Background: Under-nutrition contributes to childhood morbidity and mortality, particularly in low-income countries. While Rwanda is one of few countries on track to reduce the prevalence of underweight children under five years old by 50 % from 1990 to 2015 (a target of Millennium Development Goal1), underweight children remain a large public health problem with one out of ten children having low weight-for-age. Methods: We performed a cross-sectional study using 2010 RDHS data on 4177 children under five years of age with weight and height measurements. Children were classified as underweight if their weight-for-age Z scores (WAZs) were <2 standard deviations (SD) and severely underweight if WAZs were <3 SD from the mean of the reference population. We used multivariable logistic regression model to identify child, maternal, and household characteristics associated with being underweight. Results: Eleven percent (469) of the 4177 children sampled were underweight and 2.2 % (90) were severely underweight. After adjusting for possible confounders, we found that children were more likely to be underweight if they were male (OR = 1.42, 95 % confidence interval (CI):1.12, 1.79); had fever in the two weeks prior to survey administration (OR = 1.45, 95 % CI:1.07, 1.97) or were non-singletons compared to first-born singletons (OR = 4.04, 95 % CI:2.12, 7.71). Mothers were more likely to have underweight children if they were over 35 years of age compared to those age 17-24 years (OR = 1.67, 95 % CI:1.04, 2.70); with BMI <18.5 compared to BMI between 18.5 to 24.9 (OR = 2.62, 95 % CI:1.70, 4.04), who had no education or primary education only (OR = 3.56, 95 % CI:1.83, 6.95; OR = 3.49, 95 % CI:1. 87, 6.51, respectively) compared to secondary education or higher, and those who did not have delivery assisted by a skilled provider (OR = 1.33, 95 % CI:1.04, 1.72). Household characteristics associated with underweight children included status in the bottom two wealth quintiles compared to the highest (OR = 1.71, 95 % CI:1.27, 2.30). Conclusion: Rwanda was one of the first countries to achieve Millennium Development Goal1. However, even in light of this success, the prevalence of underweight children remains high. Our analysis of specific child, maternal and household risk factors for under-nutrition may help identify potential interventions to address this remaining burden.
BackgroundDiarrhea among children under 5 years of age has long been a major public health concern. Previous studies have suggested an association between rainfall and diarrhea. Here, we examined the association between Rwandan rainfall patterns and childhood diarrhea and the impact of household sanitation variables on this relationship.MethodsWe derived a series of rain-related variables in Rwanda based on daily rainfall measurements and hydrological models built from daily precipitation measurements collected between 2009 and 2011. Using these data and the 2010 Rwanda Demographic and Health Survey database, we measured the association between total monthly rainfall, monthly rainfall intensity, runoff water and anomalous rainfall and the occurrence of diarrhea in children under 5 years of age.ResultsAmong the 8601 children under 5 years of age included in the survey, 13.2 % reported having diarrhea within the 2 weeks prior to the survey. We found that higher levels of runoff were protective against diarrhea compared to low levels among children who lived in households with unimproved toilet facilities (OR = 0.54, 95 % CI: [0.34, 0.87] for moderate runoff and OR = 0.50, 95 % CI: [0.29, 0.86] for high runoff) but had no impact among children in household with improved toilets.ConclusionOur finding that children in households with unimproved toilets were less likely to report diarrhea during periods of high runoff highlights the vulnerabilities of those living without adequate sanitation to the negative health impacts of environmental events.
