In Uganda, infant mortality continues to be a concern, with deaths of babies still placing a heavy burden on families and communities. According to the 2022 Uganda Bureau of Statistics (UBOS) findings, the number of infant deaths stands at 43 for every 1,000 live births. In addition, the figure is still above the targets outlined in the third National Development Plan (NDP) and still above the SGD target of reducing neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.
Progress and Current Challenges
Uganda has made notable progress towards reducing child mortality over the last three decades reflecting the overall improvements in child health and survival. The under-five mortality rate has steadily declined from 200 deaths per 1,000 live births in 1990 to 39 per 1,000 live births in 2023. Despite this decline, this figure remains above the global average of 37 per 1,000 live births and higher than the sustainable development goal (SDG) target 3.2 of 25 deaths per 1,000 live births. In 2023, the infant mortality rate was 28 deaths per 1,000 live births, compared to a global average of 27.
Children in Uganda are regularly exposed to many preventable health risks. According to the WHO, the country ranks 186th out of 191 eligible countries in life expectancy. There are many cultural factors influencing the current health status of Uganda, including the negative stigma associated with sex and the use of wood-burning stoves. This stigma has resulted in a severe lack of education and communication necessary to improve the health and well-being of children.
Leading Causes of Infant Mortality
The leading causes of death among children under five in Uganda include malaria, neonatal asphyxia and trauma, preterm birth, congenital birth defects, and neonatal sepsis and infections. Malaria alone accounts for over 33,000 under-five deaths annually and remains a major contributor to child mortality and overall disability-adjusted life years (DALYs) in Uganda. Among neonates, birth asphyxia and trauma are the leading causes of death contributing to over 10,000 deaths per year highlighting the importance of improved birth care such as skilled birth attendance as part of the maternal and child morality interventions in Uganda.
Despite efforts by the ministry of health and other stakeholders to prevent and treat malaria, the disease continues to pose a heavy burden in Uganda, accounting for about 17% of all DALYs and 31% of DALYs among children under five in 2021. As such, the malaria vaccination program that started in 2025 in Uganda was a timely intervention to complement the broader malaria prevention strategy.
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Risk Factors Contributing to Infant Mortality
The key risk factors for under-five mortality in Uganda include low birth weight, short gestation, child underweight, household air pollution, and malnutrition. While child mortality has declined across all socioeconomic groups, disparities remain. For instance, children in the poorest 20% of the household in Uganda experienced 49 deaths per 1,000 live births. Whereas, children in the richest 20% experienced 28 deaths per 1,000 live births. Thus, children from the poorest households are twice as likely to die before the age of five years compared to those from the wealthiest households, highlighting the health inequities linked to the socioeconomic status of the population in Uganda.
HIV/AIDS is likely the leading health risk facing Ugandan children; it affects many facets of their physical and mental health in a variety of ways. The CDC has been fairly active in the country, working in cooperation with government organizations as well as a number of other partners. Their work has been on multiple fronts including door-to-door HIV counseling and testing. Despite these and many other efforts, there are poor rates of treatment of children. Of the 190,000 HIV-positive children in Uganda, only 35,500 received Antiretroviral medication (ARV). In addition, many of the children that receive medication have been found to lack the necessary diligence in their drug therapy routine.
It is estimated that 91,000 infants are born each year to HIV-positive women. Only 51.6% of these women receive any sort of mother-to-child HIV prevention and about 24% of all 110,000 new HIV infections in Uganda in 2009 were a result of mother-to-child transmission. To date, most of Uganda's policies to combat AIDS have focused on abstinence and fidelity, both preventative measures, while little action has been taken around youth education. The main tool of this strategy is the controversial ABC campaign (Abstinence, Be faithful, and use Condoms). While initially believed to be a successful approach, the effectiveness of this strategy is currently inconclusive as more recent studies have found that increased condom use and deaths have been responsible for the decreases in HIV infections.
According to recent studies, Uganda has seen a decrease in the HIV prevalence in the country. Adolescent girls are a group that is most severely impacted and most at risk compared to other groups of the population. Two-thirds of new HIV infections were found in this section of the population. The number of deaths decreased for children under 4 years old from 100,000 between 2000 and 2012, while the number of deaths in adolescent girls increased from below 50,000 to over 100,000 between 2000 and 2012(UNICEF, 2013). Studies have shown that children below 15 years old account for 11% of HIV cases.
Additionally, due to the fact that there is still 18% of HIV cases coming from mother-to-child transmissions, the World Health Organization has been efficiently sending out revised WHO guidelines to protect mothers and their babies and make certain that HIV-infected mothers and their children receive triple antiretroviral prophylaxis during labor, breastfeeding, and throughout the rest of life. HIV positive mothers with access to elimination of mother-to-child transmission (EMTCT) assistance has increased to 85% and thirty-three districts have full coverage now (UNICEF Uganda). On the other hand, pregnant women in four districts did not receive antiretroviral therapy and in only 29% of districts HIV infected women were given antiretroviral therapy.
