Winter, Rebecca, Thomas Pullum, Anne Langston, Ndicunguye V. Mivumbi, Pierre C. Rutayisire, Dieudonne N. Muhoza, and Solange Hakiba. 2013. Trends in Neonatal Mortality in Rwanda, 2000-2010: Further Analysis of the Rwanda Demographic and Health Surveys. DHS Further Analysis Reports No. 88. Calverton, Maryland, USA: ICF International.
Between 2000 and 2010 a dramatic decline in under-five mortality in Rwanda was accompanied by a more modest reduction in the neonatal mortality rate (NMR). The improvement in the NMR was largely concentrated in rural areas, where coverage of maternal and delivery care services has increased most, with little improvement in urban areas, where coverage was already more widespread. This suggests that the improvement in NMR was driven by an increase in coverage of maternal and delivery care services, rather than an improvement in quality of care for those receiving services. This finding highlights the need to build on the success in expanding coverage by paying increased attention to the quality of services, to ensure that their full benefits are realized.
The study identified several key indicators of maternal care and other interventions with improved coverage between the 2000 and 2010 DHS surveys, including delivery by a health professional, delivery in a facility, use of antenatal care (ANC) services, early initiation of breastfeeding, and mosquito net ownership. Three of these indicators—use of ANC services, early initiation of breastfeeding, and mosquito net ownership—were found to be associated with lower probabilities of neonatal death, after adjusting for socio-demographic factors.
Even after controlling for socio-demographic characteristics and the mother’s use of maternal care services, mosquito net ownership remained independently associated with the reduction in neonatal mortality. This finding reinforces the importance of consistent and universal mosquito net use in areas with high prevalence of malaria.