An analysis of admissions to the Paediatric Division, Mulago Hospital in 1959.

During the past decade, there has been a large influx of population into Kampala and the adjacent Mengo District of Buganda, and, in addition, people are becoming more and more hospital conscious. Both changes have considerably increased the number of attendances at hospital, thereby creating special problems in looking after an increasing number of patients without an expanding bed space. An index of the size of the problem is suggested by the fact that, while Uganda's total population is six and a half millions (1960 census), 44% of these are children. Kampala and Mengo District have shown the greatest increase in population of all parts of Uganda. The majority of our patients are the Baganda living in rural areas. The parents are peasant farmers, and the cultivation is done by the husband and wife or wives, assisted by labourers for those who can afford to engage them, using a hoe as the only implement for cultivation. There are no villages, but scattered homes; the way of life and the type of houses are changing rapidly. The demand for this change has focused the energies of most people on growing cash crops. Those who can read and write and speak some English drift to the towns to seekjobs in the expanding commercial town of Kampala. The life of the mothers of most of our patients is very arduous. She has the responsibility of growing food for the family, assisting the husband in cultivating fields of cash crops, providing water and firewood for the family and looking after her own four to eight children. Means of transport are difficult, although getting easier in most parts of the country. It is with these problems that the mother has to forsake her home and other children to bring her sick infant to hospital. This is reflected in the late arrival of many of the cases admitted and the high mortality soon after admission. The life of the educated and wealthier people is easier. They have quick means of transport. Mothers can attend child welfare clinics around Kampala, can afford to add milk to their children's diet and take their children sooner for medical advice. The immigrant tribes, designated as 'others' in this paper, include the Luo, Toro, Kiga, Nkole, Nubians, Lugbara, Nyoro, Alur, Lango, Atesot and Acholi, some of whom live in scattered housing estates around the town, and the overcrowded built-up slum areas that are found around big towns all over East Africa. They live the double life of working in towns until they have saved enough money to go home and stay at home for months before returning to work. They may or may not have their families with them. Their social problems are similar to those of other rapidly expanding towns in East Africa. The other big single group of immigrant tribes is that of people from Ruanda-Urundi, who come to work on large non-African plantations or get employed in rural areas on African farms. They face the strain of the journey, meet the problem of shortage of food in a subsistence agricultural community, work and save money to take home, and are exposed to new and different kinds of tropical parasites, as, for example, the severe manifestations of clinical malaria seen in those arriving in Kampala from the mountainous nonmalarial parts of Ruanda-Urundi. A higher incidence of kwashiorkor is found in children of this group. The Paediatric Division is part of Mulago Hospital, the teaching hospital of the University College