Birth Spacing and Undernutrition among Children Under Five Years in Rwanda: A Secondary Data Analysis of RDHS 2019/2020.

Background: Short birth intervals have been linked with increased childhood undernutrition, yet evidence in Rwanda remains limited. Using data from the 2019/2020 Rwanda Demographic and Health Survey (RDHS), this study assessed the association between birth spacing and undernutrition among children under five years. Methods: This cross-sectional study utilized weighted data from 3,815 children under five from the 2019/2020 RDHS. Undernutrition was defined as either stunting, underweight, or wasting. Birth spacing was categorized as short (<24 months), intermediate (24 - 35 months), and optimal (≥36 months) and multivariable model was used to examine the association. Results: The prevalence of undernutrition was 34.1%, and most (69.1%) had a birth interval ≥ 36 months. After adjusting for confounders, optimal birth spacing was associated with lower odds of undernutrition (AOR: 0.8; 95% CI: 0.6-0.9, p = 0.034). In addition, undernutrition was significantly associated with children from poor households, children of mothers with no education or primary education, and male children, while children of married or cohabiting mothers had lower odds of undernutrition. Conclusion: Optimal birth spacing is associated with lower odds of child undernutrition. Public health policies should strengthen access and utilization of family planning services, maternal education, and socioeconomic support to enhance child nutrition outcomes.