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Malnutrition and Its Impact
Malnutrition plagues much of Uganda's youth. According to a study by the World Food Programme (WFP), roughly one-third of Ugandan children have stunting, a permanent condition resulting from lack of proper nutrition during the first 5 years of life. Stunting in children occurs when a child is severely malnourished which leads to the child being much shorter than the average height for their age. This condition happens over a long period of time where the child is deprived of proper nutrition and infections which also arise more easily in undernourished children.
According to the World Health Organization, 23.8% were short for age and 6.9% were extremely stunted. Along with stunting, malnutrition also caused children to be underweight. Kwashiorkor is a kind of protein-energy malnutrition that is caused by repeated infections, specifically diarrheal disease. According to pediatrics, Edema must be present in order for a nutritional deficit is classified as Kwashiorkor and only 3.8% of the total sample had Kwashiorkor. Another condition named Marasmus occurs in children when they experience critical undernourishment that causes their weight to be lower than the appropriate weight for their age. The widespread presence of low MUAC (mid-upper arm circumference) was also a health issue attributed to critical malnourishment. Children that had weighed too little for their height had a condition called wasting.
The Role of Vaccinations
Vaccinations is a preventative method that can limit and terminate infectious diseases, which can eliminate the possibility of millions of deaths per year. It is a very cost-effective way to manage the overall health of a population. While many efforts are currently in place in Uganda to distribute vaccinations to children, it is still a very serious health concern. About 2 million deaths each year in Uganda are a result of vaccine preventable diseases. Tuberculosis is one example of these, which was found to be the 4th leading cause of death in Uganda in 2010 according to the CDC.
In 2001, it was found that 63% of children less than one year old had either failed to complete their vaccination schedule or not had any vaccinations at all. Recently, Uganda has been improving and diligently working on the availability of vaccinations to children. The World Health Organization is supporting Uganda in its health and vaccination efforts along with the Global Vaccination Action Plan. According to the National Administrative Immunization Performance Analysis, 22 out of Uganda's 112 districts have a good availability and use of immunization services. The services help about 80% of the children. Despite the tremendous health efforts, the overall vaccination availability and access is poor.
According to WHO, 22% and 18% of Ugandan children still do not have essential vaccines.
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Environmental and Cultural Factors
Traditionally in Uganda, as in most developing countries, open word-burning stoves are commonly used for cooking and to heat homes. It has been estimated that 95% of Ugandans rely on wood or charcoal for cooking. Many women using these wood-burning stoves to cook are unaware of the severe health issues it can cause to them and their children. Fumes from the stove are dense in particles containing harmful gases such as sulfur dioxide, carbon dioxide, and various other harmful gases. These gases are harmful to the environment and to people inhaling the fumes.
In addition to inducing cancerous disease, the fumes from the stove can damage eyesight. After long-term use, the smoke degrades eye sight and causes visual impairments. Along with eyesight impairment, the smoke causes other illnesses such as chronic bronchitis, lung infections, asthma, cataract, low birth weight, and stillbirths. The chemical pollutants in smoke also induce dizziness and irritation to the respiratory system. According to the World Health Organization, there are over 200 different chemicals and compounds in wood smoke that are hazardous enough to damage human health. Many women and girls are utilizing the wood-burning stoves every day and are not aware of the harmful effects it is having and will have on their health.
Many homes in Uganda still have inadequate ventilation stoves because they are unable to afford stoves with better ventilation. Women and girls need to be educated on how to efficiently cook and save themselves and the environment while still using the poorly ventilated stoves. The CECOD, a non-governmental organization in Uganda, has a purpose to create stoves that save energy and don't use a lot of wood which will reduce the deforestation. The CECOD has also created eco schools that educate students about the environment and how to save the environment.
Socioeconomic Barriers and Healthcare Access
Regarding the socioeconomic barriers that hinder progress, one of the glaring obstacles is that despite the fact there are still gaps in the healthcare service delivery, the budget towards health programs is being cut down continually. In tandem, the allocation of funds remains insufficient to meet the growing demands of a burgeoning population. Secondly, Uganda faces a shortage of healthcare professionals, particularly physicians. The scarcity of trained medical personnel exacerbates existing healthcare disparities, especially in rural areas where access to healthcare services is limited.
Besides, studies using the three delays model reveal that delays in reaching the health facility and most importantly delays in receiving quality care once at the health facility are also major contributors to neonatal mortality. As a result, some women end up giving birth at home without the assistance of trained healthcare professionals thereby increasing the risk of complications and infant mortality. This is mainly attributed to the failure of women living with HIV to use ARVs thereby increasing the risk of deaths.
