Background: Neonatal anaemia affects 20-25% of newborn babies worldwide. Anaemia occurring with other comorbidities such as birth asphyxia, sepsis and RDS is associated with increased mortality. Risk factors such as maternal anaemia, malaria parasetemia during pregnancy and bleeding have been linked with neonatal anaemia. The data describing the burden and risk factors for neonatal anaemia in Uganda are scarce. There are no studies done in Uganda showing the burden and causes of neonatal anaemia. Documenting the factors associated with neonatal anaemia was going to help clinicians identify neonates at risk of anaemia and thus a practical step towards reducing the high neonatal mortality. General Objective: To determine the prevalence and factors associated with anaemia among neonates admitted in Kawempe National Referral Hospital. Methods: We conducted a cross sectional study of neonates admitted to Kawempe National Referral Hospital. 378 neonates were recruited into the study. Data on prenatal, natal and demographic factors was collected. Standardized history and physical examination was done to assess for risks and features of anaemia. Blood was collected for complete blood count, bilirubin levels and peripheral blood film. “Anaemia” was expressed as a percentage of those who had Hb level <14g/dl (for the term babies) and more than 2 SD for age for the preterm babies (<16.5g/dl for those <14days and <10.8 for those >14days), to the total number of neonates that were eligible for the study. Multivariate logistic regression models were computed to assess for factors associated with anaemia. Results: Between November 2019-January 2020, we enrolled a total of 378 neonates into the study. Of these, 197/378(52.1%) were male. The median age was 12days old [interquartile range (IQR) 4 – 15] while 95/378 (25.1%) were preterm babies. The prevalence of anaemia was 27.0% (102/378) 95%CI (22.57 – 31.76). Of the 102 babies with anaemia, 16.6% (17/102) were found to have severe anaemia (Hb < 10g/dl), 32.3% (33/102) were moderately anemic (Hb 10.1-12.0g/dl) and 51.0% (52/102) were mildly anemic (Hb 12.1-14.0g/dl). Microcytic anaemia was found in 52.9% (54/102) of the neonates. Gestational age (<32 weeks) (aOR = 3.66, 95%CI 1.211 - 11.082, p = 0.021, maternal age >35 years (aOR = 9.24, 95%CI 1.135 – 75.213, p = 0.038), hyperbilirubinemia (indirect bilirubin) (aOR = 2.31, 95%CI 1.123 - 4.925, p = 0.042) and extremely low birth weight were associated with increasing odds of having anaemia among neonates. Being born full term with a normal birth weight were associated with reduced odds of anaemia among the neonates. Conclusion and recommendation This study showed that neonatal anaemia affects 1 in 4 neonates among neonates admitted in Kawempe National Referral Hospital. Indirect hyperbilirubinemia, highlighting possible hemolysis was associated with increased odds of anaemia. Babies born preterm, and having a low birth weight are more likely to also have anaemia. We recommend routine assessment of anaemia among preterm and low birth weight babies to enable early detection and guidance on its management to prevent morbidity and mortality.

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