (2021–2022) and post-protocol implementation (2023–2026) periods. Metrics include sepsis rates, antibiotic usage, and maternal-neonate contact hours across a purposive sample of facilities. Qualitatively, it incorporates semi-structured interviews and focus group discussions with healthcare workers and parents to elucidate behavioural and systemic drivers. A key methodological contribution is the framework's emphasis on contextual rigour, advocating for the triangulation of local clinical audit data with national health management information systems to ensure validity and sustainability in resource-constrained settings. The framework's significance lies in providing public health practitioners in Ethiopia and across Africa with a standardised tool to evaluate the secondary effects of emergency IPC policies. This facilitates more balanced, evidence-based decision-making that safeguards both infectious disease control and essential neonatal care, thereby strengthening overall health system resilience.