Rwanda: an impressive decline in child mortality and reduced differences between social groups


After the genocide in the mid-1990s, Rwanda initiated major social and health reforms to improve survival for all children. In his dissertation, Aimable Musafili from Uppsala University and the University of Rwanda reports an impressive decline in child mortality in Rwanda and disappearing social divides in child survival. Rwanda will as one of the few African countries reach the Millennium Development Goals for women's and children's health and survival. Challenges remain, especially at the time around delivery, when sustained efforts are needed to improve the quality of services for all.

In an analysis of the whole country over two decades, he demonstrates that child mortality had decreased. From the peak at time of the genocide when one in four children died it decreased to 65 deaths per 1000 births in 2010. Differences have disappeared in child survival between rural and urban areas and between rich and low-income families. Mortality in the first month of life has decreased more slowly, and children to educated mothers were less likely to die.

In hospital-based studies, he focuses stillbirths and deaths during the first week of life.  Mothers living in rural areas and those not covered by health insurances more frequently suffered such losses. Half of these deaths around delivery had been possible to prevent by removing barriers and improving the quality of care. A training program to manage the newborn child the first minutes of life (Helping Babies Breathe) improved knowledge and skills. A follow-up showed that repeated efforts were needed should this improved quality of care be sustained.