health in uganda health in uganda health in uganda refers to the health of the population of uganda. the average life expectancy at birth of uganda has increased from 59.9 years in 2013 to 63.4 years in 2019. this is lower than in any other country in the east african community except burundi. as of 2017, females had a life expectancy higher than their male counterparts of 69.2 versus 62.3. it is projected that by 2100, males in uganda will have an expectancy of 74.5 and females 83.3. uganda's population has steadily increased from 36.56 million in 2016 to an estimate of 42.46 in 2021. the fertility rate of ugandan women slightly increased from an average of 6.89 babies per woman in the 1950s to about 7.12 in the 1970s before declining to an estimate 5.32 babies in 2019. this figure is higher than most world regions including south east asia, middle east and north africa, europe and central asia and america. the under-5-mortality-rate for uganda has decreased from 191 deaths per 1000 live births in 1970 to 45.8 deaths per 1000 live births in 2019. ugandan patients at the out-patient department of apac hospital in northern uganda. the majority are mothers of children under five years old with malaria. development of life expectancy in uganda the human rights measurement initiative finds that uganda is fulfilling 80.0% of what it should be fulfilling for the right to health based on its level of income. total health expenditure as a percentage of gross domestic product (gdp) was 7.2 percent in 2014. in 2018, an estimated 1.4 million people in uganda were infected with hiv, and the hiv prevalence rate in the country was 5.7 percent. as of 2019, this number had increased to an estimate of 1.5 million people living with hiv. uganda has made substantial progress in control of the epidemic as 1.3 of the confirmed hiv infected population was aware of their serostatus and 1.2 million were already on treatment. physical activity uganda was the most physically active nation in the world in 2018 according to the world health organization. only 5.5% of ugandans do not achieve 150 minutes of moderate-to-intense or 75 minutes of rigorous activity per week. most work is still very physical, and commuting by vehicle is beyond the reach of most of the population. kampala, however, is not friendly towards walking or cycling, and the air is very polluted. the kampala capital city authority established the country's first cycle lane—500 metres in kololo—in 2018. common illnesses and treatments patients in uganda as of 2016, the five leading causes of death in uganda included communicable diseases such as hiv/aids, tuberculosis, malaria, respiratory tract infections, and diarrheal diseases. the risk factors most responsible for death and disability include child and maternal malnutrition, unprotected sexual activity, multiple sex partners, contaminated water, poor sanitation, and air pollution. hiv treatment in uganda has centered on human antiretroviral therapy through cross-training and increasing the scope of health workers who can administer treatment (e.g., community health workers and nurses). this shift in treatment occurred through the who's 2004 "integrated management of adult and adolescent illness" guide. studies of hiv-infected adults in uganda showed risky sexual behavior to have declined, contributing to the decline in hiv incidence. from 1990 to 2004, hiv rates declined by 70 percent and casual sex declined by 60 percent. health communication was also listed as a potential cause of inducing behavioral changes in the ugandan population. according to a 2015 study, impediments to reducing hiv incidence include food insecurity in rural areas and stigma against hiv counseling and testing. uganda has the highest incidence rate of malaria in the world, with 478 people out of 1000 population being afflicted per year. according to who data published in may 2014, malaria accounted for 19,869 deaths in uganda (6.19% of total deaths). in 2002, the ugandan government formalized the process of treating fevers through home-based care. mothers who were able to better recognize symptoms of malaria took their children to a community medicine facility early in the illness. the integrated management of childhood illness allowed for better recognition of malaria's symptoms. treatment either involved immediately taking the child to see a nearby healthcare worker or acquiring the treatment of chloroquine and sp, also known as homapak, though kits have been found to be expired in some instances. however, resistance to homapak emerged, and drug recommendations by the who changed to artemisinin combination therapy (act). after the midterm review in 2014 of the national plan for malaria reduction and the malaria programme review in 2010, the national strategy to reduce malaria is being redesigned. currently, uganda is treating malaria through distribution of insecticide-treated nets, indoor spraying of insecticides, and preventative therapy for pregnant women. the disease burden of malaria, however, remains high and is further strengthened by inadequate resources, understanding of malaria, and increased resistance to drugs. reproductive health further information: maternal health in uganda reproductive health (rh) is a state of complete physical, mental, and social well-being in all matters relating to the reproductive system and to its functions and processes. it implies that people have the capability to reproduce and the freedom to decide if, when, and how often to do so. implicit in this is the right of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility, which are not against the law, and the right of access to health care services that will enable women to go safely through pregnancy and childbirth. rh care also includes sexual health, the purpose of which is the enhancement of life and personal relations. the world health organization (who) defines maternal health as the health of women during pregnancy, childbirth, and the postpartum period. according to unicef, uganda's maternal mortality ratio, the annual number of deaths of women from pregnancy-related causes per 100,000 live births, was 440 from 2008 to 2012. the millennium development goal (mdg) for 2015 concerning the maternal mortality ratio was 131 per 100,000 births. the mdg also set a goal for all births to be attended by