Evidence: 10 Health Crises in Uganda other than COVID-19!

As the ‘scaring’ second wave of COVID-19 ‘humbles’ us, many Ugandans must be thinking that COVID-19 must be the worst thing happening to us. Sadly, this isn’t true. COVID-19 is simply one of the many health crises in Uganda now!

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As of today (27/06/2021), COVID-19 has killed 868 out of the confirmed 77,505 cases in Uganda. However, remember, 868 is an accumulative number since the outbreak in December 2019. Roughly, we have been with COVID-19 for 1.5 years. This means that, per week, only 11 people die of COVID-19, translating to 1.5 (or 2) people per day. The mortality rate of COVID-19 still stands at 1! or less!

Considering the above statistics, it is clear we even have worse health issues! In this short article, I will explore 10 health crises in Uganda other than COVID-19 (NB: Not in order of their importance)

The goal of this article is not to downplay the threat posed by COVID-19, but to direct our attention and intervention to a broad range of serious issues without forgetting any! Additionally, knowing that COVID-19 isn’t the worst of it all can inspire us to struggle through, to live with the pandemic just as we live with other crises.

READ THIS TOO: Is COVID-19 the worst pandemic the world has ever seen?

The 10 health crises in Uganda other than COVID-19!

MALARIA

Malaria is the leading cause of death in Uganda, contributing about 27% of the total crude deaths (Ministry of Health, 2016). Crude Death Rate refers to number of deaths without considering the cause of death or other specifics.

Well, according to 2020 projections, Uganda’s crude death rate is at about 6.4 per 1000 people or population. In other words, for every 1000 people, 6.4 die per year. In a country where current population estimates stand at 47m people, it means that approximately 300,800 die each year.

If we say that Malaria contributes 27% of this number, it means 81,216 people die of Malaria per year. Of course, this number is too big to believe. But it’s true! If we took these numbers serious (and they are), it means malaria kills 222 each day.

Even if we restrained from using the above population projections, we will still see that malaria is a health crisis. For example, in 2013 alone, Uganda’s ministry of health reported 16 million malaria cases and 10,500 annual deaths. If we took 10,500 as the annual deaths, then it means that 29 people died of the disease per day. If we can use the Ministry of Health’s weekly updates regarding malaria cases, we will still see a crisis in 2021. Let’s see how to go about it!

To make our estimations well, I am going to first determine average week cases. If we consider week 4 (158,188 cases), week 24 (167,291 cases), and week 29 (206,138 cases), we have an average of 177,206 cases per week. A year has 52 weeks, implying that in 2021, we are likely to have 9,214,695 malaria cases.

About mortality, averagely, 20 people die every week in 2021, implying 3 deaths per day. About fatality, if we consider the year of 2013, of the 16 million cases, only 10,500 died, implying a fatality rate of just 0.06%. If we consider the year of 2019, only 4,000 of 13.4 million cases died, suggesting a fatality rate of 0.03%. This isn’t scaring, is it? No! But it doesn’t matter.

What matters are numbers of people who die and, yeah, malaria kills us a lot! Therefore, malaria is one of the health crises in Uganda.

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2. MATERNAL MORTALITY

In Uganda, 15 women die every day during pregnancy, during labor and childbirth and shortly after childbirth. This means that 5,475 mother die each year. We can also estimate this from maternal mortality ration, which is 336 per 100,000 live births. In Uganda, current estimates put our live births at 1,670,000. If we divide this by 100,000, we have 16.7, which we multiply by 336 to have total deaths per year. And this is 5,611 deaths. It isn’t far from what we got first, the 5,475 deaths!

Well, the point is that, for every single day, 15 mothers die. This number is very scary! A mother is a unique death! Therefore, maternal mortality is one of the health crises in Uganda.

3. PNEUMONIA

Pneumonia accounts for 10% of the under-5 deaths in Uganda, killing 25 children everyday, implying 9,125 under-5 deaths due to pneumonia each year. Well, that is only in children. How about if we added adults, especially older people who succumb to the disease? Studies on community-acquired pneumonia (CAP) indicate that at least 1 in 9 patients of the disease end up in ICU, implying serious fatality rate.

