Children in Uganda are regularly exposed to many preventable health risks. According to the WHO, the country ranks 186th out of 191 eligible countries in life expectancy. The country also ranks 168th out of 188 in infant mortality rates, with a lower rank reflecting lower infant mortality. There are approximately 97 infant mortalities for every 1,000 births. There are many cultural factors influencing the current health status of Uganda including the negative stigmas associated with sex, and wood-burning stoves. The former (sex) of these has resulted in a severe lack in education and communication necessary to improve the health and well-being of children. There are multiple factors negatively impacting the health of children in Uganda. Those factors include HIV/AIDS, malnutrition, lack of sanitation, vaccinations, insufficient drugs, and an insufficient number of motivated healthcare workers. The World Health Organization attributes the tragic situation to wars that occurred before 1986 as well as the HIV/AIDS epidemic. The HIV/AIDS epidemic has resulted mainly from the mother-to-child transmission that spreads from one generation to the next, which could have easily been prevented from educating mothers and providing them with medical treatment. Medical treatment could protect them and their children. The knowledge of HIV, how people can contract it, their individual HIV status and counseling for the disease. These are several factors that assist in the prevention of HIV/AIDS and the HIV/AIDS epidemic, which is the leading cause of the detrimental state of child health in Uganda.
HIV/AIDS is likely the leading health risk facing Ugandan children; it affects many facets of their physical and mental health in a variety of ways. It is the leading cause of death in Uganda, as reported by the Center for Disease Control (CDC) in 2010.[1]
The CDC has been fairly active in the country, working in cooperation with government organizations as well as a number of other partners.[2] Their work has been on multiple fronts including door to door HIV counseling and testing. Despite these and many other efforts, there are poor rates of treatment of children. Of the 190,000 HIV-positive children in Uganda, only 35,500 received Antiretroviral medication (ARV). Uganda is not alone in this, in 21 high burden African countries, only 34 percent of eligible children receive ARVs, compared to 68 percent of adults.
In addition, many of the children that receive medication have been found to lack the necessary diligence in their drug therapy routine. Many children find the medication unpleasant and are not even aware of their HIV status. Part of this can be attributed to lapses in communication. For example, it is common practice not to inform children of their HIV status until they reach 13 years of age. Sexual lifestyles are typically frowned upon in Uganda, particularly for women, which contributes to a poor dissemination of sexual related health information.
Research has shown that efforts to improve health and awareness of parents and guardians, as well as the communities, of children with HIV/AIDS could be an effective way to improve treatment.[3] Increased education and awareness can help with communication breakdowns and access to resources. These efforts can also help decrease mother-to-child transmissions.
It is estimated that 91,000 infants are born each year to HIV-positive women.[4] Only 51.6 percent of these women receive any sort of mother-to-child HIV prevention and about 24 percent of all 110,000 new HIV infections in Uganda in 2009 were a result of mother-to-child transmission. A study published by the World Health Organization (WHO) found that antiretroviral therapy (ART) is a very effective management strategy, in terms of efficacy as well as cost, for prevention of mother-to-child transmissions.[4] In addition, often material support for parents/guardians can be an effective strategy in improving care and treatment of children, including funding for food, clothing, and educational expenses.[3]
To date, most of Uganda's policies to combat AIDS have focused on abstinence and fidelity, both preventative measures while little action has been taken around youth education. The main tool of this strategy is the controversial ABC campaign (Abstinence, Be faithful, and use Condoms). While initially believed to be a successful approach, the effectiveness of this strategy is currently inconclusive as more recent studies have found that increased condom use and deaths have been responsible for the decreases in HIV infections.[5] According to recent studies, Uganda has made a decrease in the HIV prevalence in the country. There was a reduction among children from 27,660 in 2011 to 9,629 in 2013, which measured up to the National Priority Action Plan target for 2013 which was 10,000.
