1. Understanding factors associated with rural‐urban disparities of stunting among under‐five children in Rwanda: A decomposition analysis approach.
- Author
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Kalinda, Chester, Phiri, Million, Simona, Simona J., Banda, Andrew, Wong, Rex, Qambayot, Maria Albin, Ishimwe, Sage Marie Consolatrice, Amberbir, Alemayehu, Abebe, Bekele, Gebremariam, Alemayehu, and Nyerere, Julius Odhiambo
- Subjects
MOTHERS ,STATISTICS ,SOCIAL determinants of health ,HEALTH services accessibility ,CONFIDENCE intervals ,RURAL conditions ,AGE distribution ,POPULATION geography ,RISK assessment ,INCOME ,NUTRITION education ,RESEARCH funding ,DISEASE prevalence ,DESCRIPTIVE statistics ,CHILDREN'S health ,CHI-squared test ,HEALTH equity ,METROPOLITAN areas ,CLUSTER analysis (Statistics) ,PRENATAL care ,MEDICAL appointments ,DATA analysis software ,GROWTH disorders ,SECONDARY analysis ,EDUCATIONAL attainment ,DISEASE risk factors ,CHILDREN - Abstract
Childhood stunting in its moderate and severe forms is a major global problem and an important indicator of child health. Rwanda has made progress in reducing the prevalence of stunting. However, the burden of stunting and its geographical disparities have precipitated the need to investigate its spatial clusters and attributable factors. Here, we assessed the determinants of under‐5 stunting and mapped its prevalence to identify areas where interventions can be directed. Using three combined rounds of the nationally representative Rwanda Demographic and Health Surveys of 2010, 2015 and 2020, we employed the Blinder‐Oaxaca decomposition analysis and the hotspot and cluster analyses to quantify the contributions of key determinants of stunting. Overall, there was a 7.9% and 10.3% points reduction in moderate stunting among urban and rural areas, respectively, and a 2.8% and 8.3% points reduction in severe stunting in urban and rural areas, respectively. Child age, wealth index, maternal education and the number of antenatal care visits were key determinants for the reduction of moderate and severe stunting. Over time, persistent statistically significant hotspots for moderate and severe stunting were observed in Northern and Western parts of the country. There is a need for an adaptive scaling approach when implementing national nutritional interventions by targeting high‐burden regions. Stunting hotspots in Western and Northern provinces underscore the need for coordinated subnational initiatives and strategies such as empowering the rural poor, enhancing antenatal health care, and improving maternal health and education levels to sustain the gains made in reducing childhood stunting. Key messages: Stunting among children under 5 is a major problem in Rwanda, increasing the need for more tailored interventions and increased investments in child health.The prevalence of moderate and severe stunting among children aged 0–5 years in Rwanda has reduced over the last decade.High hotspots indicating childhood moderate and severe stunting clustered in the Northern and Western provinces of the country remain persistent.There is a need for multisectoral collaboration in addressing the key determinants of stunting and sustaining the reduction that has been achieved in the last decade. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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