Ugandan Global Health Profile_MackenzieWright_2015

Uganda Health Profile

Mackenzie Wright

MIDTERM

A health profile of Uganda, including the biosocial factors contributing to its health situation.

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Uganda is a landlocked country in Eastern Africa, home to a population of nearly

37,000,000 people and an abundant wildlife; its capitol is located in Kampala, the

country’s largest city. Uganda is bordered to the east by Kenya, to the north by South

Sudan, to the west by the Democratic Republic of the Congo, to the southwest by

Rwanda, and to the south by Tanzania. The official languages of Uganda are English and

Swahili, accompanied by dozens of indigenous languages scattered across the country

such as Bantu in southern Uganda and Acholi in parts of northern Uganda. The most

prominent ethnic groups are the Baganda (16.2%), Bagisu (5.1%), Iteso (8.1%), Acholi

(4.4%), Basoga (7.7%), Lugbara (3.6%), Banyankore (8.0%), Banyoro (2.9%), Banyaruanda

(5.8%), Batoro (3.2%), Bakiga (7.1%), Karamojong (2.0%), Lango (5.6%) and others (20.3%) 1.

None of these ethnic groups constitutes a majority, thus limiting the ability of one group

to control the others. Apart from socio-economic cleavages, the ethnic groups differ in

how they have participated in the political rule of the country after independence in 1962.

The political rulers of the country have traditionally been from Baganda and are therefore

often perceived as the dominating elite. Uganda is thus struggling with fragmentation

over ethnic lines and lacks a sense of nationalism. This segmentation of the populace has

also impacted Uganda’s health care system by providing unequal care across regions,

incomes and ages.

Uganda is divided into districts, spread across four administrative regions:

Northern, Eastern, Central (Kingdom of Buganda) and Western 1. There are now over

100 districts that are responsible for providing and supplying services, such as healthcare,

based on resources provided by the government. In the past, Northern districts have

accused the central government of favoritism and corruption, claiming the President takes

better care of his home districts than the rest of the country. Uganda’s current president,

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Museveni has been in power since 1986 after a military coup by his National Resistance

Army (NRA). Transparency International has rated Uganda's public sector as one of the

most corrupt in the world. In 2014, Uganda ranked 142nd worst out of 175 and had a

score of 26 on a scale from 0 (perceived as most corrupt) to 100 (perceived as clean) 2.

Since 1987 Joseph Kony and the Lords Resistance Army have terrorized Northern

Uganda, kidnapping children and forcing them to become child soldiers, decimating

communities, killing without question and displacing hundreds of thousands of

Ugandans. In recent years President Museveni has claimed that the LRA is close to

defeat, however the terrorist group then stepped up its attacks on the civilian population,

specifically the Acholi ethnic group in the North where many internally displaced peoples

have been forced into camps over the last decade where health and sanitation facilities are

very poor 3. While Southern Uganda is relatively stable with signs of growth and progress

in health, the North is plagued by conflict and receives little aid from the government to

help those affected by violence and poor health conditions. In spite of all of this, Uganda

is seeing progress in improving the health of its populace.

While Uganda’s population steadily grows the country has begun the second stage

of the demographic transition by reducing its exceptionally high death rate. However, a

stable and high birth rate has in effect produced an imbalance in the Ugandan population.

Since its first data collection in the 1970’s, Uganda’s high mortality rates have been

surpassed by even higher fertility rates (Table 1). This imbalance signifies an unevenly

distributed population (Figure 1). In other words, there is a growing number of Ugandan

children; however, they do not have a promising chance to reach adulthood because high

mortality rates continue to reduce the adult population. This is especially true in rural

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communities. Rural regions of Uganda lack consistent and quality access to health care

these areas and have higher rates of fertility than urban regions. The higher fertility rates

are also partly due to the lack of contraception for women and children in rural areas.

Women in the poorest quintile have eight children on average during their lives, while

women in the wealthiest quintile have just over four children. Similarly, 41 percent of

young women ages 15 to 19 in the poorest quintile have begun childbearing, while only

16 percent in the wealthiest quintile have 4. Access to and prevalent use of contraceptives

varies in Uganda based on economic status. In the poorest quintile, which affects 19.6%

of the population, only 14.7% of this group uses modern or traditional methods of

contraception. For the poorest quintile in Uganda, only 27.4% who wanted family

planning actually received these resources 4.

