- Prevalence of underweight children under five
years of age is a global problem resulting in negative health outcomes.
- Rwanda is a low-income, least developed country with significant threat
of food insecurity.
- Rwanda is on track to reduce prevalence
of underweight children under five years of age by 50%
Under-nutrition or malnutrition
when an individual does not eat enough or absorb enough nutrients to be able to
cover their need for energy and growth or to maintain a healthy immune system
When children are
undernourished they tend to be underweight for their age or too short for their
age (stunted) or extremely thin (wasted).
‘Under-nutrition contributes to more than half of the deaths amongst children under the age of five, especially in low-income countries.’
Underweight children is a
large public health problem with nearly one out of ten children having low weight-for-age
Rwanda is one of few countries
with a significant threat of food insecurity and is on a mission to reduce the
prevalence of underweight children under five years old by 50 % from 1990
to 2015. This is the target of Millennium Development Goal (MDG1).
Rwanda Demographic and Health Survey (RDHS) is a survey conducted nationally in
12, 540 households and is a representative sample of 13,671 women from the ages
of 15 to 49 years, which includes information on children under the age of five
years who were reported to be underweight.
The DHS report
gave detailed information on the percentage of children who was underweight but
did not analyze the risk factors for the same. Hence a cross-sectional study
was conducted based on the 2010 RDHS data on 4177 children under the age of
five years to identify the risk factors and reduce the prevalence of
underweight children in Rwanda.
Criteria for Classification
- Children were categorized as being
"underweight" if their
weight-for-age was less than two standard deviations from the reference
- Children were classified as "severely underweight" if their
weight-for-age Z scores (WAZs) was less than three standard deviations from
the reference population.
- Children were classified as "wasted" if weight-for-height was less
than two standard deviations from the reference
- Children were classified as "stunted" if height-for-age was less than two standard deviations from the
- Multivariable logistic
regression model was used to identify child, maternal and household
characteristics associated with being
- Assessment was also done to see if there was
any relationship between the child's birth size and current age on being
- In this analysis of the 2010 RDHS,
it was seen that the prevalence of underweight children in Rwanda was low as
compared to some neighboring countries like Burundi, Democratic Republic of
Congo and Tanzania, but quite high as compared to some of the developed
- Out of the 4177 children who were sampled, 469 of them (11%) were
reported to be underweight and 90 of them (2.2%) were severely underweight.
- Gender and other
risk factors: It was also seen that male gender had an increased risk of
being underweight as compared to female (OR = 1.42, 95 % confidence interval (CI):1.12, 1.79).
Other risk factors of being underweight included fever in
the two weeks prior to survey administration (OR = 1.45, 95 % CI:1.07, 1.97), being non-singletons compared to first-born
singletons (OR = 4.04, 95 %
CI:2.12, 7.71), recent deworming treatment, and being relatively small
risk factors: Mothers of children who were underweight were found to have
following predominant characteristics:
- Greater than 35 years of age compared
to those aged 17 to 24 years (OR = 1.67,
95 % CI:1.04, 2.70)
- No education or primary
level education ((OR = 3.56,
95 % CI:1.83, 6.95; OR = 3.49, 95 % CI:1.87, 6.51,
respectively) compared to secondary level education
low body mass index (BMI) <18.5
compared to BMI between
18.5 to 24.9 (OR = 2.62, 95 % CI:1.70, 4.04)
- Have had their last child delivered by an unskilled
provider (OR = 1.33, 95 %
risk factors: Underweight
children were found to live in households in one of the two lowest wealth
quintiles compared to the highest two quintiles (OR = 1.71, 95 % CI: 1.27,
- The study is a cross-sectional
survey hence no causal conclusions could be made about the risk factors for
children which could lead them to be underweight.
survey missed measuring some important factors including household food
availability, which according to UNICEF is an important determinant of a
child's under-nutrition status.
- Being underweight cannot
really show the extent to which a child is stunted or wasted even though
underweight is a combination of both stunting and
factors associated with underweight status in children under five: an analysis of
the 2010 Rwanda Demographic Health Survey (RDHS); BMC Nutrition Journal July 2016 - (https://bmcnutr.biomedcentral.com/articles/10.1186/s40795-016-0078-2)