Evidence map›Paper›PMID 41814376›Full record

ArticleConflict and health2026

Maternal and child healthcare coverage and trends: refugee vs. non-refugee districts in Uganda.

Rogers Nsubuga, Rornald Muhumuza Kananura, Ronald Wasswa, Catherine Birabwa, Jimmy Ogwal, Winfred Dotse-Gborgbortsi, George Mwinnyaa, Amanuel Abajobir, Julius Kisozi, Alypio Nyandwi and 3 more

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Article in Conflict and health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Rogers NsubugaCenter of Excellence for Maternal, Newborn and Child Health, Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda. rnsubuga@idi.co.ug.
Rornald Muhumuza KananuraCenter of Excellence for Maternal, Newborn and Child Health, Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Ronald WasswaCenter of Excellence for Maternal, Newborn and Child Health, Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Catherine BirabwaCenter of Excellence for Maternal, Newborn and Child Health, Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Jimmy OgwalMinistry of Health, Kampala, Uganda.
Winfred Dotse-GborgbortsiDepartment of Social Statistics and Demography and WorldPop, University of Southampton, Southampton, UK.
George MwinnyaaDepartment of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, US.
Amanuel AbajobirAfrica Population and Health Research Center, Nairobi, Kenya.
Julius KisoziUnited Nations High Commissioner for Refugees, Kampala, Uganda.
Alypio NyandwiAfrica Population and Health Research Center, Nairobi, Kenya.
Ties BoermaInstittue of Global Health, University of Manitoba, Winnipeg, MB, Canada.
Peter WaiswaCenter of Excellence for Maternal, Newborn and Child Health, Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Kristine NilsenDepartment of Social Statistics and Demography and WorldPop, University of Southampton, Southampton, UK.

Funding

Gates Foundation INV-003416
6 · The paper itself

Abstract

backgroundUganda hosts the largest refugee population in Africa, which exerts much pressure on the district health systems. While refugee-hosting districts (RH) receive targeted investments, the extent to which these influence maternal and child health (MCH) service coverage remains unclear. Using routine facility data, we examined differences in MCH coverage and trends between RH and non-refugee-hosting (non-RH) districts and also explored the effects of government health financing and health system performance on MCH coverage.

methodsWe conducted a retrospective analysis utilizing routine health facility MCH data from the Uganda District Health Information System and district-level government Primary Healthcare (PHC) expenditure data from 2020 to 2023. MCH indicators were ANC1st trimester, ANC4, Institutional deliveries, mothers' Post-natal care (PNC), Measles1 and DPT3 vaccination. We computed a composite coverage index (CCI), health systems performance z-score and compared trends across RH and non-RH districts. Mixed Effects Models assessed the association between government expenditure, RH-status, health system performance over the years.

resultsRH districts consistently had modestly higher coverage of ANC1st trimester, ANC4, Institutional deliveries, PNC, Measles vaccination and CCI trends. Government expenditure was significantly higher in RH districts and refugee-dominant (RD) districts (p < 0.001 vs. p = 0.007). Refugee-dominant districts had higher but non-significant MCH coverage. Unadjusted models of MCH indicators and CCI were positively influenced by government financing and health systems performance z-score except for DPT3 and Measles, respectively. Adjusted models revealed that ANC4 coverage was 7.4% points higher in RH districts (7.42; 95% CI:0.753, 14.090; p = 0.029) and increased by 3.6% points for every unit increase in z-score (3.60; 95% CI: 0.729, 6.462; p = 0.014). CCI increased by 1.6% points and 2.3% points for every unit increased in the government expenditure and z-score respectively (1.55; 95% CI: 0.310, 2.788; p = 0.014) vs. (2.31; 95% CI: 0.642, 3.975; p = 0.007).

conclusionNovel approach - leveraging routine facility data, revealed MCH coverage was modestly consistently higher in RH districts over the years and RH status influenced ANC4 coverage. Overall district-CCI depended on Government investment and health systems performance implying increase in PHC financing could be a key driver to universal district-level improvement.

Indexed as

Coverage Composite IndexRefugee-Hosting districtsRoutine data

Identifiers

PMID41814376
PMCPMC13088383

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.