ArticleFrontiers in public health2026
Waterborne diseases burden, determinants and health system gaps in Eastern Uganda: a mixed-methods baseline study in the Busoga region.
Article in Frontiers in public 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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Abstract
Background: Waterborne diseases remain a major public health challenge in Eastern Uganda, driven by inequities in water access, sanitation quality, hygiene practice and health system constraints. A baseline study to characterize disease burden, WASH conditions, and care-seeking behaviors in the Busoga sub-region was conducted in Jinja City and Jinja and Iganga Districts. Methods: Data were triangulated from District Health Information System, household surveys, and Water, Sanitation and Hygiene assessments in schools and health facilities, complemented by observations, focus group discussions, and key informant interviews. Quantitative data were analyzed using STATA, while qualitative data were transcribed and thematically analyzed. Results: There was higher waterborne disease incidence in Jinja City (5.4%), Jinja District (5.3%), and Iganga (4.6%). However, household surveys confirm 3.8% incidence reported in the program supported villages and 5.9% in the non-program supported villages. Access to improved water sources was highest in Jinja city (72%) and lowest in Iganga (53%), while regular household water treatment remained limited (23%-41%). Although sanitation coverage appeared relatively high (75%-81%), qualitative and school data revealed major quality and equity gaps, including overcrowded school latrines. Handwashing practices were inconsistent, with only 32% of households observed to have soap and water at designated handwashing stations, and only 45% of schools and 46% of health facilities consistently having soap and water available. Waterborne diseases incidence was associated with non-program support villages (RR = 1.72, 95% CI: 1.20-2.45, Conclusions: Waterborne diseases remain high but preventable in Busoga. Strengthening access to safe water, improving sanitation and hygiene infrastructure, and addressing behavioral and health system barriers are critical to reducing disease burden.
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