Chronic Child Malnutrition
While health indicators have been improving in recent years, chronic malnutrition in Rwanda remains severe and widespread, particularly among children under five years old. When a child is chronically malnourished, he or she often has long-term effects, including poor physical growth, impaired cognitive development, and poor livelihood prospects.
Poor nutrition is estimated to be responsible for more than a third of all childhood deaths worldwide.
We analyzed how chronic malnutrition (stunting) changes over geography, demographics, and time to better understand the multisectoral nature of the problem. This approach can help monitor the performance of relevant mission investments.
How much of an issue is stunting in Rwanda?
Let's start by looking at stunting in 2010.
Nationally, 44% of children under 5 are stunted, meaning they have have abnormally low height for their age (learn more about how stunting is calculated).
Looking at the national average, though, masks important geographical variation.
Are children across the country equally likely to be stunted?
Stunting varies across the country
Grouping the children into FEWS NET livelihood zones allows us to account for the role geography plays in stunting.
With this classification, we see sharp geographic differences in stunting rates.
In the Northen Highland Beans and Wheat zone, stunting is 57% – 13% over the national average. In Urban areas, on the other hand, has the lowest stunting prevalence at 22%.
High stunting rates in the East and Northwest
Mapping this data further highlights the vast differences between rural and urban areas.
Urban areas pop out as being low compared to the rest of the country.
How have the areas changed over time? Do these patterns still hold today?
Steady gains against chronic malnutrition
In the past five years, stunting dropped sharply nationally — falling from 44% in 2010 to 38% in 2014/2015.
Have the gains been equal across the country?
Though the East has improved markedly, gains lag in the Northwest
Though the Northwest improved, households there did not change as fast as the East.
In fact, the stunting incidence in the Northwest 2014/2015 nearly equal to where it was in 2010 in the East.
Sort the data by the largest improvements
Which areas still lag in 2014/2015?
Focusing just on the most recent data, children in the West Congo-Nile Crest Tea region now have the highest incidence of stunting in Rwanda (52%).
Why do these patterns exist? Are they the result of some intrinsic difference in the people who live there; for instance, are the people in the West Congo-Nile Crest Tea region less wealthy, less educated, or have poorer diets?
Or is there something more closely tied to that region that explains this phenomenon?
Geography matters
Using the household-level data from the Demographic and Health Surveys and the Comprehensive Food Security and Vulnerability Analysis, we ran regressions to test for relationships between stunting and other factors (individual, household, community, or geographic).
So, accounting for other factors that we think might influence malnutrition – like age and sex of the child or the education and wealth of the household – we can start to compare how stunting rates differ across space, holding all else constant.
Using children in the Lake Kivu region as a reference point, we tested if being in another livelihood zone increased or decreased an individual's likelihood of being stunted.
Stunting improvements lag in the Northwest in 2014/2015
After accounting for differences in demographics, stunting is significantly higher in the Northwestern Volcanic Irish Potato and Eastern Congo-Nile Highland Subsistence Farming zones compared to the Lake Kivu Coffee zone in 2014/2015.
In 2010, conversely, the Eastern Agropastoral and Eastern Plateau Mixed Agriculture regions were significantly worse than the Lake Kivu region.
Lastly, in both years, the altitude of the household dwelling influenced whether a child was stunted, suggesting that accessibility may be partially driving high stunting.
Assets, education, health access, and family planning also influence stunting
Geography is not the only factor associated with chronic malnutrition.
Stunting is influenced by many cross-sectoral factors, not only nutrition.
In particular, some of the population pressures we investigated earlier influence stunting, presumably due to strains on resource allocation.
How is USAID addressing chronic malnutrition?
USAID's Community Health and Improved Nutrition (CHAIN) program is a cross-sectoral approach to combatting child malnutrition.
CHAIN has many interventions in the Northwest, where stunting remains high, as well as activities in the East, where stunting has declined sharply in the past 5 years.
Learn more