Adolescent girls are a group that is most severely impacted and most at risk compared to other groups of the population. Two-thirds of new HIV infections were found in this section of the population. The number of deaths decreased for children under 4 years old from 100,000 between 2000 and 2012, while the number of deaths in adolescent girls increased from below 50,000 to over 100,000 between 2000 and 2012(UNICEF, 2013). 2013 studies have shown that children below 15 years old account for 11% of HIV cases. According to UNAIDS, "HIV cases were lower among pregnant adolescents at 3% compared to older pregnant women at 4.9%, availability of anti-retroviral therapy was lower among adolescents at 94% than older pregnant women at 99%".
Additionally, due to the fact that there is still 18% of HIV cases coming from mother-to-child transmissions, the world health organization has been efficiently sending out revised WHO guidelines to protect mothers and their babies and make certain that HIV infected mothers and their children receive triple antiretroviral prophylaxis during labor, breastfeeding and throughout the rest of life. HIV positive mothers with access to elimination of mother-to-child transmission (EMTCT) assistance has increased to 85% and thirty-three districts have full coverage now (UNICEF Uganda). On the other hand, pregnant women in four districts did not receive antiretroviral therapy and in only 29% of districts HIV infected women were given antiretroviral therapy. Overall, mother to child transmission treatment coverage has greatly increased, but there is still a significant amount of unmet need across the country for women and children.
Malnutrition
Malnutrition plagues much of Uganda's youth. According to a study by the World Food Programme (WFP), roughly one-third of Ugandan children have stunting, a permanent condition resulting from lack of proper nutrition during the first 5 years of life. Consequences of this have been found to be very costly to the Ugandan government and economy, with estimated losses totaling at US$899 million annually, or 5 percent of the country's GDP.[6]
Stunting in children occurs when a child is severely malnourished which leads to the child being much shorter than the average height for their age. This condition happens over a long period of time where the child is deprived of proper nutrition and infections which also arise more easily in undernourished children. According to the World Health Organization, 23.8% were short for age and 6.9% were extremely stunted. Along with stunting, malnutrition also caused children to be underweight. According to the United States National Center for Health Statistics, 24.1% of children were underweight based on weight, age, and gender.
Kwashiorkor is a kind of protein-energy malnutrition that is caused by repeated infections, specifically diarrheal disease. According to PEDIATRICS, "Edema must be present in order for a nutritional deficit is classified as Kwashiorkor and only 3.8% of the total sample had Kwashiorkor". Another condition named Marasmus occurs in children when they experience critical undernourishment that causes their weight to be lower than the appropriate weight for their age. The widespread presence of low MUAC (mid-upper arm circumference) was also a health issue attributed to critical malnourishment. Children that had weighed too little for their height had a condition called wasting. Wasting is used as an evaluation of short-term malnourishment principally after an ailment occurred.
Vaccinations
Vaccinations is a preventative method that can limit and terminate infectious diseases, which can eliminate the possibility of millions of deaths per year. It is a very cost-effective way to manage the overall health of a population. While many efforts are currently in place in Uganda to distribute vaccinations to children, it is still a very serious health concern. About 2 million deaths each year in Uganda are a result of vaccine preventable diseases. Tuberculosis is one example of these, which was found to be the 4th leading cause of death in Uganda in 2010 according to the CDC. In 2001, it was found that 63% of children less than one year old had either failed to complete their vaccination schedule or not had any vaccinations at all. A 2012 study found that vaccination rates can be improved by providing additional support to mothers to enable them to make use of immunization services.
Recently, Uganda has been improving and diligently working on the availability of vaccinations to children. The World Health Organization is supporting Uganda in its health and vaccination efforts along with the Global Vaccination Action Plan. According to the National Administrative Immunization Performance Analysis, "22 out of Uganda's 112 districts have a good availability and use of immunization services." The services help about 80% of the children. Despite the tremendous health efforts, the overall vaccination availability and access is poor. According to WHO, "22% and 18% of Ugandan children still do not have essential vaccines. Uganda has one of the highest rank for unimmunized children.
