{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:47:24Z","timestamp":1793382444304,"version":"4.5.0"},"reference-count":51,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"\n Objective<\/jats:title>\n To determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Three subcounties of Lira district in Northern Uganda.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n This was a community-based cross-sectional study nested in a cluster randomised controlled trial.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Mother\u2013baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery-operated digital thermometer.<\/jats:p>\n <\/jats:sec>\n \n Primary and secondary outcomes<\/jats:title>\n The primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0\u00b0C to <36.5\u00b0C, moderate if the temperature was 32.0\u00b0C to <36.0\u00b0C and severe hypothermia if the temperature was <32.0\u00b0C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n We recruited 1330 neonates. The prevalence of hypothermia (<36.5\u00b0C) was 678\/1330 (51.0%, 95%\u2009CI 46.9 to 55.1). Overall, 32% (429\/1330), 95%\u2009CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249\/1330), 95%\u2009CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95%\u2009CI 1.4 to 2.6); low birth weight (aPR 1.7, 95%\u2009CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95%\u2009CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin-to-skin care could reduce the risk of neonatal hypothermia.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n ClinicalTrial.gov as\n NCT02605369<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-041723","type":"journal-article","created":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T11:43:09Z","timestamp":1613043789000},"page":"e041723","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Neonatal hypothermia in Northern Uganda: a community-based cross-sectional study"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct02605369","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02605369","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3892-9777","authenticated-orcid":false,"given":"David","family":"Mukunya","sequence":"first","affiliation":[{"name":"Department of Research, Sanyu Africa Research Institute, Mbale, Uganda"},{"name":"Department of Global Public Health and Primary Care, Centrefor Intervention Science in Maternal and Child Health (CISMAC), Centre forInternational health, University of Bergen, Bergen, Norway"},{"name":"Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K","family":"Tumwine","sequence":"additional","affiliation":[{"name":"Departmentof Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Nankabirwa","sequence":"additional","affiliation":[{"name":"Department of Global Public Health and Primary Care, Centrefor Intervention Science in Maternal and Child Health (CISMAC), Centre forInternational health, University of Bergen, Bergen, Norway"},{"name":"Center for Intervention Science in Maternal and Child Health, Center for International Health, Universitet i Bergen, Bergen, Norway"},{"name":"Departmentof Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Odongkara","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin B","family":"Tongun","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Juba University, Juba, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes A","family":"Arach","sequence":"additional","affiliation":[{"name":"Department of Nursing and Midwifery, Lira University, Lira, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Tumuhamye","sequence":"additional","affiliation":[{"name":"Department of Global Public Health and Primary Care, Centrefor Intervention Science in Maternal and Child Health (CISMAC), Centre forInternational health, University of Bergen, Bergen, Norway"},{"name":"Center for Intervention Science in Maternal and Child Health, Center for International Health, Universitet i Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Napyo","sequence":"additional","affiliation":[{"name":"Department of Nursing and Midwifery, Lira University, Lira, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Zalwango","sequence":"additional","affiliation":[{"name":"Departmentof Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicentina","family":"Achora","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Gulu University, Gulu, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4145-4044","authenticated-orcid":false,"given":"Milton W","family":"Musaba","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Ndeezi","sequence":"additional","affiliation":[{"name":"Departmentof Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorkild","family":"Tyllesk\u00e4r","sequence":"additional","affiliation":[{"name":"Centre for International health, Universitetet i Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"2025121221265420000_11.2.e041723.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31833-0"},{"key":"2025121221265420000_11.2.e041723.2","unstructured":"United Nations . Sustainable development goals. secondary sustainable development goals, 2015. Available: http:\/\/www.un.org\/sustainabledevelopment\/summit\/"},{"key":"2025121221265420000_11.2.e041723.