Social capital and uptake of primary healthcare during protracted displacement: Evidence from four refugee settlements in northern Uganda

The world's refugee populations primarily reside in low- and middle-income countries, where they face protracted displacement and limited financial and human capital. Social capital is among the few assets they can leverage for resilience. Despite its importance, few studies have examined how social capital influences the uptake of healthcare services during protracted displacement. This study examines the associations of refugee with access to maternal, newborn and child health (MNCH) services in northern Uganda's long-term settlements. We conducted cross-sectional probability household surveys across four refugee settlements with independent samples of caregivers of children 0-5, 12-23, and 0-59 months (n = 570). Caregivers' demographic characteristics and responses to 57 items from the Shortened Adapted Social Capital Assessment Tool were analyzed as independent variables. Dependent variables were MNCH service coverage and young child feeding practices. Factor analysis revealed three distinct social capital dimensions: Social Support (Ω = 0.73), Social Action (Ω = 0.72), and Community Cohesion (Ω = 0.48 indicating lower reliability). In adjusted multiple regression analyses, Social Support was positively associated with minimum dietary diversity (aOR = 1.35, 95 %CI = 1.04-1.74). Social Action was positively associated with antenatal care during the first trimester (aOR = 3.93, 95 %CI = 1.47-10.50), Tetanus Toxoid vaccination during pregnancy (aOR = 4.00, 95 %CI = 1.33-12.04) and postnatal care (aOR = 2.48, 95 %CI = 1.02-6.05). Community Cohesion showed positive associations with early initiation of breastfeeding (aOR = 3.47, 95 %CI = 1.00-12.06) and Vitamin A supplementation (aOR = 3.51, 95 %CI = 1.15-10.68). These findings suggest that social capital is linked to the uptake of essential MNCH services, with distinct dimensions showing positive associations with key health behaviors. Understanding these dynamics is important for designing effective, community-based health interventions in refugee settings.