Incidence of preterm births admissions in Uganda, 2015-2019

Abstract Background: Complications of preterm births are the largest cause of neonatal deaths and the second leading cause of deaths among children <5 years globally. The preterm birth rate in Uganda is estimated at 6.6%. Reduction of this rate is needed to achieve the United Nations Sustainable Development Goal to end all preventable deaths among newborns and children aged <5 years by 2030. We describe the trends and distribution of preterm births admissions in Uganda during 2015-2019 for advocacy, planning, and targeted interventions. Methods : We used national preterm birth admissions data from 2015-2019 abstracted from the District Health Information System 2 (DHIS2) to calculate national, regional and district annual incidence of preterm births admissions. DHIS2 defines preterm birth as birth occurring <37 weeks of gestation. We used preterm birth admissions as numerator and the total livebirths (LB) as the denominator. We used line graphs to demonstrate the trend of annual incidence for the national and regional levels and choropleth maps to show district level distribution. Significance of the trend of annual incidence was tested using modified Poisson regression with unbiased sandwich standard errors, considering calendar year as independent and preterm births admissions as dependent variable Results: The national annual incidence of preterm birth admissions/1,000 LB has significantly increased from 3 in 2015 to 14 in 2019 (Incidence Risk Ratio (IRR)=1.3, p =0.003). The annual incidence of preterm birth admissions/1,000 LB increased significantly in three regions of Uganda during 2015 -2019 (Central Region from 3 to 21, IRR=1.5, p<0.0001; Western Region from 4 to 15 IRR=1.2, p=0.039 ; Northern Region from 3 to 10, IRR=1.2, p=0.008 ; Eastern Region from 2 to 8, IRR=1.3, p=0.086 ). The Choropleth map showed minimal clustering of high incidence of preterm birth admissions at district level. Conclusion: Incidence of preterm birth admissions increased nationally and regionally in Uganda from 2015-2019. There is need to plan for and prepare health facilities to manage preterm labor and preterm babies, as well as identifying reasons for the increase. Equipping health facilities and training health workers to manage preterm labor and babies should be prioritized.