To understand the impact of these three diseases on Uganda's population and the impact on healthcare and so life expectancy and well-being, I have been brushing up on my knowledge.
HIV/AIDS
Uganda accounts for 5 percent of the global HIV burden. The country has a generalized epidemic with 1.5 million people living with HIV and an estimated prevalence rate of 7.3%.7 The country has made great headway in the control and treatment of HIV/AIDS by:
- reduction in new infections from 140,000 in 2010 to less than 100,000 at the end of 2014;
- sustained decline in HIV/AIDS mortality from 50,000 in 2010 to 33,000 in 2014;
- increase in the proportion of adults and children receiving antiretroviral therapy from 21% in 2010 (260,866) to 50% in 2014 (749,308);
- decline in the proportion of infants born to HIV infected mothers who become HIV infected from 10.6% in 2012 to 7.1% in 2014; and
- retention of people on antiretroviral therapy after 12 month of initiation on treatment has increased from 70% in 2011 to 85% at the end of 2014.
Uganda has adopted a programme that promotes abstinence from sexual relationships outside of marriage as the primary plank of its HIV/AIDS awareness education. This approach has been very successful in Uganda, unlike in many other African countries.
The role of faith communities, and in particular the Catholic Church (approximately 85% of the Ugandan population are Catholics), has been key to the success of the promotion of abstainence. Even in the short time I have been in Uganda, I have heard the Catholic Church's teaching on the sancity of marriage promoted by priests during their homilies.
Uganda accounts for 1% of tuberculosis (TB) global burden and ranks twentieth among the 22 high burden countries. The World Health Organization estimates indicate that Uganda has experienced a decline in TB incidence, prevalence and mortality and is one of the 7 amongst the 22 high burden countries that attained Millennium Development Goal 6.9 However, it is also widely acknowledged that the uncertainty around the estimates, a weak surveillance system coupled with lack of vital registration, limit the country’s ability to make firm conclusions regarding observed trends.
In the West Nile, TB testing is poor and sprodic. From discussions I have had with the Clinical Directos of a number of health clinics I have visited, it is clear that TB is a significant health probelm in this region.
Ugandans are the fifth largest population at risk of malaria in the world and the country accounts for 4% of the global burden. The country is ranked third out of the 18 countries that account for 90% of P. falciparum infections in Sub-Saharan Africa.
However, Uganda has made significant progress in reducing malaria burden as prevalence in under 5 children decreasing from 42% in 2009 to 19% in 2014/15; and an increase in homes with at least one bed net from 47% in 2009 to 90% in 2014/15. Bed net usage among children under 5 increased from 33% in 2009 to 74% in 2014/15. However, malaria remains a major public health problem accounting for 30% to 50% of the outpatient cases, 15% to 20% of admissions and 9% to14% of in-patient deaths in Uganda.
Again, I am conscious that in the few weeks I have been at Caritas, several of the staff have had to take sick leave because the malarial infection that they have contracted has become acute. This is something that is mirrored across Uganda and so must have a significant impact on the country's economy, as well as the individual and health care services.
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