The authors have declared that no competing interests exist.
In Rwanda, 38% children aged 6-59 months are stunted. In Ngoma District, stunting rate is estimated at 41% among the children aged below 5 years. The study objective was to evaluate the prevalence and factors contributing to under nutrition among children aged 6- 59 months in Ngoma District. Cluster sampling was used to determine the study participants for each sector within 14 sectors by considering the sample size of 442. The WHO Anthro software version 3.2.2 was used to determine the nutritional status of the children. SPSS version 24 was used for analysis. Of 442 children participated in the study 50.9% of them were females, 24.4% were aged 15-23 months and the majority of children (89.8%) born with normal birth weight. Study findings revealed that the prevalence of under nutrition was 33.7% for stunting, 3.6% for wasting and 6.6% underweighted. Poor sanitation facility (AOR: 4.1, 95%CI: 1.83-9.3, p=0.001), poor diet (AOR: 1.9, 95%CI: 1.18-3, p=0.008) were significantly associated with stunting. Factors such as lack of hand-washing facilities (AOR: 2.5, 95% CI: 1.013-6.3, p=0.047), not eat vegetables (AOR: 4.4, 95%CI: 1.7-10.96, p=0.001), and not eat fishes (AOR: 4.1, 95%CI: 1.6-10.6, p=0.003) were associated with wasting. Short breastfeeding duration (AOR: 4.5, 95%CI: 2.9-7.2, p=0.001), not eat vegetables (AOR: 1.9; 95%CI: 1.1-3.05, p=0.008), and not eat eggs (AOR: 2, 95%CI: 1.3-2.9, p=0.001) were associated with underweight. Poor families with under-five children need continuous support that will assist them to improve nutritional status of their children.
Under nutrition was claimed to have negative impact on the public health in both developed and developing nations and has been related to the mortality and morbidity among children aged below five years. Though, prevalence of under nutrition seems to be declining globally, nearly of 22.9% of children below 5 years still suffer from stunting while 7.7% of children below 5 years suffer from wasting
Globally, at least 23% of children aged below 5 years are estimated to be stunted and 94% of these cases are found in Asia and Africa
In Africa, prevalence of stunting among children aged under 5 years varies with region. The prevalence is above 30% in Central Africa and Eastern Africa, high in Western Africa and South Africa between 20 and 30%, medium in Northern Africa between 10 and 20% in Northern Africa
This research was a quantitative cross-sectional study. This research design is used in order to get information on the prevalence of undernutrition at the time of the study and to measure the magnitude of undernutrition. The researcher utilized structured questionnaire to collect the data and nutritional assessments of weight and height for the children aged between 6-59 months and to evaluate the factors associated with under nutrition among these children in Ngoma District, Eastern province, Rwanda.
The population of interest was 38,006 children aged between 6 and 59 months
This research accounted for a sample of children in two strata (aged between 6-23 months and aged 24-59 months) paired with their mothers or caregivers in the period of one year (January-December 2020) who were obtained during monthly screening of undernutrition at community level. The sample size calculation was rooted on the prevalence of undernutrition revealed in DHS 2014-2015 where the prevalence of stunting was at 41 %, wasting at 4% and underweight at 16% in Ngoma District
n= Z2 * PQ/e2 where n= simple size, P=Proportion of stunting (0.41), Q=1-P, Z=Level of confidence (1.96 used at 95% CI), e=Desired level of precision (5%), Design effect=1.2).
After formula’s application n= [(1.96)2 * 0.41(1-0.41)/0.052] *1.2 = 442
The researcher employed self-developed questionnaire containing close-ended questions as tool for data collection (Kumar, 2011). Data gathering was done in October 2020 during screening of undernutrition period. Anthropometric measurements were obtained after screened the children aged between 6 and 59 months.
