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Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Nutrition | Research article

Stunting, food security, markets and food policy in Rwanda

Authors: Dave D. Weatherspoon, Steve Miller, Jean Chrysostome Ngabitsinze, Lorraine J. Weatherspoon, James F. Oehmke

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Over the past two decades, Rwanda has experienced impressive economic growth, resulting in considerable improvements in living standards and poverty reduction. Despite these gains, progress on reducing the level of stunting in smallholder rural children, particularly boys, continues to be a serious concern.

Methods

Policies, dietary diversity and socio-economic factors that may influence stunting in rural Rwandan children were evaluated using a logit model with clustered variance-covariance estimators based on village membership of the household.

Results

Stunting of rural children was found to be multidimensionally related to the child’s gender, weight and age; the dietary diversity, marriage status and education level of the head of household; mother’s height; presence of a family garden or if they owned livestock; environmental factors such as altitude and soil fertility and location relative to a main road en route to a market; and a policy that promoted food production.

Conclusions

Findings suggest that agricultural policies may be subsidizing poor dietary behavior in that the aggregation of production encourages households to sell high quality nutritious food such as fruit and vegetables, for more voluminous amounts of nutritionally substandard goods, hence low dietary diversity. However, it is less clear if rural food markets are capable of supplying diverse and nutritious foods at affordable prices on a consistent basis, resulting in a lack of diversity and hence, low nutrient quality diets. Rwanda’s next round of food security policies should focus on nutrition insecurity with special emphasis on the lack of protein, micronutrients and calories. Multipronged policies and programs focused on income growth, food security, enhanced access to markets and gender-related nutrition risks from inception through 2 years of age in the rural areas are required to improve rural household health outcomes, stunting in particular.
Footnotes
1
The slight increase in food expenditure share for the 2nd richest may reflect an upgrade in dietary quality and the addition of more processed foods.
 
2
Alternative model specifications, including Probit and standard sandwich-type robust standard errors. However, the Logit model with clustered variance generally exhibited better overall fit, but the statistical significance of slope coefficients were largely unchanged across model specifications.
 
3
Other specifications were tried including share of total expenditures allocated to food and total expenditures. The coefficient on share of expenditures on food tended toward the positive, which may be expected if we interpret that lower income households will tend to spend a higher share of expenditures on food than more affluent households do.
 
