Musafili Aimable, Essén Birgitta, Baribwira Cyprien, Binagwaho Agnes, Persson Lars-Åke, Selling Katarina Ekholm
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.
Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
J Epidemiol Community Health. 2015 Sep;69(9):834-40. doi: 10.1136/jech-2014-204657. Epub 2015 Apr 13.
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.
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.
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.
Recent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths.
卢旺达已启动雄心勃勃的计划，以提供公平的卫生服务并降低儿童死亡率。其他国家的证据表明，儿童生存方面的进步往往是以不平等加剧为代价的。我们的目的是分析1990年至2010年期间卢旺达5岁以下儿童死亡率的趋势和社会差异。
我们对2000年、2005年和2010年在卢旺达进行的三次人口与健康调查的数据进行了二次分析。这些调查涵盖了1990年至2010年间15至49岁女性所生的34790名儿童。主要结局指标是随时间变化以及与母亲教育水平、城乡居住情况和家庭财富相关的新生儿死亡率（NMR）和5岁以下儿童死亡率（U5MR）。使用广义线性混合效应模型和混合效应Cox模型（脆弱模型），并对混杂因素和整群抽样方法进行了调整。
卢旺达的死亡率在1994年种族灭绝时达到峰值（NMR为每1000例活产60例，95%置信区间为51至65；U5MR为每1000例活产238例，95%置信区间为226至251）。20世纪90年代和21世纪头几年的特点是存在明显的城乡差距以及不同教育水平母亲群体在儿童生存方面的不平等。在研究期结束时（2005 - 2010年），NMR降至每1000例26例（95%置信区间为23至29），U5MR降至每1000例65例（95%置信区间为61至70），城乡之间以及家庭财富群体之间差异很小或没有差异，而未受过教育的女性所生子女的U5MR仍然显著较高。
卢旺达近期儿童死亡率的下降与儿童生存方面社会公平性的改善同时出现。当前的挑战包括预防新生儿死亡。