Wood-burning stoves
Traditionally in Uganda, as in most developing countries, open word-burning stoves are commonly used for cooking and to heat homes. It has been estimated that 95 percent of Ugandans rely on wood or charcoal for cooking.[7] Many women using these wood-burning stoves to cook are unaware of the severe health issues it can cause to them and their children. Fumes from the stove are dense in particles containing harmful gases such as sulfur dioxide, carbon dioxide, and various other harmful gases. These gases are harmful to the environment and to people inhaling the fumes. Inhaling such dangerous fumes can induce cancerous disease or even death.
In addition to inducing cancerous disease, the fumes from the stove can damage eyesight. After long-term use, the smoke degrades eye sight and causes visual impairments. Along with eyesight impairment, the smoke causes other illnesses such as chronic bronchitis, lung infections, asthma, cataract, low birth weight, and stillbirths. The chemical pollutants in smoke also induce dizziness and irritation to the respiratory system. According to the World Health Organization, "there are over 200 different chemicals and compounds in wood smoke that are hazardous enough to damage human health. Many women and girls are utilizing the wood-burning stoves every day and are not aware of the harmful effects it is having and will have on their health. Pregnant women are inhaling fumes that are harmful to them and their unborn baby which can lead to birth defects.
Interventions
Many homes in Uganda still have inadequate ventilation stoves because they are unable to afford stoves with better ventilation. Women and girls need to be educated on how to efficiently cook and save themselves and the environment while still using the poorly ventilated stoves. The CECOD, a non-governmental organization in Uganda, has a purpose to create stoves that save energy and don't use a lot of wood which will reduce the deforestation. The CECOD has also created eco schools that educate students about the environment and how to save the environment. Students in these eco schools learn and bring what they learned home, which helps to spread the knowledge and further save the environment.
Sanitary pads
One health issue facing female children specifically in Uganda as well as many other developing countries is the inability to afford sanitary pads. Besides the obvious health and sanitation concerns, this problem also often has harmful effects on education. Due to the fact that menstruation is not an openly discussed topic, many school girls have to suffer and are often distracted by the thought of soiling their clothes. On top of worrying about soiling their clothes, they are also worried about the embarrassment it can bring. Other children at school will laugh at them and ridicule them. That is part of the reason why some girls just don't go back to school because they can't handle the hassle of menstruation while focusing on schoolwork. Evaluations by the Kasiisi Project, a non-profit organization working in rural Western Uganda, found that girls will often skip school or drop out altogether as a result of menstruation and insufficient resources and facilities associated with it.
Their problem would be resolved if they were able to afford sanitary pads, but most are not. Most girls use rags and toilet paper while menstruating. According to research by Build Africa, "29.7% of girls said they missed at least four days per cycle, which included class presentations, exams, and new topics being taught. Another 24.3% of girls in the study said they were condemned whenever their uniform was soiled while on their period." Because of that many girls just decide to drop out. Menstruation is something that is kept quiet and many people, especially boys are not educated on what menstruation actually is. Some boys think it is an illness instead of a part of human nature for women. To make the problem worse, "about 24.7% of girls say their parents did not talk with them about menstruation and body changes they will go through as they get older. When discussing female health issues such as menstruation and puberty many girls only have senior women teachers at their school to talk to, which is a lot for the senior women alone to handle. So, young girls in Uganda are going through a really hard time with going through physical changes they do not understand while being ridiculed.
According to research by Build Africa, "about 90% of girls say they use a rag to pad themselves". They hang the rags to dry them but take them down before anyone sees them because it is seen as an embarrassment. However, rags are sometimes taken down that are not fully dried and girls still wear them. Bacterial-blood infiltrated rags could lead to health issues in the future and vaginal infections. These girls get vaginal infections which can lead to reproductive issues in the future and even make some of them infertile.