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71088-6"},{"key":"2025121221265420000_11.2.e041723.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71145-4"},{"key":"2025121221265420000_11.2.e041723.5","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-11-24"},{"key":"2025121221265420000_11.2.e041723.6","unstructured":"World Health Organization . Thermal protection of the newborn: a practical guide. Geneva: World Health Organization, 1997."},{"key":"2025121221265420000_11.2.e041723.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0092006","article-title":"Prevention and management of neonatal hypothermia in rural Zambia","volume":"9","author":"Lunze","year":"2014","journal-title":"PLoS One"},{"key":"2025121221265420000_11.2.e041723.8","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/41.4.210"},{"key":"2025121221265420000_11.2.e041723.9","first-page":"103","article-title":"Neonatal hypothermia levels and risk factors for mortality in a tropical country","volume":"49","author":"Kambarami","year":"2003","journal-title":"Cent Afr J Med"},{"key":"2025121221265420000_11.2.e041723.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02113.x"},{"key":"2025121221265420000_11.2.e041723.11","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2008.233"},{"key":"2025121221265420000_11.2.e041723.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60792-3"},{"key":"2025121221265420000_11.2.e041723.13","doi-asserted-by":"publisher","DOI":"10.1159\/000240198"},{"key":"2025121221265420000_11.2.e041723.14","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2012.11"},{"key":"2025121221265420000_11.2.e041723.15","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-196507000-00017"},{"key":"2025121221265420000_11.2.e041723.16","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1111\/j.1651-2227.2005.tb01821.x","article-title":"The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda: a randomized, controlled trial","volume":"94","author":"Bergstr\u00f6m","year":"2005","journal-title":"Acta Paediatr"},{"key":"2025121221265420000_11.2.e041723.17","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-8-21","article-title":"Acceptability of evidence-based neonatal care practices in rural Uganda - implications for programming","volume":"8","author":"Waiswa","year":"2008","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121221265420000_11.2.e041723.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02593.x"},{"key":"2025121221265420000_11.2.e041723.19","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/1367493516686201","article-title":"Sociocultural factors affecting uptake of home-based neonatal thermal care practices in Africa: a qualitative review","volume":"21","author":"Coalter","year":"2017","journal-title":"J Child Health Care"},{"key":"2025121221265420000_11.2.e041723.20","first-page":"23","article-title":"Neonatal hypothermia on admission to a special care unit in Dar-es-Salaam, Tanzania: a cause for concern","volume":"49","author":"Manji","year":"2003","journal-title":"Cent Afr J Med"},{"key":"2025121221265420000_11.2.e041723.21","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fmh098"},{"key":"2025121221265420000_11.2.e041723.22","doi-asserted-by":"publisher","DOI":"10.1136\/adc.53.1.58"},{"key":"2025121221265420000_11.2.e041723.23","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2010.09.007"},{"key":"2025121221265420000_11.2.e041723.24","doi-asserted-by":"crossref","DOI":"10.1186\/s13104-018-3691-0","article-title":"Determinants of hypothermia on neonates admitted to the intensive care unit of public hospitals of central zone, Tigray, Ethiopia 2017: unmatched case-control study","volume":"11","author":"Tasew","year":"2018","journal-title":"BMC Res Notes"},{"key":"2025121221265420000_11.2.e041723.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-018-1238-0","article-title":"Neonatal hypothermia and associated factors among neonates admitted to neonatal intensive care unit of public hospitals in Addis Ababa, Ethiopia","volume":"18","author":"Demissie","year":"2018","journal-title":"BMC Pediatr"},{"key":"2025121221265420000_11.2.e041723.26","unstructured":"Uganda Bureau of statistics . The National population and housing census 2014 \u2013 area specific profile series, Kampala, Uganda secondary the National population and housing census 2014 \u2013 area specific profile series, Kampala, Uganda, 2017. Available: http:\/\/www.ubos.org\/onlinefiles\/uploads\/ubos\/2014CensusProfiles\/MUKONO.pdf"},{"key":"2025121221265420000_11.2.e041723.27","unstructured":"Uganda Bureau of Statistics (UBOS) and ICF . Uganda demographic and health survey 2016. Kampala, Uganda and Rockville, Maryland, USA: UBOS and ICF, 2018."