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Providing safe and nutritious food for children globally is a challenge. In Rwanda, an initiative was introduced in 2018 to tackle chronic malnutrition by offering fortified porridge flour to economically disadvantaged families during critical periods. However, flour-based products in the sub-region have caused public health concerns following aflatoxin B1 (AFB1) contamination. This study analyzed the levels of AFB1 in 197 porridge formulations from health centers, and 248 samples of porridge ingredients from open markets in three districts of Rwanda. Samples were collected between June 2021 and December 2022 and analyzed using ultra-high-performance liquid chromatography. Of the 197 samples from health centers, 97.9 and 89.8% exceeded the European Union maximum limits for baby foods and foods for special medical purposes (0.1 [micro]g/kg), and cereals and nuts (2 [micro]g/kg), respectively with an average contamination level of 2.77 pg/kg ([+ or -]0.98). Only four samples exceeded the East African Community maximum limits of 5 [micro]g/kg for AFB1. Samples from open markets that exceeded the European Union and East African community limits of 0.1 [micro]g/kg, 2 [micro]g/kg, and 5 [micro]g/kg ranged from 17 to 100%, 0 to 100%, and 0 to 100%, respectively. Site and processing significantly influenced levels of AFB1 contamination in open-market samples. The mean AFB1 levels were 17.85 [micro]g/kg ([+ or -]70.25) in Burera District, 36.04 [micro]g/kg ([+ or -]85.59) in Huye District, and 9.01 [micro]g/kg ([+ or -]18.49) in Nyarugenge District. The average AFB1 levels significantly varied between different products. Peanut samples showed higher contamination levels of 56.79 and 99.08 [micro]g/kg for grain and flour, respectively. Flour samples in general had a higher mean of 51.65 [micro]g/kg ([+ or -]105.75), compared to grain samples, 16.5 [micro]g/kg ([+ or -]44). Thus, there are potential health risks associated with chronic exposure to AFB1 in children consuming flour-based foods from health centers and open markets. Interventions to mitigate AFB1 contamination and protect children should focus on food processing practices, implementing strict quality control measures, and raising awareness among stakeholders about the risks of AFB1 in flour-based products provided to children in Rwanda and similar settings. Key words: Flour-based porridge, contamination, aflatoxin B1, children, Rwanda, INTRODUCTION Safe and nutritious foods remain a challenge globally. Children are particularly vulnerable to malnutrition, which often leads to a higher incidence of diarrhea and hindered growth [1]. To ensure [...]

Background: Linear growth faltering remains a pervasive public health concern that affects many children worldwide. This study aimed to investigate possible maternal factors promoting normal linear growth among children aged 6-23 months of age from impoverished Rwandan households., Methods: We used a three-stage cluster sampling procedure. The study population consisted of children aged six to 23 months and their mothers who lived in the study districts. A structured questionnaire helped to collect data from 807 selected mother-child dyads. The primary outcome variable was height-for-age Z scores. The main predictors were maternal income-generating activity, maternal education, maternal depression, household decision making, number of ANC visits, use of family planning method, types of family planning, and mode of delivery. We used univariate analysis to establish median, frequencies, and percentages. Furthermore, we used the Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation tests for bivariate analysis. We included in the final model of robust linear regression for multivariate analysis the potential confounding variables identified as significantly associated with the outcome (child age, participation in works for both parents, good handwashing practice, owning a vegetable garden, and the total number of livestock) along with maternal factors., Results: Maternal factors that promoted normal linear growth of children were the presence of maternal income generation activity (β= 0.640 [0.0269 1.253], p value = 0.041), the participation of the mother in the decision-making process of the household (β=0.147 [0.080 0.214], p-value < 0.001), and the higher frequency of consultations with ANC (β=0.189 [0.025 0.354], p-value = 0.024). Additionally, a combination of household decision-making with the number of ANC visits predicted an increase in the linear growth of the child (β=0.032 [0.019 0.045], p-value < 0.001)., Conclusion: Maternal factors such as maternal income-generating activity, maternal participation in household decision making, and increased number of ANC visits were found to promote normal child linear growth. These results contribute valuable information to the formulation of interventions and policies to improve child nutrition and growth in the community studied., (© 2024. The Author(s).)

