SEARCHCROSS-SECTIONALpediatrics, nutrition

cross-sectional·pediatrics, nutrition, public_health, global_health, maternal_child_health·PMC10001740

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

International Journal of Environmental Research and Public Health · 7 authors, 2 centres

AI SUMMARY

FIDELITY 100%

POPULATION817 mother-child dyads from poor households (Ubudehe categories 1 and 2) in five Rwandan districts (Rutsiro, Burera, Nyaruguru, Kayonza, Gasabo); children aged 6–23 months, full-term, singleton

INTERVENTIONObservational study; no intervention. Exposures included child characteristics (age, sex, deworming, vitamin A, micronutrient supplementation, dietary diversity), household characteristics (father's employment, food security, vegetable garden ownership), maternal characteristics (education, employment, disability, IPV exposure, depressive syndrome), and WASH practices

COMPARISONStunted vs. non-stunted children based on WHO height-for-age Z-score < -2SD

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AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This cross-sectional study of 817 mother-child dyads from poor households in five high-stunting districts in Rwanda found a stunting prevalence of 34.1% among children aged 6–23 months, slightly above the national average of 33.1%. Key protective factors included absence of maternal physical violence, father's employment, both parents working, good maternal handwashing practice, and household vegetable garden ownership, while older child age (19–23 months) and lack of a vegetable garden increased stunting risk. The findings highlight the need to integrate IPV prevention, handwashing promotion, and home gardening into stunting reduction interventions.

Full summary

4,489 CHARS

**Background:** Stunting (low height-for-age) remains a major public health problem globally, affecting 149.2 million children under five in 2020 (22%). Sub-Saharan Africa carries a 36.8% burden. In Rwanda, the national stunting rate among children under five was 33.1% in recent surveys, far from the 2024 target of 19%. While previous Rwandan studies used DHS secondary data covering all socioeconomic categories or focused narrowly on feeding practices, none had specifically examined stunting among the poorest households. This study aimed to fill that gap by assessing prevalence and associated factors among children aged 6–23 months from poor households in five high-stunting districts.

**Methods:** A quantitative cross-sectional survey was conducted in Rutsiro, Burera, Nyaruguru, Kayonza, and Gasabo districts, purposively selected for high stunting rates based on the 2018 Rwanda Comprehensive Food Security & Vulnerability Analysis. The target population was children aged 6–23 months from poor households (Ubudehe categories 1 and 2). Inclusion criteria: full-term birth (38–40 weeks), singleton, mother–child dyad. Exclusion: severe illness preventing participation. Multi-stage cluster sampling was used, with villages as primary sampling units and systematic selection of five households per village. Sample size was calculated using n=Z²pq/d² with p=33.1%, 5% accuracy, design effect of 2, and 20% non-response rate, yielding 877 dyads (817 analyzed). Stunting was defined as height-for-age Z-score < -2SD using WHO Anthro software and 2010 Child Growth Standards. Data were analyzed in SPSS v25. Bivariate analysis identified candidate variables (p<0.05) for backward stepwise multivariate logistic regression, with final significance at p≤0.05. Results reported as adjusted odds ratios (AOR) with 95% CI.

**Key Results:** Stunting prevalence was 34.1% (slightly above the national 33.1%). In bivariate analysis, significant associations (p<0.05) were found for child sex, age, deworming, vitamin A and micronutrient supplementation, maternal disability, literacy, education, breast discomfort, delivery mode, all IPV types (controlling behavior, emotional, physical, sexual, any violence), father working alone, household hunger, child stool disposal, handwashing facility availability, handwashing practice, and vegetable garden ownership. In the final multivariate model: children aged 19–23 months were 4.4 times more likely to be stunted than those aged 6–12 months (AOR=4.410, 95% CI 1.911–10.173, p=0.01); children aged 13–18 months had nearly 3 times higher odds (AOR=2.788, 95% CI 1.302–5.968, p=0.08). Mothers not exposed to physical violence had 85.5% lower odds of having a stunted child (AOR=0.145, 95% CI 0.074–0.287, p<0.001). Households where the father alone had income-generating activity (AOR=0.036, 95% CI 0.005–0.242, p=0.001) and where both parents worked (AOR=0.208, 95% CI 0.051–0.851, p=0.029) had dramatically lower stunting odds compared to mother-only earner households. Good maternal handwashing practice reduced stunting odds by 81.9% (AOR=0.181, 95% CI 0.091–0.362, p<0.001). Households without a vegetable garden had 2.2 times higher stunting odds (AOR=2.165, 95% CI 1.201–3.905, p<0.01).

**Clinical Implications:** This study demonstrates that stunting remains critically high (34.1%) among Rwanda's poorest households, exceeding the national average and far from the 19% target. The strong protective effect of maternal freedom from physical violence (85% reduction in stunting odds) suggests that IPV prevention and screening should be integrated into maternal-child health programs. The protective role of both parents having income-generating activities (vs. mother-only earners) indicates that economic interventions should target household-level livelihood support rather than maternal employment alone. The association between good handwashing practice and reduced stunting supports WASH-nutrition integration. Vegetable garden ownership as a protective factor reinforces the value of home gardening for dietary diversity and food security. The increasing stunting risk with age (peaking at 19–23 months) highlights the need for sustained nutritional support and hygiene promotion throughout the complementary feeding period, not just in infancy. Study limitations include cross-sectional design (no causal inference), self-reported data (potential social desirability bias), and non-scientific poverty classification (Ubudehe).

PICO

PPOPULATION

817 mother-child dyads from poor households (Ubudehe categories 1 and 2) in five Rwandan districts (Rutsiro, Burera, Nyaruguru, Kayonza, Gasabo); children aged 6–23 months, full-term, singleton

IINTERVENTION

Observational study; no intervention. Exposures included child characteristics (age, sex, deworming, vitamin A, micronutrient supplementation, dietary diversity), household characteristics (father's employment, food security, vegetable garden ownership), maternal characteristics (education, employment, disability, IPV exposure, depressive syndrome), and WASH practices

OOUTCOME

Prevalence of stunting (34.1%); associated factors: child age 19–23 months (AOR=4.410, p=0.01), no vegetable garden (AOR=2.165, p<0.01), no maternal physical violence (AOR=0.145, p<0.001), father working (AOR=0.036, p=0.001), both parents working (AOR=0.208, p=0.029), good handwashing (AOR=0.181, p<0.001)

STUDY TYPE

cross-sectional

SPECIALTY

pediatrics

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10001740

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

International Journal of Environmental Research and Public Health

READ THE FULL PAPER

ABSTRACT

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.

CITATION EXPORT

Jean de Dieu Habimana, Aline Uwase, Noel Korukire et al.. Prevalence and Correlates of Stunting among Children Aged 6–23 Months from Poor Households in Rwanda. International Journal of Environmental Research and Public Health. (2023). https://doi.org/10.3390/ijerph20054068

AUTHORS

7 · 2 CENTRES

Jean de Dieu Habimana, Aline Uwase, Noel Korukire, Sara Jewett, Maryse Umugwaneza, Lawrence Rugema, Cyprien Munyanshongore

1School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 4286, Rwanda
2School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa

EDITOR / REVIEWER

Ann M. Cheney, Alison Tovar