Background: Complications of preterm births are the largest cause of neonatal deaths and the second leading cause of deaths among children <5 years globally. The preterm birth rate in Uganda is estimated at 6.6%. Reduction of this rate is needed to achieve the United Nations Sustainable Development Goal to end all preventable deaths among newborns and children aged <5 years by 2030. We describe the trends and distribution of preterm births admissions in Uganda during 2015-2019 for advocacy, planning, and targeted interventions.Methods: We used national preterm birth admissions data from 2015-2019 abstracted from the District Health Information System 2 (DHIS2) to calculate national, regional and district annual incidence of preterm births admissions. DHIS2 defines preterm birth as birth occurring <37 weeks of gestation. We used preterm birth admissions as numerator and the total livebirths (LB) as the denominator. We used line graphs to demonstrate the trend of annual incidence for the national and regional levels and choropleth maps to show district level distribution. Significance of the trend of annual incidence was tested using modified Poisson regression with unbiased sandwich standard errors, considering calendar year as independent and preterm births admissions as dependent variableResults: The national annual incidence of preterm birth admissions/1,000 LB has significantly increased from 3 in 2015 to 14 in 2019 (Incidence Risk Ratio (IRR)=1.3, p=0.003). The annual incidence of preterm birth admissions/1,000 LB increased significantly in three regions of Uganda during 2015 -2019 (Central Region from 3 to 21, IRR=1.5, p<0.0001; Western Region from 4 to 15 IRR=1.2, p=0.039; Northern Region from 3 to 10, IRR=1.2, p=0.008; Eastern Region from 2 to 8, IRR=1.3, p=0.086). The Choropleth map showed minimal clustering of high incidence of preterm birth admissions at district level.Conclusion: Incidence of preterm birth admissions increased nationally and regionally in Uganda from 2015-2019. There is need to plan for and prepare health facilities to manage preterm labor and preterm babies, as well as identifying reasons for the increase. Equipping health facilities and training health workers to manage preterm labor and babies should be prioritized.

In April 2019, the District Health Office of Oyam District, Uganda reported an upsurge in malaria cases exceeding expected epidemic thresholds, requiring outbreak response. We investigated the scope of outbreak and identified exposures for transmission to inform control measures. A confirmed case was a positive malaria rapid diagnostic test or malaria microscopy from 1 January—30 June 2019 in a resident or visitor of Acaba Sub-county, Oyam District. We reviewed medical records at health facilities to get case-patients. We conducted entomological and environmental assessments to determine vector density, and identify aquatic Anopheles habitats, conducted a case-control study to determine exposures associated with illness. Of 9,235 case-patients (AR = 33%), females (AR = 38%) were more affected than males (AR = 20%) (p<0.001). Children <18 years were more affected (AR = 37%) than adults (p<0.001). Among 83 case-patients and 83 asymptomatic controls, 65 (78%) case-patients and 33 (40%) controls engaged in activities <500m from a swamp (ORMH = 12, 95%CI 3.6–38); 18 (22%) case-patients and four (5%) controls lived <500m from rice irrigation sites (ORMH = 8.2, 95%CI 1.8–36); and 23 (28%) case-patients and four (5%) controls had water pools <100m from household for 3–5 days after rainfall (ORMH = 7.3, 95%CI 2.2–25). Twenty three (28%) case-patients and four (5%) controls did not sleep under bed nets the previous night (ORMH = 20, 95%CI 2.7–149); 68 (82%) case-patients and 43(52%) controls did not wear long-sleeved clothes during evenings (ORMH = 9.3, 95%CI 2.8–31). Indoor resting vector density was 4.7 female mosquitoes/household/night. All Anopheles aquatic habitats had Anopheles larvae. Weekly rainfall in 2019 was heavier (6.0±7.2mm) than same period in 2018 (1.8±1.8mm) (p = 0.006). This outbreak was facilitated by Anopheles aquatic habitats near homes created by human activities, following increased rainfall compounded by inadequate use of individual preventive measures. We recommended awareness on use of insecticide-treated bed nets, protective clothing, and avoiding creation of Anopheles aquatic habitats.