},{"key":"2025121221265420000_11.2.e041723.28","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.5194\/hess-11-1633-2007","article-title":"Updated world map of the K\u00f6ppen-Geiger climate classification","volume":"11","author":"Peel","year":"2007","journal-title":"Hydrol Earth Syst Sci"},{"key":"2025121221265420000_11.2.e041723.29","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2009.239"},{"key":"2025121221265420000_11.2.e041723.30","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211569"},{"key":"2025121221265420000_11.2.e041723.31","doi-asserted-by":"publisher","DOI":"10.1177\/004947559802800304"},{"key":"2025121221265420000_11.2.e041723.32","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1038\/sj.jp.7211271","article-title":"The incidence of morbidities in a cohort of neonates in rural Gadchiroli, India: seasonal and temporal variation and a hypothesis about prevention","volume":"25 Suppl 1","author":"Bang","year":"2005","journal-title":"J Perinatol"},{"key":"2025121221265420000_11.2.e041723.33","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-43"},{"key":"2025121221265420000_11.2.e041723.34","first-page":"1367","article-title":"Hypothermia in Iranian newborns. incidence, risk factors and related complications","volume":"26","author":"Zayeri","year":"2005","journal-title":"Saudi Med J"},{"key":"2025121221265420000_11.2.e041723.35","doi-asserted-by":"crossref","first-page":"129","DOI":"10.4103\/1119-3077.110120","article-title":"Neonatal hypothermia in sub-Saharan Africa: a review","volume":"16","author":"Onalo","year":"2013","journal-title":"Niger J Clin Pract"},{"key":"2025121221265420000_11.2.e041723.36","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0166405","article-title":"Newborn care practices among adolescent mothers in Hoima district, Western Uganda","volume":"11","author":"Kabwijamu","year":"2016","journal-title":"PLoS One"},{"key":"2025121221265420000_11.2.e041723.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2008.04.029"},{"key":"2025121221265420000_11.2.e041723.38","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-014-0412-0","article-title":"A qualitative study exploring newborn care behaviours after home births in rural Ethiopia: implications for adoption of essential interventions for saving newborn lives","volume":"14","author":"Salasibew","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121221265420000_11.2.e041723.39","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-015-0470-0","article-title":"\"Why not bathe the baby today?\": A qualitative study of thermal care beliefs and practices in four African sites","volume":"15","author":"Adejuyigbe","year":"2015","journal-title":"BMC Pediatr"},{"key":"2025121221265420000_11.2.e041723.40","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-14-267","article-title":"Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change","volume":"14","author":"Shamba","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121221265420000_11.2.e041723.41","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.midw.2010.02.005","article-title":"Hurdles and opportunities for newborn care in rural Uganda","volume":"27","author":"Byaruhanga","year":"2011","journal-title":"Midwifery"},{"key":"2025121221265420000_11.2.e041723.42","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-017-1599-7","article-title":"Market mechanisms for newborn health in Nepal","volume":"17","author":"Lunze","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121221265420000_11.2.e041723.43","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-016-0874-3","article-title":"Factors associated with adoption of beneficial newborn care practices in rural eastern Uganda: a cross-sectional study","volume":"16","author":"Owor","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121221265420000_11.2.e041723.44","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-018-0141-5"},{"key":"2025121221265420000_11.2.e041723.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2006.09.002"},{"key":"2025121221265420000_11.2.e041723.46","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-10-9"},{"key":"2025121221265420000_11.2.e041723.47","doi-asserted-by":"publisher","DOI":"10.1054\/midw.2001.0253"},{"key":"2025121221265420000_11.2.e041723.48","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.1998.00745.x"},{"key":"2025121221265420000_11.2.e041723.49","doi-asserted-by":"publisher","DOI":"10.1177\/000992280304200409"},{"key":"2025121221265420000_11.2.e041723.50","first-page":"259","article-title":"Evaluation of clinical thermometers for accuracy and reliability","volume":"35","author":"Latman","year":"2001","journal-title":"Biomed Instrum Technol"},{"key":"2025121221265420000_11.2.e041723.51","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7243.1174"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-041723","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:27:05Z","timestamp":1765603625000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-041723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":51,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,11]]},"published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1136\/bmjopen-2020-041723"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-041723","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2]]}}}