Stunting, food security, markets and food policy in Rwanda

Insect pollinators can unlock an annual monetary value of more than US $100 million from crop production in Rwanda

Insect pollinators provide a natural ecosystem service to more than 80% of known flowering plants, many of which are part of our diet. However, their importance in Africa and an agriculture-dependent country like Rwanda has yet to receive attention. This encumbers policy formulation and investments in insect pollinators as a strategic agronomic input. Meanwhile, Rwanda cultivates crops that can benefit significantly from insect pollinators for superior agronomic outputs. To uncover this, we characterized the dependence of the crop production subsector on insect pollinators. Using the bioeconomic approach, we assessed the total economic value and the value due to insect pollinators of crops cultivated in Rwanda. We also evaluated the crop's production value per ton and whether production would meet consumption demands in the complete absence of insect pollinators. Using 71 representative crops currently grown in Rwanda, we found a direct dependency of 62% on insect pollinators. Of 32 representative crops used for economic valuation in two years (2014 and 2020), their total monetary value is estimated at $2.551 billion to $2.788 billion. Direct insect pollinator-dependent crops accounted for 20% (2014) to 18% (2020) of this value, with the share attributed to insect pollinators above $100 million. The sector's vulnerability to insect pollinators decreased from 7.3% in 2014 to 4.3% in 2020. The mean production value per ton of the direct insect pollinator-dependent crops was found to be higher in 2014 before declining in 2020. Using 21 representative crops from 2014 to 2020, we found that many direct insect pollinator-dependent crops will struggle to meet consumption demands in the complete absence of all suitable insect pollinators. Finally, we propose interventions and future research that could be undertaken. These insights are a critical first step to propel the government to act on insect pollination to support its food security agenda.

A predictive modelling approach to illustrate factors correlating with stunting among children aged 12-23 months: a cluster randomised pre-post study

OBJECTIVE

The aim of this study was to construct a predictive model in order to develop an intervention study to reduce the prevalence of stunting among children aged 12-23 months.

DESIGN

The study followed a cluster randomised pre-post design and measured the impacts on various indicators of livelihood, health and nutrition. The study was based on a large dataset collected from two cross-sectional studies (baseline and endline).

SETTING

The study was conducted in the north-eastern region of Bangladesh under the Sylhet division, which is vulnerable to both natural disasters and poverty. The study specifically targeted children between the ages of 12 and 23 months.

MAIN OUTCOME MEASURES

Childhood stunting, defined as a length-for-age z-score <-2, was the outcome variable in this study. Logistic and probit regression models and a decision tree were constructed to predict the factors associated with childhood stunting. The predictive performance of the models was evaluated by computing the area under the receiver operating characteristic (ROC) curve analysis.

RESULTS

The baseline survey showed a prevalence of 52.7% stunting, while 50.0% were stunted at endline. Several factors were found to be associated with childhood stunting. The model's sensitivity was 61% and specificity was 56%, with a correctly classified rate of 59% and an area under the ROC curve of 0.615.

CONCLUSION

The study found that childhood stunting in the study area was correlated with several factors, including maternal nutrition and education, food insecurity and hygiene practices. Despite efforts to address these factors, they remain largely unchanged. The study suggests that a more effective approach may be developed in future to target adolescent mothers, as maternal nutrition and education are age-dependent variables. Policy makers and programme planners need to consider incorporating both nutrition-sensitive and nutrition-specific activities and enhancing collaboration in their efforts to improve the health of vulnerable rural populations.

TRIAL REGISTRATION NUMBER

RIDIE-STUDY-ID-5d5678361809b.

Prevalence and Correlates of Stunting among Children Aged 6-23 Months from Poor Households in Rwanda

Stunted linear growth continues to be a public health problem that overwhelms the entire world and, particularly, developing countries. Despite several interventions designed and implemented to reduce stunting, the rate of 33.1% is still high for the proposed target of 19% in 2024. This study investigated the prevalence and associated factors of stunting among children aged 6-23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother-child dyads (two individuals from one home) living in low-income families in five districts with a high prevalence of stunting. Descriptive statistics were used to determine the prevalence of stunting. In addition, we used bivariate analysis and a multivariate logistic regression model to measure the strength of the association between childhood stunting and exposure variables. The prevalence of stunting was 34.1%. Children from households without a vegetable garden (AOR = 2.165, p-value < 0.01), children aged 19-23 months (AOR = 4.410, p-value = 0.01), and children aged 13-18 months (AOR = 2.788, p-value = 0.08) showed increased likelihood of stunting. On the other hand, children whose mothers were not exposed to physical violence (AOR = 0.145, p-value < 0.001), those whose fathers were working (AOR = 0.036, p-value = 0.001), those whose parents were both working (AOR = 0.208, p-value = 0.029), and children whose mothers demonstrated good hand washing practice (AOR = 0.181, p-value < 0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of handwashing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight child stunting.

