Burden of diseases and Causes of deaths

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Overall 79,465 deaths were estimated to have occurred in the population during the year preceding the 2012 census with 39,863 expected deaths among males and 39,607 expected deaths among females (19). This represents, on average, about 218 deaths every day (19). The Crude Death Rate (CDR) in 2012 was 7.7 deaths per year per 1,000 inhabitants (19). The CDR was also greater among males (8.0‰) than females (7.4‰) (19).

Figure 4 Evolution of the CDR pp18.JPG

From 1978 to 2012, the standardized death rate (SDR) declined by 55% from 17.1‰ to 7.7‰. However, this decrease was not uniform over time (16). Between 1978 and 1991, the SDR dropped from 17‰ to 13‰. It then increased to reach 15‰ in 2002. From 2002-2012, the SDR experienced a more substantial decrease, and fell below 8‰ in 2012 (16).

This trend is consistent with the evolution of the health and socioeconomic status of Rwanda (16). From 1978-1991, improvements in access to health services, mass immunization campaigns, better housing, increased access to clean water and modern toilets, among numerous other improvements to living conditions led to a decline in mortality, especially among children.

The period from 1991 to 2002 was characterized by the 1994 genocide that claimed the lives of more than a million people, with direct consequences on mortality as well as indirect and long-term impact. In contrast, from 2002 to 2012, important improvements in the health sector and living conditions of the population led to a reduction of the leading causes of death in the country. The reduction in the leading causes of death are a result of many vigorous programs and interventions implemented throughout the country.

Rwanda experienced a notable decline in child mortality, with the under-five mortality rate declining from 196 deaths per 1,000 live births in 2000 to 50 deaths per 1,000 live births in 2015 (8). Additionally, infant mortality rate declined from 107 to 32 deaths per 1,000 live births between 2000 and 2015 (18).

Figure 5 Evolution of children mortality pp19.JPG

The maternal mortality ratio also experienced a notable decrease over the past 15 years from 1,071 deaths per 100,000 live births in 2000 to 210 deaths per 100,000 live births in 2015 (18).

Figure 6 Evolution of maternal mortality pp19.JPG

Reductions in child and maternal mortality can be explained by several factors including key initiatives in community health. These key initiatives include the use of community health workers (CHWs) who increase the coverage of effective interventions such as child immunization, exclusive breastfeeding, antenatal care attendance and deliveries in health facilities (20).

In 2015, infectious diseases accounted for 63% of outpatient (OPD) consultations in health centres for all age groups; with acute respiratory infections (26.4%), malaria (19.4%) and intestinal parasites (5.5%) as the most frequent reasons for outpatient consultation (17).

In district hospitals, tooth and gum diseases (24.4%) were the leading reasons for outpatient consultations in 2015, followed by eye diseases (13.1%), and physical trauma and fractures (7.8%) (17).

In 2015, emergency services represented the first reason for consultation in three of the public referral hospitals (University Teaching Hospital of Kigali, University Teaching Hospital of Butare and Rwanda Military Hospital), with emergency services representing 36.5%, 19% and 25.5% of consultations, respectively (17).

Regarding hospitalizations, the three top causes of admission in health centres in 2015 were malaria (17%), acute respiratory infections (7.7%) and obstetrical problems (7.6%) (17).

In hospitals, obstetrical problems (12.8%), neonatal illness (8.4%), physical trauma and fractures (7.3%) and malaria (7.3%) were the major causes of inpatient admission in 2015 (17).

In total, 12,467 deaths occurred in public health facilities in 2015 in Rwanda (17). Main causes of death in all public health facilities in 2015 included neonatal illness (13.7%), prematurity (11.3%) and cardio-vascular diseases (9.6%) (17). Together injuries, physical trauma and fractures accounted for 9.1% of deaths (17).

It should be noted that mortality data comes exclusively from health facilities through the Rwanda Health Management Information System (R-HMIS) (17). While the epidemiological profile in Rwanda is still dominated by communicable diseases, non-communicable diseases (NCDs) are on the rise (21)

Figure 14 Proportionate mortality due to NCDs in Rwanda.JPG