Analysing the determining factors of increase in stunting prevalence among children under five years of age: the case of Kayonza district, Rwanda.

Abstract

Rwanda has improved in many sectors including governance, poverty reduction and overall improvements of living conditions. However, the childhood stunting rates remain among the highest worldwide with 38%. Stunting has the tendency to be an invisible problem in Rwanda, yet it has devastating consequences on child growth and prosperity. This research was conducted to analyse the determining factors of increase in stunting among children under five year in Kayonza District.

To understand the reasons behind the increase in childhood stunting a comparative case study was conducted among mothers with stunted children in Kabare (Rwakavuna) in Kayonza District and (Rugando) in Kirehe District. The first study area was purposively sampled due to its higher levels of stunting and its geographical accessibility whereas the second was purposively chosen for its good progress to curb the levels of stunting and for its geographical accessibility. To gain in-depth understanding on the factors of childhood stunting, twenty households with stunted children and whose children experienced stunting in the past were interviewed in two villages, two focus group discussions were held, one in each study area.

In addition, fifteen key informant interviews were carried out to gain more information on the topic as well as photo elicitation on observable features to explain these factors. The data was collected using semi structured interviews and dietary diversity score for children; skype and WhatsApp interviews with informants and Focus group discussion as well as camera to make pictures. The data were analysed using coding in Microsoft Excel in the context of the UNICEF’s framework of undernutrition. The findings revealed that the failure to mitigate the effects of climate change was an important factor that has led to household food insecurity, thus undermining the nutrition of mothers and children. In addition, climate change has led to an increase in food prices in the communities making access to food very hard. Moreover, lack of decent job opportunities especially off-farm opportunities in the community and difficulty for pregnant and lactating mothers to secure these temporary opportunities even when they are available due to their status.

The child’s inappropriate food intake coupled with diseases were identified as continuous threats to their growth, that the complementary feedings are the same as what grown people eat, and the frequency is not consistent as per commended. In addition, children in the poorest families are still victims of diseases like malaria, waterborne diseases like diarrhoea. The parent’s attitude and knowledge towards child’s nutrition was found to be critical to stunting, especially food types and preparation of balanced diet. Inappropriate care was a pertinent issue that has contributed to childhood stunting mainly caused by home conflicts and parents’ delinquencies including alcoholism, divorces leading to lack of parenting support and proper mother and childcare during pregnancy and after birth.

Poor hygiene and unsafe living environment including open defecation, use of unclean water and inappropriate kitchens conditions were identified as accelerating factors to diseases and other health problems affecting children. Besides, the low access to agricultural land as rural people who depend more on natural resources to win their living, has been shown to be a serious hindrance to their livelihood strategy, since this contributes to inability of household to produce food. In terms of interventions from the district level, nutrition was not given much emphasis in development planning and budgeting, and it has been reserved to health department seen as a subsidiary component.

Besides there is no sustainability of support programmes being implemented, some do not reach beneficiaries as foreseen, while others are abandoned. The study recommends collaborating within an integrated approach that combines health, agriculture, WASH, education and social protection, since health sector alone as a well performing facet will not address the childhood stunting in Kayonza.

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