Determinants of Under-five Child Mortality in Rwanda: Analysis of the 2019/20 Rwanda Demographic and Health Survey

Background: Under-five child mortality (U5M) is a critical indicator of public health, particularly in regions with limited healthcare access. This study aimed to identify the determinants of U5M in Rwanda using data from the 2019/20 Rwanda Demographic and Health Survey (RDHS). Methods: A weighted sample of 8,324 Rwandan children under five was analyzed. Both bivariate and multivariate analyses were conducted to assess the relationships between U5M and a range of socioeconomic and healthcare-related factors. Results: The national under-five mortality rate (U5MR) was 38 deaths per 1,000 live births, with significant regional variations. The highest mortality rate was observed in the Northern region (44 deaths per 1,000 live births), while Kigali had the lowest rate (27 deaths per 1,000 live births). Key determinants of U5M included maternal employment (AOR = 2.23, 95% CI: 1.25-3.95), non-cesarean delivery (AOR = 1.84, 95% CI: 1.04-3.28), delayed breastfeeding initiation (AOR = 7.20, 95% CI: 4.93-12.72), multiple births (AOR = 2.19, 95% CI: 1.09-4.43), smaller-than-average birth size (AOR = 2.96, 95% CI: 1.83-4.78), and birth intervals shorter than 18 months (AOR = 1.91, 95% CI: 1.06-3.44). Conclusion: The findings highlight the need for targeted interventions, particularly in regions with higher mortality rates. Public health policies should focus on maternal and child health interventions, including breastfeeding promotion, maternal care, and addressing the needs of working mothers.