Spatio-temporal variation of child stunting and associated risk factors in Rwanda.

backgroundThe under-five child stunting has remained a public health problem in the world. In Rwanda, child stunting rates have fluctuated significantly and remained higher than the targets despite a continuing decline of the national average rate. The key drivers of the persistently high child stunting rates and their geographical variation in Rwanda are currently not well known. This study examined the spatial and temporal variation of the under-five child stunting rates and associated factors in Rwanda between 2010 and 2020.

methodsThis study analysed data from the 2010 Rwanda Demographic and Health Survey (RDHS) (n = 4075), the 2014/15 RDHS (n = 3538), and the 2019/20 RDHS (n = 3809). A series of geo-additive binary logistic regression analyses were used to identify the key risk factors for child stunting and their variation in Rwanda between 2010 and 2020.

resultsThe results show significant variation in the key risk factors over the studied period. The child's gender, birth order, age, and birth weight, mother's height and marital status, number of antenatal care visits, household economic status, and altitude were consistently significant factors of child stunting in Rwanda. The influence of place of residence, mother's education, water source, and type of toilet facility varied. The district-level spatial effects significantly attenuated in the Eastern province while they intensified in the Western and Northern provinces.

conclusionsThe key risk factors for the under-five child stunting and their importance varied considerably over time in Rwanda. The findings suggest the need to improve the household-level welfare by strengthening targeted and district-tailored intervention programs from a multi-sectorial perspective, and sustain the programs outcomes beyond the intervention period.