Recently, a ten-day outreach campaign on hygiene, nutrition and modern family planning was launched in Nyabihu District. This, according to health ministry officials, was partly geared towards curbing stunting in children below the age of five, which is still a challenge in the country.

According to experts, stunting affects both a child’s physical and mental health, with consequences on their school performance and overall development. Although the country has made tremendous steps in reducing cases of stunting, there is a lot that still needs to be done.

For instance, the 2016/17 findings by Rwanda Demographic and Health Survey (RDHS) indicate that all forms of malnutrition have decreased in all the components of stunting, underweight, wasting and anaemia to 38 per cent, 9 per cent, and 37 per cent, respectively.

However, according to Alexis Mucumbitsi, the head of the Nutrition and Hygiene Department in National Early Childhood Care and Development Program (NECDP), when these figures are compared to the under-20 per cent rate recommended by World Health Organisation, it can be noticed that there is still more that needs to be done.

On the other hand, he notes that the country has made significant progress in the effort compared to 2005 when stunting was at 50 percent.

Possible problems

Mucumbisti says the cases and rate of stunting tend to increase as the age of the child progresses, especially from six months to five years.

He explains that the prevalence of stunting by age shows that at the age of six months, stunting is 11 per cent, 6-8 months at 18per cent, 9-11 months at 21 per cent, and 12-17 months at 47 per cent, while 18-23 months is at 49 per cent.

Although the general cause of stunting is malnutrition, Mucumbitsi says insufficient access to food, poor water sanitation, inadequate health services as well as inadequate maternal and child care are the main reasons that bring about stunting in children.

On insufficient access to food, he says the health ministry is working with Ministry of Agriculture to ensure there is food security in the country.

Inadequate maternal and child care

Figures from the 2016/17 findings by Rwanda Demographic and Health Surve indicate that 36 per cent of children age 6-9 months starts late receiving complementary foods; 18 per cent of children aged 6-23 months only received minimum acceptable diet (MAD); 37 per cent of children aged 6-59 months are anaemic; 19 per cent of women aged 15-49 are anaemic; while 21 per cent of women are overweight or obese.

Mucumbitsi explains that the situation is so largely because of lack of knowledge and other related factors.

"As soon a mother conceives, they are supposed to start attending antennal care, but few of them make an effort of doing so. This calls for more education to women to prevent the stunting rate as early as possible,” he says.

Iba Mayale, a gynaecologist at Clinic Galien in Remera, Gasabo District, notes that some adults have insufficient knowledge on how to fight stunting. He points out that, the participation of men in the child’s life from 0- 5 years is very low when it comes to antenatal care, vaccination, feeding as well as sanitation.

"This is a big challenge that we need to educate the entire population about. I believe if we have to succeed in fighting stunting, men should also start participating so that they work together with the women,” he says.

Mayale adds that some men still perceive such roles as a woman’s reserve, which is a huge setback as all people need to be informed so that we move together as a country.

Some interventions though have already been put in place to curb the problem of stunting and anaemia. For instance, there is commitment from the government to end this challenge through the 1000 Days campaign that started in 2013.

The campaign has five main components which focus on pregnant women, breastfeeding, vaccination and immunisation, complimentary feeding and hygiene. Each component, however, has many activities that have been put together to ensure the reduction of the two types of malnutrition.

Another strategy is the implementation of home fortification, known as "Hongera Bingamubiri” in the local dialect (Kinyarwanda), where micronutrient powder is given to children between the ages of six and 12 for three months. These products are served in porridge.

The available data shows that children under the age of two are most affected by stunting and anaemia.

"For this reason, that’s why complimentary feeding is important and has already been put in place. The government is now giving fortified foods to all children across the country under the age of two, as well as lactating and pregnant women every month,” adds Mucumbisti.

Measures to curb stunting

Erick Musengimana, a nutritionist at CORUHUM Health Centre Kimisagara, Kigali, says preventing stunting in children should start immediately when a woman conceives.

He adds that if the mother suffers from nutrition deficiency while pregnant, it can have a detrimental impact on her baby.

Musengimana explains that malnutrition of the mother during her pre-natal and early postnatal development has health consequences for her child, especially low birth weight.

"When such mothers attend antenatal care, they can be given vitamin supplements that help in the formation and growth of the baby thus reducing chances of stunting in early stages of the child’s life,” he says.

Musengimana says these minerals and vitamins for pregnant women contain vitamins such as folic acid, vitamin D and C, among others, which are vital for the growth of the baby.

When children are born, mothers are educated on how to make sure they practice exclusive breastfeeding for six months. Also, introducing complimentary food while continue breastfeeding after six months is as well important.

However, on complimentary food Mucumbisti advises that parents should focus on quality of foods and not just serving food for the sake of the child getting full.

Complications and interventions

Prevention of long-lasting consequences of stunting, Dr Yvan Ntwari, a general practitioner in Kigali, says should be done in the first 1000 days of a child’s life (the first two years of a child’s life and the nine months of life in their mother’s womb).

He explains that if a child does not get the required nutrients during the second year of its development, the brain gets more affected than the physique, and they can fail to either follow or perform well at school.

Ntwari adds that such children’s productivity is likely to be affected because compared to a well-grown up person, their productivity is less by 10 to 20 per cent.

He further notes that stunted children are more likely to become sick due to their immunodeficiency status, and sick children are more likely to become stunted due to poor nutrient absorption in terms of disability and mortality burden.

"Stunting in children may affect adult size, intellectual ability, school performance, economic productivity and reproductive ability, and may increase the risk of metabolic disorders and cardiovascular disease as well,” Ntwari says.

Ntwari says although there is little that can be done to rectify the problem, stunted children should be continue to be given a balanced diet.

"Also, in cases where such children have been affected mentally, they need support from experts to help them cope well in the society. They also need to be helped in order to become economically productive by going through different therapies,” he says.

Experts share tips

Celestine Karangwa, medic at TCM Technology Clinic, Kicukiro: Parents should be careful when handling their children. For instance, they should keep away dirty items and maintain a clean environment always to ensure infants don’t touch or put dirty in their mouths to prevent them from suffering recurrent diarrhoea and intestinal worm infections.

Olivier Habiyaremye, general practitioner: When a mother practises exclusive breastfeeding, it plays a big role in helping the child grow up with less health issues. This is because breast milk strengthens an infant’s immune system, and gives the child the nutrients needed to grow well.

Raymond Awazi, pediatrician: Proper medical care is needed for any child to prevent infectious diseases which can affect growth leading to stunting. Washing hands with soap, ensuring good waste management are as well essential in providing a good environment for the child to grow well with less health issues.

Julius Habiman, physcian: When a child is exposed to a poor diet when still below the age of two it can negatively affect its development in general. Parents should at all times ensure their children have safe and environment always.