Background: The state of a child's nutrition is a critical indicator of their overall health and wellbeing. Public health still faces challenges from undernutrition, especially in developing nations across the globe. In Rwanda, around 33% of children aged under five years suffer from chronic undernutrition. Many factors, such as poverty, illiteracy, poor WASH practices, improper child feeding practices, and insufficient healthcare, are the leading causes of undernutrition. The study aims to assess infant and young child feeding practices, WASH, food security, and their association with the nutritional status of children under five years in Rwanda's Western and Southern provinces., Methods: A community-based cross-sectional study design was applied to study factors affecting the nutritional status of children under five years in 439 households in the Karongi, Nyabihu, and Nyamagabe districts of Rwanda. The study assessed anemia, stunting, underweight, and wasting indicators, and collected data was analyzed using SPSS version 25., Results: The study findings indicate that among the children surveyed, 29.2% (128) were identified as stunted, 5.9% (26) were underweight, 2.3% (10) suffered from wasting, and 20.9% (31) had anemia. Factors associated with these conditions included larger household size [AOR = 2.108; 95% CI (1.016-4.371)], positively associated with stunting. Additionally, children from households where the head was above 60 years old were more likely to exhibit stunting [AOR = 4.809; 95% CI (1.513, 15.283)]. Furthermore, a high household dietary diversity score was positively linked to being underweight [AOR = 6.061; 95% CI (1.535,23.942)]., Conclusion: Household characteristics like size, dietary diversity, and the age of the household head affect children's nutritional status. Improving these conditions would enhance children's nutritional status., (© 2024. The Author(s).)

Stunted linear growth continues to be a public health problem that overwhelms the entire world and, particularly, developing countries. Despite several interventions designed and implemented to reduce stunting, the rate of 33.1% is still high for the proposed target of 19% in 2024. This study investigated the prevalence and associated factors of stunting among children aged 6-23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother-child dyads (two individuals from one home) living in low-income families in five districts with a high prevalence of stunting. Descriptive statistics were used to determine the prevalence of stunting. In addition, we used bivariate analysis and a multivariate logistic regression model to measure the strength of the association between childhood stunting and exposure variables. The prevalence of stunting was 34.1%. Children from households without a vegetable garden (AOR = 2.165, p -value < 0.01), children aged 19-23 months (AOR = 4.410, p -value = 0.01), and children aged 13-18 months (AOR = 2.788, p -value = 0.08) showed increased likelihood of stunting. On the other hand, children whose mothers were not exposed to physical violence (AOR = 0.145, p -value < 0.001), those whose fathers were working (AOR = 0.036, p -value = 0.001), those whose parents were both working (AOR = 0.208, p -value = 0.029), and children whose mothers demonstrated good hand washing practice (AOR = 0.181, p -value < 0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of handwashing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight child stunting.

At 33% of under-5s, stunting rates in Rwanda remain stubbornly high, as do figures for maternal (25% of pregnant women) and childhood anaemia (37%). Intensive communication and education campaigns have provided caregivers with high levels of knowledge about best practices in Maternal, Infant and Young Child Nutrition (MIYCN), but this is not translating into the improved diets which could contribute to reducing rates of stunting. Deploying an anthropological approach via multi-module Focused Ethnographic Studies carried out within household case studies, the research team sought to understand drivers of suboptimal feeding practices in a sample of 30 households across all of Rwanda's districts. The sample included households with pregnant women as well as children in the 6-60 month age range. Analysed against a framework of proximal and underlying causes of under-nutrition, our results reveal gaps in the knowledge-capability-practice chain resulting from decisions and prioritisations taken by caregivers and heads-of-household. Pregnant women and mothers of young children possess high levels of knowledge about feeding themselves and their young children, but this is not reflected in decision-making and prioritisation around the acquisition and feeding of animal source foods, whose consumption is low among both groups. This was found to be true even in households which own and raise livestock. Turning to policy and programmes, we argue for a move towards incentivized human capital programming focusing on the 'last mile' behaviour change which is needed to translate knowledge and capability into better dietary choices., (© 2022 UNICEF. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: Malnutrition among pregnant women and lactating mothers remains an issue of public health concern in developing countries. The Gikuriro program, an integrated nutrition-specific and nutrition-sensitive intervention, was implemented in 5 districts of Rwanda for 5 y to address this problem. Postprogram quasi-experiments showed significant effect of the intervention on maternal and child undernutrition. Notwithstanding, there was a need for a qualitative study to explore the views of the beneficiaries and implementers regarding its benefits, challenges, and limitations to inform future interventions., Objective: This study aimed to explore the effect and challenges of an integrated nutrition-intervention program among pregnant women and lactating mothers., Methods: This was a qualitative study involving 25 community health officers and 27 nutritionists as key informants and 80 beneficiaries in 10 focus group discussions. All interviews and group discussions were audio-recorded, transcribed verbatim, translated into English, and double coded. A deductive and inductive content analysis approach was used with the help of ATLAS.ti, version 9.15., Results: The study identified several positive effects, such as improved knowledge and skills on nutrition, a positive mindset toward a balanced diet, perceived improved nutrition, and economic independence among pregnant women and lactating mothers. However, some of the main obstacles of the integrated nutrition intervention were lack of awareness of the program, negative beliefs, poverty, lack of spousal support, and time constraints. Moreover, the study identified a main limitation: the lack of inclusiveness for all social categories., Conclusions: This study demonstrates that integrated nutrition interventions have perceived positive effect on nutrition; however, such interventions may face some challenges and limitations. These findings suggest that, apart from contributing to the body of evidence for scale up of such interventions in resource-limited settings, economic challenges and misconceptions have to be addressed to maximize the effect of such interventions., (© 2023 The Authors.)