Road Map campaign
In 2008, Janet Museveni launched the Road Map campaign in an effort to coordinate efforts to lower maternal and neonatal death rates in Uganda.[8] She created the Elimination of Mother-to-Child- Transmission of HIV Campaign in Moroto. This campaign was part of the government's efforts to prevent HIV from affecting future generations like how it has affected past generations. Part of the campaign is the promotion of ART (antiretroviral therapy) where all pregnant women with HIV are given antiretroviral therapy for life. Uganda was one of the first developing countries to offer life-saving treatment to people infected with HIV. According to UNAIDS, " new infections among children decreased from 27,000 in 2009 to 15,000 in 2012, a 49% drop and the number of women with access to prevention of mother-to-child transmission of HIV assistance also increased at a fast rate from 45% in 2011 to 73% in 2012.
Through this campaign the Ugandan government has shown that Africans can have access to preventative treatment and that HIV/AIDS can be conquered. This campaign has also shown the motivation and effort put into having a new generation free from HIV.
Malaria
The infectious disease called Malaria is induced by parasites that are spread to humans through mosquito bites, particularly female Anopheles mosquitoes. This infectious disease is parasitic and attacks red blood cells. It is the prime cause of death among children and pregnant women in Africa. Children and women infected with the disease have symptoms including chills, high fevers, fatigue, headaches, nausea, shivering, and pain in limbs. If the person is infected with the disease over a long period of time they can contract anemia, jaundice, and low blood sugar. A person with a very strong strain of malaria can contract cerebral malaria and at its most critical state cerebral malaria can cause delirium or seizures and can lead to coma.
An outbreak of malaria occurs in certain regions for various reasons. Uninfected or partially infected people that move into a new area where malaria is widespread can cause an outbreak. Infected people moving into an area where malaria is not present but conditions permit the disease to thrive may also cause an outbreak. In situations where the mosquito carrying the disease is partly eliminated can cause a reoccurrence of the outbreak in that region. Young children and pregnant women are at a higher risk of contracting malaria due to the fact that they have a weaker immune system. Young children and pregnant women in rural areas with little knowledge of malaria, minimal financial and medical aid are also at a higher risk of developing malaria than other individuals.
Malaria is one of the leading causes of death among youth. Statistics portray that Uganda has the world's highest number of malaria cases. According to New Vision, "the malaria incidence rate is 478 cases per 1,000 people per year". About 70,000 to 100,000 people are dying from the disease and about half are children under 5 years old. Malaria is a pandemic in the country because millions of children and women are dying every year from the disease. To add to the problem many do not have access to preventative treatments and many children do not have access to preventative mosquito nets or mosquito sprays. According to the World Health Organization, "sub-saharan Africa was the source of 88% of malaria incidences[spelling?] and the source of 90% of deaths caused by malaria.
Preventative methods have been put into place but have not made a large impact and still need to be improved. Drug-resistant strains broke out and still have not been dealt with appropriately. Residual spraying inside homes and buildings has not widely impacted the country. Only small regions of the country are efficiently and effectively using this method, which in turn has allowed the disease to continue spreading. Mosquito nets that are provided are not strong enough, damaged easily, and some people don't know how to use them correctly.
Lack of malaria vaccine
Currently, there is no malaria vaccine. It is a very perplexing vaccine to make. According to the World Health Organization, "the complexity of the malaria parasite has made the creation of a malaria vaccine difficult." Malaria is caused by a variety of species of the Plasmodium protozoan and the virus of the antigens are always changing which is why creating a vaccine is so difficult. The easiest way to prevent malaria is to stay away from areas where malaria is present. In regions where mosquitos are prevalent, it is essential to sleep under mosquito nets that are treated with insecticide. It is also essential to take prescription medication that will prevent a malaria infection. People can also prevent malaria just by wearing long sleeves and insect repellant.
Healthcare workers
Among the multiple factors contributing to the poor health of children in Uganda, lack of healthcare workers is another factor adding to the problem. The healthcare workers that are absent most of the time are the highly trained doctors and clinical officers. According to IntraHealth, "results from a recent study in Uganda show that healthcare workers are missing from their position 35% of the time." Only about half of nursing positions are occupied in public health facilities in Uganda. The critical lack of staffing of healthcare workers can create an absence of motivation and responsibility among healthcare workers that are filling positions. When workers are not satisfied, they are not motivated which can negatively impact the health of the community they are serving in. Poorly motivated healthcare workers are more prone to leave their jobs for better opportunities elsewhere, in a more developed country. In the situation that Uganda is in, they can not afford to lose any more of their healthcare workers.
