Health in Uganda

Health in Uganda refers to the health of the population of Uganda. As of 2013, life expectancy at birth in Uganda was 58 years, which was lower than in any other country in the East African Community except Burundi.[1][2] As of 2015, the probability of a child dying before reaching age five was 5.5 percent (55 deaths for every 1000 live births).[3] Total health expenditure as a percentage of gross domestic product (GDP) was 7.2 percent in 2014.[4]

Ugandan patients at the Out-Patient Department of Apac Hospital in northern Uganda. The majority are mothers of children under five years old with malaria.

In 2018, an estimated 1.4 million people in Uganda were infected with HIV,[5] and the HIV prevalence rate in the country was 5.7 percent[5].

Physical activity

Uganda was the most physically active nation in the world in 2018 according to the World Health Organization. Only 5.5% of Ugandans do not achieve 150 minutes of moderate-to-intense or 75 minutes of rigorous activity per week. Most work is still very physical, and commuting by vehicle is beyond the reach of most of the population. Kampala, however, is not friendly towards walking or cycling, and the air is very polluted. The Kampala Capital City Authority established the country's first cycle lane—500 metres in Kololo—in 2018.[6]

Common illnesses and treatments
Patients in Uganda

As of 2016, the five leading causes of death in Uganda included communicable diseases such as HIV/AIDS, tuberculosis, malaria, respiratory tract infections, and diarrheal diseases.[7] The risk factors most responsible for death and disability include child and maternal malnutrition, unprotected sexual activity, multiple sex partners,[8] contaminated water, poor sanitation, and air pollution.[9]

HIV treatment in Uganda has centered on human antiretroviral therapy through cross-training and increasing the scope of health workers who can administer treatment (e.g., community health workers and nurses).[10][11] This shift in treatment occurred through the WHO's 2004 "Integrated Management of Adult and Adolescent Illness" guide.[11] Studies of HIV-infected adults in Uganda showed risky sexual behavior[8] to have declined, contributing to the decline in HIV incidence.[12] From 1990 to 2004, HIV rates declined by 70 percent and casual sex declined by 60 percent.[13] Health communication was also listed as a potential cause of inducing behavioral changes in the Ugandan population.[13] According to a 2015 study, impediments to reducing HIV incidence include food insecurity in rural areas and stigma against HIV counseling and testing.[13][14]

Uganda has the highest incidence rate of malaria in the world, with 478 people out of 1000 population being afflicted per year.[15] According to WHO data published in May 2014, malaria accounted for 19,869 deaths in Uganda (6.19% of total deaths).[16]

In 2002, the Ugandan government formalized the process of treating fevers through home-based care.[17] Mothers who were able to better recognize symptoms of malaria took their children to a community medicine facility early in the illness.[17] The Integrated Management of Childhood Illness allowed for better recognition of malaria's symptoms.[17] Treatment either involved immediately taking the child to see a nearby healthcare worker or acquiring the treatment of chloroquine and SP, also known as Homapak,[17] though kits have been found to be expired in some instances.[18] However, resistance to HOMAPAK emerged, and drug recommendations by the WHO changed to artemisinin combination therapy (ACT).[17] After the midterm review in 2014 of the national plan for malaria reduction and the malaria programme review in 2010, the national strategy to reduce malaria is being redesigned.[19] Currently, Uganda is treating malaria through distribution of insecticide-treated nets, indoor spraying of insecticides, and preventative therapy for pregnant women.[20] The disease burden of malaria, however, remains high and is further strengthened by inadequate resources, understanding of malaria, and increased resistance to drugs.[20]

Reproductive health

Reproductive health (RH) is a state of complete physical, mental, and social well-being in all matters relating to the reproductive system and to its functions and processes. It implies that people have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this is the right of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility, which are not against the law, and the right of access to health care services that will enable women to go safely through pregnancy and childbirth. RH care also includes sexual health, the purpose of which is the enhancement of life and personal relations.[21]

