Sub-Saharan Africa (sSA), accounts for 3.1 million of the 6.3 million child deaths worldwide each year, around a million of which are in neonates (0-27 days). The contribution of Group B Streptococcus (GBS), a well-established leading cause of early-onset GBS disease in high income settings, has, however, been uncertain in sSA. Recent data from Kenya suggest that GBS is an important pathogen, both in newborns and in stillbirths. This reflects a spectrum of early-onset ascending GBS infection resulting in stillbirth or early onset GBS disease, which through the use of molecular techniques (whole genome sequencing) is evidenced. Combining epidemiological and molecular analyses brings new insights into the clinical and molecular epidemiology of GBS, and helps understand why study findings differ. This has informed the methods for forthcoming estimates of the burden of GBS disease in pregnant women, stillbirths and infants worldwide. Understanding this burden is critical in establishing the case for GBS vaccine development.