Assessing the effects of interventions on child and maternal health-related outcomes in Uganda

Abstract

In this PhD, health-related outcomes studied include the under-five mortality rate (U5MR), the prevalence of fever, diarrhoea, symptoms of acute respiratory infections (ARI) as well as maternal mortality ratio (MMR. Every year in the world, millions of children die before their fifth birthday. In 2016, an estimated 5.6 million under-five deaths occurred with half of the burden concentrated in the sub-Saharan Africa (SSA) region. In these countries, the U5MR is unacceptably high yet progress is slowed down by the uneven distribution of key determinants of child mortality, for example, child interventions, childhood diseases and the socio-economic factors. Such imbalances lead to substantial variations in the U5MR within countries which may hinder the achievement of Sustainable Development Goal (SDG) target 3.2. In Uganda, the U5MR is much higher than the SDG target of 25 or less deaths per 1 000 live births. In addition, significant differences in the U5MR as well as determinants of U5MR are huge and disproportionately distributed within the country. A better understanding of the determinants of the existing inequalities in the under-five mortality would guide in the prioritization of effective and equitable strategies to realise mortality targets Another fundamental mortality indicator is the maternal mortality ratio (MMR). MMR measures the quality of the health system and also reflects inequality between sub-groups and, between and within countries. The indicator is also essential for tracking progress in development and for spurring action to improve maternal health. According to the World Health Organisation, the MMR is highest in SSA and accounts for approximately 66% of the global maternal deaths. In SSA, direct and indirect causes of maternal deaths are the most prevalent conditions yet prevention and treatment measures are hindered by dysfunctional national health systems and a low socio-economic status. This leads to poor maternal health outcomes in SSA, resulting into vulnerable families and increased chances of infant mortality before reaching their second birthday. Furthermore, maternal mortality deteriorates economic development since more women survive with chronic and incapacitating ill health for each maternal death. Uganda ranks number nine among the top ten high-burdened countries and experiences a MMR far higher than the SDG target 3.1. At the same time, large regional disparities in MMR and its determinants (e.g. maternal interventions) prevail within the country. Therefore, strategies to end maternal mortality need to be implemented, in particular, approaches to address the sources of inequities. This may reduce variations in MMR within Uganda, and thus, quicken the achievement of SDG target 3.1 in the country. The adoption of the United Nations (UN) Millennium Declaration in the late 2000, established a global partnership of countries and development partners committed to eight voluntary development goals, to be achieved by 2015. Two of the eight Millennium Development Goals…