Explaining The High Number of Deaths in 2023

The 2024 Vital Statistics data shows that nearly 33,000 people died in 2023

2024 is ending, and 2025 is next week. At KT Press, we are looking back to see what drove mortality, causing an unusual spike last year. We also paint a picture of what 2025 is like to bring.

As Rwanda’s economy continues its growth trajectory, boasting a GDP rise from $752 million in 1994 to $14.1 billion in 2023, the nation is experiencing a dual-edged transformation in public health. While improved healthcare infrastructure and services have led to better outcomes for communicable diseases, a growing prevalence of non-communicable diseases (NCDs) – often termed “rich-people diseases” – has emerged as an alarming consequence of economic development.

The phrase “rich-people diseases” is used metaphorically to describe diseases perceived to be more common in Western or affluent societies due to their association with modern, urbanized lifestyles.

With mortality statistics from the Rwanda Vital Statistics Report 2023, released in May 2024, the numbers tell a compelling story of a country grappling with the unintended health impacts of affluence. Non-communicable diseases (NCDs) such as cardiac disorders, diabetes, and cancers – accounted for 46 percent of all deaths. They were followed by communicable diseases such as HIV/AIDS, tuberculosis, and respiratory infections – accounting for 43 percent.  Injuries (External Causes) such as road traffic accidents and assault – took 11 percent of Rwandan lives.

Here is a deeper dive:

The Numbers That Speak Volumes

• Cardiac Disorders Lead the Pack:
  • “Other and unspecified cardiac diseases” accounted for 2,311 deaths (15% of total deaths), while acute cardiac disease caused 1,298 deaths (8.4%). These conditions are linked to stress, poor dietary habits, and limited physical activity, all common in urbanized, economically advancing societies.
• Rising Cancer Cases:
  • Digestive neoplasms (cancers) contributed to 1,343 deaths (8.7%), making them one of the top killers. Cancers tied to respiratory health, such as respiratory neoplasms, added 212 deaths (1.4%).
• Diabetes Mellitus:
  • A major concern, diabetes caused 629 deaths (4.1%), reflecting the impact of sugar-laden diets and sedentary living.
• Stroke:
  • Strokes, often linked to hypertension and poor cardiovascular health, claimed 831 lives (5.4%).
• Liver Cirrhosis:
  • Associated with alcohol consumption, this condition led to 266 deaths (1.7%).
• Chronic Obstructive Pulmonary Disease (COPD):
  • Resulted in 229 deaths (1.5%), highlighting the growing burden of smoking and urban air pollution.

From the report, apart from non-communicable diseases, malaria, and HIV, there are a few unusual or less common causes of mortality in Rwanda, even though their figures are relatively low. While unusual compared to the dominant non-communicable diseases and infections, highlight diverse health challenges in specific areas or populations.

1. Severe malnutrition: Though not highly frequent, it accounts for 1.1% of deaths recorded in communities.
2. Epilepsy: Another low-frequency cause of death, noted at 1.1% in communities.
3. Assault and road traffic accidents: These external causes are noted under injuries, contributing 2.9% and 2.5%, respectively, to community mortality.
4. Unspecified cardiac diseases: Surprisingly, this accounts for a significant 15% of community deaths, showing a notable occurrence despite being categorized as “unspecified”.
5. Cerebrovascular diseases (stroke): Also prevalent in community mortality statistics

2025: A Year to Watch

As 2024 ends and comes in 2025, it may bring an even sharper rise in “rich-people diseases” due to the following factors:

• Population Growth: Rwanda’s population reached 13.5 million in 2023, and urbanization is expected to accelerate.
• Dietary Shifts: Increasing dependence on processed and fast foods will likely worsen obesity, diabetes, and hypertension.
• Urban Pollution: Air quality challenges in Kigali and other growing cities could exacerbate respiratory diseases.

