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

Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data
Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data
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.
1471-2431
Amoroso, Cheryl L.
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Nisingizwe, Marie Paul
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Rouleau, Dominique
4c351096-0875-4f67-bcd5-2ff99c167331
Thomson, Dana R.
c6aa22a0-9ee2-4d86-9bd4-b3a8487eb15b
Kagabo, Daniel M.
df9a7f5b-45ec-4a29-be78-7655792367bd
Bucyana, Tatien
2cb21c5d-1324-46af-9dcd-1ed6edc5c536
Drobac, Peter
0bca14e5-381d-4cec-a798-3ccd07954092
Ngabo, Fidele
9369494d-61cc-4626-a8f1-5388a4695386
Amoroso, Cheryl L.
eaded4dc-3444-4d93-ae7c-80e5cf7d3aa1
Nisingizwe, Marie Paul
a3191db8-1453-4c61-9ff4-e0633c87e94d
Rouleau, Dominique
4c351096-0875-4f67-bcd5-2ff99c167331
Thomson, Dana R.
c6aa22a0-9ee2-4d86-9bd4-b3a8487eb15b
Kagabo, Daniel M.
df9a7f5b-45ec-4a29-be78-7655792367bd
Bucyana, Tatien
2cb21c5d-1324-46af-9dcd-1ed6edc5c536
Drobac, Peter
0bca14e5-381d-4cec-a798-3ccd07954092
Ngabo, Fidele
9369494d-61cc-4626-a8f1-5388a4695386

Amoroso, Cheryl L., Nisingizwe, Marie Paul, Rouleau, Dominique, Thomson, Dana R., Kagabo, Daniel M., Bucyana, Tatien, Drobac, Peter and Ngabo, Fidele (2018) Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data. BMC Pediatrics, 18 (1), [27]. (doi:10.1186/s12887-018-0997-y).

Record type: Article

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.

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Accepted/In Press date: 18 January 2018
e-pub ahead of print date: 5 February 2018
Published date: 5 February 2018

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Local EPrints ID: 431750
URI: http://eprints.soton.ac.uk/id/eprint/431750
ISSN: 1471-2431
PURE UUID: f8dd7131-11d5-4e7e-9773-6b71d88ef885
ORCID for Dana R. Thomson: ORCID iD orcid.org/0000-0002-9507-9123

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Date deposited: 14 Jun 2019 16:30
Last modified: 17 Dec 2019 01:28

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Contributors

Author: Cheryl L. Amoroso
Author: Marie Paul Nisingizwe
Author: Dominique Rouleau
Author: Dana R. Thomson ORCID iD
Author: Daniel M. Kagabo
Author: Tatien Bucyana
Author: Peter Drobac
Author: Fidele Ngabo

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