Healthcare workers are absent for several reasons. They are absent because some are furthering education, sickness, problems with housing or transport, social obligations, and disaster-related issues. Another element adding to the absence of healthcare workers is that they are not being held accountable by their supervisors. IntraHealth researchers did a study on the reason healthcare workers are absent most of the time. They interviewed several supervisors in public health facilities. They asked interviewees if there was a government policy on being absent and 33% said no, although there is a human resource policy that governs employees across the entire government. 11% of interviewees said they did not monitor staff coming and going and 14% said they did not use a reporting book. Supervisors were also asked another question whether or not they are included in decisions permitting their staff to be absent for extended periods of time, and 12% said no. So, the lack of accountability and motivation is a major contributing factor in the absenteeism of many healthcare workers in Uganda.
The accountability of healthcare workers needs to be maintained as well as the motivation of the workers. Accountability can be maintained by keeping track of all workers and ensuring they are working when they are supposed to be working and giving punishment for any workers that are out of work without approval from their supervisor. Motivation can be maintained by a positive relationship with supervisors and co-workers, sufficient career progression, sufficient compensation, and satisfactory working environment.
Drug shortage
There is a shortage of essential drugs in Uganda that are needed to treat the most prevalent diseases amongst children in the country. According to Uganda Country Working Group, "32% - 50% of vital medications to treat the most common disease such as malaria, HIV/AIDS, pneumonia, TB, diabetes, diarrhea, and hypertension are not easily accessible. This crisis is occurring because a serious stockout is occurring in hospitals and clinics. There was a national stockout for a drug called Coartem which is the drug used to treat malaria. Due to this national stockout, malaria was being medicated with quinine but quinine was not available so caretakers had to break the adult tablet into smaller pieces and in other cases where the adult dosage was unavailable, adults were given the child dosage. Some patients across the country are forced to travel far distances to other hospitals and clinics where drugs are still inaccessible, taking alternative treatments, or just waiting at home to die. According to doctors, "the drug shortage could lead to treatment failure and resistance to drugs".
The drug stockouts detrimentally affect 31.1% of Ugandans that live on a dollar a day by forcing them to pay for much higher priced medications from private hospitals and clinics. Those Ugandans that are surviving on a dollar a day most likely cannot afford the medication from a private facility so they are forced to do without and end up dying. Medication is usually one of the largest health expenses for people in developing countries and the stockouts only added to the severity of the problem.
According to a survey done by the Uganda Country Working Group, "the accessibility of Coartem, was 28% in the private sector, drugs for children were constantly below 30% in the private sector, Amoxillin delay was 13%, and Cotrimoxazole (Septrin) delay was 29% which is the medication for upper respiratory tract infection, leading cause of death in children." Anti-diabetic medications were less than 50% in the public sector and hypertension medications were also less than 50% in public hospitals and clinics.
Reasons for drug shortage
Drug shortage is the result of medication theft, corrupt government and lack of prioritization. The constant low accessibility of essential child medications such as hypertension and diabetics portrays a lack of prioritization for child health in the country. The lack of prioritization and availability of vital medications is increasing the health epidemic in Uganda amongst children. The National Medical Store of Uganda is not the only supplier of drugs in the country and they only supply 30–40% of drugs. The rest of the drugs are bought by the government. This shows that the widespread stockout of drugs has to be from misconduct amongst the government, which is the main distributor of drugs across the country. The main reason for drug shortages are the corrupt government not buying drugs and using the money for other purposes or selling drugs to private hospitals and clinics.
Another major cause of drug shortage is theft of medications. Some districts also delay sending orders for medications but the National Medical Store has a schedule they follow of which regions they go to on what days. So, if districts delay sending order then they have to wait for the next time the delivery truck is set to deliver to their region.
