Why is Uganda an Exemplar?

Reducing the prevalence of anemia has been a challenge for low- and middle-income countries (LMICs) worldwide, with global progress in anemia reduction stagnating since around 2010. However, a handful of LMICs have experienced substantial success in countering anemia in recent years.

These positive outliers have reduced anemia among women of reproductive age (WRA)—a segment of the population uniquely vulnerable to the condition—to a greater extent than might be predicted from these nations’ economic growth trajectories.

Uganda was selected as an Exemplar country for not only achieving a relatively high reduction in anemia prevalence that outpaced economic development, but also as a potential model for East Africa, a region with pockets of high anemia levels among WRA. Furthermore, as a malaria-endemic country, Uganda offers an important case study to explore the role of malaria prevention programs in anemia reduction.

From 2006 to 2016, Uganda experienced a reduction in mild, moderate, and severe anemia, with sharper declines in moderate and severe anemia. Severe anemia was defined as a hemoglobin concentration below 7.0 g/dL, moderate anemia as 7.0–9.9 g/dL, and mild anemia as 10.0–11.9 g/dL (or 10.0–10.9 g/dL for pregnant women and children under age three).^1,2

Overall, anemia prevalence in Uganda declined among non-pregnant women, from 40% in 2006 to 31% in 2016, and among pregnant women, from 50% to 38%. Although Uganda conducted a new Demographic and Health Survey in 2022, it did not include updated data on anemia prevalence.

Despite a slight increase in anemia prevalence between 2011 and 2016, Uganda’s overall decline from 2006 to 2016 reflects meaningful progress in anemia prevalence among WRA. This achievement positions Uganda as a strong performer both within East Africa and among other LMICs.

While all regions experienced a reduction in anemia among WRA from 2006 to 2016, the gains were not geographically uniform; progress in the Northern Region lagged behind other areas. The Western Region saw the greatest improvement, leading the country in reducing anemia prevalence, partly due to advancements in the health infrastructure, malaria control, and socioeconomic factors. Analyzing anemia prevalence by region, wealth quintile, urban versus rural residence, and maternal education level highlights these disparities and may help explain the observed increase in anemia prevalence from 2011 to 2016.

Our analysis found that the reduction of anemia among WRA was driven by improvements across multiple sectors. Key factors included enhanced malaria control, expanded access to family planning, sociodemographic advancements, strengthened nutrition governance, increased women’s education, improved health care utilization, and better antenatal care. These determinants are explored in greater detail throughout this narrative.