• Authored By: Phionah Namuliira and Hildah Namuleme
02 May 2024

In Uganda, infant mortality continues to be a concern, with deaths of babies still placing a heavy burden on families and communities. While progress has been made in recent years, there is still much work to be done to address the underlying socioeconomic factors contributing to this problem.

According to the 2022 Uganda Bureau of Statistics (UBOS) findings, the number of infant deaths stands at 43 for every 1,000 live births. This is lower than 54 for every 1,000 live births previously reported in 2015/16 but the figure is still high when compared to countries such as Kenya, Tanzania, and Rwanda with 30, 33, and 22 deaths for every 1,000 live births respectively.

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. This therefore highlights the urgent need for targeted interventions to further improve maternal and child health outcomes.

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 FY 2022/23 for example, health was provisionally allocated only UGX 4,179.3 billion down from the UGX 4739.1 billion that had been approved for FY 2022/23.

In tandem, the allocation of funds remains insufficient to meet the growing demands of a burgeoning population. This is because, without adequate financial resources, it becomes exceedingly difficult to expand access to essential healthcare services, such as maternal and child health programs, which are vital in reducing infant mortality rates.

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. According to the Uganda Medical and Dental Practitioners Council, the doctor-patient ratio stands at approximately 1:25,000, well below the recommended standard.

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. Addressing these issues requires strategic investments in medical education and training programs to bolster the country’s healthcare workforce and enhance the delivery of quality care to underserved communities.

Furthermore, HIV/AIDS prevalence and exposure among mothers are also associated with higher infant mortality rates, especially in the first four months of life.

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. (2023) revealed that HIV infection and low CD4 counts impact maternal and neonatal mortality independently, even in the presence of other effective interventions.

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. Photo/UNICEF

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. (2024) emphasize that there is a need to strengthen care for HIV-positive pregnant women and their newborns in health centres in Uganda as well as develop additional approaches that can sustainably improve antiretroviral therapy enrolment and adherence among this group, even at facilities already equipped with maternal and newborn health services.

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. According to the United Nations Women report on Violence Against Women  A report by the United Nations Population Fund (UNFPA,2021) showed that GBV is still increasing gradually with GBV cases reported to have increased from 79,888 in 2018 to 82,401 in 2019 (3.1 percent increase) and then by 9.8 percent from 82,401 in 2019 to 90,489 in 2020.

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. By addressing the root causes of GBV and promoting gender equality, we can create a conducive environment for maternal and child health and contribute to the reduction of infant mortality rates.

Therefore, addressing the socioeconomic factors driving persistent infant mortality rates in Uganda requires a multifaceted approach. This includes aggressively improving access to healthcare services especially in rural areas through the construction of additional health facilities and/or the deployment of mobile clinics to reach remote communities among other things as discussed above.

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. By addressing the socioeconomic factors that contribute to this problem, we can make significant strides towards ensuring that every child can survive and thrive.

References

Edelson, P. K., Cao, D., James, K. E., Ngonzi, J., Roberts, D. J., Bebell, L. M., & Boatin, A. A. (2023). Maternal anemia is associated with adverse maternal and neonatal outcomes in Mbarara, Uganda. The Journal of Maternal-Fetal & Neonatal Medicine, 36(1), 2190834.

Nabatanzi, M., Harris, J. R., Namukanja, P., Kabwama, S. N., Nabatanzi, S., Nabunya, P., … & Komakech, P. (2024). Improving maternal and neonatal outcomes among pregnant women who are HIV-positive or HIV-negative through the Saving Mothers Giving Life initiative in Uganda: An analysis of population-based mortality surveillance data. PLOS Global Public Health, 4(2), e0002801.

 

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