Temporal and spatial trends of low birth weight and Kangaroo Mother Care initiation in Uganda, 2015–2023

Background Low birth weight (LBW) births account for > 80% of global neonatal deaths, with the highest prevalence in low-and middle-income countries. Kangaroo Mother Care (KMC) is a low-cost, effective intervention for the survival of LBW babies in low-resource settings, including Uganda. However, the distribution of LBW births and their KMC initiation is not well documented in Uganda. We assessed trends and spatial distribution of LBW births and their KMC initiation, Uganda, 2015–2023. Methods We abstracted data on LBW, total deliveries, and LBW babies initiated on KMC during 2015–2023 from the District Health Information Software Version 2. We calculated LBW prevalence as the proportion of LBW births among total deliveries. Kangaroo Mother Care initiation coverage was computed as the proportion of LBW babies started on KMC. We stratified LBW and KMC initiation data by region, and health facility level. We used the Mann-Kendall test to assess the significance of trends. Results During 2015–2023, 605,876 of 10,952,463 births (5.5%) were LBW, with no significant change in the prevalence (p = 0.8). The highest prevalence of LBW was observed in Karamoja and West Nile (7.4%) in northern Uganda, with no trend (p = 0.14). Bukedi (p = 0.05) and Busoga (p = 0.003) subregions in eastern Uganda, had an increasing trend, whereas, Kigezi subregion in western Uganda, had a declining trend (p = 0.003). Among the 296,421 live LBW births during 2020–2023, 188,519 (64%) received KMC. Its coverage increased from 60% in 2020 to 68% in 2023 (p = 0.01). Ankole (p = 0.005), Bunyoro (p = 0.017), and West Nile subregions had increasing trends whereas Bukedi (p = 0.024) and Kampala (p < 0.001) had declining trends. Karamoja had low KMC coverage (60%) with no trend (p = 0.96). KMC initiation increased at Health Centre IIIs (sub-county level) (p = 0.006), but declined at national referral hospitals (p < 0.01). Conclusion There were regional disparities in trends of LBW births. While KMC initiation improved in certain regions and at lower-level health facilities, challenges persist in Karamoja and national referral hospitals. Further studies are needed to understand the determinants of LBW births, and initiation to KMC, to better guide region-specific interventions.