Data on age, height and weight were converted to z-scores of height or length-for-age (HAZ), weight for age (WAZ), weight for height or length (WHZ) using the World Health Organization Anthro software 3.2.2 to be able to determine the nutrition status. The World Health Organization standard reference (2010) was adopted to categorize children nutritional status in stunting (HAZ < -2), underweight (WAZ < -2) and wasting (WHZ<-2). To check for association and to observe the frequency distribution of variables, SPSS version 24 was used to determine whether dependent variables (stunting, wasting and underweight) are associated with independents variables or not. Bivariate analysis and multiple logistic regression were used to control confounding variables by backward condition with removal at p value of 0.05 and 95% confidence interval.
Ethical confirmation to conduct the research was acquired from Mount Kenya University Rwanda. In addition, permissions were obtained from local authorities and participating mothers before the study had been contacted. Participants were given adequate information on the purpose and benefit or harm that involving in the research might bring. Participants were guaranteed of privacy with respect to the data they provided and also their full right to choose not to engage or withdraw from the research without any consequence pertinent to their decision in this regard. Each participant was requested to offer oral consent and transcribed permission.
Study results in
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Male | 217 | 49.1 |
Female | 225 | 50.9 |
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6-14 | 101 | 22.9 |
15-23 | 108 | 24.4 |
24-32 | 72 | 16.3 |
33-41 | 63 | 14.3 |
42-50 | 64 | 14.5 |
51-59 | 34 | 7.7 |
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Less than 2,500 g | 45 | 10.2 |
Above 2,500 g | 397 | 89.8 |
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Single | 68 | 15.4 |
Married | 314 | 71.0 |
Divorced | 21 | 4.8 |
Widow | 17 | 3.8 |
Separated | 22 | 5.0 |
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No educational | 77 | 17.4 |
Primary school | 321 | 72.6 |
Secondary school | 24 | 5.4 |
University | 7 | 1.6 |
TVET (Technical and Vocational Education and Training) School | 13 | 2.9 |
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Category 1 | 125 | 28.3 |
Category 2 | 135 | 30.5 |
Category 3 | 152 | 34.4 |
Category 4 | 24 | 5.4 |
No category | 6 | 1.4 |
Source: Primary data, 2021
As depicted in
Variable | Length/height-for-age(Stunting) | Weight-for-length/height (Wasting) | Weight-for-age (Underweight) | Total | |||
Age group | Severe stunting (%) | Moderate stunting (%) | Severe wasting (%) | Moderate Wasting (%) | Severe Underweight (%) | Moderate Underweight (%) | n |
(6-11) | 0 | 10.8 | 0 | 1.4 | 0 | 5.4 | 74 |
(12-23) | 3.7 | 19.3 | 1.5 | 3 | 0 | 3 | 135 |
(24-35) | 25.3 | 51.8 | 1.2 | 3.6 | 1.2 | 13.3 | 83 |
(36-47) | 22.1 | 46.2 | 1 | 5.8 | 3.8 | 6.7 | 104 |
(48-59) | 26.1 | 52.2 | 0 | 4.3 | 0 | 6.5 | 46 |
Total | 13.8 | 33.7 | 0.9 | 3.6 | 1.1 | 6.6 | 442 |
Source: Primary data, 2021
Regard stunting as presented in
Variables | Adjusted OR (AOR) | 95%CI | p value | |||
