The under-five child mortality rate in Uganda was 160 per 1,000 in 1990. By 2002, it had improved to 141 per 1,000. But Uganda, like most of sub-Saharan Africa, is not on course to meet Millennium Development Goal 4 – the commitment to cut child deaths by two-thirds by 2015. AMREF in Katine is attempting to make a difference.
Sarah Boseley writes for the Guardian, that before the start of the Katine Project, the most pressing concern of local women was the polluted state of their water supply. Children were drinking from it at source and families had insufficient firewood to boil out all the germs. As a result, potentially-fatal waterborne diseases were common. Half the under-five deaths in poor countries are the result of malnutrition and the absence of safe water and sanitation. So our first priority was to improve the water quality in the villages. Thus far, eight new boreholes have been drilled and five boreholes rehabilitated.
Access to safe water
The baseline survey in Katine showed that 38% of children under five had suffered diarrhoea in the fortnight prior to the parents being questioned. The highest rates were among the under-twos. Diarrhoea is one of the biggest killers of small children, because it dehydrates them. It also sets up a vicious circle, causing malnourishment which in turn makes the baby more prone to diarrhoea, and also more susceptible to infections such as measles and malaria.
Preventing Malaria
Malaria is Uganda's biggest child killer. In 2003, there were more than 12 million cases of malaria and 8,450 deaths – and most of them were children under-five. Small children are vulnerable to all sorts of infection and disease in Uganda but over 40% of their deaths are caused by malaria. When it comes to malaria, war has to be waged on two fronts – prevention and cure. Across the affected parts of the developing world, the roll-out of insecticide-treated bed nets to prevent the parasite-carrying mosquitoes biting at night has gained real momentum. In Katine, the project is now taking on the distribution. So far this year, the project has bought 3,250 nets and handed out 2,478 of them to households where there are young children and pregnant women.
To cure those who have already contracted malaria, the project has recruited and trained 272 teams of volunteer village health workers and given them bicycles and storage kits for drugs. At the moment, however, the teams have only “Homepaks” for malaria treatment, which contain two drugs, chloroquine and sulfadoxine/pyrimethamine, to which the malaria parasite has become increasingly resistant. But the Ugandan government is now committed to rolling out drug combinations including artemisinin compounds, which are now recognised as the most effective treatment. Stocks of Coartem, an artemisinin-based combination drug, are supposed to be reaching communities like Katine soon.
The volunteer health workers are also a crucial part of our work to engender behavioural change that will improve hygiene and sanitation more generally. The workers – as well as the 41 teachers at local schools that AMREF has trained as facilitators – are giving lessons on using latrines rather than heading for the bush, and washing hands afterwards, and again before preparing or eating food.