HIV/AIDS originated in the early 20th century and has become a major public health concern and cause of death in many countries. AIDS rates varies significantly between countries, with the majority of cases concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total population infected worldwide – approximately 35 million people – were Africans, of whom around 1 million have already died. Eastern and Southern Africa alone accounted for an estimate of 60 percent of all people living with HIV and 100 percent of all AIDS deaths in 2011. The countries of Eastern and Southern Africa are most affected, leading to raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic, with life-expectancy in some countries reaching as low as thirty-nine years.
Tropical medicine is an interdisciplinary branch of medicine that deals with health issues that occur uniquely, are more widespread, or are more difficult to control in tropical and subtropical regions.
The United States President's Emergency Plan For AIDS Relief (PEPFAR) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. Launched by U.S. President George W. Bush in 2003, as of May 2020, PEPFAR has provided about $90 billion in cumulative funding for HIV/AIDS treatment, prevention, and research since its inception, making it the largest global health program focused on a single disease in history until the COVID-19 pandemic. PEPFAR is implemented by a combination of U.S. government agencies in over 50 countries and overseen by the Global AIDS Coordinator at the United States Department of State. As of 2023, PEPFAR has saved over 25 million lives, primarily in sub-Saharan Africa.
Health in Uganda refers to the health of the population of Uganda. The average life expectancy at birth of Uganda has increased from 59.9 years in 2013 to 63.4 years in 2019. This is lower than in any other country in the East African Community except Burundi. As of 2017, females had a life expectancy higher than their male counterparts of 69.2 versus 62.3. It is projected that by 2100, males in Uganda will have an expectancy of 74.5 and females 83.3. Uganda's population has steadily increased from 36.56 million in 2016 to an estimate of 42.46 in 2021. The fertility rate of Ugandan women slightly increased from an average of 6.89 babies per woman in the 1950s to about 7.12 in the 1970s before declining to an estimate 5.32 babies in 2019. This figure is higher than most world regions including South East Asia, Middle East and North Africa, Europe and Central Asia and America. The under-5-mortality-rate for Uganda has decreased from 191 deaths per 1000 live births in 1970 to 45.8 deaths per 1000 live births in 2019.
The global pandemic of HIV/AIDS began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), by 2023, HIV/AIDS had killed approximately 40.4 million people, and approximately 39 million people were infected with HIV globally. Of these, 29.8 million people (75%) are receiving antiretroviral treatment. There were about 630,000 deaths from HIV/AIDS in 2022. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2020, there are approximately 1.5 million new infections of HIV per year globally.
Diseases of poverty, also known as poverty-related diseases, are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one of the major social determinants of health. The World Health Report (2002) states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with existing interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition. Poverty increases the chances of having these diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to health services contributes towards poor health behaviour. At the same time, these diseases act as a barrier for economic growth to affected people and families caring for them which in turn results into increased poverty in the community. These diseases produced in part by poverty are in contrast to diseases of affluence, which are diseases thought to be a result of increasing wealth in a society.
The human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. It can be managed with treatment. Without treatment it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS).
Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.
Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.
HIV/AIDS in Lesotho constitutes a very serious threat to Basotho and to Lesotho's economic development. Since its initial detection in 1986, HIV/AIDS has spread at alarming rates in Lesotho. In 2000, King Letsie III declared HIV/AIDS a natural disaster. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2016, Lesotho's adult prevalence rate of 25% is the second highest in the world, following Eswatini.
As of 2012, approximately 1,100,000 people in Malawi are HIV-positive, which represents 10.8% of the country's population. Because the Malawian government was initially slow to respond to the epidemic under the leadership of Hastings Banda (1966–1994), the prevalence of HIV/AIDS increased drastically between 1985, when the disease was first identified in Malawi, and 1993, when HIV prevalence rates were estimated to be as high as 30% among pregnant women. The Malawian food crisis in 2002 resulted, at least in part, from a loss of agricultural productivity due to the prevalence of HIV/AIDS. Various degrees of government involvement under the leadership of Bakili Muluzi (1994–2004) and Bingu wa Mutharika (2004–2012) resulted in a gradual decline in HIV prevalence, and, in 2003, many people living in Malawi gained access to antiretroviral therapy. Condoms have become more widely available to the public through non-governmental organizations, and more Malawians are taking advantage of HIV testing services.
