Mortality: It is time to talk numbers

It’s election time, that crazy season where finding the truth within all the campaign speeches can be challenging. Among the key issues is health care. The United Nations Development Program’s report on Uganda’s progress in meeting the Millennium Development Goals (MDGs) notes important successes, but listening to campaign rhetoric, it becomes hard to tell.

So what is the real state of Uganda’s health sector?

For many, the statistics on maternal and child mortality is an indication as to whether a country’s health sector is in fact healthy. Poor numbers often do indicate problems within the sector, but they can also mean better reporting or other issues, such as during the 1980’s when there were upticks due to HIV/AIDS.

In the last decade, Uganda has achieved great results, as indicated by both national authorities (Uganda Demographic and Health Statistics) and international organisations (World Health Organisation).

Child and infant mortality trends show remarkable improvement in all components of early childhood mortality rates. Infant mortality rates for children aged less than 1 year old have been cut in half, declining from 88 deaths per 1,000 live births in 2001 to 45 in 2014.  (Figure 1)

The trend for under-5 mortality rates is even more impressive with a drop of more than two-thirds. These mortality rates went from 152 deaths per 1,000 live births in 2001 to 45 in 2014. (Figure 2)

The change in neonatal mortality rate is positive, though not as pronounced as the others. It declined from 33 deaths per 1,000 live births in 2001, to 23 in 2014. (Figure 3)

Another important indicator of the quality of healthcare is the maternal mortality rate, or how many mothers die giving birth. The trend is clear: for every 100,000 births, the number of mothers dying has gone from 524 in 2001, to 360 in 2014 (data from WHO – Figure 4).

The risk of a mother dying in the health facility while giving birth fell from 194 per 100,000 in 2010 to 118 per 100,000 in 2015, a 40% reduction in just five years. This statistic is particularly important as it shows an overall improvement of health facilities and training of medical staff.

In addition to child and maternal mortality rates decreasing, there was also a significant reduction in maternal deaths due to complications of unsafe abortions, going from 13% in 2013/14 to just 3% in 2014/15.

All of these indicators have had steady downward movement. In fact, only the maternal mortality rate had a slight uptick in 2011, though WHO notes this may be due to the confidence level of reporting between 2011 and the previous survey.

In 2014, Uganda registered the best historical performance on children immunisation, pregnant women attending health facilities, assisted births, decline in children malnutrition and anaemia, and highest patient satisfaction with health services.

Of course, the death of any child or mother is a tragedy, and thus work still must be done to bring these numbers down even further and to continually improve, especially considering the mounting demographic pressure on facilities and health workers. But one thing is clear: Uganda’s health system has made great strides.

 

mortality rates infant
Figure 1: Infant mortality rate (deaths per 1,000 live births)
martality-rates-under5
Figure 2: Under-5 mortality rate (deaths per 1,000 births)

 

martality-rates-neonatal
Figure 3: Neonatal mortality rate (deaths per 1,000 live births)

 

martality-rates-maternal
Figure 4: Maternal mortality rate (deaths per 100,000 births)