Within the perimeters of Omran’s “Stages of Epidemiologic Transition” Uganda

is currently in Stage Two, the ‘Age of Receding Pandemics,’ where mortality

progressively declines as increased technologies and improvements to health mitigate

Stage One nutritional deficiencies or infectious diseases and emerging Stage Two chronic

diseases. Even though Uganda is in Stage Two of its Epidemiologic Transition, the

country still suffers from many Stage One causes of death. Communicable diseases,

maternal and perinatal conditions and nutritional deficiencies are cause for 63.7% of

Uganda’s Disability-Adjusted Life Years (DALY) (Table 2). Prevalent Stage Two chronic

or non-communicable diseases such as mental and behavioral disorders or cardiovascular

disease also make up only 24.3% of total DALYs, illustrating that Uganda has not moved

out of Stage Two, the last stage in which cause of death is not dominated by chronic

disease (Table 2). In terms of the number of years of life lost due to premature death in

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Uganda, HIV/AIDS, malaria, and lower respiratory infections were the highest-ranking

causes. The HIV/AIDS epidemic is a prominent reason for the failure of the process of

epidemiologic transition as mortality rates soared and fertility rates remained at their

already high level. Additionally, with one of the highest rates of alcohol consumption in

the world the leading risk factor in Uganda is alcohol use, directly affecting Ugandan’s

DALY and ability to progress in terms of health. Another factor that describes the failure

of the process of epidemiologic transition is the high prevalence of violence and conflict

that has plagued Uganda for decades. From the Lords Resistance Army in Northern

Uganda to strife between President Museveni, neighboring countries and Northern

districts, Uganda has lost many lives to violence and conflict.

Uganda has taken great strides and made incredible progress improving maternal

and child health in the last three decades. Pregnant women receiving more than one

antenatal clinic visit are currently at 95%, which is highest rate ever recorded (Table 3).

This high proportion of pregnant mothers acting on their ability to have an antenatal

check-up in a clinic at least once is astounding progress in Uganda and has no doubt been

a leading factor in improved maternal health overall. Unlike in fertility rates, there is very

little difference within economic classes regarding access to and use of antenatal care in

Uganda. In the poorest quintile, 94% received at least one antenatal visit and in the

richest quintile 97% received the same care. However, as we move to an increased

number of visits (more than four) these numbers drop and a familiar trend can be seen

between the poorest and richest quintiles 4. Unfortunately, all Ugandan women are less

likely to visit an antenatal clinic four or more times during pregnancy (Table 3). Poor

mothers are the least likely to receive this care at only 41.6% with 58% of wealthier

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mothers receiving more than four antenatal check-ups 4. Clearly, there are still

improvements to be made in Uganda’s healthcare delivery system to mothers and their

children of all economic means. Another key Ugandan maternal health improvement is

the growing use of a skilled health attendant at birth. In 1990 health personnel attended

only 37% of births for the general population, but in 2013 this number has reached 58%

(Table 3). There are stark differences in healthcare again between economic classes in

which only 44.5% of mothers in the poorest quintile have a personnel attendant at birth

yet 89.2% of the richest quintile receives this care 4. Between the fourth and fifth quintile

is the largest and most notable gap where in the fourth richest quintile only 61.3% of

births are attended by health personnel compared to nearly 90% in the very next

economic class; it is clear Ugandans with higher economic status receive far better

maternal and child health care.

According to the World Health Report the maternal mortality ratio of Uganda as

of 2013 is 360 out of 100,000 live births (Table 3). This has greatly improved since 1990

with a maternal mortality ratio of 780 out of 100,000 live births. Compared to its

neighbors South Sudan with the highest maternal mortality ratio of 2,054/100,000, Kenya

with the same ratio of 360 and Rwanda slightly lower with 340/100,000, Uganda is faring

well on a regional level and is on a progressive and steady path toward even better

maternal health 5. Uganda’s infant mortality rate of 45 out of 1,000 live births is another

significant improvement, from 111.4 in 1990 (Table 3). However, this improvement has

not been seen equally across Uganda as its richest quintile benefits from the progressive

health services far more than the poorest quintile. The top quintile experiences only a

47.7 infant mortality rate, with the poorest quintile at a steadily higher rate of 75.7 deaths/

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1,000 live births the Ugandan poor do not receive the same maternal and child care as

does the 17.3% of the population with higher economic status 4. The Three Delays Model

– delays in seeking, reaching and receiving care -- is incredibly relevant and useful to

explain possible reasons for higher mortality rates within poorer quintiles. In each stage

of the model, decision to seek care, identifying and reaching medical facility, receipt of

adequate and appropriate treatment, poorer mothers are less successful in getting the

health care they may need than are richer mothers facing the same health problems. As of

2012, the annual Rate of Reduction of Under-five Deaths is at 4.3% with the Under-five

Mortality rate per 1,000 live births at 69 (Table 3). Similar to maternal mortality there is a

trend between economic status and health care received. Once again the richer factions of

the Ugandan population benefit more and have access to better health care and have

lower mortality rates than do poorer populations. At 124 deaths per 1,000 live births, the

Under five-Mortality Rate in the poorest quintile is close to double that of the highest

quintile at 71 deaths per 1000 live births 4. This trend of inequality has been blatantly

evident in Uganda since at least 1995.

