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. 2023 Jul;19(3):e13511.
doi: 10.1111/mcn.13511. Epub 2023 Mar 30.

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

Chester Kalinda  1 , Million Phiri  2 , Simona J Simona  2 , Andrew Banda  2 , Rex Wong  1 , Maria Albin Qambayot  3 , Sage Marie Consolatrice Ishimwe  4 , Alemayehu Amberbir  4 , Bekele Abebe  5 , Alemayehu Gebremariam  6 , Julius Odhiambo Nyerere  7
Affiliations

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

Chester Kalinda et al. Matern Child Nutr. 2023 Jul.

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.

Keywords: DHS; Oaxaca-Blinder; Rwanda; moderate and severe stunting.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hotspot and coldspot analysis of moderate stunting clusters: each point data on the map represents a single enumeration area with moderately stunted children for the period (a) 2010, (b) 2015, (c) 2020. Statistically significant high‐risk (hotspot) clusters and low‐risk (cold spot) clusters of moderate stunting. Colours indicate different types of clusters: brown colour‐hotspot clusters of health facilities with higher risk surrounded by areas of relatively lower risk; light to blue—cold spot clusters of lower risk than the surrounding areas. Shades of each colour represent the corresponding significance of results (i.e., white—nonsignificant); progressively darker depending on their probability values.
Figure 2
Figure 2
Statistically significant high‐risk (hotspot) clusters and low‐risk (cold spot) clusters of severe stunting for the period (a) 2010, (b) 2015, (c) 2019/20.
Figure 3
Figure 3
A decomposition analysis of factors contributing to moderate stunting reduction in rural areas.
Figure 4
Figure 4
A decomposition analysis of factors contributing to moderate stunting reduction in urban areas.
See this image and copyright information in PMC

References

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