In our continuing assessment of Uganda's performance
on the Millennium Development Goals, RICHARD M.
KAVUMA reports that hundreds of Ugandan children
still die every day of illnesses that could be easily prevented
Mary Gorette Nakalyango, 23, ran the blue comb through
her hair and patted it, looking in the small mirror with
quiet excitement, like a teenager expecting her suitor.
On the bare hospital mattress before her, her second child,
3-month-old Allen Namukwaya, grinned as she grabbed at some
invisible objects. Outside this paediatric ward at Biikira
Hospital in Rakai district, a boda boda motorcycle waited
to take mother and child back home.
Nakalyango’s excitement was borne out of relief.
|ESCAPE: This baby from Iganga
got malaria in her second week but recovered. Hundreds
other Ugandan babies die each day
Four days earlier, she had arrived here anxious, with
baby Allen hardly able to breathe or keep her eyes open.
But after two units of blood and water, the baby had now
“I was so scared. I feared my child would die. No
mother wants to produce children for death to grab,”
said Nakalyango, by now cuddling her baby as the impatient
boda boda man revved his engine.
She had reason to be relieved. In Uganda, for every 1,000
babies born, 88 die within one year (infant mortality),
while 152 die before making five (child mortality). And
every year, malaria kills 70,000 Ugandan children.
Baby Allen could easily have been one of them.
In 1990, Uganda’s child mortality rate stood at 167
for every 1,000 live births. In the last 15 years, it has
only fallen to 152 per 1,000 whereas the internationally
agreed Millennium Development Goal (MDG) 4 aims to reduce
it to 57 over the next 10 years.
Clearly, this is an ambitious target, a point that government
According to the Ministry of Finance, Planning and Economic
Development, child mortality is influenced by factors such
as education, safe water, basic healthcare and security.
In a July 2005 progress report on the MDGs, the ministry
says infant and child mortality have stagnated since the
Government missed its own targets of reducing infant deaths
to at least 78 per 1,000 live births by 2002 and 68 by 2005.
Uganda is therefore unlikely to meet the MDG target of reducing
infant mortality to 31 per 1,000 births by 2015.
Under-5 mortality rates have not done any better: “In
view of the current performance, it is hard to be optimistic
about the attainment of both the 2005 PEAP target 
and the 2015 MDG ,” the report says.
Why do the children die?
According to Dr. Chris Baryomunsi, a programme officer
with the United Nations Population Fund (UNFPA) in Kampala
[He has since become Kinkizi East MP - Ed], most of Uganda’s
children die of preventable diseases such as malaria, diarrhoea
as well as HIV/AIDS-related illnesses.
The government’s Poverty Eradication Action Plan
(PEAP) document says the level of education and sensitisation
is important. Studies show that mothers who are educated
or have specific information about the causes of illness
prevent and manage diseases better.
Assistant Commissioner for Child Health, Dr. Charles Mugero,
also blames child deaths on “underlying environmental
factors” such as poverty, hygiene and sanitation conditions,
as well as limited safe water supply at household level.
Dr. Jotham Musinguzi, director of the Population Secretariat,
says that to save children, emphasis must also be put on
maternal health because most infants die soon after delivery.
“Things to do with delivery and safe motherhood become
very important for the protection of infants,” he
said. MDG5 aims to improve maternal health.
“The other cause is immunisable diseases on which
the Ministry of Health has done very well, with coverage
of over 84% from less than 50% barely eight years ago,”
While the death of children from preventable diseases is
a huge indictment on the country, it is also an opportunity:
these children can be saved.
Malaria alone, which could easily have claimed Nakalyango’s
baby, is said to kill around 70,000 children every year.
“The real problem that we have now is malaria and
we need to tackle it,” says Musinguzi. “And
the easy way to tackle it is universal use of insecticide-treated
nets. Most of the time, the mosquitoes bite the people at
night when they are sleeping. I sleep under a bed net and
I have not had malaria for the last seven years.”