Low birth weight is yet another indicator of the difference in quality and access to

health services between economic classes in Uganda. At a national average rate of 12%

Low Birth Weight in 2012, Ugandans with poorer economic status are at a much higher

level, around 45%, than the children born into richer families (Table 3) 4. Similarly, with a

national average of 14.1% of children who are Underweight, a large portion of that 14%

comes from poorer economic classes. A ratio of 17.2% Underweight children from the

poorest quintile compared to less than half of that, at 8.5% for wealthier Ugandans,

proves a debilitating trend in favor of the economically richer quintiles. The ratio of

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children moderately or severely stunted, averaging 33.7% nationally, at 53.5% for the

poor and 25.7% for the wealthy shows the poorest quintiles are again suffering from lack

of or substandard health care in relation to the richest (Table 3) 4. Again doubling the ratio

of the rich quintile of wasted children at 3.1% compared to 6.4% in the poorest quintiles

illustrates Uganda’s serious health care inequality 4.

Early nutrition is proven to be an important marker for good health outcomes.

Ugandan children are exclusively breastfed for the first six months of their lives 57% of

cases and 46% of children are breastfed until age two (Table 3). 82% of children are

introduced to solid, semi-solid and soft foods between six to eight months of age. 99% of

households consume iodized salt, greatly important in Uganda’s hot climate where meat

and other foods quickly go bad. 57% of households have full coverage of Vitamin A

supplementation and 82% of children receive their measles immunization. However, a

staggeringly low 34% of the population uses improved sanitation facilities as of 2013

(Table 3). The recurring trend of the richer factions of the population receiving more and

better health care than poorer quintiles is blatantly apparent in each of these statistics as

well, except for the consumption of iodized salt where the poorer quintiles do not vary

from the richer.

The HIV/ AIDS epidemic has decimated the continent of Africa with little sign of

slowing down. Since the beginning of the epidemic, almost 78 million people have been

infected with the HIV virus and about 39 million people have died of HIV worldwide.

Within Uganda 7.2% of the adult population is infected with HIV and there is estimated

to be 1,500,000 people of all ages living with the virus (Table 4). Women living with HIV

make up nearly half of this number, at 780,000 these women risk mother to child

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transmission, further increasing the toll of HIV/ AIDS on the country. Children born and

living with HIV figures around 190,000 (Table 4). Without increased education the number

of those infected in Uganda will not drop, proven by the low levels of comprehensive

knowledge of HIV within the younger population, all below 50% in 2012 and the

corresponding increasing occurrence of HIV infection in Uganda. Because treatment is so

costly, both economically and physically, only those with the resources to afford the drug

and its potential continuing care are able to rid themselves of the deadly disease, leaving

the poorest quintiles vulnerable to the deadly spread and infection of HIV/ AIDS.

In the last two decades Uganda has made incredible improvements in the overall

health of its people. From child mortality to the prevalence of breastfeeding Uganda is on

the right path towards better health, however, in nearly every category exists economic

inequalities that diminish the progress being made as a whole. Uganda must implement

strategies that ensure all healthcare remains accessible and of equal and excellent quality

for the entire population if the country wishes to improve the lives of each of its citizens

by means of health. Uganda has several policies and action plans that address major

population and development issues, yet none effectively deal with the country's fertility,

which is among the highest in the world. Despite economic growth in the past decade,

many Ugandans live in poverty and face social and economic inequities. Even though the

country continues to improve the health of its people, Uganda will need to address its

high fertility in rural areas, increase the number of youth who attend secondary school

and higher, and foster job creation so that its families, communities, and the nation as a

whole grow economically which will in turn improve health.

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Table 1: Demographic and Economic Indicators 2012 Indicator Latest year Value Source

Population 2012 36,346,000 SOWC

Crude Death Rate 2012 10 SOWC

Crude Birth Rate 2012 44 SOWC

Life Expectancy at Birth

2012 59 SOWC

Total Fertility Rate 2012 6.0 SOWC

Contraceptive Prevalence %

2012 30% SOWC

Total Adult Literacy % 2012 73% SOWC

GNI per capita $ 2012 $440 SOWC

GINI Coefficient 2012 44.3 UNDPHDR

Pop. Living < $1.25 % 2012 38.1% UNDPHDR

Sources: UNICEF. The State of the World’s Children 2014 in Numbers: Revealing disparities, advancing children’s rights, Every Child Counts. New York City, USA: United Nations Children’s Fund, 2014. Print. Hall, Jon. Human Development Reports. New York City, USA: Published for the United Nations Development Programme, 2014. Print.

