Abstract
BackgroundSustained investments in Rwanda’s health system have led to historic reductions in under five (U5) mortality. Although Rwanda achieved an estimated 68% decrease in the national under U5 mortality rate between 2002 and 2012, according to the national census, 5.8% of children still do not reach their fifth birthday, requiring the next wave of child mortality prevention strategies.MethodsThis is a cross-sectional study of 9002 births to 6328 women age 15–49 in the 2010 Rwanda Demographic and Health Survey. We tested bivariate associations between 29 covariates and U5 mortality, retaining covariates with an odds ratio p < 0.1 for model building. We used manual backward stepwise logistic regression to identify correlates of U5 mortality in all children U5, 0–11 months, and 12–59 months. Analyses were performed in Stata v12, adjusting for complex sample design.ResultsOf 14 covariates associated with U5 mortality in bivariate analysis, the following remained associated with U5 mortality in multivariate analysis: household being among the poorest of the poor (OR = 1.98), child being a twin (OR = 2.40), mother having 3–4 births in the past 5 years (OR = 3.97) compared to 1–2 births, mother being HIV positive (OR = 2.27), and mother not using contraceptives (OR = 1.37) compared to using a modern method (p < 0.05 for all). Mother experiencing physical or sexual violence in the last 12 months was associated with U5 mortality in children ages 1–4 years (OR = 1.48, p < 0.05). U5 survival was associated with a preceding birth interval 25–50 months (OR = 0.67) compared to 9–24 months, and having a mosquito net (OR = 0.46) (p < 0.05 for both).ConclusionsIn the past decade, Rwanda rolled out integrated management of childhood illness, near universal coverage of childhood vaccinations, a national community health worker program, and a universal health insurance scheme. Identifying factors that continue to be associated with childhood mortality supports determination of which interventions to strengthen to reduce it further. This study suggests that Rwanda’s next wave of U5 mortality reduction should target programs in improving neonatal outcomes, poverty reduction, family planning, HIV services, malaria prevention, and prevention of intimate partner violence.
Highlights
Sustained investments in Rwanda’s health system have led to historic reductions in under five (U5) mortality
With the establishment of the Millennium Development Goals (MDGs), the United Nations Millennium project published a list of immediately implementable “quick impact initiatives” that could result in major short-term gains in health for relatively low cost [3]
This article aims to identify areas for potential further intervention by evaluating socio-demographic and health factors associated with Under five (U5) mortality in the 2010 Rwanda Demographic and Health Survey (RDHS)
Summary
Sustained investments in Rwanda’s health system have led to historic reductions in under five (U5) mortality. Millennium Development Goal Four (MDG4) called for a two-thirds reduction in under five (U5) mortality between 1990 and 2015. In contrast to regional trends, Rwanda achieved an estimated 70% decrease in the national U5 mortality rate between 2000 and 2011 [2]. Data suggest this could be the most rapid reduction of its kind ever documented, and as a result, Rwanda was one of a few low income countries to meet MDG4 by 2015 [1, 2]. Like many countries in sub-Saharan Africa [4], Rwanda’s Health Sector Strategic Plan includes many such interventions, these were integrated into a longer-term strategy, and included the elimination of user fees for some health services, the expansion of access to sexual and reproductive health information and services, and the training and support of community health workers [3, 5]
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