Socioeconomic and Healthcare Determinants of Under-Five Mortality in Rwanda: Evidence from the 2019/20 RDHS
Mochama M and Andegirogish AK
Published on: 2025-03-26
Abstract
Background: Under-five child mortality (U5M) is a critical indicator of public health, particularly in regions with limited healthcare access. This study aimed to identify the socioeconomic and healthcare of U5M in Rwanda using data from the 2019/20 Rwanda Demographic and Health Survey (RDHS).
Methods: This study utilized secondary data from the 2019/20 RDHS, a nationally representative survey. A weighted sample of 8,324 children under five was analyzed. Both bivariate and multivariate analyses were conducted to assess the relationships between U5M and a range of socioeconomic and healthcare-related factors. The dependent variable was child mortality status, while independent variables included Maternal age at birth, Maternal education level, Maternal employment status, Household wealth index, Place of residence, Sex of the child, Birth order, Birth interval, Size at birth, Mode of delivery, Multiple births, Antenatal care visits, Place of delivery and Breastfeeding initiation time. Multivariate logistic regression was applied to control for confounders.
Results: The national under-five mortality rate (U5MR) was 38 deaths per 1,000 live births, with significant regional variations. The highest mortality rate was observed in the Northern region (44 deaths per 1,000 live births), while Kigali had the lowest rate (27 deaths per 1,000 live births). Key determinants of U5M included maternal employment (AOR = 2.23, 95% CI: 1.25-3.95), non-cesarean delivery (AOR = 1.84, 95% CI: 1.04-3.28), delayed breastfeeding initiation (AOR = 7.20, 95% CI: 4.93-12.72), multiple births (AOR = 2.19, 95% CI: 1.09-4.43), smaller-than-average birth size (AOR = 2.96, 95% CI: 1.83-4.78), and birth intervals shorter than 18 months (AOR = 1.91, 95% CI: 1.06-3.44).
Conclusion: The findings highlight the need for targeted interventions, particularly in regions with higher mortality rates. Public health policies should focus on maternal and child health interventions, including breastfeeding promotion, maternal care, and addressing the needs of working mothers.
Keywords
Under-five mortality; Rwanda; Demographic and Health Survey; Child health; DeterminantsIntroduction
Child mortality remains a major public health challenge globally, with under-five mortality rate (U5MR) serving as a key indicator of child health and overall development. Over the past three decades, substantial progress has been made in reducing U5MR worldwide, declining from 90 deaths per 1,000 live births in 1990 to 37.7 per 1,000 in 2019. However, this progress has been uneven, with sub-Saharan Africa accounting for more than 50% of all under-five deaths globally [1]. The leading causes of under-five deaths include neonatal conditions such as preterm birth complications, birth asphyxia, and infections, as well as pneumonia, diarrhea, and malnutrition While medical interventions such as immunization, oral rehydration therapy, and improved prenatal care have contributed to mortality reduction, many preventable deaths persist due to socioeconomic disparities, limited healthcare access, and gaps in maternal education [2].
Rwanda has made remarkable progress in reducing child mortality over the past two decades due to expanded healthcare coverage, improved maternal and child health programs, and government investments in community health. The under-five mortality rate (U5MR) declined from 238 deaths per 1,000 live births in 1994 to 50 per 1,000 in 2015, reflecting a nearly 75% reduction [3, 4]. This success coincided with malaria control interventions, integrated community case management (iCCM) of childhood illnesses, and expanded access to healthcare services. The implementation of iCCM led to a 38% decline in child mortality, while insecticide-treated net distribution increased from 4% to 70% among children under five, and indoor residual spraying covered 1.3 million people in high-burden districts by 2010 [5–7]. Interestingly, by 2010, disparities in U5MR between urban and rural areas had significantly narrowed, suggesting that Rwanda's efforts effectively reached marginalized populations [4]. However, socioeconomic and educational disparities persist, with children of mothers with no formal education still experiencing higher mortality rates. While Rwanda is among Africa’s top-performing countries in child survival, it has not yet met the Sustainable Development Goal (SDG) target of reducing U5MR to 25 per 1,000 live births by 2030 [8]. Addressing these remaining disparities requires a deeper understanding of the determinants influencing child survival.
Existing studies on child mortality in Rwanda have primarily focused on national-level trends, with limited research examining specific risk factors and regional disparities [9]. Furthermore, there is a gap in knowledge regarding how maternal, socioeconomic, and health-related factors influence U5M in Rwanda. This study aims to identify key determinants of under-five mortality using the latest 2019/20 RDHS data. Understanding these factors is critical for designing targeted interventions that can accelerate progress toward SDG child survival targets.
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