The World Health Organization (WHO) defines maternal health as the health of women during pregnancy, childbirth, and the postpartum period.[22] According to UNICEF, Uganda's maternal mortality ratio, the annual number of deaths of women from pregnancy-related causes per 100,000 live births,[23] was 440 from 2008 to 2012.[24] The Millennium Development Goal (MDG) for 2015 concerning the maternal mortality ratio was 131 per 100,000 births. The MDG also set a goal for all births to be attended by a skilled health professional,[25]

In rural areas, conceiving pregnant women seek the help of traditional birth attendants (TBAs) because of the difficulty in accessing formal health services and high transportation or treatment costs. TBAs are trusted as they embody the cultural and social life of the community. The TBAs' lack of knowledge and training and the use of traditional practices, however, have led to risky medical procedures resulting in high maternal mortality rates. Those rates also persist because of an overall low use of contraceptives, the limited capacity of health facilities to manage abortion/miscarriage complications, and the prevalence of HIV/AIDS among pregnant women. Despite malaria being one of the leading causes of morbidity in pregnant women, prevention and prophylaxis services are not well established according to a 2013 published report.[26]

Only 47 percent of Ugandan women receive the recommended four antenatal care visits, and only 42 percent[24] of births are attended by skilled health personnel. Among the poorest 20 percent of the population, the share of births attended by skill health personnel was 29 percent in 2005/2006 compared to 77 percent among the wealthiest 20 percent of the population.[25]. The Human Rights Measurement Initiative has given Uganda a score of 47.9% for contraceptive use.

Malnutrition

Malnutrition is a major development concern in Uganda, affecting all regions of the country and most segments of the population. The current levels of malnutrition hinder Uganda’s human, social, and economic development. Although the country has made tremendous progress in economic growth and poverty reduction over the past 20 years, its progress in reducing malnutrition remains very slow. The ultimate objective of the Uganda Nutrition Action Plan (UNAP) is to ensure that all Ugandans are properly nourished so they can live healthy and productive lives. However, it is at the start of life in particular that we must work together to ensure that all Ugandans are properly nourished. According to the three most recent Uganda Demographic Health Surveys (UDHS), nutrition indicators for young children and their mothers have not improved much over the past 15 years, with some indicators showing a worsening trend. For example, in 1995, 45 percent of children under five years old in Uganda were short for their age (stunted); 10 years later, the prevalence of stunted under-fives had fallen to only 39 percent (UDHS, 2006). Stunting indicates chronic malnutrition in children; the stunting prevalence rate of 39 percent means that about 2.3 million young children in Uganda today are chronically malnourished. UNICEF[27] The Human Rights Measurement Initiative gives Uganda a score of 79.5% for stunted children.

Consider the nutrition profile of Uganda for children under five years of age as per USAID[28][29]

PopulationPop. Under 5% stunting% Underweight
41.5 million7.7 million2911

This has a huge burden on the country through lost income that directly affects the GDP where as much as 5.6% or US$899 million is lost annually. WFP[30]

Despite the worrying numbers, latest research shows that the numbers of children under five suffering from malnutrition are declining.[31]

Gender based violence

Domestic violence (DV) is a key issue in reproductive health and rights. Most of the DV is gender-based.[32] Physical violence is the most prevalent type of DV in Uganda, with one quarter of women reporting it. More than 60 percent of women who have ever been married have reported experiencing emotional, physical, or sexual violence from a spouse.[33]

In 2011, about two percent of women reported to have undergone female genital mutilation, a practice that is dying away in the areas where it was more frequently practiced.[34]

Health in the Northern Region

Northern Uganda is one of the four major administrative regions in Uganda. The region was devastated by a protracted civil war between the government of Uganda and the Lords Resistance Army as well as the cattle rustling conflict that lasted for 20 years.[35][36]

Since the war ended in 2006, the internally displaced person camps have been destroyed and people have resettled back to their former homesteads. The region, however, still has many health challenges, such as poor health care infrastructure and inadequate staffing at all levels (2008 published report);[37] lack of access to the national electricity grid (2007 published report);[38] an inability to attract and retain qualified staff;[39] frequent stock outs in the hospitals and health facilities;[39] emerging and re-emerging diseases such as Ebola, nodding syndrome, onchocerciasis, and tuberculosis;[40] proneness to malaria epidemics, the leading cause of death in the country;[39] reintegration of former abducted child soldiers who returned home (2007 study);[41] lack of safe drinking water as most boreholes were destroyed during the war;[42] the HIV/AIDS epidemic (2004 published report);[43] poor education standards with high failure rates in primary and secondary school national examinations (2015 published report);[44] and poverty (2013 published report).[45]

