Uganda has made some important strides in tackling malnutrition
By Joyce Moriku
Two days after World Health Day on April 7, I found myself driving through the lush hills of Tooro, past the region's crater lakes, its scenic forests and the rugged traces of a mountain on the horizon. The United Nations World Food Programme (WFP) in Uganda had invited me to Fort Portal along with an MP, who is a nutrition expert, a commissioner from the Office of the Prime Minister (OPM) and a professor in nutrition from Makerere University.
My role was to lead a panel debating the topic: Can Uganda reduce child stunting soon enough to meet global health targets aimed to slash stunting rates by 40% among children under five by 2025?
The challenge is enormous in Tooro, where stunting affects one in four children — Uganda's highest rate — according to the 2016 National Demographic and Health Survey (UDHS). Other leading regions include Bugisu (36%), Karamoja (35%), Bunyoro (35%) and West Nile (34%).
That means that more than a third of young children in these areas did not eat enough of the right nutritious foods at a critical time in their lives - their first two years. As a result, they are short for their age and may have had their cognitive capacity irreversibly impaired. Stunted children are more likely in later life to be sickly, perform poorly at school, be less productive at work and die early.
Uganda has made some important strides in tackling malnutrition — and the Government is now formulating new ways to build on these achievements. Between 2011 and 2016, stunting dropped 10% in Karamoja, while the national rate fell from 31 to 29%. The DHS also showed how Uganda made major gains in reducing child wasting — or low weight for a given height — in line with the global targets.
But with some parts of the country falling behind on stunting, strikingly including the capital Kampala, Uganda cannot yet celebrate. We continue to pay a heavy price for frequent infections, repeated classes and a less productive workforce.
The Cost of Hunger in Africa: Uganda 2013 study, co-sponsored by the African Union, the Uganda government and WFP, found that Uganda loses about 5.6% of its Gross Domestic Product annually due to the economic impact of stunted growth, which is often an inter-generational problem.
Since its first National Development Plan, Uganda has taken time to identify its aspirations, all of them fundamentally rooted in the quality of its human capital. But with worrying rates of stunting, none of these goals can be realised. Indeed, the World Health Organisation has identified stunting as one of the most significant impediments to human development globally.
Rapid urbanisation is a key underlying cause of stunting in Uganda. People arriving in Kampala in search of work, for example, often find themselves squeezed in squalid settlements, where basic social services are limited and sanitation is poor. Their children are prone to ill health as a result. Moreover, many of these same households cannot afford regular healthy diets, which should include some animal protein.
The country's high fertility rate of more than 5% is another challenge. It leads to poor child-spacing, which dangerously limits opportunities for exclusive and continued breastfeeding.
Broken homes, teenage pregnancies and domestic violence are other catalysts for poor child growth. Tellingly, the DHS found that the Tooro, Bugisu and Bunyoro regions that ranked among the country's highest for stunting, also have some of the highest rates of adolescent pregnancy countrywide.
One major force that will drive Uganda's battle against stunting is high-level political will, coupled with leadership at all levels and effective policies on reproductive health. Uganda will also greatly benefit from strengthened community health systems and teaching households how to manage food, including making smart, nutritious, but affordable diet choices. The same kind of high-level political engagement significantly contributed to dramatic declines in stunting in both Brazil and Peru in recent decades.
In Uganda, nutrition ranks second among the six priorities of the government's preventive health promotion strategy, after immunisation. (The others are sanitation and hygiene, prevention of malaria and addressing non-communicable and lifestyle diseases). To realise significant outcomes, including on stunting, the Ministry of Health is implementing an integrated and coordinated approach to service delivery.
In addition, the Ministry of Health, together with the Ministry of Public Service, is reviewing local government human resource structures to better reflect the population's nutrition needs. Through this review, and as we encourage more students to pursue nutrition sciences, we will potentially have more nutritionists playing an active role at the district and sub-county levels — if they accept to work in rural regions.
Uganda has a nutrition champion in the Prime Minister, Dr. Ruhakana Rugunda, whose office coordinates the implementation of the Government's multi-sectoral plan against stunting, including through District Nutrition Coordination Committees. Effective co-ordination of local and international actors and sectors is another means by which Uganda will significantly reduce stunting. Moreover, OPM is overseeing the formulation of what will be Uganda's first nutrition policy.
These are just some of the many ways Uganda can effectively fight stunting. But we must harness these opportunities with extreme urgency. As it is now, too many lives have been left behind.
The writer is the Minister of State for Health (Primary Health Care), a Member of Parliament, a paediatrician and an academic