OBJECTIVES: We assessed the levels and trends of childhood mortality between 1990 and 2006, and assessed the determinants of under-five mortality. Results of this study are intended to aid formulate health policy interventions in the achievement of the Millennium Development Goals.

METHODS: Three Uganda Demographic Health Survey (DHS) data sets collected in 1995, 2000/2001 and 2006 were used to estimate the levels and trends of childhood mortality between 1990 and 2006. The 2006 Uganda DHS was used to assess the determinants of under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 9,006 women aged 15-49 years who contributed 8369 children to the study. Proportions of the children were estimated, and Pearson's chi-square test was used to determine differences. Multivariate logistic regression analyses was used to assess the determinants of under-five mortality

RESULTS: Under-five mortality remained unchanged between the periods 1991-1995 and 1996-2000, and then declined in the period 2001-2005. Results of the Cox regression modelling show that sex of the child (female) was associated with a lower risk of under-five mortality, while birth interval (less than 24 months after the preceding birth), type of birth (multiple), region of residence (northern region), and mother's education (primary, and no education) were associated with an increased risk of children dying before their fifth birthday.

CONCLUSIONS: Uganda is not on track to meet the MDG Goal 4 (cutting under-five mortality by two-thirds by 2015-using the 1990 level as the baseline). However, with prompt multi-sectoral child health promotion strategies, coupled with diminished impacts of HIV/AIDS, and armed conflicts, improved maternal education, public enlightenment to lengthen birth intervals, improved living conditions in the north, the potential for Uganda to close the MDG 4 target gap remains high. Further studies are needed to assess the effects of contextual determinants of child survival in Uganda