Published in PLOS One on 2026-06-10, 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: Hamdi Mohamed Yusuf, Munanura Turyasiima, Jolly Nankunda, Sabinah Wesigemukama Twesigemukama, Walufu Ivan Egesa, Abdullahi Mohamed Abdulle, Walyeldin Elfakey, Zakaria Abdi Said, Ahmed Hassan Mohamud, Joshua Epuitai, Feisal Dahir Kahie, Hanan Asad Hassan, Awil Abdulkadir Abdi, Theoneste Hakizimana, Abshir Mohamed Hirsi, Martin Nduwimana
Source: PLOS One • DOI 10.1371/journal.pone.0349861
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Neonatal hyperbilirubinemia remains a leading cause of preventable neurological impairment and death in low-resource settings, particularly in sub-Saharan Africa. Despite its burden, data on incidence and risk factors in Uganda are limited. This study aimed to determine the incidence and predictors of hyperbilirubinemia among neonates at a Ugandan referral hospital.
A prospective cohort study was conducted at Mubende Regional Referral Hospital from November 2024 to February 2025. A total of 539 mother-infant pairs were enrolled, with 534 completing follow-up. Neonates were followed from birth up to 7 days of life. Data on maternal and neonatal characteristics were collected through interviews and medical records. Laboratory tests included total serum bilirubin and ABO/Rh blood grouping. Modified Poisson regression was used to identify independent predictors of hyperbilirubinemia, with statistical significance set at p < 0.05.
The risk of hyperbilirubinemia requiring phototherapy was increased by close to two times among neonates born to mothers who were underweight, overweight, or obese (based on maternal BMI during pregnancy) (aIRR = 1.703, CI = 1.082–2.680, P = 0.021; aIRR = 1.916, CI = 1.447–3.183, P < 0.001; aIRR = 1.930, CI = 1.233–3.022, P = 0.004), those from households with monthly income <200,000 UGX (aIRR = 1.798, CI = 1.306–2.477, P < 0.001), those delivered by cesarean section (aIRR = 1.835, CI = 1.291–2.610, P = 0.001), and those with premature rupture of membranes (PROM) (aIRR = 1.538, CI = 1.109–2.132, P = 0.010). The risk of hyperbilirubinemia requiring phototherapy was increased by over two times for the preterm (aIR = 2.776, CI = 1.978–3.895, P < 0.001), those in whom feeding was initiated after 1 hour (aIRR = 2.145, CI = 1.411–3.261, P < 0.001), instrumental delivery (aIRR = 2.005, CI = 1.109–3.625, P = 0.021) and ABO incompatibility (aIRR = 2.985, CI = 2.060–4.325, P < 0.001).
2 in 10 neonates developed hyperbilirubinemia requiring phototherapy. The condition was associated with both modifiable factors, such as delayed initiation of breastfeeding, and non-modifiable factors, including ABO incompatibility, prematurity, and mode of delivery.
1. Background
Neonatal hyperbilirubinemia remains a significant global health concern, particularly in low- and middle-income countries. According to the Global Burden of Disease 2016 report, neonatal jaundice contributes to approximately 1,008 deaths per 100,000 live births, with the highest burden observed in South Asia and sub-Saharan Africa, where an estimated 1.1 million infants are affected annually 1 [1]. Clinically, neonatal hyperbilirubinemia is characterized by elevated serum bilirubin levels exceeding 85 µmol/L (5 mg/dL), although some studies define significant hyperbilirubinemia as total serum bilirubin levels exceeding 342 µmol/L in term and late preterm infants [2], typically presenting as jaundice, and a yellow discoloration of the skin, conjunctival icterus, and mucous membranes resulting from bilirubin deposition [3].
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 hospital systems 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 Hamdi Mohamed Yusuf, Munanura Turyasiima, Jolly Nankunda, Sabinah Wesigemukama Twesigemukama, Walufu Ivan Egesa, Abdullahi Mohamed Abdulle, Walyeldin Elfakey, Zakaria Abdi Said, Ahmed Hassan Mohamud, Joshua Epuitai, Feisal Dahir Kahie, Hanan Asad Hassan, Awil Abdulkadir Abdi, Theoneste Hakizimana, Abshir Mohamed Hirsi, Martin Nduwimana. 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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