What Needs to Be Done

To curb the rise of “rich-man diseases,” the following measures must be prioritized:

• Public Awareness Campaigns: Educating citizens on healthy diets, physical activity, and regular health check-ups.
• Enhanced Healthcare Services: Expanding NCD prevention and treatment programs, particularly in rural areas.
• Tackling Air Pollution: Implementing stricter regulations on emissions in urban areas.
• Road Safety Initiatives: Reducing deaths from road accidents through infrastructure improvements and traffic law enforcement.

Here are the top 10 causes of mortality in Rwanda in 2023, ranked in descending order by percentage and explained with figures:

1. Other and Unspecified Cardiac Disorders
   • 15.0% of deaths, totaling 2,311 cases.This broad category includes deaths caused by various cardiac conditions not specifically diagnosed or categorized.
2. HIV/AIDS-Related Deaths
   • 9.5% of deaths, with 1,467 cases.This highlights the ongoing impact of HIV/AIDS as a leading cause of mortality despite advancements in treatment.
3. Digestive Neoplasms
   • 8.7%, accounting for 1,343 deaths.These include cancers affecting the digestive system, such as colorectal or stomach cancer.
4. Acute Cardiac Disease
   • 8.4%, or 1,298 deaths.Includes sudden and severe heart conditions, potentially indicating limited access to emergency cardiac care.
5. Stroke
   • 5.4%, with 831 cases.A major cause of disability and death, emphasizing the need for stroke prevention and treatment programs.
6. Diabetes Mellitus
   • 4.1%, resulting in 629 deaths.Reflects the growing burden of non-communicable diseases in Rwanda, likely linked to lifestyle changes.
7. Pulmonary Tuberculosis
   • 3.5%, representing 539 deaths.A reminder of the persistent challenge posed by tuberculosis, particularly in developing countries.
8. Acute Respiratory Infections, Including Pneumonia
   • 3.4%, or 524 deaths.Often associated with children and the elderly, these conditions underline the importance of respiratory care.
9. Assault (Homicide)
   • 2.9%, totaling 453 deaths.Reflects societal challenges and the need for enhanced public safety measures.
10. Diarrheal Diseases
    • 2.5%, with 392 cases.These preventable conditions highlight the importance of clean water, sanitation, and public health interventions

WHAT EXPLAINS SPIKE in 2023 compared to other years?

The trend in registered deaths from 2019 to 2023 shows both upward and downward shifts, with a notable spike in 2023. The reasons for these changes are explained as follows:

1. Factors Contributing to Upward and Downward Trends

• Death Registration Completeness:
  • The completeness of death registration improved significantly, from 31.1% in 2022 to 41.8% in 2023, which increased the number of recorded deaths in 2023. In earlier years, lower completeness rates likely contributed to underreporting of deaths.
• Epidemics and Health Crises:
  • In 2020 and 2021, the COVID-19 pandemic likely caused a temporary increase in deaths. However, disruptions in death registration during the pandemic may have led to underreporting, particularly in 2021.
• Impact of Public Health Measures:
  • Vaccination campaigns and improvements in healthcare services have contributed to fluctuations in mortality rates, particularly for preventable diseases like malaria and respiratory infections.

2. Reasons for the Spike in 2023

• Increased Mortality from NCDs and Injuries:
  • Non-communicable diseases (e.g., cardiac conditions) accounted for 46% of deaths, and external causes like road accidents increased to 11% of deaths, up from 8% in 2022.
• Improved Reporting Systems:
  • The adoption of the National Centralized and Integrated Civil Registration and Vital Statistics (NCI-CRVS) system in 2020 has enhanced the timeliness and accuracy of death registration. In 2023, 97.7% of deaths were registered within 30 days, an improvement from 94.8% in 2022.
• Population Growth:
  • Rwanda’s population has grown steadily, from 12.37 million in 2019 to 13.5 million in 2023, which naturally leads to more deaths due to a larger base population.
• Communicable Diseases:
  • Despite declines in malaria-related deaths, communicable diseases like HIV/AIDS and tuberculosis continue to contribute significantly, accounting for 43% of all deaths in 2023.