Current health expenditure and under-five mortality rates in Uganda (2001 to 2021)

Abstract

Numerous studies in Sub-Saharan Africa have shown that increased healthcare spending contributes to lower child mortality rates. This study examined whether this relationship holds true for Uganda by assessing the impact of both economic and health system factors on under-five mortality between 2001 and 2021. The main objective was to determine the extent to which current health expenditure per capita influences child survival outcomes, alongside GDP per capita, immunization coverage, and population size. An observational ecological longitudinal (time-series) was used to analyze national-level data from Uganda (2001–2021) on under-five mortality and its one-year lagged predictors, including health expenditure, GDP per capita, immunization coverage, and population size. Data were obtained from UNICEF and World Bank databases. Ridge-adjusted hierarchical regression models were applied to assess associations while controlling for multicollinearity and ensuring model validity. Descriptive analysis revealed substantial variability in under-five mortality (mean = 81.5 deaths per 1,000 live births, standard deviation of 33.14.) and in economic indicators over the 21-year period. Correlation analysis indicated significant negative relationships between under-five mortality and health expenditure per capita, immunization coverage, population size, and GDP per capita. The hierarchical regression model showed that including immunization and population variables increased the explained variance in under-five mortality from 88% to 98%. In the ridge- adjusted model, current health expenditure per capita (β = –0.70, 95% CI -1.40 to -0.01, p = 0.047), immunization coverage (β = –0.97,95% CI -1.52 to -0.41, p = 0.002), and population (β = –2.85, 95% CI -3.86 -1.85, p < 0.001) remained significant predictors, while GDP per capita was not. The study concludes that higher current health expenditure per capita significantly reduces under- five mortality in Uganda, underscoring the importance of targeted health investments in improving child survival. Immunization coverage and population dynamics also play vital roles, whereas general economic growth alone does not ensure better health outcomes. Policy efforts should therefore focus on increasing and efficiently utilizing health spending and sustaining universal immunization programs to accelerate progress toward reducing under-five mortality.

Subject Keywords: Health expenditure; Children under-five; mortality rates; Child mortality; Uganda