Ugandan Global Health Profile_MackenzieWright_2015

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<ul><li><p>Uganda Health Profile </p><p>Mackenzie Wright </p><p>MIDTERM </p><p>A health profile of Uganda, including the biosocial factors contributing to its health situation. </p></li><li><p>Wright 1 </p><p>Uganda is a landlocked country in Eastern Africa, home to a population of nearly </p><p>37,000,000 people and an abundant wildlife; its capitol is located in Kampala, the </p><p>countrys largest city. Uganda is bordered to the east by Kenya, to the north by South </p><p>Sudan, to the west by the Democratic Republic of the Congo, to the southwest by </p><p>Rwanda, and to the south by Tanzania. The official languages of Uganda are English and </p><p>Swahili, accompanied by dozens of indigenous languages scattered across the country </p><p>such as Bantu in southern Uganda and Acholi in parts of northern Uganda. The most </p><p>prominent ethnic groups are the Baganda (16.2%), Bagisu (5.1%), Iteso (8.1%), Acholi </p><p>(4.4%), Basoga (7.7%), Lugbara (3.6%), Banyankore (8.0%), Banyoro (2.9%), Banyaruanda </p><p>(5.8%), Batoro (3.2%), Bakiga (7.1%), Karamojong (2.0%), Lango (5.6%) and others (20.3%) 1. </p><p>None of these ethnic groups constitutes a majority, thus limiting the ability of one group </p><p>to control the others. Apart from socio-economic cleavages, the ethnic groups differ in </p><p>how they have participated in the political rule of the country after independence in 1962. </p><p>The political rulers of the country have traditionally been from Baganda and are therefore </p><p>often perceived as the dominating elite. Uganda is thus struggling with fragmentation </p><p>over ethnic lines and lacks a sense of nationalism. This segmentation of the populace has </p><p>also impacted Ugandas health care system by providing unequal care across regions, </p><p>incomes and ages. </p><p>Uganda is divided into districts, spread across four administrative regions: </p><p>Northern, Eastern, Central (Kingdom of Buganda) and Western 1. There are now over </p><p>100 districts that are responsible for providing and supplying services, such as healthcare, </p><p>based on resources provided by the government. In the past, Northern districts have </p><p>accused the central government of favoritism and corruption, claiming the President takes </p><p>better care of his home districts than the rest of the country. Ugandas current president, </p></li><li><p>Wright 2 </p><p>Museveni has been in power since 1986 after a military coup by his National Resistance </p><p>Army (NRA). Transparency International has rated Uganda's public sector as one of the </p><p>most corrupt in the world. In 2014, Uganda ranked 142nd worst out of 175 and had a </p><p>score of 26 on a scale from 0 (perceived as most corrupt) to 100 (perceived as clean) 2. </p><p>Since 1987 Joseph Kony and the Lords Resistance Army have terrorized Northern </p><p>Uganda, kidnapping children and forcing them to become child soldiers, decimating </p><p>communities, killing without question and displacing hundreds of thousands of </p><p>Ugandans. In recent years President Museveni has claimed that the LRA is close to </p><p>defeat, however the terrorist group then stepped up its attacks on the civilian population, </p><p>specifically the Acholi ethnic group in the North where many internally displaced peoples </p><p>have been forced into camps over the last decade where health and sanitation facilities are </p><p>very poor 3. While Southern Uganda is relatively stable with signs of growth and progress </p><p>in health, the North is plagued by conflict and receives little aid from the government to </p><p>help those affected by violence and poor health conditions. In spite of all of this, Uganda </p><p>is seeing progress in improving the health of its populace. </p><p>While Ugandas population steadily grows the country has begun the second stage </p><p>of the demographic transition by reducing its exceptionally high death rate. However, a </p><p>stable and high birth rate has in effect produced an imbalance in the Ugandan population. </p><p>Since its first data collection in the 1970s, Ugandas high mortality rates have been </p><p>surpassed by even higher fertility rates (Table 1). This imbalance signifies an unevenly </p><p>distributed population (Figure 1). In other words, there is a growing number of Ugandan </p><p>children; however, they do not have a promising chance to reach adulthood because high </p><p>mortality rates continue to reduce the adult population. This is especially true in rural </p></li><li><p>Wright 3 </p><p>communities. Rural regions of Uganda lack consistent and quality access to health care </p><p>these areas and have higher rates of fertility than urban regions. The higher fertility rates </p><p>are also partly due to the lack of contraception for women and children in rural areas. </p><p>Women in the poorest quintile have eight children on average during their lives, while </p><p>women in the wealthiest quintile have just over four children. Similarly, 41 percent of </p><p>young women ages 15 to 19 in the poorest quintile have begun childbearing, while only </p><p>16 percent in the wealthiest quintile have 4. Access to and prevalent use of contraceptives </p><p>varies in Uganda based on economic status. In the poorest quintile, which affects 19.6% </p><p>of