Understanding factors associated with rural‐urban disparities of stunting among under‐five children in Rwanda: A decomposition analysis approach

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.

Effects of Physical Activity on Physical Health, Behavior and Personality by Social Status of Urban and Rural Children: A Systematic Review

“…Some of the environmental factors that may influence these differences include access to healthcare, air pollution, lifestyle, and socio-economics. Studies suggest that differences in access to healthcare and diet may affect health outcomes between urban and rural areas Smith et al, 2019;Fadelu et al, 2022;Samosir, Radjiman & Aninditya, 2023;Kalinda, 2023). In addition, studies highlight the impact of air pollution on public health in urban areas.…”

Determinants of coexistence of undernutrition and anemia among under-five children in Rwanda; evidence from 2019/20 demographic health survey: Application of bivariate binary logistic regression model

“…Stunting shows a substantial correlation with child age, wealth index, maternal education, and the number of antenatal care visits, according to a Rwandan study on children under the age of five [10]. The same study in Rwanda on children under the age of five found a strong correlation between anemia and parental education level, geographic location, and the child's sex [11].…”

“When we have served meat, my husband comes first”: A qualitative analysis of child nutrition among urban and rural communities of Rwanda

“…However, there is a paucity of information on the appropriate personal, family, sociocultural, and context-relevant factors. These factors may be bottlenecks in reducing stunting among children under five years, especially in high-risk population areas [ 12 , 14 ]. This qualitative study explored the lived experiences of women and men to identify issues that are key to influencing childhood nutrition and stunting and explore possible solutions to address the problem.…”

“…Several national-level analyses have explored the determinants of stunting in Rwanda [ 14 , 15 ]. These studies have provided important insights into the individual, household, and macro drivers of stunting as well as documenting and proposing critical top-down policy directions to enhance stunting reductions.…”