Refugees

Uganda has been hosting refugees and asylum seekers since achieving its independence in 1962. In fact, the 2016 United Nations Summit for Refugees declared Uganda’s refugee policy a model. The 2006 Refugee Act and 2010 Refugee Regulations allow for integration of refugees within host communities with refugees having access to the same public services as nationals. They have freedom of movement and are free to pursue livelihood opportunities, including access to the labour market and to establish businesses. Uganda is currently hosting 1,252,470 refugees and asylum seekers making it the largest refugee hosting country in Africa and the third largest in the world (GoU and UNHCR, 2017) UNDP.[46] This has placed a huge burden on the country that has a GDP per capita of just 710 dollars, yet the aid received per person is very small. "Aid received per person against income" Cost disaggregated by sector

SectorValue (US$)Percentage distribution
Education795,4190.25
Health5,201,0261.61
Security3,045,8580.94
Land29,746,2099.21
Ecosystem loss90,682,16928.07
Energy and water145,881,76145.16
Other costs2,406,8140.75
Estimated tax

exemption to UN

agencies		45,254,12514.01
Total323,013,382100.00

There are regular outbreaks of diseases such as cholera, ebola and marburg. 2017 Uganda Marburg virus outbreak. The policy of allowing refugees to freely move within the country increases the risk of spreading these outbreaks beyond refugee camp borders.

Health indicators

According to the 2015 Uganda Bureau of Statistics (UBOS) report:[47]

  • The region has one of the highest HIV prevalence rates of 8 percent in the country, second only to Kampala.
  • The region leads in poverty with 80 percent of households living below poverty line compared to only 20 percent of the country in general living in poverty. The region has the lowest per capita house hold expenditure of UGX:21,000 compared to UGX:30,000 of the general population. Up to 26 percent of people are chronically poor
  • The region leads in illiteracy with only 60 percent of the population aged 10 years and above being literate compared to 71 percent of the general country population.
  • Most districts in the region lack clean piped water supply with the exception of a few town centers like Gulu, Lira, Arua, and Soroti. The pit latrine coverage ranges from 4 to 84 percent in some districts, the worst in the country.
  • The region has the lowest numbers of health facilities compared to other regions of the country. Of the total 5,229 health facilities in Uganda (2,867 operated by the government, 874 operated by non-governmental organizations (NGOs), and 1,488 private facilities), there are only 788 health facilities in the Northern Region (664 operated by government, 122 operated by NGOs, and 2 private facilities). Health facility deliveries range from 7 percent in Amudat, to 81 percent in Gulu.[47]
  • The region has the highest total fertility rate of 7.9 children per woman compared to the nationwide 6.1 rate.[34]
  • The Karamoja sub-region has high maternal mortality ratios.[48] According to the 2001 Uganda Demographic and Health Survey, the Northern Region was the worst in infant child mortality indicators (under age five mortality: 178 deaths per 1000 live births) (under age one mortality: 105 deaths per 1000 live births) (neonatal mortality: 42 deaths within the first month of life per 1000 live births).[25] For purposes of the 2011 Uganda Demographic and Health Survey, the Northern Region was subdivided into West Nile, North, and Karamoja, with the other three regions having seven subdivisions, for a total of ten subdivisions nationwide. Karamoja's under age five mortality rate (153 deaths per 1000 live births) was the worst in the country, with West Nile's rate (125) the third worst and the North's rate (105) the fourth best. West Nile's under age one mortality rate (88) was the worst in the country, with Karamoja's rate (87) the second worst and the North's rate (66) the fifth best. West Nile's under one month mortality rate (38) was the second worst in the country, with the North's rate (31) tied for fourth worst and Karamoja's rate (29) being the fourth best.[25]
  • Nodding syndrome hit the region during the early to mid-2000s, although the international community did not become aware of it until 2009 when the WHO and the US Centers for Disease Control and Prevention first investigated it.[49] The disease affected children aged 5–15 years, mainly in the Acholi sub-region and a few in the Lango sub-region.[50] Over 3,000 confirmed cases were documented as of 2012, with Uganda having the highest number of cases in the world.[51] The disease has profound health effects on children, families, and communities.[52] The children who were previously healthy and growing well are observed by the parents to nod mainly at meal times initially, progressing to head nod when it is cold, etc. These children eventually develop various forms of epileptic seizures as well as disabilities such as severe malnutrition, burns, contractures, severe kyphosis, cognitive impairment, and wandering away from homes.[52] Since the interventions began in 2012, there have been no new cases reported in the region. The exact cause of this disease has not been found, although there is strong association with onchocerciasis. Communities believe their children could have been exposed to chemicals during the war, particularly when they were displaced into internally displaced persons camps because they observed that their children became sick only when in the camps.[53]
Sub CountyNodding SNodding SEpilepsyEpilepsy
MaleFemaleMaleFemale
Awere230188231198
Atanga1441299584
Lapul34322322
Agagura1191087064
Laguti172164115110
Acholi Bur03041823
Puranga1312148146
Pader13112116
Total728648721663
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See also

