High Burden of Undernutrition among At-Risk Children in Neonatal Follow-Up Clinic in Rwanda

Mutsindashyaka, Theoneste; Nshimyiryo, Alphonse; Beck, Kathryn; Kirk, Catherine M.; Wilson, Kim; Mutaganzwa, Christine; Bradford, Jessica; Havugarurema, Silas; Bihibindi, Vianney; Ngamije, Patient; Mubiligi, Joel; Miller, Ann C.

doi:10.5334/aogh.2636

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…There is also limited knowledge on feeding practices for small and sick newborns, who are at greater risk for feeding difficulties and malnutrition [46]; limited skills and time for health workers to provide counseling that allows for "trial and error" of different interventions [47]; and limited use of existing resources, such as guidelines for managing challenges related to cleft lip/palate [48]. In addition, primary health care is often overstretched and underfunded, which affects the quality of support services for all children.…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Nutritional care for children with feeding difficulties and disabilities: A scoping review

Klein

Uyehara

Cunningham

et al. 2023

PLOS Glob Public Health

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One billion people worldwide have a disability, and 80 percent of them live in low- and middle-income countries (LMICs). The prevalence of feeding difficulties globally ranges from 25–45 percent to 33–80 percent in children without and with disabilities, respectively. The U.S. Agency for International Development’s (USAID) flagship multi-sectoral nutrition project, USAID Advancing Nutrition, conducted a scoping review of programs supporting nutritional care of children with disability and non-disability related feeding difficulties. The non-systematic scoping review included a desk review of peer-reviewed and non-peer-reviewed literature and key informant interviews. In all, 127 documents with publication dates ranging from 2003 to 2022 were identified through keyword searches and snowballing and met the inclusion criteria, and 42 experts in nutrition and disability were interviewed. Findings were organized using structured matrices of challenges and opportunities across the universal progressive model of care framework in the identification and management of feeding difficulties and disabilities and support for children with feeding difficulties and disabilities and their families. The review found insufficient policies, programs, and evidence to support children with feeding difficulties and disabilities and their families. While some resources and promising approaches exist, they are not standardized or universally used, staff are not trained to use them, and there is insufficient funding to implement them. The combination of challenges in identifying feeding difficulties and disabilities, a lack of understanding of the link between disabilities and feeding, and weak or nonexistent referral or specialized services puts these children at risk of malnutrition. Additionally, their families face challenges providing the care they need, including coping with high care demands, accessing support, obtaining appropriate foods, and managing stigma. Four areas of recommendations emerged to support children with feeding difficulties and disabilities: (1) Strengthen systems to improve identification and service provision; (2) Provide direct support to families to address determinants that affect nutrition outcomes; (3) Conduct advocacy to raise awareness of the needs and opportunities; and (4) Build the evidence base on effective interventions to identify and support these children and their families.

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Section: Plos Global Public Healthmentioning

confidence: 99%

Nutritional care for children with feeding difficulties and disabilities: A scoping review

Klein

Uyehara

Cunningham

et al. 2023

PLOS Glob Public Health

Self Cite

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“…Feeding difficulties among children with disabilities are associated with high rates of malnutrition and early life mortality [45]. Previous studies conducted in Rwanda among children born small and sick reported high rates of potential disabilities at ages 2 to 4 years [46] and higher rates of malnutrition among children with feeding difficulties [47], thus additional specialized nutrition interventions are likely required to address these children's needs. Based on this challenge, in 2019, the PDC program integrated early intervention using the Baby Ubuntu model [48], a group participatory early intervention program starting from 6 months for young children with disability and their families.…”

Section: Plos Onementioning

confidence: 99%

Factors associated with recovery from stunting at 24 months of age among infants and young children enrolled in the Pediatric Development Clinic (PDC): A retrospective cohort study in rural Rwanda

