ArticleBMC global and public health2026
A national spatial prioritisation framework for the targeted expansion of essential sickle cell disease services across health-facility catchments in Uganda.
Article in BMC global and 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
backgroundSickle cell disease causes substantial childhood morbidity and premature mortality in sub-Saharan Africa, while access to essential services remains uneven. In Uganda, geographic variation in inherited SCD risk supports spatially targeted service planning.
methodsWe conducted a national facility-linked ecological spatial planning analysis using 280 eligible higher-level public facilities. Populated cells were assigned to the nearest eligible facility within a modelled 60-minute travel-time boundary. Epidemiological context was represented by a study-specific co-risk index combining standardised haemoglobin S (HbS) allele frequency and Plasmodium falciparum parasite rate among children aged 2 to 10 years (PfPR2-10). Reported availability was assessed for newborn screening, hydroxyurea, blood transfusion, and specialised SCD clinic care. We derived service-deficit, structural-vulnerability, programme-priority, service-specific priority, and coverage-to-need measures and assessed sensitivity to alternative weighting specifications.
resultsAmong 280 planning zones, 122 (43.6%) had none of the four reported services and 205 (73.2%) had no more than one. Co-risk ranged from 0.003 to 0.934 and service-mediated SCD structural vulnerability from 0.000 to 0.905. Higher programme-priority scores were concentrated mainly in northern, north-eastern, eastern, and parts of central Uganda, while lower-priority tiers were more common in the south-west. Newborn-screening and hydroxyurea priorities were closely aligned, transfusion priorities extended more broadly into northern and central Uganda, and specialised-clinic priorities were more spatially mixed. The overall coverage-to-need gap had a mean of 0.190 and median of 0.205. The 56 zones comprising the national top 20% of programme priority contained approximately 7.0 million people, representing 17.3% of the population within the analytic framework. Priority concentration was strongest in Lango, Teso, Acholi, Karamoja, and Busoga.
conclusionsThe framework identified a concentrated set of candidate service-strengthening nodes under the specified assumptions, mainly in northern, north-eastern, and eastern Uganda. The findings can support further programme assessment and stakeholder review for phased, regionally coordinated, and service-specific expansion of SCD care.
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