Background: The under five mortality rate (U5MR) is measure of wellbeing and decreasing the U5MR by two thirds is the target towards the achievement of the millennium development goal number four (MDG4). Objective: To describe the changes in U5MR in Uganda from 1954 to 2000 and use them to project future trends up to 2015. Methods: We did a retrospective analysis of the Uganda national censuses of 1969, 1991 and 2002. We calculated the percentage of the annual average reduction rate (AARR) of U5MR between the years 1954-1966, 1966- 1975, 1975-1988 and from 1988 to 2000. The AARRs of U5MR between 1954 and 2000 were then compared to that of 4.4% required to achieve MDG4. Results: The U5MR in Uganda between 1954 and 1966 decreased from 261 to 180 deaths per 1000 live births with an AARR of 3.05%. Between 1975 and 1988, the U5MR increased with AARR from 1966 to 1975 being -1.05% while the AARR from 1976 to 1988 was -0.11%. From 1988 to 2000 U5MR decreased from 205 to 152 deaths per 1000 live births with an AARR of 2.46%. Conclusions: The AARRs for the U5MR of -1.05-3.05% were below the 4.4% required to achieve MDG4.