Dietary Diversity, Household Food Insecurity and Stunting among Children Aged 12 to 59 Months in N'Djamena-Chad

BACKGROUND

Household food insecurity is increasingly recognized as a global health problem, particularly in sub-Saharan Africa. This study aimed to contextualize the associations between household food insecurity, dietary diversity and stunting in N'Djamena.

METHODS

This study is a community-based cross-sectional study, and the SMART (Standardized Monitoring and Assessment of Relief and Transitions) methodology was used to calculate the sample size. A total of 881 households were selected for the survey. A 24-h recall evaluated the dietary diversity score (DDS), the Household Food Insecurity Access Scale (HFIAS) made it possible to assess household food insecurity (HFI), and stunting among children aged 12 to 59 months was assessed by anthropometric measurements. Logistic regression was constructed to determine the association between household food insecurity, dietary diversity, and stunting. The study was conducted from January to March 2022.

RESULTS

The prevalence of severe food insecurity was 16.6%, and that of stunting was 25.3%. The mean DDS was 6.5 ± 1.6. Severe food insecurity (OR 2.505, CI: 1.670-3.756) was significantly associated with stunting. The association between DDS and stunting was not significant.

CONCLUSIONS

This study's prevalence of household food insecurity and stunting was very high. Household food insecurity and household size were significantly associated with stunting.

Prediction of Stunting Among Under-5 Children in Rwanda Using Machine Learning Techniques

OBJECTIVES

Rwanda reported a stunting rate of 33% in 2020, decreasing from 38% in 2015; however, stunting remains an issue. Globally, child deaths from malnutrition stand at 45%. The best options for the early detection and treatment of stunting should be made a community policy priority, and health services remain an issue. Hence, this research aimed to develop a model for predicting stunting in Rwandan children.

METHODS

The Rwanda Demographic and Health Survey 2019-2020 was used as secondary data. Stratified 10-fold cross-validation was used, and different machine learning classifiers were trained to predict stunting status. The prediction models were compared using different metrics, and the best model was chosen.

RESULTS

The best model was developed with the gradient boosting classifier algorithm, with a training accuracy of 80.49% based on the performance indicators of several models. Based on a confusion matrix, the test accuracy, sensitivity, specificity, and F1 were calculated, yielding the model's ability to classify stunting cases correctly at 79.33%, identify stunted children accurately at 72.51%, and categorize non-stunted children correctly at 94.49%, with an area under the curve of 0.89. The model found that the mother's height, television, the child's age, province, mother's education, birth weight, and childbirth size were the most important predictors of stunting status.

CONCLUSIONS

Therefore, machine-learning techniques may be used in Rwanda to construct an accurate model that can detect the early stages of stunting and offer the best predictive attributes to help prevent and control stunting in under five Rwandan children.

What Kigali’s open-air markets reveal about achieving food and nutrition security: the role of African indigenous crops

Background

Household dietary diversity in Rwanda remains low and significantly contributes to the double burden of malnutrition. Rwanda has one of the highest under five stunting rates globally, and malnutrition remains one of the most pressing public health issues; therefore, factors that shape food and nutrition security are of utmost concern. Globally, the variety of foods available in open-air markets has been shown to affect dietary diversity. Furthermore, the consumption of indigenous foods can contribute to a diverse diet and improve nutrition status. At present, there are limited data on foods available for purchase in open-air markets in Africa. Therefore, this study was designed to provide data on food availability in the largest open-air markets of Rwanda’s most populated city, Kigali, and to highlight which foods indigenous to Africa can be purchased.

Methods

All consumables were inventoried between October and December of 2020 in three open-air markets of Kigali, the capital city of Rwanda. Consumables were organized by the site of domestication and the nutritional contents of some African indigenous crops were compared to similar non-indigenous items.

Results

A variety of raw and processed consumables was available in the open-air markets inventoried; however, only 25.8% of available species are indigenous to Africa. All Rwanda’s staples, including sweet potatoes, plantains, beans, maize, banana, and cassava, are endemic to other continents. Indigenous plant species, which are often drought-resistant and more nutritious, for example, Africa’s pineapple fruits (Myrianthus holstii), could not be purchased in Kigali’s open-air markets. Pineapple fruits are richer in iron, vitamin C, protein, and vitamin A than banana, which is the most consumed fruit in Rwanda.

Conclusions

Given rapid population growth, limited arable land, and erratic climate patterns, policies to conserve and promote indigenous species, especially those already adapted to harsh environmental conditions, should be enacted in Rwanda. The cultivation of native vegetables and fruits in home gardens, and the conservation of edible wild species, can improve dietary diversity and enhance food and nutrition security across the entire country.

