INTRODUCTION:
Drought is projected to intensify across East Africa, yet evidence remains limited on whether drought conditions influence caregivers’ healthcare seeking for childhood illnesses.

METHODS:
We pooled four Uganda DHS rounds (2000-2016) and analysed episodes of diarrhoea (n=4626), fever (n=7641), and acute respiratory infection (ARI) (n=2216). SPEI (1-, 3-, 6-month) was linked to clusters using displacement buffers. Survey-weighted logistic regression with splines modelled no care-seeking and, among care seekers, informal provider use, reporting predicted probabilities and absolute risk differences at SPEI 0, -1.00, -1.43, and -1.83.

RESULTS:
At SPEI-3 and SPEI=0, predicted probabilities of no care seeking were 22.9% (95% CI 19.8 to 26.3) for diarrhoea, 14.1% (12.0 to 16.6) for fever, and 14.9% (11.8 to 18.6) for ARI. At extreme drought (SPEI=-1.83), absolute risk differences in no care seeking were -0.6 percentage points (-6.7 to 5.5) for diarrhoea, 0.5 (-3.8 to 4.8) for fever, and 1.2 (-7.0 to 9.4) for ARI, indicating no significant deviation. At SPEI=0, informal provider use was 11.8% (9.2 to 15.0) for diarrhoea, 13.0% (10.8 to 15.7) for fever, and 8.4% (6.0 to 11.8) for ARI. At SPEI=-1.83, absolute risk differences in informal provider use were -0.3 percentage points (-5.7 to 5.1) for diarrhoea, 2.1 (-2.9 to 7.1) for fever, and 5.3 (-3.7 to 14.3) for ARI. Sensitivity analyses for fever showed time-scale-dependent heterogeneity: under SPEI-1 at SPEI=-1.83, informal provider use increased by 8.1 percentage points (3.1 to 13.0), whereas under SPEI-6 at SPEI=-1.83, the probability of no care increased by 5.3 percentage points (0.3 to 10.2).

CONCLUSIONS:
Seasonal drought, as measured by SPEI-3, showed no meaningful association with overall care-seeking for diarrhoea, fever, or ARI. However, extreme drought may compromise the protective role of care for fever by shifting towards informal providers during acute shocks and increasing forgone care during prolonged stress.