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Figure 1: Population Pyramid of Uganda 2015

United States Census Bureau. "International Database Population Pyramid Graph - Custom Region - Uganda." United States Census Bureau. N.p., n.d. Web. 15 Oct.2015.<https://www.census.gov/population/international/data/idb/region.php?N=%20Results%20&T=12&A=separate&RT=0&Y=2015&R=-1&C=UG>.

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Table 2. Burden of disease for Uganda

Uganda Value Population of your country 35,919 Total DALYs lost 25,597.7 Communicable diseases, maternal and perinatal conditions and nutritional deficiencies --

DALYs lost 16,310.9 Percent of total DALYs 63.7% Top three causes of DALYs lost 1. Infectious and Parasitic Diseases 2. HIV/ AIDS 3. Neonatal Conditions

-- 9,871.7 3,841.6 2,876.2

Noncommunicable conditions -- DALYs lost 6,235.3 Percent of total DALYs lost 24.3% Top three causes of DALYs lost 1. Mental and Behavioral Disorders 2. Cardiovascular Disease 3. Congenital Anomolies

-- 936.9 933.2 573.5

Injuries -- DALYs lost 3,051.5 Percent of total DALYs lost 11.9% Top three causes of DALYs lost 1. Unintentional Injuries 2. Intentional Injuries 3. Road Injury

-- 2,361.8 689.7 677.6

Sources: World Health Organization. "Mortality and Global Health Estimates." World Health Organization Global Health Observatory data. N.p., n.d. Web. 15 Oct. 2015. <http://www.who.int/gho/mortality_burden_disease/en/>. World Health Organization. "Health statistics and information systems." World Health Organizations Global Health Estimates. N.p., n.d. Web. 15 Oct. 2015. <http://www.who.int/healthinfo/global_burden_disease/en/>.

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Table 3: Maternal and Child Health and Nutrition

Indicator Latest year Value Source Pregnant women who received 1+ antenatal clinic visit (%)

2013 95% World Health Report

Pregnant women who received 4+ antenatal clinic visit (%)


Births attended by skilled health personnel %


Maternal mortality ratio (per 100,000 live births)

2013 360 World Health Report

Annual rate of reduction of under-five deaths %

2012 4.3% SOWC

Infant Mortality Rate per 1000 live births


Under Five Mortality Rate per 1000 live births


Infants Born Low Birth Weight %

2012 12% SOWC

Children exclusively Breastfed < 6 months %


Intro of solid, semi-solid, soft foods 6-8 months %

2012 67% SOWC

Children Breastfeeding at age 2 %

2012 46% SOWC

Children Moderately or Severely Underweight %

2012 14.1 World Health Report

Children Moderately or Severely Wasted %


Children Moderately or Severely Stunted %


Households consuming iodized salt %

2012 99% SOWC

Vitamin A supplementation full coverage %


Children 1 y/o receiving measles immunization %


Pop using improved sanitation facilities %


Sources: UNICEF. The State of the World’s Children 2014 in Numbers: Revealing disparities, advancing

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children’s rights, Every Child Counts. New York City, USA: United Nations Children’s Fund, 2014. Print. World Health Organization, comp. Global Health Observatory (GHO) data. N.p.: n.p., 2015. Print.

Table 4: HIV/AIDS

Indicator Latest year Value Source Adult HIV prevalence (%)

2012 7.2% SOWC

People of all ages living with HIV (estimate) (thousands)

2012 1,500 SOWC

Women living with HIV (thousands)

2012 780 SOWC

Children living with HIV (thousands)

2012 190 SOWC

Sources: UNICEF. The State of the World’s Children 2014 in Numbers: Revealing disparities, advancing children’s

rights, Every Child Counts. New York City, USA: United Nations Children’s Fund, 2014. Print.

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Works Cited 1. Federal Research Division of the Library of Congress. Uganda: a Country Study. 2nd

ed. United States of America: Library of Congress Cataloging-in-Publication Data, 1990. Print. Area Handbook.

2. Transparency International. "Corruption Perceptions Index 2014: Results."

Transparency International. N.p., n.d. Web. 14 Oct. 2015. <http://www.transparency.org/cpi2014/results>.

3. "Timeline: Uganda's Fitful Path Toward Peace Under Museveni." The Christian

Science Monitor: 10. Sep 13 2005. ProQuest. Web. 14 Oct. 2015 . 4. "Health Equity Monitor Country Profiles." Global Health Observatory Data

Repository. World Health Organization, n.d. Web. 14 Oct. 2015. <http://apps.who.int/gho/data/view.wrapper.HE-VIZ11?lang=en&menu=hide>.

5. "Country Comparison > Maternal mortality rate." Index Mundi. N.p., n.d. Web. 14

Oct. 2015. <http://www.indexmundi.com/g/r.aspx?v=2223>.

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