In Uganda, CAP mortality can be as high as 18% (Ferreira-Coimbra, Sarda, & Rello, 2020). Hospital-acquired pneumonias are some of the worst infections on the planet, accounting for about 25% of ICU deaths. Because more than 90% of these pneumonias are acquired during mechanical ventilation, a patient in a Uganda’s ICU is likely not to survive if mechanical ventilation is involved!

In 2018, Pneumonia reached about 28,255 deaths in 2018, contributing 10% to the total death rate (World Health Organization, 2018). This would translate into 77 deaths per day or 3 per day.

Getting data about pneumonia is a little bit tricky. First, researchers have concentrated on pneumonia in under-5 children. Secondly, pneumonia in adults is either studied as a hospital acquired infection among inpatients or as a community-acquired infection. Because of these sub-themes of pneumonia, it’s hard to get general data regarding how many people die of the disease per year. Despite this setback, it is already clear the disease is a killer, taking away 25 children everyday or 77 ‘general’ people per day.

4. CANCER

Each year, we have about 60,000 cases of cancer in Uganda and 25,000 of these are new cases (incident cases). 22,000 deaths occur due to cancer each year, which means the disease kills 60 people per day. In this scenario, fatality rate is 36%. That is a lot! Cervical and breast cancers champion the list of the most common ones. To be specific, in 2018, 56,238 people were living with cancer, 32,000 were new cases, and 21,000 deaths occurred in Uganda. In this case, fatality rate is 37%.

For cancer, fatality rate heavily depends on the type and timely treatment. Apparently, cancers that cause more than 70% of the cancer deaths can be prevented or treated if diagnosed early. These include cervical, breast, and prostate cancers! In other words, cancer awareness and screening programs can do magic! Anyway, the point is, we are losing 60 people to cancers each day!

5. ROAD TRAFFIC ACCIDENTS

In 2018, World Health Organization reported that Uganda had more than 11,000 deaths due to RTA, contributing 4.52% to general total death rate. If we consider our death rate (300,800 deaths), then we have 13,596 RTA-related deaths per year. This would mean that 37 people die in road accidents each day. Uganda Police has different figures!

According to 2020 crime report by Uganda Police, Uganda had 12,249 accidents in 2020 compared to 12,858 in 2019, a 4.7% reduction. Sadly, shows the report, 3,269 of the 12,249 died, either on spot or within a year due to the injuries sustained. 5,805 were serious injuries. If we consider this report, then we have only 10 deaths per day. This is bad already!

Other studies insist that police misses a lot of data, often reporting low figures. According to Daily Monitor, a 2019 Makerere University study revealed that actually about 9,000 people die due to RTA (Road Traffic Accident) each year. If we take this, then we have 25 deaths per day.

In my view, let us not trust anyone! In this case, let’s just do an average> Well, 25+10+37, divide by 3, giving us 24 RTA-related deaths per day. Isn’t this bad already? Yeah, it is! Therefore, RTA is one of the health crises in Uganda.

Uganda stands alongside other countries like South Africa, Nigeria, Iran, and Thailand when it comes to high prevalence of accidents.

6. HIV/AIDS

People no longer talk about HIV/AIDS. However, it is still here and a threat! According to World Health Organization’s 2018 data, in 2018, we had 28,319 deaths, contributing 10.91% to total deaths. Globally, more than 38 million people are living with HIV. Sadly, developing world is the home to most of them!

By the end of 2020, Uganda had a little more than 1.43 million cases, with a adult prevalence rate of 6.2% and 0.5% among children (below 15 years). According to Ministry of Health’s 2016/2017 population-based HIV impact assessment, prevalence remain high among women, urban dwellers, and young people (15-24 years).

Well, how many new cases do we have every year? According to UNAIDS (2020), cites Avert, we had 53,000 new infections and 21,000 HIV-related deaths in 2019. This would mean 145 new infections everyday and 6 per hour. In other word, count 1 hour and you know 6 people have just acquired HIV/AIDS. This is too bad. About death, it means HIV/AIDS kills 58 people per day or 2 people per hour. This is a real pandemic!

