Rwanda has made tremendous gains in reducing under-five mortality rates over almost two decades now, according to a new study by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington’s School of Medicine.
IHME provides a rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them.
The study, dubbed, Mapping 123 Million Neonatal, Infant and Child Deaths between 2000 and 2017, was published on Wednesday in the journal Nature, a weekly journal that publishes the finest peer-reviewed research in all fields of science and technology.
It is seen as a tool that offers an opportunity to the identification of local success stories that could be replicated elsewhere, according to the researchers who carried out the study.
“Rwanda showed notable progress during the study period, reducing mortality from 144 in its best-achieving district in 2000 (Rubavu) to 57.2 in its worst-achieving district in 2017 (Kayonza),” the study states.
The highest district-level mortality rate was registered at 57.2 in Kayonza, while the lowest was 41.5 in Rubavu in 2017.
“Such gains have been partially credited to focused investments in the country’s poorest populations, expanding the Mutuelles de santé [– community-based health insurance –] program, and developing a strong workforce of community health workers who provide evidence-based treatment and health promotion,” the study pointed out.
They found that, in Rwanda, 19,328 children died before their fifth birthday in 2017, compared to 60,793 in 2000, representing a reduction of more than three times.
Globally, the report said, some 5.4 million children died before their fifth birthdays in 2017, as compared to 9.7 million in 2000, implying that, overall, successful reductions in child mortality were observed throughout entire countries.
Though the vast majority of the 17,554 districts among the 99 nations studied saw improvement in lowering child deaths, the report indicated that levels of inequality between districts were more variable over the study period.
According to the findings, mortality rates varied as much as 10-fold between districts within a country, while across all the countries studied, the likelihood of a child dying before age five varied more than 40-fold at the district level.
The study, the first of its kind, mapped child deaths in 99 low- and middle-income countries at the level of individual districts.
The findings include precision maps illuminating health disparities within countries and regions often obscured by national-level analyses.
The study, funded by the Bill & Melinda Gates Foundation, showed areas of success where strategies could be replicated across and within countries.
The researchers said they observed estimated under-five mortality rates of more than 80 across large geographical areas in Western and Central sub-Saharan Africa, and within Afghanistan, Cambodia, Haiti, Laos, and Myanmar.
“It is as reprehensible as it is tragic that, on average, nearly 15,000 children under age 5 die every day,” said Dr. Simon I. Hay, the senior author on the study, who is the Director of the Local Burden of Disease (LBD) group at IHME.
“Why are some areas doing so well, while others struggle? In order to make progress, we need to enable precise targeting of interventions, such as vaccines.
“Our findings provide a platform for nations’ health ministers, clinicians, and others to make focused improvements in health systems,” he said.