Prevalence and Factors Associated with Under Nutrition among Children Aged 6 to 59 Months in Ngoma District, Rwanda

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 ¹.

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 ². Furthermore, these estimates demonstrated that around 45% of deaths of children below 5 years are associated to under nutrition ². Stunting affected an estimated of 21.3% of children below 5 and wasting affected an estimated of 6.9% of children below under 5 years. Majority of all stunted children under 5 years (54%) and most of all wasted children under 5 years (69%) lived in Asia, 40% of stunted children under 5 years and 24% of wasting children resided in Africa ³.

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 ⁴. In Rwanda the prevalence of undernutrition remains high. According to the Rwanda Demographic Health Survey (DHS) conducted in 2014-2015 children aged under 5 years, stunting rate was 38 %, wasting rate was 2% and underweight was 9% ⁵. In Ngoma District where the study is focused, 41% were stunted, 16% had underweight and 4% were wasted ⁵. The objective of this study was determine the prevalence and factors associated with Under- Nutrition among childre under the age of five in Ngoma District.

Study results in Table 1 indicated that 50.9% of children were females, 24.4% were aged 15-23 months and the majority of children (89.8%) born with normal birth weight. It was found that most of the mothers who participated in the study (71%) were married; (72.6%) had only primary education and more than half (58.8%) were living in poor socio-economic conditions.

As depicted in Table 2, the prevalence of stunting, wasting and underweight among the 442 children aged 6 to 59 months were at 33.7%, 3.6%, and 6.6%, respectively. The highest stunting rate (52.2%) was in children aged 48 to 59 months. The highest wasting rate (5.8%) was in children aged 36-47 months and the highest underweight rate (6.7%) was in children aged 36-47 months.

Regard stunting as presented in Table 3, many factors have been found as associated with it but the most significant with high risks were female children with 2.3 times more likely to have stunting than males (AOR: 2.3; 95%CI: 1.599 -3.434), children from families who did not have toilet were 4.1 times more likely to develop stunting than those from families with toilets (AOR: 4.1; 95%CI: 1.8-1.12), children who stopped breastfeeding early were 4.5 times more likely to be stunted than children continued to breastfeed even above 2 years (AOR: 4.5; 95%CI: 2.9-7.2), children who did not eat vegetables were 1.9 times more likely to be stunted than children who ate it (AOR: 1.9; 95%CI: 1.18-3.05) while children who did not eat eggs were 2 times more likely to be stunted than those who ate it (AOR: 2:95%CI: 1.3-2.944).

Findings in Table 4 revealed that wasting was 5.8 times more among female children male children (AOR: 5.8; 95%CI: 1.68-20.19), children who did not have the toilets in their families were 26 times more likely to develop wasting than those who owned it home (AOR: 26; 95%CI: 9.6-69.9), children who did not practice hand washing were 2.5 times more likely to develop wasting than children who used to wash their hands (AOR: 2.5; 95% CI: 1.013-6.3), children who started to breastfeed later were 2.6 times more likely to be wasted than the children who started to breastfeed within the first hour of life (AOR: 2.6; 95%CI: 1.03-6.7). children who did not eat vegetables were 4.4 times more like to be wasted than the children who ate vegetables (AOR: 4.4; 95%CI: 1.7-10.96), children who did not eat fruits were 6.7 times more likely to be wasted than the children who ate fruits (AOR: 6.7; 95%CI: 2.2-20.5), children who did not eat beans were 10.9 times more likely to be wasted than the children who ate beans (AOR: 10.9; 95%CI: 4.2-27.9) while children who did not eat fishes or small fishes were 4.1 times more likely to be wasted than the children who ate it (AOR: 4.1; 95%CI: 1.6-10.6). Table 5

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) ⁸.

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% ⁹. The difference might be due difference in time and methodology used in this study compared to that of national level.

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 ¹⁰. Child weight at birth, mothers never attended school, household wealth index at poorest level (1^st social category) were less likely contribute to under nutrition. This finding was consistent with a study done in Rwanda ¹¹ which shows that child age 24-59 months, low child weight at birth, mother’s never attended school and household wealth index poorest level were contributing factors of stunting.

Low birth weight (less than 2,500g) contributes to poor health outcomes ⁸. In this study children born with weight lesser than 2,500g were likely to be affected by under nutrition (p<0.05) which was consistent with the study done in Malawi where the childhood under nutrition is significantly associated with low birth weight ¹².

Breastfeeding is the foundation of child health ¹³. The present study found that late breastfeeding was associated with underweight (AOR: 4.5, 95%CI: 2.9-7.2, p=0.001). Contrary to the study done in Kenya where breastfeeding was not associated with wasting ¹⁴. But, it was consistent with a study done in Sudan where there was statistical significance between breastfeeding and malnutrition ¹⁵.

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 ¹⁶ where eat diverse diet was significantly associated with the reduction of under nutrition.

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.

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