the population, only 14.7% of this group uses modern or traditional methods of </p><p>contraception. For the poorest quintile in Uganda, only 27.4% who wanted family </p><p>planning actually received these resources 4. </p><p>Within the perimeters of Omrans Stages of Epidemiologic Transition Uganda </p><p>is currently in Stage Two, the Age of Receding Pandemics, where mortality </p><p>progressively declines as increased technologies and improvements to health mitigate </p><p>Stage One nutritional deficiencies or infectious diseases and emerging Stage Two chronic </p><p>diseases. Even though Uganda is in Stage Two of its Epidemiologic Transition, the </p><p>country still suffers from many Stage One causes of death. Communicable diseases, </p><p>maternal and perinatal conditions and nutritional deficiencies are cause for 63.7% of </p><p>Ugandas Disability-Adjusted Life Years (DALY) (Table 2). Prevalent Stage Two chronic </p><p>or non-communicable diseases such as mental and behavioral disorders or cardiovascular </p><p>disease also make up only 24.3% of total DALYs, illustrating that Uganda has not moved </p><p>out of Stage Two, the last stage in which cause of death is not dominated by chronic </p><p>disease (Table 2). In terms of the number of years of life lost due to premature death in </p></li><li><p>Wright 4 </p><p>Uganda, HIV/AIDS, malaria, and lower respiratory infections were the highest-ranking </p><p>causes. The HIV/AIDS epidemic is a prominent reason for the failure of the process of </p><p>epidemiologic transition as mortality rates soared and fertility rates remained at their </p><p>already high level. Additionally, with one of the highest rates of alcohol consumption in </p><p>the world the leading risk factor in Uganda is alcohol use, directly affecting Ugandans </p><p>DALY and ability to progress in terms of health. Another factor that describes the failure </p><p>of the process of epidemiologic transition is the high prevalence of violence and conflict </p><p>that has plagued Uganda for decades. From the Lords Resistance Army in Northern </p><p>Uganda to strife between President Museveni, neighboring countries and Northern </p><p>districts, Uganda has lost many lives to violence and conflict. </p><p>Uganda has taken great strides and made incredible progress improving maternal </p><p>and child health in the last three decades. Pregnant women receiving more than one </p><p>antenatal clinic visit are currently at 95%, which is highest rate ever recorded (Table 3). </p><p>This high proportion of pregnant mothers acting on their ability to have an antenatal </p><p>check-up in a clinic at least once is astounding progress in Uganda and has no doubt been </p><p>a leading factor in improved maternal health overall. Unlike in fertility rates, there is very </p><p>little difference within economic classes regarding access to and use of antenatal care in </p><p>Uganda. In the poorest quintile, 94% received at least one antenatal visit and in the </p><p>richest quintile 97% received the same care. However, as we move to an increased </p><p>number of visits (more than four) these numbers drop and a familiar trend can be seen </p><p>between the poorest and richest quintiles 4. Unfortunately, all Ugandan women are less </p><p>likely to visit an antenatal clinic four or more times during pregnancy (Table 3). Poor </p><p>mothers are the least likely to receive this care at only 41.6% with 58% of wealthier </p></li><li><p>Wright 5 </p><p>mothers receiving more than four antenatal check-ups 4. Clearly, there are still </p><p>improvements to be made in Ugandas healthcare delivery system to mothers and their </p><p>children of all economic means. Another key Ugandan maternal health improvement is </p><p>the growing use of a skilled health attendant at birth. In 1990 health personnel attended </p><p>only 37% of births for the general population, but in 2013 this number has reached 58% </p><p>(Table 3). There are stark differences in healthcare again between economic classes in </p><p>which only 44.5% of mothers in the poorest quintile have a personnel attendant at birth </p><p>yet 89.2% of the richest quintile receives this care 4. Between the fourth and fifth quintile </p><p>is the largest and most notable gap where in the fourth richest quintile only 61.3% of </p><p>births are attended by health personnel compared to nearly 90% in the very next </p><p>economic class; it is clear Ugandans with higher economic status receive far better </p><p>maternal and child health care. </p><p>According to the World Health Report the maternal mortality ratio of Uganda as </p><p>of 2013 is 360 out of 100,000 live births (Table 3). This has greatly improved since 1990 </p><p>with a maternal mortality ratio of 780 out of 100,000 live births. Compared to its </p><p>neighbors South Sudan with the highest maternal mortality ratio of 2,054/100,000, Kenya </p><p>with the same ratio of 360 and Rwanda slightly lower with 340/100,000, Uganda is faring </p><p>well on a regional level and is on a progressive and steady path toward even better </p><p>maternal health 5. Ugandas infant mortality rate of 45 out of 1,000 live births is another </p><p>significant improvement, from 111.4 in 1990 (Table 3). However, this improvement has </p><p>not been seen equally across Uganda as its richest quintile benefits from the progressive </p><p>health services far more than