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Introduction
Although socio-economic conditions in developing countries have significantly improved in the last ten years, it still remains unclear if many of the millennium development goals (MDGs) were achieved by the 2015 deadline (Imam and Koch, 2004; Lay, 2010). Other regions appear to be on track to meet established targets but Sub-Saharan Africa and Oceania are falling behind (United Nations, 2013). Between 1990 and 2000, poverty rates increased in Sub-Saharan Africa (Mogford, 2004) and it has the highest child mortality rates worldwide at 98 deaths per 1,000 live births (You et al., 2013).
The United Nations and its agencies use the under-five mortality rate (U5MR) as an indicator of well-being and consequently decreasing this rate is millennium development goal number four (MDG 4) (United Nations, 2006). According to goal four, Uganda was expected to reduce U5MR by two-thirds; from 195 deaths in 1990 to 65 deaths per 1,000 births in 2015. However, between 1995 and 2000 the U5MR actually increased from 147.3 to 151.5 deaths per 1,000 live births. The reasons for the increase are not clear (UBOS, 2001; Okuonzi, 2004).
In many areas, substantial progress has been made toward achieving MDG 4. The total number of under-five deaths worldwide declined from 12.6 million in 1990 to 6.6 million in 2012. This implies that fewer than 17,000 children were dying every day in 2012 as compared to 1990 (UNICEF et al., 2012). In all regions, except for Sub-Saharan Africa and Oceania, U5MR reduced by at least 50 percent. The average annual rate of reduction in under-five mortality accelerated from 1.2 percent per year from 1990 to 1995 to 3.9 percent per year during the 2005-2012 period but this is still too low to achieve MDG 4, particularly in Oceania, Sub-Saharan Africa and Southern Asia (UNICEF et al., 2012).
In 2000, the Government of Uganda committed to meeting the global MDGs by 2015. In this regard, the government put particular attention on achieving MDG 4 for child survival. However, the country seems to be off track for this goal because an estimated 103,000 children die every year before their fifth birthday and the infant mortality rate (IMR) has remained high at 45 deaths per 1,000 live births (UNICEF et al., 2011, 2012)....