title: Trends and social differentials in child mortality in Rwanda 1990-2010: results from three demographic and health surveys.
abstract: BACKGROUND
  Rwanda has embarked on ambitious programmes to provide equitable health services and reduce mortality in childhood. Evidence from other countries indicates that advances in child survival often have come at the expense of increasing inequity. Our aims were to analyse trends and social differentials in mortality before the age of 5 years in Rwanda from 1990 to 2010.
  
  
  METHODS
  We performed secondary analyses of data from three Demographic and Health Surveys conducted in 2000, 2005 and 2010 in Rwanda. These surveys included 34 790 children born between 1990 and 2010 to women aged 15-49 years. The main outcome measures were neonatal mortality rates (NMR) and under-5 mortality rates (U5MR) over time, and in relation to mother's educational level, urban or rural residence and household wealth. Generalised linear mixed effects models and a mixed effects Cox model (frailty model) were used, with adjustments for confounders and cluster sampling method.
  
  
  RESULTS
  Mortality rates in Rwanda peaked in 1994 at the time of the genocide (NMR 60/1000 live births, 95% CI 51 to 65; U5MR 238/1000 live births, 95% CI 226 to 251). The 1990s and the first half of the 2000s were characterised by a marked rural/urban divide and inequity in child survival between maternal groups with different levels of education. Towards the end of the study period (2005-2010) NMR had been reduced to 26/1000 (95% CI 23 to 29) and U5MR to 65/1000 (95% CI 61 to 70), with little or no difference between urban and rural areas, and household wealth groups, while children of women with no education still had significantly higher U5MR.
  
  
  CONCLUSIONS
  Recent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths.
authors: Department of Paediatrics and Child Health, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
authors: Aimable
authors: A
authors: Musafili
authors: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
authors: Birgitta
authors: B
authors: Essén
authors: Maternal and Child Health, Pediatric HIV-AIDS, PMTCT-Rwanda Program of the Institute of Human Virology, School of Medicine, University of Maryland, Kigali, Rwanda.
authors: Cyprien
authors: C
authors: Baribwira
authors: Ministry of Health, Kigali, Rwanda Harvard Medical School, Boston, Massachusetts, USA Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
authors: Agnes
authors: A
authors: Binagwaho
authors: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
authors: Lars-Åke
authors: LÅ
authors: Persson
authors: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
authors: Katarina Ekholm
authors: KE
authors: Selling
mesh_terms: D000293:Adolescent; D000328:Adult; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D063365:Genocide / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D012423:Rural Health; D012432:Rwanda / Q000453:epidemiology; D064890:Social Determinants of Health / Q000191:economics / Q000639:trends*; D014504:Urban Health; D014857:Warfare; D055815:Young Adult
keywords: CHILD HEALTH; INEQUALITIES; MORTALITY