Musinguzi argues that for nets to be effective, they should
not just be for children and women but all Ugandans.
But as Dr. Baryomunsi noted, such interventions can be
frustrated by local attitudes. There are longstanding fears,
for instance, that immunisation is dangerous to children.
One time, a radio station actively campaigned against the
programme. Similarly, many people claim that insecticide-treated
nets must be harmful to people.
“If a mosquito can land on the net and it dies, why
do you think a person can sleep under it for the whole night,
inhaling that substance, and they are not affected?”
asked a middle-aged university graduate in Kampala.
Poverty too is a hindrance. Mid last year, The Daily Monitor
reported that poor brides in Tororo were making bridal dresses
out of mosquito nets provided free by an NGO. In a district
where only 10 percent of households use mosquito nets, the
case demonstrates just how difficult it is to wage an effective
campaign against malaria.
Another intervention being considered is the use of DDT
residual spray against mosquitoes. Although highly regarded,
DDT is opposed by environmentalists and, lately, exporters.
These insist that it would be harmful both to human beings
and to business with the European Union which imports our
fish and flowers.
“Of course we should also study the possible use
of DDT while we protect our exports,” says Dr. Musinguzi.
“DDT is very effective but we need to make sure we
use it for public health and it does not get into agriculture.”
According to Dr. Mugero, the government is addressing child
mortality through four key initiatives: Nutrition, Integrated
Management of Childhood Illnesses (IMCI), Control of Diarrhoeal
Diseases and School Health.
IMCI, developed by WHO, USAID and UNICEF, involves comprehensive
diagnosis and treatment of sick children, including advice
on nutrition. One strategy against malaria, the leading
killer, is home-based management and treatment of the disease.
Selected people in villages distribute malaria drugs (Homapak)
for use within 24 hours of recognising malaria symptoms.
But as Baryomunsi and Musinguzi noted, for these measures
to make an observable impact, they must be made available
in each village. For instance, Nakalyango had never heard
of Homapak and her first response was the hospital, which
came after 36 hours of fearing that her child was sick.
Assistant Commissioner Mugero also raises another challenge
for the Homapak, containing sulfadoxine-pyrimethamine (Fansidar)
and Chloroquine. With the drug policy adopting Artemisinin
as the first-line of treatment for malaria, the Homapak
now needs to be repackaged. Not only does Artemisinin cost
over 10 times more than Fansidar and Chloroquine, its supply
is still limited.
According to the PEAP document, Uganda could learn from
countries like Cuba, China and Sri Lanka that were able
to improve child health without large budgets.
“The lessons suggested by these countries include
the enormous importance of getting simple health messages
out to the population, and the importance of community-level
management using very cheap personnel sometimes known as
barefoot doctors,” the document says.
Uganda’s children also feed very poorly and suffer
an acute lack of vitamin A. Despite the fertile soils and
the fact that we grow lots of food, Baryomunsi says, malnutrition
is behind 60 percent of the causes of child-deaths.
The Uganda NGO Forum suggests in its May 2005 report on
MDGs that the government should prioritise this indicator
and provide children with vitamin A-fortified foods.
An underlying cause of the poor child health was, ironically,
the introduction of decentralisation in the mid 1990s. Some
districts lacked capacity to undertake programmes like immunisation.
According to Dr. Chris Baryomunsi, many local governments
seem to be more concerned with politicking than development
“Government must initiate and lead a campaign to ensure
that local leaders focus on issues like child health and
maternal health, which impact directly on the lives of the
people,” he said.
Perhaps recognising that gap, Mugero, the assistant commissioner
for child heath, highlights the need to “strengthen
district and community participation in child survival interventions.”
As a relieved Nakalyango left hospital with her baby,
she couldn’t have agreed more: “Government should
help us with mosquito nets. For me, I want the net but I
haven’t got the money.”
Only in The Weekly Observer Next
Thursday: How many more mothers must die before decisive
action is taken