Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data

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.

Predictive model and determinants of under-five child mortality: evidence from the 2014 Ghana demographic and health survey

“…Under-five childhood mortality is significantly higher among children belonging to mothers who do not use and do not intend to use contraceptive compared to their counterparts from mothers who use modern contraceptive method. Also, the likelihood of under-five mortality increases with total children ever born and number of births in last 5 years and these findings are consistent with previous studies [15, 18, 25]. All these variables are related to family planning.…”

“…The likelihood of child survival decreased among children who are products of multiple births compared to their counterparts who were products of singletons. Low birthweight or competition for nutritional intake which occurs more among children who are products of multiple births could be a plausible explanation [11, 22, 25]. This study also showed that being a female child decreased the likelihood of under-five mortality.…”

“…Also, increase in total children ever born and number of births in last 5 years could result in lack of care, low birthweight, premature births and heavy drain on the limited household resources as children have to compete for the little resources available for their survival. A previous study also reported that meeting all the contraceptive needs of women could result in 17% reduction in under-five mortality [25, 28, 29].…”

Geostatistical analysis and mapping: social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana demographic and health survey

“…Monden and Smits (2017) show that mortality among under five children who were products of multiple births is 3 times higher than the mortality among singletons in sub-Saharan Africa [ 22 ]. This could partly be attributable to competition for nutrients and health complications that usually occur more among children who are products of multiple births [ 3 , 17 , 19 , 23 ]. The unexpected finding that the number of children under-five in household is associated with lower risk of U5M warrants further investigation as reported in a previous study [ 3 ].…”

Geostatistical analysis and mapping: Social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana Demographic and Health Survey.

“…It is also expected to result in optimal childcare and feeding practices with its resultant improved health outcomes for the child [3,[17][18][19]. U5M is significantly higher among children born multiple compared to those born singleton which could be due to competition for nutrients and health complications that usually occur more among children who are products of multiple births [3,17,19,20]. The unexpected finding that the number of children under-five in household is protective of U5M warrants further investigation as reported in a previous study [3].…”