Inside Rwanda’s battle against early child deaths

Health Minister Dr Diane Gashumba vaccinates a child against measles and rubella in 2017. The country reduced under-5 mortality by 79 per cent since 2000, making it the biggest mover of change in improving children’s lives in the region. Courtesy.

Rwanda is the second global biggest mover of change in improving children’s lives over the last two decades, according to a new report by Save the Children.

Launched last week, the 2019 Global Childhood Report also named Rwanda as the country that made the most gains in the region in improving children’s lives.

It says the country reduced under-5 mortality by 79 per cent since 2000, an achievement the report largely attributes to major health sector reforms, investments in health workforce, increased immunisation coverage, and increased exclusive breastfeeding.

The report evaluates 176 countries across the globe on their ability to protect children ‘childhood enders’ – life-changing events like child marriage, early pregnancy, exclusion from education, sickness, malnutrition and violent deaths.

Mothers and their children wait for vaccination at a clinic. Courtesy.

“Many more children are in school and fewer children are married before age 18, with the out-of-school rate and child marriage rate both down by 60 percent. Rwanda also cut child labour, adolescent births and child homicides in half since 2000,” the report reads in part.

Rwanda’s score rose 241 points, from 503 in 2000 to 744 in Save the Children’s “End of Childhood”, with the report indicating that the central African nation “improved on most indicators” 25 years after the Genocide against the Tutsi.

Sierra Leone made the most dramatic progress globally, registering a 99 per cent reduction in the number of people forcibly displaced from home, with 1 in every 5 people displaced in 2000, compared to 1 in 700 today, the report adds.

Ethiopia and Niger also made significant progress globally, with the report citing “political choices” as the single most important factor behind the successes in the four African countries.

Globally, Singapore topped the rankings as the country that best protects and provides for its children, with eight Western European countries and South Korea completing the top 10.

Rwanda is among the four countries in East and Southern Africa, – alongside Ethiopia, Angola and Zambia – that increased their index scores by 200 points, representing substantial improvements for children over the past 20 years, the report shows.

But how did Kigali turn things around to become one of the most child-friendly countries on the continent?

According to findings from the 2015 Rwanda Demographic and Health Survey (RDHS), the infant mortality rate (IMR) and under-five mortality rate (U5MR) in the country had been declining significantly for the previous 15 years.

Under-five mortality rate (U5MR) is defined as the probability of dying between birth and exactly five years of age, expressed per 1,000 live births, while infant mortality rate (IMR) is probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.

In 2000 alone, as many as 107 infants (IMR) and 196 children under the age of five (U5MR) died in Rwanda, official figures indicated.

However, by 2014/15, these numbers had significantly plummeted, with IMR falling to 32 and U5MR to 50.

Crucially, the study showed that the country had consistently been making progress over the years.

For instance, in 2002 /03, IMR stood at 96 and U5MR at 173, with the mortality rates reducing in 2005 to 86 (IMR) and 152 (U5MR).

In 2007 /08, the country covered more ground, with infant mortality rate reducing to 62 deaths and U-5 mortality rate to 103, before further progress was registered by 2010 when 50 and 76 deaths (for IMR and U5MR, respectively), were recorded.

Beyond the numbers

But what’s behind these numbers?

This progress is in large part a result of a myriad of interventions and philosophy that drive public service delivery in the country, according to Dr Felix Sayinzoga, the division manager of maternal, clinic and community health at Rwanda Biomedical Centre (RBC).

 He cited a comprehensive policy approach that combines adolescent, maternal and child health which has been elaborated to ensure a continuum of care; starting from preconception period through five years of life.

“A specific strategic plan for child survival was elaborated and the top killer diseases identified and targeted in what we call integrated management of childhood illness,” he told this newspaper.

He cited diarrhea, pneumonia, and malaria. 

In addition, Sayinzoga said, a community health programme, was rolled out and has resulted into the deployment of community health workers that have played a major role in improving the lives of infants, children, mothers and children at the grassroots level. There are four Community Health Workers (CHWs) in each village, the smallest administrative unit in the country.

Two of these CHWs are in charge of treating under five children, specifically targeting the three killer diseases.

To protect children from the three killer diseases, Sayinzoga said Rwanda became the first country in Africa to introduce both vaccines against rotavirus (which causes many of the diarrhea cases) and the pneumococcal vaccine against pneumonia.

He said that a big proportion of under-five deaths occurs in the first days of life – known as the neonatal period – and the Government has rolled out several initiatives designed for that group of children.

In addition, a neonatology unit has been established in all health centres to extend specialised care to newborns, such as Kangaroo mother care for babies born prematurely.

Another initiative that has been commended for improving the health of infant is ‘Baby-to-Breathe’, which targets newborns in their first minute of life.

“All health providers in maternity wards can help a baby to breathe and this has helped in avoiding preventable deaths,” said Dr Sayinzoga.

All the while, he said, “all under-5 deaths are subject to clinical audits and this has been key to avoiding similar deaths in the future and inform next interventions.”

A network of health care providers involved with neonatology, pediatric and maternity services, as well as professional associations such as Rwanda Midwives Association, Rwanda Pediatric Association and Rwanda Society of Gynecologists and Obstetricians was also set up for continuous consultations and technical support.