Published in PLOS One on 2026-01-06, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Mahad Muweesi, Agnes Nyabigambo, Arthur Bagonza, Musaazi John Francis Kimuli, Grace Rickson Nsubuga, Christopher Garimoi Orach
Source: PLOS One • DOI 10.1371/journal.pone.0340572
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Hospital-Acquired Diarrhea (HAD) is a global health threat and a leading cause of illness and death in children with Severe Acute Malnutrition (SAM). In Uganda, HAD significantly affects children under five with SAM, creating a heavy health and economic burden. This study explored caregivers’ and health workers’ perceptions and experiences of HAD among children aged (0–59) months with SAM regarding HAD at Mwanamugimu Nutrition Unit, Mulago, Uganda.
A qualitative study was conducted at Mwanamugimu Nutrition Unit, involving 12 caregivers and 10 health workers. Audio-recorded data were collected through in-depth interviews (IDIs) and key informant interviews (KIIs). Data was managed using Atlas ti version 6 and thematically analyzed to identify perceptions and experiences of HAD among children (0–59) months with SAM at Mwanamugimu.
The results are presented according to the major themes that emerged from the data: understanding health risk of HAD and their impact, advantages and challenges of health interventions, empowerment through health education, prompts and motivators for action. Caregivers reported emotional distress, inadequate communication with patient progress by health workers, limited family social support, difficulty in maintaining clean toilets, and financial constraints for diapers and other sanitary items as contributors to HAD. Health workers attributed HAD to inconsistent water supply, inadequate dietary knowledge, and poor infection control. Both groups stressed that motivational triggers are essential for sustainable adherence to management guidelines.
This study emphasizes the urgent need to empower caregivers through targeted health education, adequate hygiene support, and structured ward routines. Strengthening caregiver confidence and participation enhances adherence and recovery among children with severe acute malnutrition. Integrating psychosocial support and participatory strategies into hospital nutrition programs can reduce hospital-acquired diarrhea and promote sustainable, high-quality child health outcomes.
Background
Approximately 1.6 million deaths occur each year globally due to diarrhea, with the highest burden in developing countries and economically disadvantaged regions [1,2]. Hospital-Acquired Diarrhea (HAD) is a significant concern in pediatric healthcare settings worldwide. In the United States, around 20,000 cases of Clostridioides difficile infection (CDI), a leading cause of HAD, are reported annually among children [3]. In low- and middle-income countries (LMICs), particularly in sub-Saharan Africa, the burden is even more pronounced due to limited resources and healthcare infrastructure. In sub-Saharan Africa, Uganda stands out with the highest mortality rate for children under five, where 0–22% of these deaths are attributed to HAD [4].
Hospital-acquired diarrhea (HAD) refers to diarrhea contracted from a health care setting where patients admitted for different medical conditions develop watery stool after 72 hours of admission or 48 hours post discharge from the hospital [5]. In the context of severe acute malnutrition (SAM) treatment, this condition is of particular concern due to the susceptibility of children with compromised nutritional status leading to dehydration, prolonged hospital stays, increased healthcare costs, electrolyte imbalances, organ dysfunction, and compromised nutritional recovery in malnourished children [6]. Hospitalization often exposes these children to various pathogens and risk factors that can trigger or exacerbate diarrhea [7]. Severe acute malnutrition (SAM) poses serious health risk of HAD, as malnourished children have weakened immunity, making them highly susceptible to infections [8]. HAD exacerbates dehydration, electrolyte imbalances, and nutrient loss, delaying recovery and increasing mortality hence the vicious cycle [9].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Mahad Muweesi, Agnes Nyabigambo, Arthur Bagonza, Musaazi John Francis Kimuli, Grace Rickson Nsubuga, Christopher Garimoi Orach. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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