Prevalence and factors associated with hypothermia among neonates born at selected health facilities in Kabale Municipality, south-western Uganda: a cross-sectional study

Abstract Background Global estimates of neonatal hypothermia ranges between 32% to 85%, with disproportionately higher rates reported in Sub-Saharan Africa. Reported prevalence varies widely between 50–83%, however, we never came across any published data that exists on the magnitude and prevalence of hypothermia in Kable Municipality and the wider Kigezi sub-region. We aimed to determine the prevalence and factors associated with hypothermia among neonates admitted at four health facilities in Kabale Municipality, south-western Uganda. Methods A cross-sectional study enrolled a total of 384 neonate consecutively between 1st April and 30th June, 2026 from the four facilities in Kabale Municipality, southwestern Uganda. Pproportionate to size sampling was used across study sites based on average monthly deliveries. Core temperature was measured using a digital rectal thermometer, and a structured, pre-tested questionnaire was used which can captured socio-demographic, maternal, newborn, obstetric, and newborn care characteristics. Multivariable logistic regression used to identify predictors of hypothermia in neonates. Results The prevalence of neonatal hypothermia was 50.3% (n = 193/384, 95% CI: 45.1–53.4%). After adjustment, factors independently associated with neonatal hypothermia were categorized into maternal and neonatal factors. Maternal factors included maternal level of education (primary; AOR = 1.35, 95% CI: 1.08–2.06), spouse’s employment status (unemployed; AOR = 1.52, 95% CI: 1.37–1.69) mother having breastfeeding issues (absence versus presence; AOR = 1.59, 95% CI: 1.25–2.04), leaking liquor/premature rupture of membranes (AOR = 1.72, 95% CI: 1.27–2.32), and Mode of delivery (caesarean delivery: AOR = 1.84, 95% CI: 1.29–2.47). Neonatal factors included not wearing a cap after birth (AOR = 1.38, 95% CI: 1.08–2.21), and low birth weight (AOR = 1.68, 95% CI: 0.79–3.55). Conclusions Neonatal hypothermia affects approximately one in every two neonates admitted at these four Kabale Municipality facilities, underscoring it as a major public health concern in this setting. The high burden reflects the combined influence of maternal socio-demographic and obstetric characteristics alongside neonatal care practices, suggesting that no single intervention point is sufficient on its own. Given the substantial proportion of affected neonates, targeted facility-level interventions and continuous health worker training on thermal care protocols are warranted to reduce the associated morbidity and mortality risks in this population.