Trends in burden and risk factors associated with childhood stunting in Rwanda from 2000 to 2015: policy and program implications

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Rwanda has made substantial economic progress over the past two decades. However, evidence suggests that malnutrition among children remains high in spite of this progress. This study aims to examine trends and potential risk factors associated with childhood stunting from 2000 to 2015 in Rwanda.

Methods

Data for this study come from the 2000 to 2015 Rwanda’s Demographic and Health Surveys (DHS), a cross-sectional, population-based survey that is conducted every 5 years. Following prior work, we define stunting based on age and weight as reported in the DHS. We assess the overall prevalence of stunting among children under the age of 5 in Rwanda and then conduct bivariate analyses across a range of policy-relevant demographic, socioeconomic, and health variables. We then incorporate key variables in a multivariable analysis to identify those factors that are independently associated with stunting.

Results

The prevalence of stunting among children under the age of 5 in Rwanda declined from 2000 (47.4%) to 2015 (38.3%), though rates were relatively stagnant between 2000 and 2010. Factors associated with higher rates of stunting included living in the lowest wealth quintile, having a mother with limited education, having a mother that smoked, being of the male sex, and being of low-birth weight.

Conclusions

Though overall stunting rates have improved nationally, these gains have been uneven. Furthering ongoing national policies to address these disparities while also working to reduce the overall risk of malnutrition will be necessary for Rwanda to reach its overall economic and health equity goals.

Related collections

Most cited references 18

Record: found
Abstract: found
Article: not found

Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data

Gretchen Stevens, Mariel Finucane, Christopher Paciorek … (2012)

Summary Background There is little information on country trends in the complete distributions of children's anthropometric status, which are needed to assess all levels of mild to severe undernutrition. We aimed to estimate trends in the distributions of children's anthropometric status and assess progress towards the Millennium Development Goal 1 (MDG 1) target of halving the prevalence of weight-for-age Z score (WAZ) below −2 between 1990 and 2015 or reaching a prevalence of 2·3% or lower. Methods We collated population-representative data on height-for-age Z score (HAZ) and WAZ calculated with the 2006 WHO child growth standards. Our data sources were health and nutrition surveys, summary statistics from the WHO Global Database on Child Growth and Malnutrition, and summary statistics from reports of other national and international agencies. We used a Bayesian hierarchical mixture model to estimate Z-score distributions. We quantified the uncertainty of our estimates, assessed their validity, compared their performance to alternative models, and assessed sensitivity to key modelling choices. Findings In developing countries, mean HAZ improved from −1·86 (95% uncertainty interval −2·01 to −1·72) in 1985 to −1·16 (–1·29 to −1·04) in 2011; mean WAZ improved from −1·31 (–1·41 to −1·20) to −0·84 (–0·93 to −0·74). Over this period, prevalences of moderate-and-severe stunting declined from 47·2% (44·0 to 50·3) to 29·9% (27·1 to 32·9) and underweight from 30·1% (26·7 to 33·3) to 19·4% (16·5 to 22·2). The largest absolute improvements were in Asia and the largest relative reductions in prevalence in southern and tropical Latin America. Anthropometric status worsened in sub-Saharan Africa until the late 1990s and improved thereafter. In 2011, 314 (296 to 331) million children younger than 5 years were mildly, moderately, or severely stunted and 258 (240 to 274) million were mildly, moderately, or severely underweight. Developing countries as a whole have less than a 5% chance of meeting the MDG 1 target; but 61 of these 141 countries have a 50–100% chance. Interpretation Macroeconomic shocks, structural adjustment, and trade policy reforms in the 1980s and 1990s might have been responsible for worsening child nutritional status in sub-Saharan Africa. Further progress in the improvement of children's growth and nutrition needs equitable economic growth and investment in pro-poor food and primary care programmes, especially relevant in the context of the global economic crisis. Funding The Bill & Melinda Gates Foundation and the UK Medical Research Council.

0 comments Cited 141 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Inequities in under-five child malnutrition in South Africa

Eyob A Zere, Diane McIntyre (2003)