Of course, HIV is a long-term infection and more of its cases might actually mean that people are on treatment and living longer. However, like we said earlier, no need of complex analyses. To us, what matters is surely how many of us the disease claims per day. And that is what matters!

7. DIARRHOEAL DISEASE

Diarrhoea is among the top 5 killers of children in Uganda. In 2016, Uganda’s Demographic and Health Survey reported 20% prevalence rate among children below 5 years. By the end of 2017, diarrhoeal disease were contributing 6.4% to total deaths, and by the end of 2018, we had 18,866 deaths, contributing to 7.27% of total deaths. Most of our diarrhoea is due to rotavirus (40%). Good news, we have rotavirus vaccine now, right? Take those children for immunization please!

Well, if we took up the above numbers, it means that diarrhoeal disease kills 52 people per day, especially children. This would translate into 2 per hour. Diarrhoea is mostly due to poor water and sanitation and, of course, bad health care.

Unless people have full access to free or affordable clean water, we have no business! And while most of diarrhoeal episodes would be cured, a lot of factors make timely and quality health care impossible! So, yeah, it is one of the health crises in Uganda now!

8. VIOLENCE OR CRIME

Do you guys read Uganda’s annual crime reports? Well, I have been on them since 2015! Considering the latest 2020 crime report by Uganda Police, we had a total of 195,931 reported crime cases in 2020 compared to 212,224 in 2019. Well, without going any further, how many cases do you think were not reported? About crime rate, Uganda Police puts it at 502 per 100,000. In other words, for every 100,000 people, 502 are victims of crime.

According to the report, top five crimes are: Common assaults, domestic violence, defilement, threatening violence, and obtaining by false pretense. In this article, I am going to concentrate on domestic violence, sex related crimes, and homicide because they (the crimes) directly target a human being!

Well, we had 17,664 domestic violence cases in 2020 compared to 13,693 in 2019, a 29% increase, possibly due to COVID-19 and related consequences. However, 18,872 people were direct victims of this violence, 3,408 males and 13,145 females. In general, it means that 52 people are victims of domestic violence per day or 2 people per hour.

About sex crimes, we had a total of 16,144 cases in 2020 compared to 15,638 in 2019, a decrease of 2.7%. About 14,320 were female juvenile victims, 202 male juvenile victims, 1,632 female adult victims, and 103 male adult victims.

Defilement cases were 14,134 of which 3,721 were aggravated defilement. About rape, 1,521 women were victims of rape. I am wondering why the report captured no male victims! Are males never raped? Or they never report, do they? Well, for other sex offences, we had 354 indecent assault, 58 incest, and 79 unnatural, including sodomy, lesbianism, and bestiality.

In summary, it means we have 44 victims of sex-related crimes per day and 2 victims per day.

About homicide, we had 4,460 cases in 2020 compared to 4,718 cases in 2019, implying a decrease by 5.4%. It also means, each day, 12 people are killed or murdered by their fellows, either due land wrangles, paybacks (people taking law in their hands), business rivalry or crime of passion. Count a day and 12 people has just be killed by their fellows! Isn’t this the real pandemic?

In my view, these numbers are just ‘a drop in the ocean’. First, COVID-19 and related effects aggravated most of these cases, especially domestic violence, rape, defilement, theft, and much more. Secondly, government’s attention got diverted to COVID-19 only, implying that most of these cases were not attended to, increasing fatality and consequences. Thirdly, cases were not adequately reported simply because, well, first, it is a trend (reporting rarely helps). Importantly, lockdown made it impossible to report anything! So, yeah, in my humble opinion, the above is just a drop in the ocean!

NB: There are other important related cases that we may not dig in. These include unsafe or induced abortions, early marriage, teenage pregnancies, and more. Studies show that all of these were or are aggravated during COVID-19 pandemic. Read here, here, here, here, here and here. To me, these are the real pandemics, affecting young people in large numbers and directly blurring their future.

