Prevalence, Morphological Types, and Associated Factors of Neonatal Anemia at a Rural Referral Hospital, Uganda

This study aimed to determine the prevalence, morphological classification, and factors associated with anemia among neonates at Soroti Regional Referral Hospital neonatal unit.

We conducted a hospital-based cross-sectional study among 239 neonates between June and August 2025. Data on sociodemographic characteristics of neonates and mothers were collected using structured questionnaires and a review of medical records. Venous blood was collected from mothers during labor and cord blood was collected within 30 minutes of delivery or in situation where cord blood was not collected, then venous blood was collected from neonates. Hemoglobin estimation was done using a Nihon Kohden automated analyser. Neonates with umbilical cord hemoglobin <13 g/dL and mothers with venous blood haemoglobin <11 g/dL were classified as anemic. For anemic neonates, Giemsa-stained blood smears were examined to determine morphological type of anemia and screen for malaria parasites. Bivariate and multivariate logistic regression analysis were employed to identify factors associated with neonatal anemia, with a p-value ≤0.05 considered statistically significant.

The median age for neonates in days was 1 day and ranged from 0 to 27 days. The prevalence of neonatal anemia was 11.7% (95% CI: 7.6-15.8). Normocytic normochromic anemia was the most frequent morphological type (78.6%), followed by normocytic hypochromic (10.7%) and microcytic hypochromic anemia (10.7%). Multivariate analysis identified four factors independently associated with neonatal anemia: maternal history of anemia (AOR: 5.39 [95% CI: 1.15-25.32], p=0.033), lack of iron-folate supplementation during pregnancy (AOR: 6.62 [95% CI: 2.23-19.7], p=0.001), infrequent consumption of fruits and vegetables (AOR: 6.52 [95% CI: 1.23-34.48], p=0.027), and the presence of maternal anemia at delivery (AOR: 5.48 [2.11-14.21], p<0.001).

This study confirms that neonatal anemia is a persistent health issue in eastern Uganda. The identified risk factors are primarily rooted in maternal health and nutrition. Our findings underscore the imperative for integrative antenatal strategies that combine nutritional education, promotion of iron-folate supplementation, and proactive management of maternal anemia to effectively reduce the burden of neonatal anemia.