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

Background: During 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 the focus on surveillance for birth asphyxia and other childhood-related illnesses. In 2016, the Ministry of Health implemented an evidence-based educational program for birth attendants about neonatal resuscitation techniques to improve the management of birth asphyxia. We described the trends and distribution of birth asphyxia in Uganda during 2017-2020 following these renewed efforts.

Methods: We analysed birth asphyxia surveillance data from the District Health Information System 2 from January 2017-December 2020. We calculated the 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. We used logistic regression to evaluate the significance of the trends. Using choropleth maps, we described the distribution of birth asphyxia incidence at district level.

Results: The average national annual incidence of birth asphyxia in 2020 was 31 per 1,000, with an increase of 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 by 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.

Conclusion: The incidence of birth asphyxia increased nationally from 2017-2020. We recommend efforts towards reducing the burden of birth asphyxia in Uganda, with emphasis on the most affected districts.