a skilled health professional, in rural areas, conceiving pregnant women seek the help of traditional birth attendants (tbas) because of the difficulty in accessing formal health services and high transportation or treatment costs. tbas are trusted as they embody the cultural and social life of the community. the tbas' lack of knowledge and training and the use of traditional practices, however, have led to risky medical procedures resulting in high maternal mortality rates. those rates also persist because of an overall low use of contraceptives, the limited capacity of health facilities to manage abortion/miscarriage complications, and the prevalence of hiv/aids among pregnant women. despite malaria being one of the leading causes of morbidity in pregnant women, prevention and prophylaxis services are not well established according to a 2013 published report. only 47 percent of ugandan women receive the recommended four antenatal care visits, and only 42 percent of births are attended by skilled health personnel. among the poorest 20 percent of the population, the share of births attended by skilled health personnel was 29 percent in 2005/2006 compared to 77 percent among the wealthiest 20 percent of the population. the human rights measurement initiative has given uganda a score of 47.9% for contraceptive use. malnutrition malnutrition is a major development concern in uganda, affecting all regions of the country and most segments of the population. the current levels of malnutrition hinder uganda's human, social, and economic development. although the country has made tremendous progress in economic growth and poverty reduction over the past 20 years, its progress in reducing malnutrition remains very slow. the ultimate objective of the uganda nutrition action plan (unap) is to ensure that all ugandans are properly nourished so they can live healthy and productive lives. however, it is at the start of life in particular that we must work together to ensure that all ugandans are properly nourished. according to the three most recent uganda demographic health surveys (udhs), nutrition indicators for young children and their mothers have not improved much over the past 15 years, with some indicators showing a worsening trend. for example, in 1995, 45 percent of children under five years old in uganda were short for their age (stunted); 10 years later, the prevalence of stunted under-fives had fallen to only 39 percent (udhs, 2006). stunting indicates chronic malnutrition in children; the stunting prevalence rate of 39 percent means that about 2.3 million young children in uganda today are chronically malnourished. unicef the human rights measurement initiative gives uganda a score of 79.5% for stunted children. consider the nutrition profile of uganda for children under five years of age as per usaid populationpop. under 5 % stunting % underweight 41.5 million7.7 million2911 this has a huge burden on the country through lost income that directly affects the gdp where as much as 5.6% or us$899 million is lost annually. wfp despite the worrying numbers, latest research shows that the numbers of children under five suffering from malnutrition are declining. gender based violence domestic violence (dv) is a key issue in reproductive health and rights. most of the dv is gender-based. physical violence is the most prevalent type of dv in uganda, with one quarter of women reporting it. more than 60 percent of women who have ever been married have reported experiencing emotional, physical, or sexual violence from a spouse. in 2011, about two percent of women reported to have undergone female genital mutilation, a practice that is dying away in the areas where it was more frequently practiced. substance and drug use substance and drug abuse is a public health very big concern in uganda affecting both the child and adolescent populations. a drug commonly used among the youth is cocaine. as of 2019, substance use disorders account for 0.34% of total disability-adjusted-life-years (dalys) and 0.13% deaths in uganda. alcohol use disorders account for 0.2% of dalys and 0.11% of total deaths. this is relatively low compared to countries in north africa, europe, north america and central asia regions. this may be a result of under reporting of these cases or failure to diagnose these disorders in uganda. alcohol consumption in uganda was reported high in the world at 26.0 l of alcohol per capita per year in 2016. in march 2013, a cnn study ranked uganda 8th in the world in liquor intake and first on the african continent. a recent study in uganda showed an unexpected discovery of alcohol abuse and dependence among 5-8-year-old children. this was found during clinical interviews in a 2020 published article with a common phrase among the children, "i feel good when i drink." in this study, 7.4% children scored positive for alcohol abuse and dependence. 10 out of 148 children had high strengths and difficulties questionnaire (sdq) scores (≥ 14). these 10 children that had high sdq scores had mental health comorbidities which included suicide attempts (30%) and separation anxiety disorders (50%). only one child had a lower sdq score (below 14) had no comorbidities despite a positive drinking experience. most children reported access to homemade brew, caretaker's knowledge on drinking and difficult household situations that prompted them to take alcohol. in 2016, uganda registered the highest number of deaths from alcohol-related liver disease with a total of 118 deaths per 100,000 from liver disease secondary to excessive alcohol consumption. the legal regulations on alcohol in uganda had not been updated since 1960 as of 2016 with a legal age of alcohol consumption being 18 years while alcohol sales to minors' penalty is a fine not exceeding ush 500/=($0.14) and children are allowed to buy alcohol on behalf of the adults. the liquor act, cap-93 still imposes fines of 205/= ($0.058) for underage alcohol consumption. a key issue on alcohol consumption in uganda is that the alcohol industry has targeted young people through an increase in packaging of 30 ml alcohol tots/ packs that are readily accessible to any ugandan youth at only 200/= ($0.057) with ongoing massive alcohol campaigns close to schools, kindergartens, media platforms, and along ugandan roads. the uganda national bureau