Uganda’s 2018 GHI score is 31.2, on the upper end of the serious category. This reflects an improvement relative to its 2000 and 2005
GHI scores (41.2 and 34.2 respectively) yet is virtually unchanged relative to its 2010 GHI score of 31.3 (Figure 2). Uganda ranks 105th out of 119 countries with 2018 GHI scores.
In terms of the indicators used to calculate GHI scores, Uganda’s 2015–2017 undernourishment rate — used in its 2018 GHI score — is 41.4 percent and has risen steadily since 2004–2006, indicating an increasing proportion of the population that is not able to meet minimum calorie requirements on a regular basis. Uganda has historically experienced periodic droughts, which affect agricultural production and food security, and these have become more frequent as a result of global climate change (OPM GOU 2012). In 2015/2016, a severe drought associated with El Niño affected much of East Africa and sharply increased food insecurity in Uganda into 2017 (OPM GOU 2017). Karamoja, one of the poorest and most food-insecure regions of Uganda and long reliant on donor food assistance, was particularly hard hit by the recent drought and continues to have the highest level of food insecurity of any region in Uganda (FEWS NET 2016, 2017, 2019).
Uganda’s child undernutrition levels and child mortality rate have declined in recent years (see Figure 2). According to the latest survey data, Uganda’s child stunting rate is 28.9 percent and its child wasting rate is 3.6 percent, down from 44.8 percent and 5.0 percent in 2000–2001, respectively. Uganda’s child mortality rate is 5.3 percent, down from 17.0 percent in 2000. Child undernutrition in Uganda is caused by a variety of factors including a high disease burden, inadequate maternal and child care practices, poor access to safe water, suboptimal sanitation and hygiene practices, and underlying environment and policy factors (FTF 2018). A study in rural Uganda, Ankole region, found that the main predictors of stunting were low access to appropriate complementary diets, the sex of the child (with boys more likely to be stunted than girls), food insecurity, low knowledge about stunting by the primary caregiver, and poor socioeconomic status (Bukusuba, Kaaya, and Atukwase 2017). WHO and UNICEF recommend exclusive breastfeeding up to 6 months of age, and in Uganda 66 percent of children under 6 months are exclusively breastfed—a rate that has changed fairly little since 2000. For children aged 6–23 months, just 15 percent receive a minimum acceptable diet, representing an improvement from a dismally low proportion of only 6 percent in 2011 (UBOS and ICF 2012, 2018).
At the regional level, there is substantial variation in children’s nutritional status. The highest regional stunting rate, at 40.6 percent, is in Tooro region in the west of the country, and the highest regional wasting rates—10.4 percent in West Nile and 10.0 percent in Karamoja—are in the north (Table 1). Karamoja’s high wasting rate can be explained at least in part by its high levels of poverty, food insecurity, and childhood diseases, while the high wasting rate in West Nile may be influenced by its large refugee population, which has high rates of child undernutrition (Buzigi 2018). Tooro region is not particularly poor relative to other regions of Uganda, nor has it been as vulnerable to drought as other regions (UBOS and ICF 2018; Groen and Jacobs 2012). Tooro does, however, fare poorly in terms of infant and young child feeding practices: out of 15 regions, it has the second-lowest rate of children aged 6–23 months who receive a minimum acceptable diet (UBOS and ICF 2018). In the southwest of the country, shortfalls in the water, sanitation, and hygiene environment combine with poor child feeding practices to create nutritional challenges despite relatively high levels of access to food of adequate quantity and quality (FTF 2018).
The typical diet in Uganda is relatively low in dietary diversity and micronutrient-rich foods. A study in Kampala and two rural regions in southwestern and northern Uganda revealed substantial variation in food and micronutrient intakes across regions. It also showed widespread inadequacies in people’s intakes of vitamin A, vitamin B-12, iron, zinc, and calcium—micronutrients for which foods of animal origin are good sources (Harvey, Rambeloson, and Dary 2010). A study in Kiboga district, North Central region, found that the study population’s diet was high in white roots, tubers, and bananas and low in other fruits and vegetables and animal-source foods (Nabuuma, Ekesa, and Kennedy 2018). In urban Uganda, fruit and vegetable consumption is low and is influenced much more by educational status than by household income, suggesting that more should be done to raise awareness of the importance of fruit and vegetable consumption (Madhavan-Nambiar et al. 2015). An analysis of the diets of pastoralist and agro-pastoralist households in the cattle corridor, North Central region, found that meat, poultry, and eggs were consumed infrequently even among pastoralist households (Mayanja et al. 2015).
There is evidence that poor water, sanitation, and hygiene conditions compromise children’s nutritional status, most likely through negative impacts on their health and their ability to properly absorb nutrients (Fink, Günther, and Hill 2011; Ngure et al. 2014). Whereas 78 percent of Ugandan households have access to an improved source of drinking water, just 19 percent of households use improved toilet facilities (UBOS and ICF 2018).