Literature
2.
go back to reference World Health Organization. Nutrition Landscape Information System (NLIS) country profile indicators: interpretation guide. Geneva: WHO Document Production Services; 2010. ISBN 978 92 4 159995 5 World Health Organization. Nutrition Landscape Information System (NLIS) country profile indicators: interpretation guide. Geneva: WHO Document Production Services; 2010. ISBN 978 92 4 159995 5
4.
go back to reference Adair LS. Filipino children exhibit catch-up growth from age 2 to 12 years. J Nutr. 1999;129:1140–8.CrossRef Adair LS. Filipino children exhibit catch-up growth from age 2 to 12 years. J Nutr. 1999;129:1140–8.CrossRef
8.
go back to reference Hoddinott J, Alderman H, Behrman JR, Haddad L, Horton S. The economic rationale for investing in stunting reduction. Matern Child Nutr. 2013;9:69–82.CrossRef Hoddinott J, Alderman H, Behrman JR, Haddad L, Horton S. The economic rationale for investing in stunting reduction. Matern Child Nutr. 2013;9:69–82.CrossRef
9.
go back to reference National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], and ICF International. 2015. Rwanda Demographic and Health Survey 2014-15. Rockville, Maryland, USA: NISR, MOH, and ICF International. National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], and ICF International. 2015. Rwanda Demographic and Health Survey 2014-15. Rockville, Maryland, USA: NISR, MOH, and ICF International.
11.
go back to reference Smith LC, Haddad L. How potent is economic growth in reducing undernutrition? What are the pathways of impact? New cross-country evidence. Econ Dev Cult Chang. 2002;51:55–76.CrossRef Smith LC, Haddad L. How potent is economic growth in reducing undernutrition? What are the pathways of impact? New cross-country evidence. Econ Dev Cult Chang. 2002;51:55–76.CrossRef
12.
go back to reference Masters WA, Rosenblum NZ, Alemu R. Agricultural transformation, nutrition transition and food policy in Africa: Preston curves reveal new stylised facts. J Dev Stud. 2018;54(5):788–802.CrossRef Masters WA, Rosenblum NZ, Alemu R. Agricultural transformation, nutrition transition and food policy in Africa: Preston curves reveal new stylised facts. J Dev Stud. 2018;54(5):788–802.CrossRef
14.
go back to reference Kelly VA, Tefft JF, Oehmke JF, Staatz JM. Identifying policy relevant variables for reducing childhood malnutrition in rural Mali. In: Department of Agricultural Economics Staff Paper Series, Michigan State University; 2004. Available from http://purl.umn.edu/11528. Kelly VA, Tefft JF, Oehmke JF, Staatz JM. Identifying policy relevant variables for reducing childhood malnutrition in rural Mali. In: Department of Agricultural Economics Staff Paper Series, Michigan State University; 2004. Available from http://​purl.​umn.​edu/​11528.
22.
go back to reference Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Peerson JM, Arimond M, Ashorn U, Zeilani M, Vosti S, Dewey K. Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial. Am J Clin Nutr. 2016;104:797–808.CrossRef Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Peerson JM, Arimond M, Ashorn U, Zeilani M, Vosti S, Dewey K. Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial. Am J Clin Nutr. 2016;104:797–808.CrossRef
24.
go back to reference Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243–60.CrossRef Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243–60.CrossRef
25.
go back to reference Wondimagegn ZT. Magnitude and determinants of stunting among children in Africa: a systematic review. Curr Res Nutr Food Sci J. 2014;2:88–93.CrossRef Wondimagegn ZT. Magnitude and determinants of stunting among children in Africa: a systematic review. Curr Res Nutr Food Sci J. 2014;2:88–93.CrossRef
26.
go back to reference United Nations World Food Programme. Food consumption analysis: calculation and use of the food consumption score in food security analysis. Rome: VAM unit HQ-Rome; 2008. United Nations World Food Programme. Food consumption analysis: calculation and use of the food consumption score in food security analysis. Rome: VAM unit HQ-Rome; 2008.
27.
go back to reference Godoy R, Nyberg C, Eisenberg DTA, Magvanjav O, Shinnar E, Leonard W, Gravlee C, Reyes-García V, McDade T, Huanca T, Tanner S. Short but catching up: Statural growth among native Amazonian Bolivian children. Am J Hum Biol. 2010;22:336–47.CrossRef Godoy R, Nyberg C, Eisenberg DTA, Magvanjav O, Shinnar E, Leonard W, Gravlee C, Reyes-García V, McDade T, Huanca T, Tanner S. Short but catching up: Statural growth among native Amazonian Bolivian children. Am J Hum Biol. 2010;22:336–47.CrossRef
28.
