Uganda: Karamoja region is "worst place to be a child"

NAMUDUKA, 2 October 2008 (IRIN) - The remote Karamoja region of northeastern Uganda has such poor health indicators that up to 100 children younger than five die each week, many of preventable illnesses, officials said.

"Karamoja faces development challenges that put it in a different sphere from the rest of Uganda," Health Minister Stephen Malinga said on 1 October at the launch of a child health campaign. "The situation is alarming and health indicators are beyond emergency levels."

Speaking at Namuduka village in Moroto District, he said: "Only 3.4 percent of households in Karamoja have two insecticide-treated bed nets and 5.9 have one, yet the regional target is 60 percent of households with two nets."

Keith McKenzie, head of the UN Children's Fund (UNICEF) in Uganda, said the region was "off-track in meeting health and nutrition-related Millennium Development Goals. Karamoja is the worst place to be a child, with highly elevated levels of early childhood mortality and morbidity," he said.

"Health indicators are the worst in the country, decidedly worse than in LRA-affected [rebel Lord's Resistance Army] northern districts and the rest of the country," McKenzie said.

Home to about 1.1 million people, Karamoja is a harsh, semi-arid region largely inhabited by agro-pastoralists.

Ugandan and UN officials attributed the poor health indicators to extremely low access and utilisation of basic health services - averaging 24 percent compared with the national rate of 72 percent. The situation is compounded by lack of awareness among local communities.

Malinga said maternal mortality in Karamoja stood at 750 per 100,000 live births - 50 percent higher than Uganda's national average.

"Karamoja is a complex developmental challenge, currently manifesting as a child survival crisis," UNICEF and the government said in a joint statement. "Accelerated ... actions are needed to reduce child mortality and mitigate the impact of political and climatic shocks on women and children."

Immunisation drive

The Accelerated Child Survival Campaign programme aims to immunise all under-fives in the region, and identify and refer for treatment those with acute malnutrition, especially in the hardest-to-reach areas.

Children aged one to 14 years will also be de-wormed, while each household will be provided with mosquito nets. "Many children suffering from acute malaria are also malnourished," said Peter Ken Lochap, the Moroto district council chairman.

Alice Ngorok, a mother of six, who was waiting for polio drops for her son, said: "I hope that now my children will live. They have promised us some mosquito nets that will prevent malaria that kills our children all the time."

Malinga decried the lack of education, saying primary-school attendance in Karamoja was 43 percent compared with 82 percent in the rest of Uganda. "Let us send our children to school, that will improve the situation. Our children must go for immunisation. This is the time to change," he said.

Observers, however, said the challenge of raising social-service delivery in Karamoja would require the active involvement of the local population. For example, latrine coverage is at 2 percent compared with the national average of 52 percent and improving this would require massive sensitisation.

There is also concern that while HIV prevalence rates are falling across Uganda, they are rising in Karamoja. Health officials in Matany regional hospital said sentinel surveillance had shown prevalence among pregnant women rising from 1.7 percent in 2000 to current levels of 3.5 percent.

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