Lower limit | Upper limit | |||||
Child sex | ||||||
Male | Ref. | |||||
Female | 2.343 | 1.599 | 3.434 | 0.001 | ||
Marital status | ||||||
Single | 0.432 | 0.252 | 0.739 | 0.02 | ||
Married | 1.006 | 0.367 | 2.755 | 0.991 | ||
Divorced | 1.135 | 0.375 | 3.438 | 0.823 | ||
Widowed | 1.327 | 0.477 | 3.685 | 0.588 | ||
Separated | Ref. | |||||
Education status of mothers or caregivers | ||||||
No educational | 0.553 | 0.333 | 0.919 | 0.022 | ||
Primary school | 0.319 | 0.122 | 0.837 | 0.02 | ||
Secondary school | 0.319 | 0.122 | 0.837 | 0.02 | ||
University school | 0.191 | 0.049 | 0.753 | 0.018 | ||
TVET School | Ref. | |||||
Weight of the child at delivery | ||||||
Less than 2500 g | Ref. | |||||
Above 2500 g | 0.514 | 0.273 | 0.969 | 0.04 | ||
Treatment of water | ||||||
Boiled water | 0.943 | 0.612 | 1.455 | 0.792 | ||
Filter water | 1.823 | 1.123 | 2.959 | 0.015 | ||
No treatment of water | Ref. | |||||
Sanitation facility | ||||||
Yes | Ref. | |||||
No | 4.131 | 1.833 | 9.312 | 0.001 | ||
Handwashing practices | ||||||
Yes | Ref. | |||||
No | 1.569 | 1.067 | 2.309 | 0.022 | ||
Malaria infection | ||||||
Yes | Ref. | |||||
No | 0.377 | 0.152 | 0.936 | 0.035 | ||
Diarrhea | ||||||
Yes | Ref. | |||||
No | 0.332 | 0.136 | 0.811 | 0.016 | ||
Milk support | ||||||
No | Ref. | |||||
Yes | 0.22 | 0.125 | 0.389 | 0.001 | ||
Ongera intungamubiri | ||||||
No | Ref. | |||||
Yes | 0.237 | 0.159 | 0.353 | 0.001 | ||
Still breastfeeding | ||||||
Yes | Ref. | |||||
No | 4.599 | 2.913 | 7.26 | 0.001 | ||
Complementary breastfeeding | ||||||
Before six months | Ref. | |||||
After six months | 0.526 | 0.359 | 0.771 | 0.001 | ||
Eating vegetables | ||||||
Yes | Ref. | |||||
No | 1.9 | 1.181 | 3.057 | 0.008 | ||
Eating fruits | ||||||
Yes | Ref. | |||||
No | 1.695 | 1.153 | 2.492 | 0.007 | ||
Eating meat | ||||||
No | Ref. | |||||
Yes | 0.507 | 0.315 | 0.813 | 0.005 | ||
Eating fishes or small fishes | ||||||
Yes | Ref. | |||||
No | 1.651 | 1.105 | 2.467 | 0.014 | ||
Eating eggs | ||||||
Yes | Ref. | |||||
No | 2.012 | 1.374 | 2.944 | 0.001 |
Source: Primary data, 2021
Findings in
Variables | Adjusted OR (AOR) | 95%CI | p-value* | |
Lower limit | Upper limit | |||
Child sex | ||||
Male | Ref. | |||
Female | 5.83 | 1.684 | 20.19 | 0.005 |
Marital status | ||||
Single | 0.121 | 0.038 | 0.384 | 0.001 |
Married | 0.789 | 0.154 | 4.042 | 0.777 |
Widowed | 1.184 | 0.285 | 4.917 | 0.816 |
Separated | Ref. | |||
Education status of mothers or caregivers | ||||
No educational | 0.103 | 0.037 | 0.285 | 0.001 |
Primary school | 0.236 | 0.029 | 1.913 | 0.176 |
University school | 0.451 | 0.054 | 3.802 | 0.464 |
TVET School | Ref. | |||
Weight of the child at delivery | ||||
Less than 2500 gr | Ref. | |||
Above 2500 gr | 0.09 | 0.035 | 0.232 | 0.001 |
Treatment of water | ||||
Boiled water | 1.74 | 0.482 | 6.282 | 0.398 |
Filter water | 4.439 | 1.356 | 14.527 | 0.014 |
No treatment of water | Ref. | |||
Sanitation facility | ||||
Yes | Ref. | |||
No | 26.022 | 9.684 | 69.919 | 0.001 |
Handwashing | ||||
Yes | Ref. | |||
No | 2.532 | 1.013 | 6.329 | 0.047 |
Malaria | ||||
Yes | Ref. | |||
No | 0.024 | 0.008 | 0.069 | 0.001 |
Diarrhea | ||||
Yes | Ref. | |||