References
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  49. WHO. "International Scientific Meeting on Nodding Syndrome, Kampala, Uganda, 30 July – 1 August 2012" (PDF). Geneva: World Health Organization (WHO). Retrieved 17 October 2016.
  50. Idro, R.; Musubire, K. A. Byamah; Mutamba, B.; Namusoke, H.; Muron, J.; Abbo, C.; Oriyabuzu, R.; Ssekyewa, J.; Okot, C.; Mwaka, D.; Ssebadduka, P.; Makumbi, I.; Opar, B.; Aceng, J. R.; Mbonye, A. K. (2 June 2013). "Proposed guidelines for the management of nodding syndrome" (PDF). African Health Sciences. 13. doi:10.4314/ahs.v13i2.4. Retrieved 17 October 2016.
  51. Nakiyimba, Gloria (16 March 2012). "Northern Uganda has highest number of nodding syndrome cases". Paris, France: Radio France Internationale (RFI). Retrieved 17 October 2016.
  52. Dowell, Scott F.; Sejvar, James J.; Riek, Lul; Vandemaele, Katelijn A. H.; Lamunu, Margaret; Kuesel, Annette C.; Schmutzhard, Erich; Matuja, William; Bunga, Sudhir; Foltz, Jennifer; Nutman, Thomas B.; Winkler, Andrea S.; Mbonye, Anthony K. (2013). "Nodding Syndrome". Emerging Infectious Diseases. 19 (9): 1374–84. doi:10.3201/eid1909.130401. PMC 3810928. PMID 23965548.
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Notes
  • UBOS and ICF International. Uganda Demographic and Health Survey 2011. Kampala, Uganda and Calverton, Maryland: Uganda Bureau of Statistics (UBOS) and ICF International Inc., 2012
  • Uganda Bureau of Statistics (UBOS) and Macro International Inc. Uganda Demographic and Health Survey 2006. Calverton, Maryland, US: UBOS and Macro International Inc, 2007
  • MOH and ICF International. Uganda AIDS Indicator Survey 2011. Kampala, Uganda and Calverton Maryland, US: Ministry of Health and ICF International, 2012
  • MOH and ORC Macro. Uganda HIV/AIDS Sero-behavioural Survey 2004–2005. Calverton, Maryland, US: Ministry of Health and ORC Macro, 2006.
  • Government of Uganda MOH. Safe Male Circumcision Policy. In: Ministry of Health, editor. Kampala 2010
  • Population Reference Bureau. 2014 World Population Data sheet. Washington DC, US: PRB; 2014 [www.prb.org]
  • Population Reference Bureau. 2012 World Population Data sheet. Washington DC, US: PRB; 2012 [www.prb.org]
  • Population Reference Bureau. 2013 World Population Data sheet. Washington DC, US: PRB; 2013 [www.prb.org]
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