**Background:** Despite global Sustainable Development Goals aimed at reducing inequalities, hard-to-reach districts like Nakapiripirit in Karamoja, Uganda, continue to score low on health indices. In Sub-Saharan Africa, nearly half of under-five mortality after the neonatal period is attributable to malaria, pneumonia, and diarrhea. Karamoja is consistently among the highest malaria transmission regions in Uganda. The lack of quality disaggregated data often leads to treatment guidelines insufficient for local contexts. This study aimed to systematically describe the burden of disease in Nakaale parish to inform district-level planning and accountability.
**Methods:** This descriptive, cross-sectional study was conducted at Akisyon a Yesu Presbyterian Clinic (AYPC), a private-not-for-profit Health Centre II in Nakaale, Nakapiripirit District. Data were retrospectively collected from Uganda's Health Management Information System (HMIS) Form 031 (outpatient register) for all clients seen between January and December 2019. A data extraction tool was designed using Excel, and analysis was performed in Stata version 16.0. Diagnoses were coded according to ICD-10. Residential locations were verified using Ugandan Electoral Commission data, the Land Conflict Mapping Tool, and U.S. Geological Survey maps. Normally distributed continuous variables were summarized as means and standard deviations; skewed variables as medians and interquartile ranges. Frequencies and percentages were calculated for categorical variables. Ethical approval was obtained from CURE Children's Hospital Uganda Research and Ethics Committee (reference no. CCHU-REC/05/021).
**Key Results:** Of 15,818 total observations, 14,685 were included after excluding 1,133 with incomplete data. The median age was 5 years (IQR 1, 25). Nearly half (48.9%) of clients were under five years old (22.1% under 1 year; 26.8% aged 1–4). More females (57.1%) than males sought care. Almost all clients (96.5%) resided in rural areas, and 58.9% traveled five or more kilometers to reach AYPC. Only 2.6% of visits occurred during on-call (emergency) hours. Most clients (67.1%) presented with a single diagnosis, while 30.7% had two diagnoses and 2.2% had three. A total of 163 different diagnoses were recorded across 19,840 illness entries. The top five most diagnosed diseases were malaria (35%), pneumonia (11%), amoebiasis (6%), urinary tract infection (5%), and giardiasis (4%). By category, infectious diseases (42.2%) dominated, followed by respiratory diseases (18.7%), gastrointestinal and hepatic diseases (16.9%), renal and urinary diseases (5.5%), and eye conditions (3.4%). Among under-fives, 58% of infectious diseases and 66% of respiratory diseases were diagnosed. Laboratory investigations confirmed 60% of all cases. Seasonally, 66% of visits occurred from July through December, coinciding with the rainy season and peak malaria transmission. Geographically, AYPC served clients from 189 villages across 66 parishes, 32 sub-counties, and 10 districts. While 42% of clients came from the local sub-county (Loregae), 58% traveled from other sub-counties that have their own health centers, including from up to 26 km away within the same district and from outside Nakapiripirit District.
**Clinical Implications:** This study provides the first systematic profile of disease burden and catchment area for this hard-to-reach setting in Karamoja. The predominance of communicable, maternal, neonatal, and nutritional diseases (CMNN) confirms that the epidemiological transition to non-communicable diseases has not yet occurred at this rural village level. The high proportion of under-five patients (48.9%) and the fact that 58% of clients bypass closer health facilities to travel five or more kilometers to AYPC indicate substantial gaps in local health service delivery. The clinic's ability to maintain consistent medicine and laboratory supplies, along with having a medical officer on staff, likely drives this bypassing behavior. These findings should inform district health planning to prioritize pediatric services, ensure adequate supply of antimalarials and antibiotics during the July–November peak season, and address the broader geographic disparities in healthcare access. The study also generated the first systematic map of villages in Nakapiripirit District in over ten years, providing a critical tool for future health service planning.