the poorest quintile. The top quintile experiences only a </p><p>47.7 infant mortality rate, with the poorest quintile at a steadily higher rate of 75.7 deaths/ </p></li><li><p>Wright 6 </p><p>1,000 live births the Ugandan poor do not receive the same maternal and child care as </p><p>does the 17.3% of the population with higher economic status 4. The Three Delays Model </p><p> delays in seeking, reaching and receiving care -- is incredibly relevant and useful to </p><p>explain possible reasons for higher mortality rates within poorer quintiles. In each stage </p><p>of the model, decision to seek care, identifying and reaching medical facility, receipt of </p><p>adequate and appropriate treatment, poorer mothers are less successful in getting the </p><p>health care they may need than are richer mothers facing the same health problems. As of </p><p>2012, the annual Rate of Reduction of Under-five Deaths is at 4.3% with the Under-five </p><p>Mortality rate per 1,000 live births at 69 (Table 3). Similar to maternal mortality there is a </p><p>trend between economic status and health care received. Once again the richer factions of </p><p>the Ugandan population benefit more and have access to better health care and have </p><p>lower mortality rates than do poorer populations. At 124 deaths per 1,000 live births, the </p><p>Under five-Mortality Rate in the poorest quintile is close to double that of the highest </p><p>quintile at 71 deaths per 1000 live births 4. This trend of inequality has been blatantly </p><p>evident in Uganda since at least 1995. </p><p>Low birth weight is yet another indicator of the difference in quality and access to </p><p>health services between economic classes in Uganda. At a national average rate of 12% </p><p>Low Birth Weight in 2012, Ugandans with poorer economic status are at a much higher </p><p>level, around 45%, than the children born into richer families (Table 3) 4. Similarly, with a </p><p>national average of 14.1% of children who are Underweight, a large portion of that 14% </p><p>comes from poorer economic classes. A ratio of 17.2% Underweight children from the </p><p>poorest quintile compared to less than half of that, at 8.5% for wealthier Ugandans, </p><p>proves a debilitating trend in favor of the economically richer quintiles. The ratio of </p></li><li><p>Wright 7 </p><p>children moderately or severely stunted, averaging 33.7% nationally, at 53.5% for the </p><p>poor and 25.7% for the wealthy shows the poorest quintiles are again suffering from lack </p><p>of or substandard health care in relation to the richest (Table 3) 4. Again doubling the ratio </p><p>of the rich quintile of wasted children at 3.1% compared to 6.4% in the poorest quintiles </p><p>illustrates Ugandas serious health care inequality 4. </p><p>Early nutrition is proven to be an important marker for good health outcomes. </p><p>Ugandan children are exclusively breastfed for the first six months of their lives 57% of </p><p>cases and 46% of children are breastfed until age two (Table 3). 82% of children are </p><p>introduced to solid, semi-solid and soft foods between six to eight months of age. 99% of </p><p>households consume iodized salt, greatly important in Ugandas hot climate where meat </p><p>and other foods quickly go bad. 57% of households have full coverage of Vitamin A </p><p>supplementation and 82% of children receive their measles immunization. However, a </p><p>staggeringly low 34% of the population uses improved sanitation facilities as of 2013 </p><p>(Table 3). The recurring trend of the richer factions of the population receiving more and </p><p>better health care than poorer quintiles is blatantly apparent in each of these statistics as </p><p>well, except for the consumption of iodized salt where the poorer quintiles do not vary </p><p>from the richer. </p><p>The HIV/ AIDS epidemic has decimated the continent of Africa with little sign of </p><p>slowing down. Since the beginning of the epidemic, almost 78 million people have been </p><p>infected with the HIV virus and about 39 million people have died of HIV worldwide. </p><p>Within Uganda 7.2% of the adult population is infected with HIV and there is estimated </p><p>to be 1,500,000 people of all ages living with the virus (Table 4). Women living with HIV </p><p>make up nearly half of this number, at 780,000 these women risk mother to child </p></li><li><p>Wright 8 </p><p>transmission, further increasing the toll of HIV/ AIDS on the country. Children born and </p><p>living with HIV figures around 190,000 (Table 4). Without increased education the number </p><p>of those infected in Uganda will not drop, proven by the low levels of comprehensive </p><p>knowledge of HIV within the younger population, all below 50% in 2012 and the </p><p>corresponding increasing occurrence of HIV infection in Uganda. Because treatment is so </p><p>costly, both economically and physically, only those with the resources to afford the drug </p><p>and its potential continuing care are able to rid themselves of the deadly disease, leaving </p><p>the poorest quintiles vulnerable to the deadly spread and infection of HIV/ AIDS. </p><p>In the last two decades Uganda has made incredible improvements in the overall </p><p>health of its people. From child mortality to the prevalence of breastfeeding Uganda is on </p><p>the right path towards better health, however, i...</p></li></ul>