Trends and distribution of birth asphyxia, Uganda, 2017-2020: A retrospective analysis of public health surveillance data

BackgroundDuring 2018-2020, almost half of all neonatal deaths reviewed in Uganda were due to birth asphyxia. In 2015, Uganda adopted the Every Newborn Action Plan interventions to renew focus on surveillance for birth asphyxia and other childhood-related illnesses. In 2016, Ministry of Health implemented an evidence-based educational program for birth attendants about neonatal resuscitation techniques to improve management of birth asphyxia. Birth asphyxia is reported on a monthly basis in Uganda as part of routine reporting. We described the trends and distribution of birth asphyxia in Uganda during 2017-2020 following these renewed efforts. MethodsWe analysed birth asphyxia surveillance data from the District Health Information System 2 during January 2017-December 2020. We calculated incidence of birth asphyxia per 1,000 deliveries at district, regional, and national levels. We used line graphs to demonstrate the trend of birth asphyxia incidence with the corresponding reporting rates at national and regional levels and used logistic regression to evaluate significance of the trends. Using choropleth maps, we described the distribution of birth asphyxia incidence at district level. ResultsThe average national annual incidence of birth asphyxia increased by 4.5% from 2017 to 2020 (OR=1.05; 95%CI=1.04-1.05, p=0.001), with national quarterly reporting rates of 70-80% over the same period. Incidence in the Northern and Eastern Regions increased 6% (OR=1.06; 95%CI=1.05-1.07, p=0.001) and 5% (OR=1.05; 95%CI=1.03-1.05, p=0.001), respectively, over the study period. Bundibugyo, Iganga, and Mubende Districts had rates of >60/1,000 during each of the four years of the study period. The least affected district was Kazo District, with an overall incidence of 3/1,000 over the study period. ConclusionThe incidence of birth asphyxia increased nationally from 2017-2020. Continuous capacity-building in birth asphyxia management, with emphasis on the most affected districts, could reduce the burden of this public health problem in Uganda.