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Abstract:
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.
Trends in Neonatal Mortality in Rwanda, 2000-2010 (PDF, 855K)