Background: Type 2 Diabetes Miletus (T2DM) is a public health burdens that alarmingly increases and leads to morbidity and mortality over the last decades globally. Its management is multifaceted and adherence to diabetic medications plays great roles in life of T2DM patients. But epidemiology on adherence and its associated factors remain unknown in Rwanda. Therefore, this study determined the extent of non-adherence and its predictors among T2DM patients seeking healthcare services at the Clinique Medicale la Fraternite., Methods: A cross-sectional study among 200 adults' patients with T2DM receiving care in the Medicale la Fraternite clinic was investigated. Bivariate and multivariate logistic regression models were performed based on odds ratio employed to examine associated predictors of non-adherence. The cut-off value for all statistical significances tests were considered at p < 0.05 with 95% for the confidence intervals., Results: Overall, more than a half of T2DM patients (53.5%) had poor medication adherence. Being females [OR = 2.1, 95%CI(1.13-3.71), p = 0.002], consuming anti-diabetic drugs for 4-10 years [OR = 2.18, 95%CI(1.09-4.34), p = 0.027], experiencing poor communication with healthcare providers [OR = 2.4; 95%CI (1.36-4.25), p = 0.003] and being perceived as burden of the family [OR = 5.8; 95%CI(1.3-25.7), p < 0.021] had higher odds of non-adherence to anti-diabetic medications. Those with poor HbA1C [OR = 4.26; 95%CI(1.7-10.67), p = 0.002] had 4.26 times higher odds to be non-adherent compared to those with good HbA1C. Respondents with primary [OR = 3.56; 95%CI (1.12-11.28), p = 0.031] and secondary education [OR = 2.96; 95%CI (1.11-7.87), p = 0.03] were more likely to be non-adherent than those with informal education respectively. Those with normal BMI [OR = 5.17; 95%CI(1.63-16.37), p = 0.005] and those with overweight or obese [OR = 3.6; 95%CI (1.04-9.1), p < 0.02] had higher odds of being non-adherent than those with underweight., Conclusion: Sex, glycaemia, communication with healthcare providers, education and gycosylated hemoglobin were the major predictors of non-adherence. Interventions for tackling this problem through bringing together efforts to stem this epidemic and controlling predictors of non-adherence are urgently recommended., (© 2022. The Author(s).)

Competing Interests: CH reports grants from the UK National Institutes for Health Research, the Biotechnology and Biological Sciences Research Council, the Wellcome Trust, the Swiss Agency for Development and Cooperation, the UK Foreign, Commonwealth and Development Office, the Food and Agricultural Organisation of the United Nations (FAO), the UK Department for Environment, Food and Rural Affairs, the George Institute for Global Health, the Global Alliance for Improved Nutrition, UNICEF, the Bill & Melinda Gates Foundation, and the Esmée Fairbairn Foundation; honoraria from Imperial College London and Cornell University; and support for attending meetings from the Glasgow Centre for Population Health, the EAT Forum, the FAO, Co-Create, Bloomberg Philanthropies, Deakin University, the World Food Summit Copenhagen, the European Commission, GAIN, UNICEF, Food Active, Southampton City Council, LEAP, Salzburg Global, UKRI, Parabere, and the Swiss Agency for Development and Cooperation. RA reports grants from Purdue University, the Bill & Melinda Gates Foundation, the Eleanor Crook Foundation, the UK Foreign, Commonwealth and Development Office, and the EAT Forum. KA reports grants from Deakin University, the Australian Department of Health, the Bill & Melinda Gates Foundation, HORT Innovation Australia, and the Meat and the Livestock Association of Australia. JB reports grants from the School of Health Sciences Research Sustainability Fund, School of Health Sciences, City, University of London. LC reports grants from the International Development Research Centre (IDRC), Global Health Advocacy Incubator (GHAI), the Ministry of Health Government of Argentina, UNICEF Argentina, and the Pan-American Health Organization. NF reports grants from the UKRI Transforming UK Food Systems Strategic Priorities Fund as part of the UK Food Systems CDT. HM reports grants from CGIAR Trust Fund contributors, the United States Agency for International Development (USAID), the Bill & Melinda Gates Foundation, the International Fund for Agricultural Development (IFAD), and the IDRC. AN reports grants and support to attend meetings from the International Rescue Committee and grants from European Civil Protection and Humanitarian Aid Operations, UNICEF, and BHA. FS reports grants from the Bill & Melinda Gates Foundation and consulting fees from USAID Advancing Nutrition. MU reports grants from the National Council for Science and Technology and consulting fees from the International Food Policy Research Institute (IFPRI). MNW reports grants from the IDRC. CZ reports grants from Deakin University and the Victorian Health Promotion Foundation (VicHealth), the Australian Government, and Cancer Council Victoria, an award from the Victorian Government for Victorian Premier's Awards for Public Health Research, and scholarships awards to attend conferences from Deakin University, the Public Health Association of Australia, and Dietitians Australia.