BackgroundTo guide efficient investment of limited health resources in sub-Saharan Africa, local researchers need to be involved in, and guide, health system and policy research. While extensive survey and census data are available to health researchers and program officers in resource-limited countries, local involvement and leadership in research is limited due to inadequate experience, lack of dedicated research time and weak interagency connections, among other challenges. Many research-strengthening initiatives host prolonged fellowships out-of-country, yet their approaches have not been evaluated for effectiveness in involvement and development of local leadership in research.MethodsWe developed, implemented and evaluated a multi-month, deliverable-driven, survey analysis training based in Rwanda to strengthen skills of five local research leaders, 15 statisticians, and a PhD candidate. Research leaders applied with a specific research question relevant to country challenges and committed to leading an analysis to publication. Statisticians with prerequisite statistical training and experience with a statistical software applied to participate in class-based trainings and complete an assigned analysis. Both statisticians and research leaders were provided ongoing in-country mentoring for analysis and manuscript writing.ResultsParticipants reported a high level of skill, knowledge and collaborator development from class-based trainings and out-of-class mentorship that were sustained 1 year later. Five of six manuscripts were authored by multi-institution teams and submitted to international peer-reviewed scientific journals, and three-quarters of the participants mentored others in survey data analysis or conducted an additional survey analysis in the year following the training.ConclusionsOur model was effective in utilizing existing survey data and strengthening skills among full-time working professionals without disrupting ongoing work commitments and using few resources. Critical to our success were a transparent, robust application process and time limited training supplemented by ongoing, in-country mentoring toward manuscript deliverables that were led by Rwanda’s health research leaders.
Background: Preterm birth (PTB) is a leading cause of early childhood mortality and morbidity, including long-term physical and mental impairment. The risk factors for PTB are complex and include maternal nutritional status and infections. This study aimed to identify potentially modifiable risk factors for targeted interventions to reduce the occurrence of PTB in Rwanda. Methods: We conducted a prospective, longitudinal cohort study of healthy pregnant women aged 18 to 49 years. Women at 9-15 gestational weeks were recruited from 10 health centers in Gasabo District, Kigali Province between September and October 2017. Pregnancy age was estimated using ultrasonography and date of last menstruation. Anthropometric and laboratory measurements were performed using standard procedures for both mothers and newborns. Surveys were administered to assess demographic and health histories. Categorical and continuous variables were depicted as proportions and means, respectively. Variables with p < 0.25 in bivariate analyses were included in multivariable logistic regression models to determine independent predictors of PTB. The results were reported as odds ratios (ORs) and 95% confidence intervals (CI), with statistical significance set at p < 0.05. Results: Among 367 participants who delivered at a mean of 38.0 ± 2.2 gestational weeks, the overall PTB rate was 10.1%. After adjusting for potential confounders, we identified the following independent risk factors for PTB: anemia (hemoglobin < 11 g/dl) (OR: 4.27; 95%CI: 1.85-9.85), urinary tract infection (UTI) (OR:9.82; 95%CI: 3.88-24.83), chlamydia infection (OR: 2.79; 95%CI: 1.17-6.63), inadequate minimum dietary diversity for women (MDD-W) score (OR:3.94; CI: 1.57-9.91) and low mid-upper arm circumference (MUAC) < 23 cm (OR: 3.12, 95%CI; 1.31-7.43). indicators of nutritional inadequacy (low MDD-W and MUAC) predicted risk for low birth weight (LBW) but only UTI was associated with LBW in contrast with PTB.
Introductionin Rwanda, despite different interventions to improve child nutrition status, malnutrition in children under five years of age continue to be a public health concern. This study aimed to evaluate the factors that contribute to childhood stunting by assessing feeding practices of Rwandans in children ≤ 2 years of age.MethodsA cross-sectional study with data obtained from the 2010 Rwanda Demographic and Health Survey was conducted on 1,634 children ≤ 2 years of age with complete anthropometrical measurements. Multivariable logistic regression analysis was used to assess the association between feeding practices and childhood stunting.ResultsThe results revealed that 35.1% of 1,634 children were stunted. Breastfeeding for 1 year (OR = 2.77, 95% CI = 1.91-4.01, P < 0.001) increased the risk of childhood stunting. After controlling for confounders, solid food initiation (OR = 1.21, 95% CI = 0.47-3.16, P≥ 0.690) and early initiation to breastfeeding (OR = 1.16, CI = 0.90-1.51, P = 0.243) were not associated with childhood stunting.ConclusionThere was a significant association between continued breastfeeding for 1 year and childhood stunting. We suggest supplementary feeding for children who are breastfed for ≥1 year.
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