What went wrong on health?

By Flavia Nassaka

Two months to MDGs deadline, Uganda trails world on indicators

On a daily basis, over 18000 children die according to the United Nations Children’s Agency. Some of the children die at delivery whereas others die before attaining the age of five. Similarly, the World Health Organisation estimates indicate that 800 mothers die daily. In many cases, HIV/AIDS or malaria is to blame.

Recognising that birth-related deaths, including death of children and mothers at and after delivery and deaths of children below five years of age as a result of predicaments like malaria and HIV among others, is a major setback to development, world leaders at the UN millennium summit in September 2000 unanimously agreed to set goals and targets that would guide them in achieving a healthy population. They were tagged Millennium Development Goals (MDGs) 4, 5 and 6 for reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria plus other diseases respectively.

Child mortality

MDG members at the largest gathering of world leaders set a goal to reduce by two thirds, between 1990 and 2015, the under- five mortality rate which came to be tagged MDG 4.

The under-five mortality rate is the probability per 1,000 that a newborn baby will die before reaching age five.

The MDG Advocates’ leaders report released on Sept 25 indicates that globally during the past two decades, the likelihood of a child dying before the age of five has been nearly cut in half, which means about 17,000 children have been saved every day.

For Uganda, though the 2013 Uganda MDG progress report indicated that the country was on track to hit the 2015 target which is less than three months ahead, stakeholders have come to doubt it because the challenge is still far spread especially in upcountry districts.

Dr. Sabiiti Nsungwa, a Child Health expert at the ministry of health says each year in Uganda 141, 000 children die before reaching their fifth birthday, 26% of these die in their first month of life.

MDG 4 requires an average reduction in the rate of under-five deaths of 5% each year. But in 11 years between 1995 and 2006, the under-five mortality rate in Uganda fell from 156 per 1,000 live births to 137 per live births, translating into an average annual reduction of only 1.2%. Considerable reduction was only seen between 2006 and 2011 when child mortality rate fell from 137 to 90 deaths per 1,000 live births, an average annual reduction of 8.1%.

Meanwile, the infant mortality rate which was previously at 76 deaths per 1000 live births had by 2011 reduced to 54 deaths per 1000 live births.

But for the last three years, Sabiiti says, the extent of reduction has not been remarkable.

He says Uganda would have hit the 2015 target if they had sustained the 2011 rapid rate of progress in tackling both child and infant mortality.

Sabiiti says for Uganda to hit the target, it needs to put in place sustainable yet cost effective measures like increasing access to information and immunisation to avoid preventable health risks.

Medics have cited malaria and respiratory diseases as the leading cause for childhood death.  However little efforts have been directed towards respiratory infections and Dr. Rebecca Nantanda, a pediatrician at the Mulago National Referral Hospital, cites asthma and pneumonia to be the leading cause of death at the children’s clinic.

“Asthma in children is often under diagnosed and pneumonia facilities are not readily available especially in rural Uganda. Of the 200 children admitted with asthma syndrome, 95% have not been diagnosed with the disease before,” she says.

Doctors say emphasis on simple but practical remedies, like ensuring that mothers breastfeed babies for minimum six months as recommended, could save lives. On average currently, the longest a baby is exclusively breastfed is about four months. For such and other reasons, experts have noted that policies to protect newborn babies need to be closely linked to better maternal health.

Maternal mortality

In Uganda, statistics show at least 16 women die every day from pregnancy and child birth related complications which at the end of every year registers a gigantic 342,900 deaths.

Maternal mortality rate stands at 438 deaths per 100,000 live births. A third of these deaths are caused by abortion.

Karamoja region has the highest maternal death rates, according to Dr. Collin Tusingwire, the commissioner Maternal Health at the Ministry of Health.

He says there are only a few trained mid-wives with the ratio currently being estimated at 1:5000. In addition, some women have failed to embrace family planning techniques because of associated negative myths.

Tusingwire says contraceptives use has remained stagnant at 30% despite the government efforts to increase access. He says 22% of all women die because of obstructed labour, 36% die of malaria, whereas 42% died due to over-bleeding.

Dr Kenneth Omona Olusegun (MP Kaberamaido County), the chairperson of the Parliamentary Committee on Health says 67% of mothers still do not receive any postnatal check-up yet over 60% of maternal deaths in developing countries are estimated to occur 23 to 48 hours after delivery. This is mainly due to excessive bleeding and hypertensive disorders.

The statistics show that Uganda is not on track to achieve MDG 5, which set out to ensure that maternal health is improved by reducing maternal mortality by three quarters and achieving universal access to reproductive health by 2015.

Though Uganda adopted to achieve all the targets, experts say it’s a tough call especially given that the country still has poorly facilitated health systems of hospitals lacking adequate supplies and operated by poorly facilitated health workers.

Curbing Disease

On the HIV/AIDS reduction front, Dr. Vinand Nantulya, the chairman of the Uganda AIDS Commission is optimistic about MDG 6.

He says Uganda has made commendable work in rolling out anti-retroviral (ARV) drugs and patients on treatment were 577,000 by end of 2013. In that year alone, 193,000 patients were initiated on treatment.

When reacting to the UNAIDS global report on the status of the epidemic which was comparing the number of new infections in 2005 to that in 2013 and indicated that in 2013 new infections in Uganda were much higher than 2005, Dr. Nantulya, said that the commission was already aware of that and are implementing strategies that they set out in the HIV strategic plan (2011-2015). He said, it has begun yielding positive results.

The number of new infections reported for 2013 dropped to 137,000 compared to 170,000 recorded in 2011 (19.4% drop); the number of new babies born with HIV dropped to less than 8,000 in 2013 compared to 26,000 in 2011(69% drop).

However, the report says Uganda has suffered a reversal in the effort to halt the spread of HIV/Aids.

On this basis, the overall assessment in the report is that while Uganda may earlier on have been well under way to reverse or halt the spread of HIV, today the situation is deteriorating. On malaria, the report says Uganda has slowed down in its effort to combat the disease and could risk failing to meet the target of reversing malaria and other diseases by 2015.

Globally according to the MDG leaders’ report 2014, maternal mortality ratio dropped by 45 per cent whereas access to antiretroviral therapy for HIV-infected people has saved 6.6 million lives. An estimated 3.3 million deaths from malaria were averted due to a major expansion of simple preventions, such as bed nets, and treatments. Efforts to fight tuberculosis have saved an estimated 22 million lives.

Since July 2012 consultations have been taking place globally to define the new international development framework that will replace the MDG agenda after 2015. This process was initiated by the Secretary General of the United Nations, Ban Ki-moon, to shape the Post 2015 global development agenda. What’s the way forward for Uganda?

Health Commissioner Tusingwire says that though they are now certain that Uganda will not achieve most of the targets by 2015 but lessons have been learned over what works, what does not work and what needs to be done differently to achieve better development results. Uganda has now turned focus to vision 2040.

Goal 7: Ensure environmental sustainability