No | 0.021 | 0.007 | 0.061 | 0.001 |
Milk support | ||||
Yes | Ref. | |||
No | 0.185 | 0.074 | 0.463 | 0.001 |
Start to breastfeed the child | ||||
Within the first hour | Ref. | |||
Later | 2.647 | 1.035 | 6.77 | 0.042 |
Introduction of solid/semi solid foods | ||||
Before six months | Ref. | |||
After six months | 0.17 | 0.056 | 0.518 | 0.002 |
Eating vegetables | ||||
Yes | Ref. | |||
No | 4.41 | 1.775 | 10.96 | 0.001 |
Eating fruits | ||||
Yes | Ref. | |||
No | 6.752 | 2.218 | 20.554 | 0.001 |
Eating beans | ||||
Yes | Ref. | |||
No | 10.912 | 4.257 | 27.969 | 0.01 |
Eating meat | ||||
No | Ref. | |||
Yes | 1.912 | 1.309 | 2.792 | 0.001 |
Eating fishes or small fishes | ||||
Yes | Ref. | |||
No | 4.171 | 1.627 | 10.698 | 0.003 |
Age group of the child | ||||
6-14 | 0.087 | 0.044 | 0.171 | 0.001 |
15-23 | 0.015 | 0.002 | 0.111 | 0.001 |
24-32 | 0.016 | 0.002 | 0.118 | 0.001 |
51-59 | Ref. |
Source: Primary data, 2021
Variables | Adjusted OR (AOR) | 95%CI | p-value* | |||
Lower limit | Upper limit | |||||
Child sex | ||||||
Male | Ref. | |||||
Female | 2.343 | 1.599 | 3.434 | 0.001 | ||
Marital status | ||||||
Single | 0.432 | 0.252 | 0.739 | 0.02 | ||
Married | 1.006 | 0.367 | 2.755 | 0.991 | ||
Divorced | 1.135 | 0.375 | 3.438 | 0.823 | ||
Widowed | 1.327 | 0.477 | 3.685 | 0.588 | ||
Separated | Ref. | |||||
Education status of mothers or caregivers | ||||||
No educational | 0.553 | 0.333 | 0.919 | 0.022 | ||
Primary school | 0.319 | 0.122 | 0.837 | 0.02 | ||
Secondary school | 0.319 | 0.122 | 0.837 | 0.02 | ||
University school | 0.191 | 0.049 | 0.753 | 0.018 | ||
TVET School | Ref. | |||||
Weight of the child at delivery | ||||||
Less than 2500 gr | Ref. | |||||
Above 2500 gr | 0.514 | 0.273 | 0.969 | 0.04 | ||
Treatment of water | ||||||
Boiled water | 0.943 | 0.612 | 1.455 | 0.792 | ||
Filter water | 1.823 | 1.123 | 2.959 | 0.015 | ||
No treatment of water | Ref. | |||||
Sanitation facility | ||||||
Yes | Ref. | |||||
No | 4.131 | 1.833 | 9.312 | 0.001 | ||
Handwashing practices | ||||||
Yes | Ref. | |||||
No | 1.569 | 1.067 | 2.309 | 0.022 | ||
Malaria infection | ||||||
Yes | Ref. | |||||
No | 0.377 | 0.152 | 0.936 | 0.035 | ||
Diarrhea | ||||||
Yes | Ref. | |||||
No | 0.332 | 0.136 | 0.811 | 0.016 | ||
Milk support | ||||||
No | Ref. | |||||
Yes | 0.22 | 0.125 | 0.389 | 0.001 | ||
Ongera intungamubiri | ||||||
No | Ref. | |||||
Yes | 0.237 | 0.159 | 0.353 | 0.001 | ||
Still breastfeeding | ||||||
Yes | Ref. | |||||
No | 4.599 | 2.913 | 7.26 | 0.001 | ||
Complementary breastfeeding | ||||||
Before six months | Ref. | |||||
After six months | 0.526 | 0.359 | 0.771 | 0.001 | ||
Eating vegetables | ||||||
Yes | Ref. | |||||
No | 1.9 | 1.181 | 3.057 | 0.008 | ||
Eating fruits | ||||||
Yes | Ref. | |||||
No | 1.695 | 1.153 | 2.492 | 0.007 | ||
Eating meat | ||||||
No | Ref. | |||||
Yes | 0.507 | 0.315 | 0.813 | 0.005 | ||
Eating fishes or small fishes | ||||||
Yes | Ref. | |||||
No | 1.651 | 1.105 | 2.467 | 0.014 | ||
Eating eggs | ||||||
Yes | Ref. | |||||
No | 2.012 | 1.374 | 2.944 | 0.001 |
Source: Primary data, 2021
