The Republic of Uganda is a landlocked country of East-central Africa endowed with large fresh-water resources and a high agricultural potential. The population, young and predominantly rural, is mostly engaged in subsistence rain-fed farming. A high population growth rate exerts pressure on the country’s resources. Although poverty is decreasing, it remains widespread, especially in the northern regions. Northern and north-eastern regions of Uganda have experienced severe civil insecurity which resulted in mass displacement of people to Internally Displaced Persons camps. Since 2006, the security situation in northern Uganda has progressively improved; but the situation remains tense in the north-east (Karamoja).
The high incidence of infectious diseases, compounded by very limited access to improved sanitation, together with a low immunization coverage and limited access to essential health care contribute to a high rate of young child mortality. The maternal mortality ratio also remains very high. Nevertheless, both young child and maternal mortality rates are decreasing.
Although the contribution of the agricultural sector to the economy is declining, this sector continues to play a pivotal role in Uganda’s development. As for staple food crops, a steady increase in production has been observed and although cereal imports have been increasing, dependence on imports for staples is limited.
The Ugandan diet is mainly composed of plantain, starchy roots (cassava, sweet potatoes) and cereals (maize, millet, sorghum). Pulses, nuts and green leafy vegetables complement the diet. In urban areas, which are undergoing a nutrition transition, food consumption patterns are changing and rice is gaining importance. Overall, the diet remains poor in micronutrient-rich foods. Food insecurity persists in some parts of the country, mainly due to poverty, adverse climatic conditions, low agricultural productivity and prolonged civil insecurity in some regions. These factors combine in Karamoja where food insecurity remains widespread. The dietary energy supply meets the population energy requirements, but the share of lipids and that of protein are at the lower limits of recommendations. Undernourishment affects 15% of the population, a proportion which has decreased over the last decade.
Although early initiation of breastfeeding is progressing it is still not widely practised. A majority of infants are exclusively breastfed until six months of age, but currently the practice is not increasing. Complementary feeding is insufficiently diversified. These inappropriate practices, along with high morbidity, poverty and food insecurity, are major determinants of malnutrition among young children. The prevalence of chronic malnutrition (stunting) among children under 5 years of age (38% in 2006) places the country at a high level of malnutrition. Stunting is particularly widespread in the Southwest region. Nonetheless, overall prevalence is decreasing. Among adult women, undernutrition persists, particularly in the northern and eastern parts of the country. Meanwhile, the country is undergoing a nutrition transition, still strictly limited to urban areas, where more than one third of women are overweight or obese.
Thanks to the universal salt iodization strategy developed in 1994, iodine deficiency disorders have regressed considerably. The 2005 nation-wide survey highlighted excessive iodine intake among children, calling for a reinforcement of the surveillance system. On the basis of sub-clinical data, vitamin A deficiency is considered a severe public health problem among children. Vitamin A supplementation coverage remains limited among both children and women. Anemia affects almost three quarters of underfives and half of women of childbearing age. Iron supplementation coverage of pregnant women should be expanded. Long-term measures to combat vitamin A and iron deficiencies, such as promotion of production and intake of vitamin A and iron-rich foods and food fortification need to be strengthened considerably.
Although the situation remains critical in certain regions, a gradual return to stability in the northern part of the country and a current favourable agricultural context at national level are opportunities to further develop long-term food-based strategies and improve the nutritional quality of the diet.