go back to reference Wamani H, Åstrøm AN, Peterson S, Tumwine JK, Tylleskär T. Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys. BMC Pediatr. 2007;7:17.CrossRef Wamani H, Åstrøm AN, Peterson S, Tumwine JK, Tylleskär T. Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys. BMC Pediatr. 2007;7:17.CrossRef
29.
go back to reference Teshome B, Kogi-Makau W, Getahun Z, Taye G. Magnitude and determinants of stunting in children underfive years of age in food surplus region of Ethiopia: the case of west gojam zone. Ethiop J Health Dev. 2009;23(2):99–106. Teshome B, Kogi-Makau W, Getahun Z, Taye G. Magnitude and determinants of stunting in children underfive years of age in food surplus region of Ethiopia: the case of west gojam zone. Ethiop J Health Dev. 2009;23(2):99–106.
30.
go back to reference Mukabutera A, Thomson DR, Hedt-Gauthier BL, Basinga P, Nyirazinyoye L, Murray M. Risk factors associated with underweight status in children under five: an analysis of the 2010 Rwanda demographic health survey. BMC Nutr. 2016;2:40.CrossRef Mukabutera A, Thomson DR, Hedt-Gauthier BL, Basinga P, Nyirazinyoye L, Murray M. Risk factors associated with underweight status in children under five: an analysis of the 2010 Rwanda demographic health survey. BMC Nutr. 2016;2:40.CrossRef
32.
go back to reference Heimer J, Staudacher O, Steiner F, Kayonga Y, Havugimana JM, Musemakweri A, Harms G, Gahutu JB, Mockenhaupt F. Age-dependent decline and association with stunting of Giardia Duodenalis infection among schoolchildren in rural Huye District, Rwanda. Acta Trop. 2015;145:17–22.CrossRef Heimer J, Staudacher O, Steiner F, Kayonga Y, Havugimana JM, Musemakweri A, Harms G, Gahutu JB, Mockenhaupt F. Age-dependent decline and association with stunting of Giardia Duodenalis infection among schoolchildren in rural Huye District, Rwanda. Acta Trop. 2015;145:17–22.CrossRef
36.
go back to reference M'Kaibi FK, Steyn NP, Ochola SA, Du Plessis L. The relationship between agricultural biodiversity, dietary diversity, household food security, and stunting of children in rural Kenya. Food Sci Nutr. 2017;5:243–54.CrossRef M'Kaibi FK, Steyn NP, Ochola SA, Du Plessis L. The relationship between agricultural biodiversity, dietary diversity, household food security, and stunting of children in rural Kenya. Food Sci Nutr. 2017;5:243–54.CrossRef
37.
go back to reference Niyibituronsa M, Kyallo F, Mugo C, Gaidashova S. The effects of household food practices and diseases prevalence on nutritional status of under-five children in Ruhango District, Rwanda. Afr J Food Agric Nutr Dev. 2015;15(1, January):9744–61. Niyibituronsa M, Kyallo F, Mugo C, Gaidashova S. The effects of household food practices and diseases prevalence on nutritional status of under-five children in Ruhango District, Rwanda. Afr J Food Agric Nutr Dev. 2015;15(1, January):9744–61.
38.
go back to reference Ruel MT, Alderman H, Black RE, Alderman H, Bhutta ZA, Gillespie S, Haddad L, Horton S, Lartey A, Mannar V, Victora C, Walker S, Webb P, Van Ameringen M, Arabi M, Baker S, Bloem M, Branca F, Elder L, McLean E, Monteiro C, Mwadime R, Piwoz E, Schultink W, Sullivan L, Taylor A, Yach D. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382(9891):536–51. https://doi.org/10.1016/S0140-6736(13)60843-0.CrossRefPubMed Ruel MT, Alderman H, Black RE, Alderman H, Bhutta ZA, Gillespie S, Haddad L, Horton S, Lartey A, Mannar V, Victora C, Walker S, Webb P, Van Ameringen M, Arabi M, Baker S, Bloem M, Branca F, Elder L, McLean E, Monteiro C, Mwadime R, Piwoz E, Schultink W, Sullivan L, Taylor A, Yach D. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382(9891):536–51. https://​doi.​org/​10.​1016/​S0140-6736(13)60843-0.CrossRefPubMed
40.
go back to reference Ozaltin E, Hill K, Subramanian SV. Association of Maternal Stature with offspring mortality, underweight, and stunting in low- to middle-income countries. JAMA. 2010;303(15):1507–16.CrossRef Ozaltin E, Hill K, Subramanian SV. Association of Maternal Stature with offspring mortality, underweight, and stunting in low- to middle-income countries. JAMA. 2010;303(15):1507–16.CrossRef
41.
go back to reference Habyarimana F, Zewotir T, Ramroop S, Ayele DG. Spatial distribution of determinants of malnutrition of children under five years in Rwanda: simultaneous measurement of three anthropometric indices. J Hum Ecol. 2017b;54(3):138–49.CrossRef Habyarimana F, Zewotir T, Ramroop S, Ayele DG. Spatial distribution of determinants of malnutrition of children under five years in Rwanda: simultaneous measurement of three anthropometric indices. J Hum Ecol. 2017b;54(3):138–49.CrossRef
42.