Nemerimana,

Havugarurema,

Nshimyiryo

et al. 2023

PLoS ONE

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Introduction Stunting (low height/length-for-age) in early life is associated with poor long-term health and developmental outcomes. Nutrition interventions provided during the first 1,000 days of life can result in improved catch-up growth and development outcomes. We assessed factors associated with stunting recovery at 24 months of age among infants and young Children enrolled in Pediatric Development Clinics (PDC) who were stunted at 11 months of age. Methods This retrospective cohort study included infants and young children who enrolled in PDCs in two rural districts in Rwanda between April 2014 and December 2018. Children were included in the study if their PDC enrollment happened within 2 months after birth, were stunted at 11 months of age (considered as baseline) and had a stunting status measured and analyzed at 24 months of age. We defined moderate stunting as length-for-age z-score (LAZ) < -2 and ≥-3 and severe stunting as LAZ <-3 based on the 2006 WHO child growth standards. Stunting recovery at 24 months of age was defined as the child’s LAZ changing from <-2 to > -2. We used logistic regression analysis to investigate factors associated with stunting recovery. The factors analyzed included child and mother’s socio-demographic and clinical characteristics. Results Of the 179 children who were eligible for this study, 100 (55.9%) were severely stunted at age 11 months. At 24 months of age, 37 (20.7%) children recovered from stunting, while 21 (21.0%) severely stunted children improved to moderate stunting and 20 (25.3%) moderately-stunted children worsened to severe stunting. Early stunting at 6 months of age was associated with lower odds of stunting recovery, with the odds of stunting recovery being reduced by 80% (aOR: 0.2; 95%CI: 0.07–0.81) for severely stunted children and by 60% (aOR: 0.4; 95% CI: 0.16–0.97) for moderately stunted children (p = 0.035). Lower odds of stunting recovery were also observed among children who were severely stunted at 11 months of age (aOR: 0.3; 95% CI: 0.1–0.6, p = 0.004). No other maternal or child factors were statistically significantly associated with recovery from stunting at 24 months in our final adjusted model. Conclusion A substantial proportion of children who were enrolled in PDC within 2 months after birth and were stunted at 11 months of age recovered from stunting at 24 months of age. Children who were severely stunted at 11 months of age (baseline) and those who were stunted at 6 months of age were less likely to recover from stunting at 24 months of age compared to those with moderate stunting at 11 months and no stunting at 6 months of age, respectively. More focus on prevention and early identification of stunting during pregnancy and early life is important to the healthy growth of a child.

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Women’s exposure to intimate partner violence and its association with child stunting: findings from a population-based study in rural Rwanda

Utumatwishima,

Mogren,

Elfving

et al. 2024

Global Health Action

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Background Child stunting is a significant challenge for most districts in Rwanda and much of sub-Saharan Africa and persists despite multisectoral efforts. There is a notable lack of population-based studies examining the correlation between violence against women and child stunting in Rwanda. Objective We aimed to investigate the association between Rwandan women’s exposure to intimate partner violence (IPV) and child stunting in children under 3 years of age. Methods In December 2021, a population-based cross-sectional study was conducted in the Northern Province of Rwanda, including 601 women and their children <3 years of age. The World Health Organization (WHO) Women’s Health and Life Experiences Questionnaire for IPV research was utilized. Child stunting was assessed using the WHO criteria for low height for age. Multivariable logistic regression was used to examine the association between IPV and child stunting before and during pregnancy. Results Of 601 women, 47.4% ( n = 285) experienced any form of IPV during pregnancy. The prevalence rates of the types of IPV associated with child stunting varied: 33% for psychological, 31.4% for sexual, and 25.7% for physical violence. Exposure to physical violence before pregnancy and sexual violence during pregnancy was associated with higher odds of child stunting; the adjusted odds ratios were 1.29 (95% CI, 1.01–2.03) and 1.25 (95% CI, 1.04–2.01), respectively. Conclusion Women’s exposure to physical and psychological violence is associated with an increased risk of child stunting. Urgent targeted interventions and support systems are needed to address the complex relationship between women’s exposure to IPV and adverse effects on child growth.

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High Burden of Undernutrition among At-Risk Children in Neonatal Follow-Up Clinic in Rwanda

Cited by 3 publications

References 24 publications

Nutritional care for children with feeding difficulties and disabilities: A scoping review

Nutritional care for children with feeding difficulties and disabilities: A scoping review

Factors associated with recovery from stunting at 24 months of age among infants and young children enrolled in the Pediatric Development Clinic (PDC): A retrospective cohort study in rural Rwanda

Women’s exposure to intimate partner violence and its association with child stunting: findings from a population-based study in rural Rwanda

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