Inadequate maternal nutrition before and during pregnancy is a principal risk factor for poor fetal development, resulting in low birth weight (LBW) and subsequently, poor child growth. Most studies focus on the impact of nutritional interventions after birth while only a few interventions consider integrated nutrition service packages. Therefore, there is limited evidence on whether integrated maternal nutrition interventions have a positive effect on birthweight. Thus, a post-program quasi-experimental study was carried out to determine the effectiveness of the integrated maternal nutrition intervention package on low birth weight in Rwanda. A total of 551 mother-baby pairs from the intervention and 545 controls were included in the analysis. Data regarding socio-demographic, maternal anthropometric parameters, and dietary diversity were collected using a structured questionnaire. Birth weight was assessed right after delivery, within 24 h. Logistic regression, linear regression, and path analysis were fitted to determine the effectiveness of the intervention on birth weight. The study found that the intervention reduced LBW by 66.99% ( p < 0.001) and increased average birth weight by 219 g ( p < 0.001). Logistic regression identified reduced risk of LBW among the intervention group (AOR = 0.23; 95%CI = 0.12-0.43; p < 0.001). It was also observed that the direct effect of the intervention on birth weight was 0.17 (β = 0.17; p < 0.001) and the main indirect mediator was maternal MUAC (β = 0.05; p < 0.001). Moreover, maternal passive smoking exposure and MUAC < 23 cm were found as risk factors for LBW. This study has demonstrated that an integrated maternal nutritional intervention package can significantly reduce LBW in low-income settings and should, therefore, be considered to improve birth weight., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Habtu, Agena, Umugwaneza, Mochama and Munyanshongore.)

Maternal undernutrition remains a major public health concern in Rwanda despite significant gains and progress. An integration of nutrition-specific and nutrition-sensitive interventions was implemented in five districts of Rwanda to improve maternal and child nutrition. The package included nutrition education and counselling, promotion of agricultural productivity, promotion of financial literacy/economic resilience and provision of Water, Hygiene and Sanitation services. However, there is limited evidence about the effect of such interventions in reducing maternal undernutrition. A postintervention quasi-experimental study was conducted among pregnant women to determine the effect of the integrated intervention on their nutritional status. It was carried out in two intervention districts, namely Kicukiro and Kayonza, and two control districts, namely Gasabo and Gisagara between November 2020 and June 2021. Five hundred and fifty-two women were recruited for the intervention arm, while 545 were recruited for the control arm. Maternal undernutrition was defined as either having low mid-upper arm circumference (<23 cm) during delivery or low body mass index (<18.5 kg/m 2 ) in the first trimester or both. A multivariable logistic regression model was used to assess the effect of the integrated interventions. The prevalence of maternal undernutrition was significantly lower in the intervention group compared with the control group (4.7% vs. 18.2%; p < 0.001). After controlling the potential confounders, the risk of maternal undernutrition was 77.0% lower in the intervention group than in the control group [adjusted odds ratio= 0.23; 95% confidence interval = 0.15-0.36; p < 0.001]. Further studies are therefore recommended to establish causation and inform the potential scale-up of these interventions nationally in Rwanda., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

The aim of the present study was to identify and describe the factors influencing feeding practices of children aged 6-23 months in Rwanda. This is a cross-sectional descriptive qualitative study. A total of ten focus group discussions were conducted separately with mothers, fathers, grandmothers and community health workers (CHWs) from five different districts in Rwanda. The discussions were recorded, transcribed verbatim, and thematically analysed using qualitative data analysis software, Atlas.ti. The study participants were mothers, fathers and grandmothers of children aged 6-23 months and CHWs in charge of child health. Caregivers' knowledge and beliefs about the benefits of breast-feeding and timely introduction of complementary food were found to be the primary individual factors facilitating good infant and young child feeding practices. The common belief of caregivers that infants should be given liquids (thin gruel, fruit juices and meat broth) as first foods instead of semi-solid foods was a barrier to good feeding practices. The community-based nutrition education and counselling programmes were facilitators of good complementary practices at the group level. At the society level, poverty in rural agrarian households was a barrier to optimal feeding practices. The study shows that there is a need to empower caregivers with more specific guidelines, especially on complementary feeding., (© The Author(s) 2021.)