Becky Crowder
Nutrition in Uganda
From: Secretary of Health, Uganda
To: Minister of Finance, Uganda
Introduction:
Despite past efforts to improve nutrition in Uganda, undernutrition is still a severe
problem, which principally affects women and children. This problem results in underweight,
stunting, and micronutrient deficiencies. Among children under five, 38% are stunted; 16% are
underweight; and 6% are wasted.i Children who are undernourished between conception and two
have a high risk for impaired cognitive development, hindering the productivity and economic
growth of Uganda in the future. Nutritional problems vary by region, with undernutrition much
more prevalent in rural areas, where 40% of children are stunted. ii Risk factors go beyond
income, to include maternal nutrition and education, poor infant feeding practices, access to
nutritional food, the high burden of disease, and micronutrient deficiencies, most importantly
Vitamin A, Iron, Iodine, and Zinc. Uganda has higher rates of stunting than countries with lower
per capita income, including Zimbabwe, Sierra Leone, Gambia, Togo, and Burkina Faso. iii
Proper nutrition will help Uganda build a strong and capable work force to help grow our
economy. To achieve this goal we must address three major issues: infant feeding practices, the
high burden of disease, and access to nutritious food, including the essential micronutrients.
Nature and Magnitude of the Problem:
Uganda has set an example for how to begin to address the problem of malnutrition;
however the problem persists as a main cause of child death. Despite significant strides toward
eradicating malnutrition through the Uganda National Action Plan for Children, as well as
through other community based nutrition programs, undernutrition in Uganda remains severe.iv
Today 38% of children under five are stunted; 16% are underweight; and 6% are wasted.v
Although the prevalence of stunting and underweight has decreased over the past two decades, it
has not been lowered enough to meet the first Millennium Development Goal, which works to
eradicate extreme poverty and hunger.
Micronutrient deficiencies are a major contributor to undernourishment. The most
important micronutrients for proper physical and mental development in children from
conception to 24 months are Vitamin A, Iron, Iodine, and Zinc. However 28% of preschool aged
children and 23% of pregnant women are deficient in Vitamin A.vi 64% of preschool aged
children and 41% of pregnant women lack proper levels of iron, a condition known as anemia.vii
Affected Populations:
Populations affected by malnutrition vary by region, with the lowest rates in urban areas,
and the highest in rural areas. 40% of children in rural areas are stunted, compared with 26% of
children in urban areas.viii With only 13% of our population in urban centers,ix the majority of
Uganda lives in highly afflicted regions. The prevalence of stunting in Kampala is 22%,
compared with 50% in the Southwest region.x Although the southwest is primarily where food is
produced, the diet in this area lacks sufficient variety. As a result, stunting is particularly relevant
in the Southwest region. The northern regions suffer from food price and climate shocks, which
disrupt access to food. Poor health conditions and the poor status of the health system in the
north caused poor nutritional levels in this region.5
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Risk Factors:
Although undernutrition is related to poverty, it is also related to the mother’s education
level, household size, poor infant feeding practices, access to a diverse diet, the high burden of
disease, and vitamin and mineral deficiencies. Mothers’ level of education is strongly inversely
associated with stunting; prevalence of stunting is much higher among children whose mothers
have primary to no education.xi Since education level reflects income level, we see that poverty
has a negative effect on a child’s nutrition level. However, undernutrition is not just a problem of
poverty; one fourth of children even in the wealthiest quartile are stunted.xii
Although infant feeding practices are improving, they are still a grave concern, with only
40% of infants under six months being breastfed and one-fifth of infants between the important
transition period of six to nine months not being fed appropriately with both breast milk and
other food.xiii Children should be exclusively breastfed until 6 months.
Undernourished children who fall ill are much more likely to die from that disease than
properly nourished children. The high burden of disease in Uganda exacerbates this problem.
Economic and Social Consequences:
Undernutrition in women and children has severe long and short-term consequences for
our country’s economy and social welfare. The first two years of life are the most formative and
telling of a child’s future life. Children who are undernourished between conception and 2 are
highly at risk for impaired cognitive development. Also, children who fall ill cannot attend
school or properly develop technical skills. Malnutrition directly affects the economy, increasing
the burden on our health system, but also indirectly, diminishing the future productivity of our
people.
