Child stunting prevalence determination at sector level in Rwanda using small area estimation
Tóm tắt
Stunting among children under 5 years of age remains a worldwide concern, with 148.1 million (22.3%) stunted in 2022. The recent 2019/2020 Rwanda Demographic Health Survey (RDHS) revealed that the prevalence of stunting in Rwanda among under five children was 33.5%. In Rwanda, there is no sufficient evidence on stunting status to guide prioritized interventions at the sector level, the lowest administrative unit for implementing development initiatives. This study aimed to provide reliable estimates of stunting prevalence in Rwanda at the sector level. In this article, Small Area Estimation (SAE) techniques were used to provide sector level estimates of stunting prevalence in children under five in Rwanda. By plugging in relevant significant covariates in the generalized linear mixed model, model-based estimates are produced for all sectors with their corresponding Mean Square Error (MSE). The findings showed that, overall, 40 out of 416 sectors had met the national target of having a stunting rate less than or equal to 19%, while 194 sectors were far from meeting this target, having a stunting rate higher than the national prevalence of 33.5% in the year 2020. The majority of the sectors with stunting prevalence that were higher than the national average of 33.5% were found in the Northern Province with 68 sectors out of 89 and in Western Province with 64 sectors out of 96. In contrast, the prevalence of stunting was lower in the City of Kigali where 14 out of 35 sectors had a stunting rate between 0 and 19%, and all sectors were below the national average. This study showed a substantial connection between stunting and factors such as household size, place of residence, the gender of the household head, and access to improved toilet facilities and clean water. The results of this study may guide and support informed policy decisions and promote localised and targeted interventions in Rwanda’s most severely affected sectors with a high stunting prevalence in Rwanda.
Tài liệu tham khảo
FAO, Ifad, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World. Urbanization, agrifood systems transformation and healthy diets across the rural-urban continuum. Rome. 2023;2023. https://doi.org/10.4060/cc3017en.
WHO. Levels and trends in child malnutrition: UNICEF/WHO/The World Bank Group joint child malnutrition estimates: key findings of the 2021 edition. World Health Organization; 2021.
of Statistics of Rwanda NI, of Health (MOH) M, ICF. Rwanda Demographic and Health Survey 2019-20. National Institute of Statistics of Rwanda; 2021.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57.
Desa U, et al. Transforming our world: The 2030 agenda for sustainable development. United Nations; 2016.
of Statistics of Rwanda NI, of Health (MOH) M, ICF. Rwanda Demographic and Health Survey 2015. National Institute of Statistics of Rwanda; 2016.
of Statistics of Rwanda NI, of Health (MOH) M, ICF. Rwanda Demographic and Health Survey 2010. National Institute of Statistics of Rwanda; 2012.
Wirth JP, Rohner F, Petry N, Onyango AW, Matji J, Bailes A, et al. Assessment of the WHO Stunting Framework using Ethiopia as a case study. Matern Child Nutr. 2017;13(2):12310.
UNICEF, et al. Improving child nutrition: the achievable imperative for global progress. New York: UNICEF; 2013. p. 1–14.
Eshetu E, Woldesenbet S. Are there particular social determinants of health for the world’s poorest countries? Afr Health Sci. 2011;11(1):108–15.
Roediger R, Hendrixson DT, Manary MJ. A roadmap to reduce stunting. Oxford University Press; 2020.
Group WMGRS, de Onis M. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr. 2006;95:76–85.
Saei A, Chambers R. Small area estimation under linear and generalized linear mixed models with time and area effects. Southampton: Southampton Statistical Sciences Research Institute; 2003. p. 31.
National Institute of Statistics of Rwanda (NISR) R, of Finance M, Economic Planning (MINECOFIN) R. Fourth Rwanda Population and Housing Census. Thematic Report: Population Projections. National Institute of Statistics of Rwanda; 2012.
Srivastava S, Chandra H, Singh SK, Upadhyay AK. Mapping changes in district level prevalence of childhood stunting in India 1998–2016: an application of small area estimation techniques. SSM-Popul Health. 2021;14:100748.
Mercer L, Wakefield J, Chen C, Lumley T. A comparison of spatial smoothing methods for small area estimation with sampling weights. Spat Stat. 2014;8:69–85.
Liu B, Lahiri P, Kalton G. Hierarchical Bayes modeling of survey-weighted small area proportions. Proceedings of the survey research methods section. Salt Lake City: ASA; 2007. p. 3181–3186.
Habimana S, Biracyaza E. Risk factors of stunting among children under 5 years of age in the eastern and western provinces of Rwanda: analysis of Rwanda demographic and health survey 2014/2015. Pediatr Health Med Ther. 2019;10:115.
Nshimyiryo A, Hedt-Gauthier B, Mutaganzwa C, Kirk CM, Beck K, Ndayisaba A, et al. Risk factors for stunting among children under five years: a cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health. 2019;19(1):1–10.
Bigirimana JB. Stunting among Under Five Years Old Children in Rwanda: Influences of Family Planning Status and Household Size and Composition. Rwanda J Med Health Sci. 2021;4(1):112–30.
Rugema J, Mukantwari J, Twagirayezu I, Tuyisenge MJ, Rutayisire R, Katende G. Predictors and factors associated with stunting among under-five-year children: a cross-sectional population-based study in Rwanda of the 2014–2015 demographic and Health Survey. Afr Health Sci. 2022;4(4):671–8.
Ndagijimana S, Kabano IH, Masabo E, Ntaganda JM. Prediction of stunting among under-5 children in Rwanda using machine learning techniques. J Prev Med Pub Health. 2023;56(1):41.
Ahsan KZ, Arifeen SE, Al-Mamun MA, Khan SH, Chakraborty N. Effects of individual, household and community characteristics on child nutritional status in the slums of urban Bangladesh. Arch Public Health. 2017;75(1):1–13.
Binagwaho A, Rukundo A, Powers S, Donahoe KB, Agbonyitor M, Ngabo F, et al. Trends in burden and risk factors associated with childhood stunting in Rwanda from 2000 to 2015: policy and program implications. BMC Public Health. 2020;20(1):1–9.
Iruhiriye E, Olney DK, Frongillo EA, Niyongira E, Nanama S, Rwibasira E, et al. Translation of policy for reducing undernutrition from national to sub-national levels in Rwanda. Food Secur. 2022;14(4):977–93.