Concerning underweight, female children were 2.3 times more likely to be underweighted than male children (AOR: 2.3, 95%CI: 1.5-3.4, p=0.001), children from households without toilets were 4.1 times more likely to be underweighted than the children from households with hygiene sanitation (AOR: 4.1; 95%CI: 1.8-9.3, p=0.001), mothers who did not practice hand washing were 1.5 times more likely to have underweighted children than those who used to wash their hands (AOR: 1.5; 95%CI: 1.06-2.3, p=0.022), children who started to breastfeed later were 4.5 times more likely to be underweighted than the children who started to breastfeed within the first hour of life (AOR: 4.5, 95%CI: 2.9-7.2, p=0.001), children who did not eat vegetables were 6.2 times more like to be underweight than the children who ate vegetables (AOR: 6.2; 95%CI: 3-12.8), children who did not eat fruits were 1.6 times more likely to be underweight than the children who ate fruits (AOR: 1.6, 95%CI: 1.1-2.4, p=0.007), and children who did not eat eggs were 2.9 times more likely to be underweight than the children who ate eggs (AOR: 2, 95%CI: 1.3-2.9, p=0.001).
The purpose of this research was to determine the prevalence and factors associated with undernutrition among children aged 6 to 59 months in Ngoma District, Rwanda. In Rwanda, the prevalence of under nutrition (stunting, wasting and underweight) among children aged 6-59 months was 33.7%, 3.6% and 6.6%, respectively. In contrast, prevalence of under nutrition in Ngoma District were found high than the country level as reported by the DHS 2019-2020 (32.5% stunting, 0.7% wasting and 8.5 % underweight) and high compared to the WHO cut-off value (< 20% stunting, < 5% wasting and < 10% underweight)
Prevalence of stunting was lower at 33.7% in Ngoma District compared to the results of comprehensive food security and vulnerability analysis in 2018 where the report showed the stunting rate in Ngoma District was 37%
In this study, female children were 2.3 times more likely to have stunting (AOR: 2.3; 95%CI: 1.599 -3.434) than male children, which is contrary to the study done in Kenya where males were about 1.2 more likely to be stunted than females
Low birth weight (less than 2,500g) contributes to poor health outcomes
Breastfeeding is the foundation of child health
The study finding showed that minimum dietary diversity was significantly associated with the decrease of under nutrition. This finding was consistent with findings from a study done in Tanzania
In Ngoma District, stunted children were at 33.7 % and wasting at 3.6 % among those ones aged between 6-59 months compared to the national level where stunting was at 32.7 % and wasting at 0.7%. Socio-economic factors associated with under nutrition identified were child gender, water treatment, hand washing practices, and sanitation facility. Feeding practices in infant and young child, feeding the child before six months, breastfeeding, dietary diversity (vegetables, beans, fruits and fishes) were associated with under nutrition among children aged between 6-59 months. Efforts should be made to improve nutritional status for the children under 5 years, to improve the environment where the children live and to educate mothers or caregivers how to prepare balance diet specifically for the children under five years.