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.
Child mortality in Uganda
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. Neonatal mortality rate was 18 per 1,000 live births, higher than both the global average (17) and the SDG target of 12 per 1,000 live births.
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. 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
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. It is the leading cause of death in Uganda, as reported by the Centers for Disease Control and Prevention (CDC) in 2010.
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). Uganda is not alone in this, in 21 high burden African countries, only 34% of eligible children receive ARVs, compared to 68% of adults.
In addition, many of the children that receive medication have been found to lack the necessary diligence in their drug therapy routine. Many children find the medication unpleasant and are not even aware of their HIV status. Part of this can be attributed to lapses in communication. For example, it is common practice not to inform children of their HIV status until they reach 13 years of age. Sexual lifestyles are typically frowned upon in Uganda, particularly for women, which contributes to a poor dissemination of sex-related health information.
Research has shown that efforts to improve health and awareness of parents and guardians, as well as the communities, of children with HIV/AIDS could be an effective way to improve treatment. Increased education and awareness can help with communication breakdowns and access to resources. These efforts can also help decrease mother-to-child transmissions.
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. A study published by the World Health Organization (WHO) found that antiretroviral therapy (ART) is a very effective management strategy, in terms of efficacy as well as cost, for prevention of mother-to-child transmissions. In addition, often material support for parents/guardians can be an effective strategy in improving care and treatment of children, including funding for food, clothing, and educational expenses.
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. There was a reduction among children from 27,660 in 2011 to 9,629 in 2013, which measured up to the National Priority Action Plan target for 2013, which was 10,000.
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. According to UNAIDS, HIV cases were lower among pregnant adolescents at 3% compared to older pregnant women at 4.9%, availability of anti-retroviral therapy was lower among adolescents at 94%, compared to older pregnant women at 99%.
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. Overall, mother to child transmission treatment coverage has greatly increased, but there is still a significant amount of unmet need across the country for women and children.
Malnutrition
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. Consequences of this have been found to be very costly to the Ugandan government and economy, with estimated losses totaling at 899 million US dollar annually, or 5% of the country's GDP.
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. According to the United States National Center for Health Statistics, 24.1% of children were underweight based on weight, age, and gender.
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. Wasting is used as an evaluation of short-term malnourishment principally after an ailment occurred.
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. A 2012 study found that vaccination rates can be improved by providing additional support to mothers to enable them to make use of immunization services.
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. Uganda has one of the highest rank for unimmunized children.
Wood-burning stoves