To date, HIV continues to impact maternal and child health outcomes despite the progress that has been made in HIV prevention of mother-to-child transmission (PMTCT) programmes and treatment. A study conducted in Mbarara by Edelson et al. Strengthening maternal and child health programs, including prenatal care, immunizations, and nutrition education helps to ensure that mothers and infants receive the care they need to thrive. Therefore, efforts to combat HIV/AIDS must be integrated into broader maternal and child health initiatives to effectively mitigate its adverse effects on infant mortality rates. In addition, Nabatanzi et al. The scourge of gender-based violence (GBV) in addition, exacerbates infant mortality.
It has been noted that GBV not only inflicts physical and psychological harm but also perpetuates cycles of poverty and inequality as well as increasing the risk of maternal and infant mortality. Thus, there is a need to address GBV given its significant effects on infants. To do so, this requires multifaceted interventions that prioritize prevention, protection, and support services for survivors.
Strategies and Interventions
Therefore, addressing the socioeconomic factors driving persistent infant mortality rates in Uganda requires a multifaceted approach. Additionally, efforts should be made to strengthen maternal and child health programs, including prenatal care, immunizations, and nutrition education, to ensure that mothers and infants receive the care they need to thrive. Also, government agencies, non-profit organizations, and international partners must continue to work together to enforce the implement comprehensive strategies to tackle infant mortality in Uganda.
In 2008, Janet Museveni launched the Road Map campaign in an effort to coordinate efforts to lower maternal and neonatal death rates in Uganda. She created the Elimination of Mother-to-Child-Transmission of HIV Campaign in Moroto. This campaign was part of the government's efforts to prevent HIV from affecting future generations like how it has affected past generations. Part of the campaign is the promotion of ART (antiretroviral therapy) where all pregnant women with HIV are given antiretroviral therapy for life. Uganda was one of the first developing countries to offer life-saving treatment to people infected with HIV. Through this campaign the Ugandan government has shown that Africans can have access to preventative treatment and that HIV/AIDS can be conquered.
The infectious disease called Malaria is induced by parasites that are spread to humans through mosquito bites, particularly female Anopheles mosquitoes. This infectious disease is parasitic and attacks red blood cells. It is the prime cause of death among children and pregnant women in Africa. Children and women infected with the disease have symptoms including chills, high fever, fatigue, headaches, nausea, shivering, and pain in limbs. If the person is infected with the disease over a long period of time they can contract anemia, jaundice, and low blood sugar.
A community based cohort of 2500 infants was enrolled from birth up to 8 weeks of age and followed for 1â2 years. During follow up, several mortality reduction activities were implemented to enhance cohort survival and retention. A total of 152 children died over a median follow up period of 2.0 years. The overall crude mortality rate was 60.8/1000 or 32.9/1000 person years with 40 deaths per 1000 for children who died in their first year of life. Anaemia, malaria, diarrhoeal diseases and pneumonia were the top causes of death. There was no death directly attributed to tuberculosis. The overall two year mortality in the study cohort was unacceptably high and tuberculosis disease was not identified as a cause of death. Interventions to reduce mortality of children enrolled in the cohort study did not have a significant impact.
Table: Causes of Death in a Cohort of Ugandan Infants
| Cause of Death | Percentage of Deaths |
|---|---|
| Anaemia | High percentage |
| Malaria | High percentage |
| Diarrhoeal Diseases | High percentage |
| Pneumonia | High percentage |
| Tuberculosis | Rare |
In this cohort of 2500 infants, 152 participants died with nearly two thirds of them dying in their first year of life. The overall two year crude mortality and the study infant mortality rate for this cohort were 60.8/1000 and 40/1000 respectively. Our results showed anaemia, malaria, diarrhoeal diseases and pneumonia to be the leading causes of death in this cohort. Therefore, the study infant mortality rate was much lower than the infant mortality (IMR) of 74/1000 expected in the region because the study missed most of the neonatal deaths (the median cohort enrolment age was 19 days).
In this cohort, deaths were mainly due to common childhood illnesses but not tuberculosis. Most of the children who died sought care from a health facility for the sickness that immediately preceded their death. However, one third of those referred did not reach the referral care points. This has implications for child health services and for clinical research involving children. Among those who sought care, about half of them were referred to hospital by their first point of care.
Children born to very young mothers (13â17 yrs) had the highest risk of dying. Concerning childâs place of birth, in our cohort children born in a health facility had a significantly lower risk of dying than those whose place of birth was outside a health facility.
Health Focus: What is driving up maternal and infant mortality in Uganda?
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