Mozambique is a country particularly hard-hit by the HIV/AIDS epidemic. According to 2008 UNAIDS estimates, this southeast African nation has the 8th highest HIV rate in the world. With 1,600,000 Mozambicans living with HIV, 990,000 of which are women and children, Mozambique's government realizes that much work must be done to eradicate this infectious disease. To reduce HIV/AIDS within the country, Mozambique has partnered with numerous global organizations to provide its citizens with augmented access to antiretroviral therapy and prevention techniques, such as condom use. A surge toward the treatment and prevention of HIV/AIDS in women and children has additionally aided in Mozambique's aim to fulfill its Millennium Development Goals (MDGs). Nevertheless, HIV/AIDS has made a drastic impact on Mozambique; individual risk behaviors are still greatly influenced by social norms, and much still needs to be done to address the epidemic and provide care and treatment to those in need.
HIV and AIDS is a major public health issue in Zimbabwe. The country is reported to hold one of the largest recorded numbers of cases in Sub-Saharan Africa. According to reports, the virus has been present in the country since roughly 40 years ago. However, evidence suggests that the spread of the virus may have occurred earlier. In recent years, the government has agreed to take action and implement treatment target strategies in order to address the prevalence of cases in the epidemic. Notable progress has been made as increasingly more individuals are being made aware of their HIV/AIDS status, receiving treatment, and reporting high rates of viral suppression. As a result of this, country progress reports show that the epidemic is on the decline and is beginning to reach a plateau. International organizations and the national government have connected this impact to the result of increased condom usage in the population, a reduced number of sexual partners, as well as an increased knowledge and support system through successful implementation of treatment strategies by the government. Vulnerable populations disproportionately impacted by HIV/AIDS in Zimbabwe include women and children, sex workers, and the LGBTQ+ population.
Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.
With an estimated 150,000 people living with HIV/AIDS in 2016, Haiti has the most overall cases of HIV/AIDS in the Caribbean and its HIV prevalence rates among the highest percentage-wise in the region. There are many risk-factor groups for HIV infection in Haiti, with the most common ones including lower socioeconomic status, lower educational levels, risky behavior, and lower levels of awareness regarding HIV and its transmission.
In precolonial Ghana, infectious diseases were the main cause of morbidity and mortality. The modern history of health in Ghana was heavily influenced by international actors such as Christian missionaries, European colonists, the World Bank, and the International Monetary Fund. In addition, the democratic shift in Ghana spurred healthcare reforms in an attempt to address the presence of infectious and noncommunicable diseases eventually resulting in the formation of the National Health insurance Scheme in place today.
The current population of Myanmar is 54.05 million. It was 27.27 million in 1970. The general state of healthcare in Myanmar is poor. The military government of 1962-2011 spent anywhere from 0.5% to 3% of the country's GDP on healthcare. Healthcare in Myanmar is consistently ranked among the lowest in the world. In 2015, in congruence with a new democratic government, a series of healthcare reforms were enacted. In 2017, the reformed government spent 5.2% of GDP on healthcare expenditures. Health indicators have begun to improve as spending continues to increase. Patients continue to pay the majority of healthcare costs out of pocket. Although, out of pocket costs were reduced from 85% to 62% from 2014 to 2015. They continue to drop annually. The global average of healthcare costs paid out of pocket is 32%. Both public and private hospitals are understaffed due to a national shortage of doctors and nurses. Public hospitals lack many of the basic facilities and equipment. WHO consistently ranks Myanmar among the worst nations in healthcare.
A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index. Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.
Expenditure on health in Senegal was 4.7% of GDP in 2014, US$107 per capita.
HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.
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