Child stunting and associated risk factors in selected food-insecure areas in Rwanda: an analytical cross-sectional study

Introduction

stunting rates among the under-five children are generally high in Rwanda. They are unexpectedly lower than the national average stunting rate in some districts where poverty rates are the highest in the country. This study aimed to ascertain the key factors that protect children from stunting in these poorest areas, where stunting rates are lower than expected.

Methods

we analysed cross-sectional data from 2019/2020 Rwanda Demographic and Health Survey (RDHS) for 477 under-five children from Karongi, Rulindo, Nyanza, and Gisagara districts. Univariate and bivariate statistical analyses were used to find out the factors to retain for multivariable analysis. We obtained the key risk factors of child stunting through a multivariable binary logistic regression analysis.

Results

the child stunting rate in the study districts was 30 percent, which is three percent lower than the national average rate. Child stunting was negatively associated with a birth weight of at least 2.5 kg (AOR = 0.393, 95% CI: 0.180 - 0.856), a high household economic status (AOR = 0.506, 95%CI: 0.273 - 0.937), urban residence (AOR = 0.467; 95% CI: 0.222 - 0.984), and health insurance coverage (AOR = 0.418; 95% CI: 0.228 -0.767). Children aged one year and above, as well as female-headed households, were associated with at least three times and two times greater odds of child stunting than children aged below 12 months and those from male-headed households respectively.

Conclusion

the nutritional performance of children in the study districts is substantially driven by the high uptake of health insurance, which fosters increased access to healthcare services. To address child-stunting gaps in low-income areas in Rwanda, child nutrition programs should improve the utilization of healthcare services, and leverage the potential high effect of nutrition education, especially during pregnancy and lactation.

When Local Trade-Offs between SDGs Turn Out to Be Wealth-Dependent: Interaction between Expanding Rice Cultivation and Eradicating Malaria in Rwanda

Interactions between SDGs are increasingly mapped and mediating factors that determine whether existing synergies or trade-offs can be identified. However, if and how the wealth status of the concerned population shapes whether SDG interaction constitutes a vicious or virtuous circle is largely overlooked. This article focuses on interaction between SDG2 (nutrition) and SDG3 (health), in particular, the relationship between rice production intensification and the fight against malaria, and thus the role of wealth in explaining the trade-off. This study employed a large-scale survey of rural households (n = 3968) in eastern Rwanda, conducted at a time when a rapid expansion of rice fields co-existed with a strong resurgence of malaria. Logistic regression shows that rice-cultivating households faced significant higher malaria risk, as proxied by fever incidence, confirming the negative externality of agricultural intensification on public health through offering a habitat for vector-borne diseases. Even though rice-cultivating households tend to be higher up the local wealth distribution than those outside the rice sector, its distributional effects are generally biased against the poor. Poorer households outside the rice sector hardly share in the benefits from increased rice production but suffer the consequences in terms of increased malaria risk. The case thus draws attention to the importance of using a distributional lens when analyzing interaction between SDGs locally.

Potential Role of African Fermented Indigenous Vegetables in Maternal and Child Nutrition in Sub-Saharan Africa

Hunger and malnutrition continue to affect Africa especially the vulnerable children and women in reproductive age. However, Africa has indigenous foods and associated traditional technologies that can contribute to alleviation of hunger, malnutrition, and communicable and noncommunicable diseases. The importance of African indigenous vegetables is undeniable, only that they are season-linked and considered as "food for poor" despite their high nutritional contents. The utilization of African indigenous vegetables (AIVs) is hindered by postharvest losses and antinutrients affecting the bioavailability of nutrients. In Africa, fermentation is among the oldest food processing technologies with long history of safe use. Apart from extending shelf life and improving food organoleptic properties, fermentation of African indigenous vegetables (AIVs) is known to improve food nutritional values such as proteins, minerals, vitamins, and other beneficial phytochemicals. It can also increase bioavailability of various vitamins, minerals, and phytochemicals and increase synthesis of vital blood pressure regulators thus protecting against cardiovascular diseases and cancer and further helping fight certain malnutrition deficiencies. Some lactic acid bacteria (LAB) involved in food fermentation are known to produce exopolysaccharides with cholesterol-lowering, immunomodulator, antioxidant, and anticancer properties. Fermented foods (vegetables) are superior in quality and safety since most microorganisms involved in fermentation are good starter cultures that can inhibit the growth of foodborne pathogens and detoxify harmful compounds in foods. Thus, fermented foods can boost growth and well-being in children and women due to their higher nutritional contents. Therefore, fermentation of AIVs can contribute to the attainment of food and nutrition security especially among women and children who rely on these vegetables as a staple source of micronutrients and income. These benefits have a positive impact on the implementation of the second sustainable development goals and African Union agenda 2063. This review is aimed at shedding light on the potential of African fermented indigenous vegetables in combating maternal and child malnutrition in Sub-Sahara Africa.