9. TUBERCULOSIS

By 2018, we had about 10,514 tuberculosis related deaths, accounting for 4% of total deaths. According to Ministry of Health, annual incidence or new cases stand at 330. This isn’t bad, is it? Well, the ministry adds that in 100,000 people tested, 136 return with positive smear test. This is the real deal. For every 100,000 people tested, 136 turn out to be positive. So, if we roughly tested all people, the 47 million people, how many positives would we get?

Anyway, studies have revealed a huge gap in Uganda’s abilities to screen out TB. In other words, many cases are unknown!

In the year of 2019 alone, TB’s incidence rate was at 200 per 100,000 population and death rate at 35 per 100,000 population. Well, again, if we use our rough population projections of 47 million, it means that 94,000 are getting TB in this year. Of course, that’s rough. There is so much that might have changed regarding the infection spread rate, and more. Besides, other reports put 2019’s death rate at only 16 per 100,000 population.

If we can consider the least number, 16 deaths per 100,000, it means we shall roughly have 7,520 deaths in 2021. This alone isn’t good!

Well, more than 60% of HIV patients are co-infected with TB and TB is the leading cause of HIV patients. With our HIV annual deaths of 21,000, we can surely connect the dots!

But even if we took the above recorded statistics, for the WHO’s 2018 report, we see ourselves losing 29 people to the disease per day. That is bad already, isn’t it? Therefore, TB is one of the health crises in Uganda.

10. CARDIOVASCULAR DISEASES

Cardiovascular diseases are hard to explore because they are many. Common diseases are hypertension or high blood pressure, Coronary Heart Disease (CHD), stroke, and many more. According to Ministry of Health, cites Kyeyune (2021), hypertension alone kills about 500,000 Ugandans per year!

What! At the beginning of this article, didn’t we project that if the crude death rate doesn’t change, which is about 6.4 deaths per 1000 population, we will have about 300,800 deaths in 2021? Where does hypertension get half a million to kill? Ugandan data is crazy! Anyway, we have other options to consider!

A detailed 2015 study explored the prevalence of hypertension across Uganda and reported urban prevalence rate of 28.9% and the one of rural 25.8%, giving us a general prevalence of 26.2%. Indeed, some studies and Uganda’s Minister of Health, Aceng, said that 25% of Ugandans have high blood pressure. At a prevalence of 25%, it would mean that about 11,750,000 Ugandans have the disease. Of course, it is important to note that much of this is just mild and people live with it for years without knowing or even caring!

Coronary heart disease alone reached 10,442 deaths in 2018 and stroke killed 9,922. If we total up this, we would have about 20k deaths due to just CHD and stroke in a year! Isn’t this bad already? Well, like I said earlier, putting them together is complex. Besides, heart diseases are all connected, hypertension causing stroke or CHD causing hypertension. In a less sophisticated environment like Uganda, it is hard to be sure about which specific cardiac disease has really killed someone!

Irrespective of the complexities, if we took all things together, cardiovascular diseases are a real killer in Uganda, claiming thousands of people per year. After all, according to Meghan and colleagues, non-communicable diseases are really on rise, here in Uganda and Africa, and cardiovascular diseases are taking the lead! (Meghan et al., 2021).

TAKE HOME: 10 health crises in Uganda

As already noted, the purpose of this article isn’t to downplay COVID-19 and the possible threat it poses on our lives or country. However, many studies have already shown that Uganda government and her health system diverted attention and resources from everything else to COVID-19 and lockdowns, leaving other health crises escalating!

Reports have shown thousands of girls being abused, dropping out of schools, getting early pregnancy and marriage, maternal mortality on increase for lack of supplies and human resource and poor transport options in lockdowns, and much more.

Already, during lockdowns, it is hard for people to follow up with their check-ups or drug re-fills. Socio-economically, COVID-19 and consequent lockdowns make it hard for individuals and families to access care simply because there is nowhere to have such care or no money to pay for it!

If we don’t pause on this nervous fight against COVID-19 and calmly examine what else or who else we are forgetting behind, we might wake up to a purely destroyed nation! So, yeah, let’s consider these health crises as well and treat them as equally relevant!

THANK YOU

For a complete health profile for Uganda, try this link: https://www.worldlifeexpectancy.com/country-health-profile/uganda. GOD BLESS YOU