go back to reference Lee J, Houser RF, Must A, de Fulladolsa PP, Bermudez OI. Disentangling nutritional factors and household characteristics related to child stunting and maternal overweight in Guatemala. Econ Hum Biol. 2010;8:188–96.CrossRef Lee J, Houser RF, Must A, de Fulladolsa PP, Bermudez OI. Disentangling nutritional factors and household characteristics related to child stunting and maternal overweight in Guatemala. Econ Hum Biol. 2010;8:188–96.CrossRef
43.
go back to reference Lee J, Houser RF, Must A, de Fulladolsa PP, Bermudez OI. Socioeconomic disparities and the familial coexistence of child stunting and maternal overweight in Guatemala. Econ Hum Biol. 2012;10:232–41.CrossRef Lee J, Houser RF, Must A, de Fulladolsa PP, Bermudez OI. Socioeconomic disparities and the familial coexistence of child stunting and maternal overweight in Guatemala. Econ Hum Biol. 2012;10:232–41.CrossRef
45.
go back to reference Dang S, Yan H, Yamamoto S. High altitude and early childhood growth retardation: new evidence from Tibet. Eur J Clin Nutr. 2008;62:342–8.CrossRef Dang S, Yan H, Yamamoto S. High altitude and early childhood growth retardation: new evidence from Tibet. Eur J Clin Nutr. 2008;62:342–8.CrossRef
46.
go back to reference Pomeroy E, Stock JT, Stanojevic S, Miranda JJ, Cole TJ, Wells JC. Stunting, adiposity, and the individual-level “dual burden” among urban lowland and rural highland Peruvian children. Am J Hum Biol. 2014;26(4):481–90.CrossRef Pomeroy E, Stock JT, Stanojevic S, Miranda JJ, Cole TJ, Wells JC. Stunting, adiposity, and the individual-level “dual burden” among urban lowland and rural highland Peruvian children. Am J Hum Biol. 2014;26(4):481–90.CrossRef
47.
go back to reference Frongillo EA, de Onis M, Hanson KMP. Socioeconomic and demographic factors are associated with worldwide patterns of stunting and wasting of children. J Nutr. 1997;127:2302–9.CrossRef Frongillo EA, de Onis M, Hanson KMP. Socioeconomic and demographic factors are associated with worldwide patterns of stunting and wasting of children. J Nutr. 1997;127:2302–9.CrossRef
48.
go back to reference Milman A, Frongillo EA, de Onis M, Hwang JY. Differential improvement among countries in child stunting is associated with long-term development and specific interventions. J Nutr. 2005;135:1415–22.CrossRef Milman A, Frongillo EA, de Onis M, Hwang JY. Differential improvement among countries in child stunting is associated with long-term development and specific interventions. J Nutr. 2005;135:1415–22.CrossRef
53.
go back to reference U.S. Agency for International Development (USAID) 2015. Gender Analysis for USAID/Rwanda Feed the Future (FtF) Project: External Version. U.S. Agency for International Development (USAID) 2015. Gender Analysis for USAID/Rwanda Feed the Future (FtF) Project: External Version.
57.
go back to reference Neumann C, Harris DM, Rogers LM. Contribution of animal source foods in improving diet quality and function in children in the developing world. Nutr Res. 2002;22(1–2):193–220.CrossRef Neumann C, Harris DM, Rogers LM. Contribution of animal source foods in improving diet quality and function in children in the developing world. Nutr Res. 2002;22(1–2):193–220.CrossRef
58.
go back to reference Abu-Saad K, Fraser D. Maternal nutrition and birth outcomes. Epidemiol Rev. 2010;32(1):5–25.CrossRef Abu-Saad K, Fraser D. Maternal nutrition and birth outcomes. Epidemiol Rev. 2010;32(1):5–25.CrossRef
59.
go back to reference Webb P, Luo H, Gentilini U. Measuring multiple facets of malnutrition simultaneously: the missing link in setting nutrition targets and policymaking. Food Sec. 2015;7(3):479–92.CrossRef Webb P, Luo H, Gentilini U. Measuring multiple facets of malnutrition simultaneously: the missing link in setting nutrition targets and policymaking. Food Sec. 2015;7(3):479–92.CrossRef
61.
go back to reference Satterthwaite FE. An approximate distribution of estimates of variance components. Biom Bull. 1946;2:110–4.CrossRef Satterthwaite FE. An approximate distribution of estimates of variance components. Biom Bull. 1946;2:110–4.CrossRef
62.
go back to reference Tukey JW. One degree of freedom for non-additivity. Biometrics. 1949;5(3):232–42.CrossRef Tukey JW. One degree of freedom for non-additivity. Biometrics. 1949;5(3):232–42.CrossRef
Metadata
Title
Stunting, food security, markets and food policy in Rwanda
Authors
Dave D. Weatherspoon
Steve Miller
Jean Chrysostome Ngabitsinze
Lorraine J. Weatherspoon
James F. Oehmke
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Nutrition
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7208-0

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