Uganda’s Maternal, Newborn, Child, and Adolescent Health (RMNCAH) sector has presented its Q3 performance review, drawing data from the DHIS2 system, revealing a landscape of mixed progress with several persistent challenges in critical areas.
While some indicators show improvements, others highlight significant gaps and regional disparities that demand urgent attention.
Family Planning: Declining Protection and Low Uptake
The report indicates a nearly 5% point decline in Couple Years of Protection (CYP) between Q2 and Q3, attributed to operational slowdowns of implementing partner (IP) activities following a US government stop-work order and slow resumption after festive holidays.
There is a general reduction in CYPs across all quarters from FY23/24 to FY24/25. Access to family planning services is largely dominated by short-term methods, with DMPA-SC taking the biggest share, while implants (especially 3-year Implanon NXT) lead among long-term methods.
A significant concern is the consistently low uptake of immediate Postpartum Family Planning (iPPFP), remaining at 2.0% and showing a decline in the last two quarters. Regional variations exist, with Lango, Bukedi, and Busoga showing lower uptake, while Karamoja, West Nile, and Buganda North have higher rates.
Recommendations include improving health worker skills for FP services and initiating FP counseling during Antenatal Care (ANC). Postabortion Family Planning (PAFP) uptake is also low at 9.0%, indicating limited access to Post-Abortion Care (PAC) services.
Adolescents opting for PAFP are relatively low nationally at 10.5%, with Busoga, West Nile, and Lango experiencing the highest abortion cases among adolescents, yet West Nile also has some of the lowest PAFP uptake. The report stresses the need to train and mentor providers and strengthen PAC FP integration.
Antenatal Care: Early Visits Lagging Despite High Coverage
ANC 1 coverage stands at a high 93.6%, an increase from 84.1% in the previous quarter. However, the proportion of first ANC visits occurring in the first trimester dropped by 2% points to 38.5%, falling short of the 50% national target.
Kampala, Tooro, North, and South Central regions reported the lowest percentages for early ANC visits.
Approximately 18% of mothers attending ANC are aged 19 years and below, with Lango, Bukedi, and Bugisu recording high proportions in this age group.
The ANC 4th visit rate is 51.5%, slightly below the national target of 56%, though it increased from 51.0% in the last quarter.
Teso and South Central regions remain below the national target for ANC 4th visits.
Crucially, 8th ANC visits remain notably low across all regions, with only Teso showing a drop compared to the previous quarter.
Performance for Hemoglobin (HB) testing, Iron & Folic acid supplementation, and deworming has stagnated.
Anemia screening is highest in Lango, but lowest access to HB tests is noted in Teso, Bunyoro, Karamoja, Tooro, and South Central. Karamoja, Teso, Acholi, and Bunyoro exhibited the highest rates of anemia among pregnant women at their first ANC visit.
Malaria in Pregnancy (MiP) shows a gradual reduction, with a 4% prevalence in Q3, though Busoga, Lango, and Teso have the highest prevalence. Obstetric ultrasound scan rates at any ANC visit saw about a 1% reduction, with Busoga, Bukedi, Bunyoro, and Karamoja having the lowest rates.
Institutional Deliveries: High C-Section Rates Raise Concerns
About 67.4% of mothers delivered at a health facility. South Central recorded the lowest institutional deliveries at 49.1%, though this was an improvement from the previous quarter. Institutional deliveries by adolescents show a decline, with Lango, Bukedi, and Teso recording the highest numbers.
The Caesarean section rate is 14.2%, just below the WHO recommendation of 15%.
However, Kampala and South Central show the highest C-section rates, with referral centers (RRH/NRH) having particularly high rates. Some facilities are identified as having unacceptably high C-section rates, requiring an audit of their services.
The report highlights “Group 1” (nulliparous, term, cephalic, spontaneous labour) as a high-contributing Robson group at 39.9%, suggesting potential overuse of C-sections in this low-risk group due to possible labor management gaps, limited supportive care, or fear of complications.
Recommendations include strengthening intrapartum monitoring and enforcing adherence to labor guidelines, as well as promoting Trial of Labour After Caesarean (TOLAC) for Robson Group 5.
Postnatal Care and Newborn Health: Missed Opportunities and Persistent Mortality
PNC uptake remains low along the continuum of care. The report details missed opportunities for PNC, with regions like Karamoja, Bugisu, and Busoga showing the highest percentages of missed opportunities.
Approximately 5% of live babies are underweight, with Kampala reporting the highest figures. While approximately 90.3% of babies were breastfed within one hour, this falls short of the national target of 95%. The prevalence of birth asphyxia shows a gradual reduction, but still contributes significantly to perinatal deaths. Cough or cold (no pneumonia) and confirmed malaria are the most prevalent childhood illnesses at OPD.
Mortality: High Maternal and Perinatal Death Rates
A national average of 250 maternal deaths was reported per quarter, with Kampala registering the highest figures across all quarters.
The Perinatal Mortality Rate (PMR) remains high at an average of 16.3 per 1,000 births across the last four quarters. Bunyoro (21.4), Kampala (35.1), and Acholi (21.1) consistently registered the highest PMR.
Birth Asphyxia remains the leading cause of early neonatal deaths among reviewed perinatal deaths. The death rate of hospitalized children under five years is 1.3% nationally, with Karamoja notably high at 4.2%.
Key Issues and Future Actions The report identifies several key issues for action:
• Late initiation of Postpartum Family Planning (PPFP) negates expected benefits.
• Early initiation of ANC needs improvement.
• Low coverage on ANC quality interventions.
• ANC completion of 4 visits is low and generally reducing.
• While institutional births average 64%, some regions, like South Central, require significant support to improve.
• High C-section rates at referral sites and other facilities necessitate audits.
• Low PNC uptake along the continuum of care.
• Maternal Mortality Ratio (MMR) is high in older women, and Postpartum Hemorrhage (PPH) risk increases with age.
• There’s a need for targeted interventions to regions/districts driven by data.
• Urgent call to improve the quality of labor and delivery care at birth to enhance perinatal health outcomes.
• Strengthening multisectoral collaboration for community interventions is crucial.
