Socio-demographic and environmental determinants of under-5 stunting in Rwanda: Evidence from a multisectoral study.

Child stunting is an important household, socio-economic, environmental and nutritional stress indicator. Nationally, 33% of children under 5 in Rwanda are stunted necessitating the need to identify factors perpetuating stunting for targeted interventions. Our study assessed the individual and community-level determinants of under-5 stunting essential for designing appropriate policy and program responses for addressing stunting in Rwanda. A cross-sectional study was conducted between September 6 and October 9, 2022, in five districts of Rwanda including, Kicukiro, Ngoma, Burera, Nyabihu and Nyanza. 2788 children and their caregivers were enrolled in the study and data on the individual level (child, caregiver/household characteristics), and community-level variables were collected. A multilevel logistic regression model was used to determine the influence of individual and community-level factors on stunting. The prevalence of stunting was 31.4% (95% CI: 29.5-33.1). Of this, 12.2% were severely stunted while 19.2% were moderately stunted. In addition, male gender, age above 11 months, child disability, more than six people in the household, having two children below the age of five, a child having diarrhea 1-2 weeks before the study, eating from own plate when feeding, toilet sharing, and open defecation increased the odds of childhood stunting. The full model accounted for 20% of the total variation in the odds of stunting. Socio-demographic and environmental factors are significant determinants of childhood stunting in Rwanda. Interventions to address under-five stunting should be tailored toward addressing individual factors at household levels to improve the nutritional status and early development of children.