Priority Action Steps:
To comprehensively respond to this problem we need to address poor infant feeding
practices, the high burden of disease, limited access to nutritious food, and micronutrient
deficiencies. Since the most irreversible damage due to malnutrition occurs when a child is
between the stages of gestation and 24 months,xiv it is most important that we target pregnant and
breastfeeding mothers, as the caregivers that develop nutrition during this time.
To ensure proper infant feeding practices, we must improve the outreach of education to
women and information on proper childcare and infant feeding procedures. Extending credit and
income-generating activities to women will also help raise their position in society and develop
educational opportunities.
To improve nutrition, we must also enhance our programs to stop infection and disease in
young children. Hand washing campaigns, deworming, and continued access to food
supplements during illness are important to stop this.
We must also insure that all women and children have proper levels of the important
micronutrients in their diet: Vitamin A, Iron, Iodine, and Zinc. Vitamin A supplementation for
children and mothers needs to be significantly extended. Presently Vitamin A supplementation
covers 64% of children 6 to 59 months old, but statistics vary widely by region.xv In 1994,
Uganda started a successful campaign for universal salt iodization. We should follow this model,
which considerably decreased the prevalence of iodine deficiency disorders. Anemia affects
almost ¾ of under fives and ½ of women of childbearing age.xvi To address micronutrient
deficiencies, we must increase the supplementation of pregnant women and provide multiple
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micronutrient supplements to infants and young children. We can increase the reach of iron and
iodine through commercial fortification efforts.
“The State of the World’s Children.” UNICEF. 2009.
http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf
i
“Nutrition Country Profile: The Republic of Uganda.” Food and Agriculture Organization of
the United Nations. 2010. ftp://ftp.fao.org/ag/agn/nutrition/ncp/uga.pdf
ii
“Nutrition at a Glance: Uganda.” The World Bank.
http://siteresources.worldbank.org/NUTRITION/Resources/281846-1271963823772/Uganda.pdf
iii
“Counting on Communication: The Uganda Nutrition and Early Childhood Development
Project.” The World Bank. 2005. http://hetv.org/pdf/countingoncomms.pdf
iv
“The State of the World’s Children.” UNICEF. 2009.
http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf
v
“Nutrition at a Glance: Uganda.” The World Bank.
http://siteresources.worldbank.org/NUTRITION/Resources/281846-1271963823772/Uganda.pdf
vi
vii
Ibid.
“Nutrition Country Profile: The Republic of Uganda.” Food and Agriculture Organization of
the United Nations. 2010. ftp://ftp.fao.org/ag/agn/nutrition/ncp/uga.pdf
viii
“Uganda Demography and Population.” The Henry J. Kaiser Foundation. 2009.
http://www.globalhealthfacts.org/country.jsp?c=219&cat=7
ix
“Nutrition Country Profile: The Republic of Uganda.” Food and Agriculture Organization of
the United Nations. 2010. ftp://ftp.fao.org/ag/agn/nutrition/ncp/uga.pdf
x
“Uganda Human Development Report 2005.” United Nations Development Program. 2005.
http://hdr.undp.org/en/reports/nationalreports/africa/uganda/uganda_2005_en.pdf
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“Nutrition Country Profile: The Republic of Uganda.” Food and Agriculture Organization of
the United Nations. 2010. ftp://ftp.fao.org/ag/agn/nutrition/ncp/uga.pdf
xi
“Nutrition at a Glance: Uganda.” The World Bank.
http://siteresources.worldbank.org/NUTRITION/Resources/281846-1271963823772/Uganda.pdf
xii
“The State of the World’s Children.” UNICEF. 2009.
http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf
xiii
“Tracking Progress on Child and Maternal Nutrition: a Survival and Development Priority.”
UNICEF. November 2009.
xiv
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http://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_
EN_110309.pdf
xv
“Uganda: Statistics.” UNICEF. http://www.unicef.org/infobycountry/uganda_statistics.html
“Nutrition Country Profile: The Republic of Uganda.” Food and Agriculture Organization of
the United Nations. 2010. ftp://ftp.fao.org/ag/agn/nutrition/ncp/uga.pdf
xvi
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