The future of human malnutrition: rebalancing agency for better nutritional health

The major threat to human societies posed by undernutrition has been recognised for millennia. Despite substantial economic development and scientific innovation, however, progress in addressing this global challenge has been inadequate. Paradoxically, the last half-century also saw the rapid emergence of obesity, first in high-income countries but now also in low- and middle-income countries. Traditionally, these problems were approached separately, but there is increasing recognition that they have common drivers and need integrated responses. The new nutrition reality comprises a global ‘double burden’ of malnutrition, where the challenges of food insecurity, nutritional deficiencies and undernutrition coexist and interact with obesity, sedentary behaviour, unhealthy diets and environments that foster unhealthy behaviour. Beyond immediate efforts to prevent and treat malnutrition, what must change in order to reduce the future burden? Here, we present a conceptual framework that focuses on the deeper structural drivers of malnutrition embedded in society, and their interaction with biological mechanisms of appetite regulation and physiological homeostasis. Building on a review of malnutrition in past societies, our framework brings to the fore the power dynamics that characterise contemporary human food systems at many levels. We focus on the concept of agency, the ability of individuals or organisations to pursue their goals. In globalized food systems, the agency of individuals is directly confronted by the agency of several other types of actor, including corporations, governments and supranational institutions. The intakes of energy and nutrients by individuals are powerfully shaped by this ‘competition of agency’, and we therefore argue that the greatest opportunities to reduce malnutrition lie in rebalancing agency across the competing actors. The effect of the COVID-19 pandemic on food systems and individuals illustrates our conceptual framework. Efforts to improve agency must both drive and respond to complementary efforts to promote and maintain equitable societies and planetary health.

Building a resilient and sustainable food system in a changing world - A case for climate-smart and nutrient dense crops

Current food production and consumption practices have had negative impacts on the environment and are central to global health concerns. Using a mixed-methods review, we examined the nutritional and environmental impacts of our global food systems and addressed the apparent decrease in food sources and crop diversity, and its implication on sustainable and healthy diets. Moreover, we explored the merits of weighing the use of natural capital and agricultural inputs against the output generated in terms of nutrient density. Transforming our food systems to safeguard planetary health will require a shift towards sufficient production of nutrient dense crops that are environmentally sustainable. Such a transformation largely depends on valuing crops for their natural nutrient density and matching them to suitable environments.

Agri-Food Markets in Qatar: Drivers, Trends, and Policy Responses

Agri-food markets are vital in achieving food security, especially for resource-poor, food-importing countries such as Qatar. The paper provides an overview of the evolution of agri-food markets in Qatar and explores the implications of past and ongoing changes in terms of food security and food system sustainability. In particular, the review analyzes drivers of changes, trends, and challenges as well as policy responses to address the emerging challenges while ensuring the country’s food security. It draws upon a systematic review of scholarly literature indexed in the Web of Science as well as data from gray literature (e.g., reports) and databases (e.g., FAOSTAT). Different drivers (e.g., population growth with huge expatriate inflow, urbanization, income increase) affected the functioning of agri-food markets as well as the structure of the food chain (viz. production, processing, distribution, consumption) in Qatar. In addition to drivers, the food-related trends were also shaped by numerous environmental (e.g., land/water scarcity), economic, health, and trade challenges. To ensure long-term food and nutrition security for its population, Qatar implemented various policies and strategies (e.g., National Food Security Strategy 2018–2023). In this context, agri-food markets, as functional links between production and consumption, can foster transition towards sustainable food consumption and production patterns in Qatar.

Agri-Food Markets towards Sustainable Patterns

In recent decades, the confluence of different global and domestic drivers has led to progressive and unpredictable changes in the functioning and structure of agri-food markets worldwide. Given the unsustainability of the current agri-food production, processing, distribution and consumption patterns, and the inadequate governance of the whole food system, the transition to sustainable agriculture and food systems has become crucial to effectively manage a global agri-food market able in supporting expected population growth and ensuring universal access to sufficient, safe, and nutritious food for all. Based on a critical review of the existing international literature, the paper seeks to understand the evolutionary paths of sustainability issues within agri-food markets by analyzing their drivers and trends. An extensive analysis was conducted highlighting the development and importance of the body of knowledge on the most important sustainability transition frameworks, focusing mainly on the relationship between markets, trade, food and nutrition security, and other emerging issues within agri-food markets. Finally, the study makes suggestions to extend the research in order to improve basic knowledge and to identify opportunities to design meaningful actions that can shape agri-food markets and foster their transition to sustainability.