Determinants of Under-Five Child Mortality in Rwanda: Analysis of the 2019/20 Rwanda Demographic and Health Survey

Abstract

Jean Marie Vianney NIYONSENGA, Amanuel Kidane Andegirogish and Monica Mochama

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.

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