Seasonality

The extent, causes and implications of seasonality in health facility delivery indicators: lessons from Rwanda

Seasonality in some health indicators is a known phenomenon, such as those linked to rainfall and food availability. Health interventions, such as distribution of mosquito nets, are scheduled around the seasonal norms. However, seasonality of maternal health indicators is less obvious and has not been investigated in detail in Rwanda. Our aim was to determine the extent of seasonality of these indicators to inform policy and implementation of interventions accordingly.

We used trend data from the Health Management Information System, disaggregating by month for the past ten years. We found strong seasonality for health deliveries, low in January and February and higher in May and June. A higher proportion of marriages are planned in July and August, which coincides with low rainfall. Other indicators follow the same trend but are not as marked.

The findings have implications in diverse areas:

• Trainings and annual leave of health professionals in maternity and neonatal units should be tailored to the seasonal workload.
• Routine orders for medical commodities should be adjusted for periods of high and low use to avoid stockouts.
• The use of an outlier detection tool in the Health Management Information System should be adapted for seasonal fluctuations in caseloads for some services.