Prevalence and Factors Associated with Under Nutrition among Children Aged 6 to 59 Months in Ngoma District, Rwanda

In Rwanda, 38% children aged 6-59 months are stunted. In Ngoma District, stunting rate is estimated at 41% among the children aged below 5 years. The study objective was to evaluate the prevalence and factors contributing to under nutrition among children aged 659 months in Ngoma District. Cluster sampling was used to determine the study participants for each sector within 14 sectors by considering the sample size of 442. The WHO Anthro software version 3.2.2 was used to determine the nutritional status of the children. SPSS version 24 was used for analysis. Of 442 children participated in the study 50.9% of them were females, 24.4% were aged 15-23 months and the majority of children (89.8%) born with normal birth weight. Study findings revealed that the prevalence of under nutrition was 33.7% for stunting, 3.6% for wasting and 6.6% underweighted. Poor sanitation facility (AOR: 4.1, 95%CI: 1.83-9.3, p=0.001), poor diet (AOR: 1.9, 95%CI: 1.18-3, p=0.008) were significantly associated with stunting. Factors such as lack of hand-washing facilities (AOR: 2.5, 95% CI: 1.013-6.3, p=0.047), not eat vegetables (AOR: 4.4, 95%CI: 1.7-10.96, p=0.001), and not eat fishes (AOR: 4.1, 95%CI: 1.6-10.6, p=0.003) were associated with wasting. Short breastfeeding duration (AOR: 4.5, 95%CI: 2.9-7.2, p=0.001), not eat vegetables (AOR: 1.9; 95%CI: 1.1-3.05, p=0.008), and not eat eggs (AOR: 2, 95%CI: 1.3-2.9, p=0.001) were associated with underweight. Poor families with under-five children need continuous support that will assist them to improve nutritional status of their children. Correspondig author: Dr. Erigene Rutayisire, Head of Public Health Department and Senior Lecturer, Public Health Department, Mount Kenya University Rwanda Kigali-Rwanda


Introduction
Under nutrition was claimed to have negative impact on the public health in both developed and developing nations and has been related to the mortality and morbidity among children aged below five years.
Though, prevalence of under nutrition seems to be declining globally, nearly of 22.9% of children below 5 years still suffer from stunting while 7.7% of children below 5 years suffer from wasting [1].
Globally, at least 23% of children aged below 5 years are estimated to be stunted and 94% of these cases are found in Asia and Africa [2]. Furthermore, these estimates demonstrated that around 45% of deaths of children below 5 years are associated to under nutrition [2]. Stunting affected an estimated of 21.3% of stunted children under 5 years and 24% of wasting children resided in Africa [3].
In Africa, prevalence of stunting among children aged under 5 years varies with region. The prevalence is above 30% in Central Africa and Eastern Africa, high in Western Africa and South Africa between 20 and 30%, medium in Northern Africa between 10 and 20% in Northern Africa [4]. In Rwanda the prevalence of undernutrition remains high. According to the Rwanda Demographic Health Survey (DHS) conducted in 2014-2015 children aged under 5 years, stunting rate was 38 %, wasting rate was 2% and underweight was 9% [5]. In Ngoma District where the study is focused, 41% were stunted, 16% had underweight and 4% were wasted [5]. Each participant was requested to offer oral consent and transcribed permission.

Results
Study results in Table 1 indicated that 50.9% of children were females, 24.4% were aged 15-23 months and the majority of children (89.8%) born with normal birth weight. It was found that most of the mothers who participated in the study (71%) were married; (72.6%) had only primary education and more than half (58.8%) were living in poor socio-economic conditions.
As depicted in Table 2, the prevalence of stunting, wasting and underweight among the 442 children aged 6 to 59 months were at 33.7%, 3.6%, and 6.6%, respectively. The highest stunting rate (52.2%) was in children aged 48 to 59 months. The highest wasting rate (5.8%) was in children aged 36-47 months and the highest underweight rate (6.7%) was in children aged 36-47 months.
Regard stunting as presented in Table 3    This finding was consistent with a study done in Rwanda [11] which shows that child age 24-59 months, low child weight at birth, mother's never attended school and household wealth index poorest level were contributing factors of stunting.
Low birth weight (less than 2,500g) contributes to poor health outcomes [8]. In this study children born with weight lesser than 2,500g were likely to be affected by under nutrition (p<0.05) which was consistent with the study done in Malawi where the childhood under nutrition is significantly associated with low birth weight [12].
Breastfeeding is the foundation of child health [13]. The present study found that late breastfeeding was associated with underweight (AOR: 4.5, 95%CI: 2.9-7.2, p=0.001). Contrary to the study done in Kenya where breastfeeding was not associated with wasting [14]. But, it was consistent with a study done in Sudan where there was statistical significance between breastfeeding and malnutrition [15].
The study finding showed that minimum dietary diversity was significantly associated with the decrease of under nutrition. This finding was consistent with findings from a study done in Tanzania [16] where eat diverse diet was significantly associated with the reduction of under nutrition.

Conclusion
In Ngoma District, stunted children were at 33.7 % and wasting at 3.6 % among those ones aged between 6-59 months compared to the national level where stunting was at 32.7 % and wasting at 0.7%.