Objectives To assess and quantify the magnitude of inequalities in under-five child malnutrition, particularly those ascribable to socio-economic status and to consider the policy implications of these findings. Methods Data on 3765 under-five children were derived from the Living Standards and Development Survey. Household income, proxied by per capita household expenditure, was used as the main indicator of socio-economic status. Socio-economic inequality in malnutrition (stunting, underweight and wasting) was measured using the illness concentration index. The concentration index was calculated for the whole sample, as well as for different population groups, areas of residence (rural, urban and metropolitan) and for each province. Results Stunting was found to be the most prevalent form of malnutrition in South Africa. Consistent with expectation, the rate of stunting is observed to be the highest in the Eastern Cape and the Northern Province – provinces with the highest concentration of poverty. There are considerable pro-rich inequalities in the distribution of stunting and underweight. However, wasting does not manifest gradients related to socio-economic position. Among White children, no inequities are observed in all three forms of malnutrition. The highest pro-rich inequalities in stunting and underweight are found among Coloured children and metropolitan areas. There is a tendency for high pro-rich concentration indices in those provinces with relatively lower rates of stunting and underweight (Gauteng and the Western Cape). Conclusion There are significant differences in under-five child malnutrition (stunting and underweight) that favour the richest of society. These are unnecessary, avoidable and unjust. It is demonstrated that addressing such socio-economic gradients in ill-health, which perpetuate inequalities in the future adult population requires a sound evidence base. Reliance on global averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of improvements in averages, but also improvements in distribution. Furthermore, addressing problems of stunting and underweight, which are found to be responsive to improvements in household income status, requires initiatives that transcend the medical arena.

0 comments Cited 83 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Risk factors for stunting among children under five years: a cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey

Alphonse Nshimyiryo, Bethany Hedt-Gauthier, Christine Mutaganzwa … (2019)

Background Child growth stunting remains a challenge in sub-Saharan Africa, where 34% of children under 5 years are stunted, and causing detrimental impact at individual and societal levels. Identifying risk factors to stunting is key to developing proper interventions. This study aimed at identifying risk factors of stunting in Rwanda. Methods We used data from the Rwanda Demographic and Health Survey (DHS) 2014–2015. Association between children’s characteristics and stunting was assessed using logistic regression analysis. Results A total of 3594 under 5 years were included; where 51% of them were boys. The prevalence of stunting was 38% (95% CI: 35.92–39.52) for all children. In adjusted analysis, the following factors were significant: boys (OR 1.51; 95% CI 1.25–1.82), children ages 6–23 months (OR 4.91; 95% CI 3.16–7.62) and children ages 24–59 months (OR 6.34; 95% CI 4.07–9.89) compared to ages 0–6 months, low birth weight (OR 2.12; 95% CI 1.39–3.23), low maternal height (OR 3.27; 95% CI 1.89–5.64), primary education for mothers (OR 1.71; 95% CI 1.25–2.34), illiterate mothers (OR 2.00; 95% CI 1.37–2.92), history of not taking deworming medicine during pregnancy (OR 1.29; 95%CI 1.09–1.53), poorest households (OR 1.45; 95% CI 1.12–1.86; and OR 1.82; 95%CI 1.45–2.29 respectively). Conclusion Family-level factors are major drivers of children’s growth stunting in Rwanda. Interventions to improve the nutrition of pregnant and lactating women so as to prevent low birth weight babies, reduce poverty, promote girls’ education and intervene early in cases of malnutrition are needed.

0 comments Cited 60 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Agnes Binagwaho:

ORCID: http://orcid.org/0000-0002-6779-3151

agnes_binagwaho@hms.harvard.edu

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 20 January 2020

Publication date PMC-release: 20 January 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 83

Affiliations

[1 ]University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda

[2 ]ISNI 000000041936754X, GRID grid.38142.3c, Harvard Medical School, ; Boston, MA USA

[3 ]ISNI 0000 0001 2179 2404, GRID grid.254880.3, Dartmouth Geisel School of Medicine, ; Hanover, NH USA

[4 ]Independent Consultant, Montréal, Québec, Canada

[5 ]ISNI 0000 0000 9136 933X, GRID grid.27755.32, University of Virginia, ; Charlottesville, VA USA

[6 ]Partners In Health, Freetown, Sierra Leone

[7 ]ISNI 0000 0001 2348 0746, GRID grid.4989.c, School of Public Health, , Universite libre de Bruxelles, ; Brussels, Belgium

Author information

Agnes Binagwaho http://orcid.org/0000-0002-6779-3151

Article

Publisher ID: 8164

DOI: 10.1186/s12889-020-8164-4

PMC ID: 6971879

PubMed ID: 31959142

SO-VID: cf756609-1a2d-41bc-beb0-e30a3f3c6e28

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 23 August 2019

Date accepted : 6 January 2020

Custom metadata

ScienceOpen disciplines: Public health

Keywords: malnutrition,rwanda,children,stunting,global health

Data availability:

ScienceOpen disciplines: Public health

Keywords: malnutrition, rwanda, children, stunting, global health

Comments

Comment on this article

scite_

Cited by 9

See all cited by

Most referenced authors 300

See all reference authors

Trends in burden and risk factors associated with childhood stunting in Rwanda from 2000 to 2015: policy and program implications

Read this article at

Abstract

Background

Methods

Results

Conclusions

Related collections

Global Health Next Generation Network

Most cited references 18

Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data

Inequities in under-five child malnutrition in South Africa

Risk factors for stunting among children under five years: a cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 503

Cited by 9

Most referenced authors 300