Health and Nutrition

The health of children in Uganda is faced with many threats. However, many of the deaths in early childhood can be prevented by immunizing the children against preventable diseases and by ensuring that children receive prompt and appropriate treatment when they become ill. Today, malaria is responsible for more illnesses and deaths than any other single disease in Uganda. Malaria is highly endemic with 63 per cent of the population exposed to high transmission levels and 25 per cent exposed to moderate transmission levels while 12 per cent live in areas with low or unstable malaria transmission that are epidemic prone (MOH, 2005). The 2005- 2006 Uganda National Household Survey (UBOS, 2006) revealed that half of the population that had fallen sick in the previous 12 months reported malaria or fever as their major illnesses.

All four known species of malaria parasites exist in Uganda. However, over 90 per cent of the cases are due to plasmodium falciparum, which is responsible for severe malaria (MOH, 2005). Unfortunately, strains of this parasite have developed resistance to Chloroquine and Sulphadoxine Pyrimethamine (SP), the most common anti malaria drugs, and this resistance continues to rise. While those with low immunity- pregnant women, children under five years, and people living with HIV/AIDS- are particularly vulnerable, all persons living in Uganda are at risk of being infected with malaria parasites and suffering from resulting illnesses.

The Roll Back Malaria (RBM) initiative was undertaken by the World Health Organization (WHO) in 1998 as an international effort to control malaria. Its aim was to halve the 2000 levels of malaria morbidity and mortality by 2010, and reducing this malaria burden by a further 50 per cent by 2015. The RBM initiative is the framework within which Uganda implements malaria control activities. The objectives of the initiative are to ensure that pregnant women and children under five years of age have access to the most suitable and affordable combination of personal and community protective measures such as insecticide-treated mosquito nets (ITNs) and prompt, effective treatment for malaria within 24 hours of onset of illness. Another objective is to ensure that at least 60 per cent of all pregnant women have access to intermittent preventive treatment (ITP).

To control malaria, the Government of Uganda has put in place the Uganda Malaria Control Strategic Plan (UMCSP) 2005/6- 2009/10, which is the second plan in the country to address the malaria problem in a sustainable manner. The plan complements the broader five- year Health Sector Strategic Plan, which is part of the Poverty Eradication Action Plan (PEAP). In the PEAP, malaria features as a high priority health and poverty issue. The plan builds on the achievements and challenges of the previous five-year period and describes core intervention strategies and their specific objectives and sets targets. The PEAP also highlights several interventions in the control of malaria, for instance the waiving of taxes on mosquito nets and insecticides and launching of the home-based treatment programme for combating malaria.

Insecticide-treated nets are currently considered the most cost-effective method of malaria prevention in highly endemic areas. But even this method is still out of reach for a large section of Ugandans. All households in the 2006 UDHS were asked whether they own mosquito nets and, if so, how many. The data showed that only 34 per cent of households in Uganda have a mosquito net, whether treated or untreated. About 15 per cent of the households have more than one mosquito net. About 20 per cent own at least one ever-treated mosquito net, while 8 per cent of the households have more than one ever-treated mosquito net. Only 16 per cent of the households own at least one ITN, while only 6 per cent own more than one.

HIV/AIDS is another major threat to health in Uganda. Initially HIV was not a threat to children except those that were born with the virus, but due to early involvement in early sexual activities by children, it is no longer a preserve of the adults alone. More awareness in this area is therefore needed. Acquired Immune Deficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV) that weakens the immune system, making the body susceptible to and unable to recover from other opportunistic infections that lead to death through these infections. The predominant mode of transmission is through heterosexual contact, followed in magnitude by prenatal transmission, in which the mother passes the virus to the child during pregnancy, delivery or breastfeeding. Other modes of transmission are through coming into contact with infected blood.

The health of children is also affected by low nutrition standards. Though malnutrition researchers have found out that a balanced diet is with in the reach of most households in Uganda due to abundance and variety of foodstuffs, a large number of children are still malnourished. A 2007 UNICEF Situation Analysis Report put malnutrition prevalence rate in Moroto district at 17.9 per cent, while Kotido and Nakapiriprit districts of Karamoja stood at 8.1 per cent and 10.4 per cent, respectively. In some places in Uganda severe malnutrition prevalence is estimated at 3.2 per cent, which is far below the acceptable limit of 15.0 per cent by the World Health Organisation.

According to the Millennium Development Report (2007), the greatest proportion of children going hungry are found in Southern Asia and Sub- Saharan Africa, including Uganda. It further explains that if the current trends continue, the world will miss the 2015 target by 30 million children, essentially robbing them of their full potential. Other reports show that 38 per cent of children under five are stunted and 15 per cent are severely stunted, in Uganda. Six per cent of children under five are wasted, and 16 per cent are underweight. It is due to this that ACHEF is bent on improving health and nutrition among children by way of emphasising to households the ultimate importance of a balanced diet specifically among children.