Photo by Laura Elizabeth Pohl/Bread for the World. Uganda, 2011
Seattle, WA – Uganda is succeeding on several fronts in child health and development, according to a new study by researchers from the Infectious Diseases Research Collaboration (IDRC) and the Institute for Health Metrics and Evaluation (IHME). Nonetheless, large disparities between the health trends found in Kampala, Uganda’s urban epicenter and capital, and other areas of the country have endured over time.
Published today in BMC Medicine, “Benchmarking health system performance across regions in Uganda: systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 1990-2011,” provides the first-ever comprehensive assessment of Uganda’s gains and gaps in addressing regional health needs. This work was conducted as part of the Malaria Control Policy Assessment (MCPA) project.
Since the early 2000s, Uganda has rapidly scaled up a number of health interventions. As an early adopter of the pentavalent vaccine in 2002, Uganda brought coverage up to levels comparable to vaccines that had been on the immunization schedule for decades. In more recent years, coverage of key malaria interventions, such as ownership of insecticide-treated nets (ITNs) and artemisinin-based combination therapies (ACTs), increased dramatically.
However, amid these gains, several worrisome trends emerged. For many regions, declines in child mortality slowed after 2007, and the proportion of women who had at least four antenatal care visits (ANC4) before giving birth steadily fell. Absolute levels of immunization coverage for the measles and oral polio vaccines generally remained lower than optimal through 2011.
“Uganda’s overall child health landscape has notably changed since 1990, and for the most part, these changes reflect a successful expansion of health services throughout the country,” said Dr. Emmanuela Gakidou, IHME’s Senior Director of Organizational Development and Training and the study’s senior author. “But massive inequalities persist, particularly for the Karamoja region, and far less progress has occurred for maternal health. Regular subnational benchmarking – and at even more local levels – could help inform more targeted efforts to further accelerate Uganda’s health gains.”
Additional findings include the following:
- Under-5 mortality significantly declined in every region from 1990 to 2011. While regional disparities in childhood survival somewhat narrowed over time, a large gap remained between Kampala and the rest of the country. Reductions in under-5 mortality slowed in Karamoja after 2007, flagging a potential need for more targeted policy and program attention.
- Coverage of nearly all malaria interventions quickly increased throughout Uganda, with most of the gains occurring after 2007. The uptake of ACTs, Uganda’s first-line drug against malaria since 2006, was particularly fast – an important success story given the country’s historically high burden of malaria. At the same time, coverage of preventive measures for pregnant women, known as intermittent preventive treatment during pregnancy (IPTp), remained steadfastly low across regions.
- Trends in immunization coverage generally pointed to progress and increased receipt of four key childhood vaccines: BCG, measles, polio, and the pentavalent vaccines. Although rates of polio immunization generally stagnated over time, Uganda rapidly increased coverage of the pentavalent vaccine across regions. The Gavi Full Country Evaluations (FCE) project at IHME has sought to update these estimates as well as track coverage rates of newly introduced vaccines, such as pneumococcal conjugate vaccine (PCV) against pneumonia.
- Coverage of maternal health interventions was much more variable across regions: for instance, rates of skilled birth attendance ranged from 27% to 95% in 2011. Nationally, ANC4 coverage negligibly changed between 1990 and 2011, but regional trends revealed a much more heterogeneous picture. Some regions, especially those located along Uganda’s western border, saw improving rates of ANC4, whereas others experienced steady declines over time.
To learn more about these results or other projects at IHME, please contact [email protected].