Socio-demographic and environmental determinants of under-5 stunting in Rwanda: Evidence from a multisectoral study

"When we have served meat, my husband comes first": A qualitative analysis of child nutrition among urban and rural communities of Rwanda

BACKGROUND

Stunting among children under five years of age is a global public health concern, especially in low-and middle-income settings. Emerging evidence suggests a gradual reduction in the overall prevalence of stunting in Rwanda, necessitating a qualitative understanding of the contributing drivers to help develop targeted and effective strategies. This qualitative study explored the lived experiences of women and men to identify key issues that influence childhood nutrition and stunting as well as possible solutions to address the problem.

METHODS

Ten (10) focus group discussions (FGDs) were conducted with fathers and mothers of children under five years of age from five districts, supplemented by forty (40) in-depth interviews (IDIs) with Nurses and Community Health Workers (CHWs). Transcripts were coded inductively and analysed thematically using Dedoose (version 9.0.86).

RESULTS

Three themes emerged: (1) Awareness of a healthy diet for pregnant women, infants, and children with subthemes Knowledge about maternal and child nutrition and feeding practices; (2) Personal and food hygiene is crucial while handling, preparing, and eating food with subthemes, food preparation practices and the feeding environment (3) factors influencing healthy eating among pregnant women, infants, and children with subthemes; Barriers and facilitators to healthy eating among pregnant women and children.

CONCLUSION

Several factors influence child stunting, and strategies to address them should recognise the cultural and social contexts of the problem. Prioritisation of nutrition-based strategies is vital and should be done using a multifaceted approach, incorporating economic opportunities and health education, especially among women, and allowing CHWs to counsel households with conflicts.

Leveraging multisectoral approach to understand the determinants of childhood stunting in Rwanda: a systematic review and meta-analysis

BACKGROUND

Addressing childhood stunting is a priority and an important step in the attainment of Global Nutrition Targets for 2025 and Sustainable Development Goals (SDGs). In Rwanda, the prevalence of child stunting remains high despite concerted efforts to reduce it.

METHODS

Utilizing the United Nations International Children's Emergency Fund (UNICEF) framework on maternal and child nutrition, this study systematically evaluated the determinants of child stunting in Rwanda and identified available gaps. Twenty-five peer-reviewed papers and five Demographic and Health Surveys (DHS) reports were included in the final selection of our review, which allowed us to identify determinants such as governance and norms including wealth index, marital status, and maternal education, while underlying determinants were maternal health and nutrition factors, early initiation of breastfeeding, water treatment and sanitation, and immediate factors included infections.

RESULTS

A total of 75% of the overall inequality in stunting was due to the difference in the social determinants of stunting between poor and nonpoor households. Maternal education (17%) and intergenerational transfer (31%) accounted for most of the inequalities in stunting, and an increase in gross domestic product per capita contributed to a reduction in its prevalence. There is a paucity of information on the impact of sociocultural norms, early life exposures, maternal health and nutrition, and Rwandan topography.

CONCLUSION

The findings of this study suggest that improving women's status, particularly maternal education and health; access to improved water, sanitation, and hygiene-related factors; and the socioeconomic status of communities, especially those in rural areas, will lay a sound foundation for reducing stunting among under-5 children.