At a recent growth monitoring exercise in Rutsiro District, Jeannette Mukashyaka, a resident of Kivumu Sector, brought her one-and-a-half-year-old daughter to be screened for her health status. At bimonthly exercises carried out in every village, community health workers take measurements of children’s height, weight, and upper arm circumference to diagnose malnutrition. “The measurements they take give us a picture of our children’s growth,” said Mukashyaka. “If your child is losing weight or becoming malnourished, you can detect it with the tools used by community health workers. As a parent, I cannot miss these screenings because they show me whether I am feeding my child well. Then, my husband and I look for ways to improve our diet.” Among the tools are a scale, a child-length mat, and mid-upper arm circumference (MUAC) tapes, among others. “The bi-monthly screening exercises are some of the interventions that help us track malnutrition among children. We organize special screening campaigns twice a year,” said Abdul Madjid Ntawuruhunga, who coordinates early childhood development (ECD) initiatives in Rutsiro District. “Children found to be malnourished or at risk of malnutrition are monitored, with health workers intervening. Sometimes, officials are even tasked with helping families with malnourished children to ensure that the interventions put in place are effective,” he said. There are also ECD centres across the district, where children are looked after by caregivers and their health status is tracked every day. The ECD centres are one of the initiatives that were introduced to tackle malnutrition and stunting rates across the country and to prepare the kids for school, among other objectives. In Rutsiro, men have also been mobilised to prioritise the well-being of their children, unlike in the past when they tended to leave the task to their wives. Evariste Subwanone said that they have come to understand that a man plays a significant role in ensuring the well-being of his children and preventing them from malnutrition. “For example, my wife and I worked together to have a vegetable garden at our home. I use part of my daily wage to buy Isambaza for our young children. If my son gets sick, I take him to the health centre, because that is what every parent, not just the mother, has to do,” he said. Ntawuruhunga explained that the fight against stunting in Rutsiro District has led to some gains. According to the Demographic and Health Survey by the National Institute of Statistics of Rwanda (NISR), in 2010, the child stunting rate in Rutsiro was 53.8 per cent, before declining to 45.3 per cent in 2015. As of 2020, stunting stood at 44.4%. The national rate declined from 38% to 33% over the same period. The government's target is to reach 19% in 2024. Rutsiro is one of 13 districts that benefit from the World Bank-sponsored ‘Stunting Prevention and Reduction Project’ (SPRP), which supports community-based approaches to improve the delivery of high-impact nutrition and health interventions. Ntawuruhunga said all the interventions by Rutsiro District are geared towards reducing the stunting rate to 19 per cent or below. All the interventions are mainly led by thousands of community health workers. The team of community health workers conducts home visits to pregnant mothers to follow up on their pregnancy and ensure that they attend antenatal care (ANC) visits to the health centres to prevent the child’s risk of stunting. During these ANC visits, the expectant women also get iron and folic acid tablets for the pregnancy. These tablets help women prevent anaemia and stunting in babies during pregnancy. Expectant and breastfeeding women from low-income categories are given fortified cereal flour, called Shisha Kibondo, to complement their diet. During the antenatal visits, women are also taught how to prepare a balanced diet with the available resources. Jean Pierre Tuyisabe, a community health worker in Kivumu Sector, said, “We are proud to help our community fight malnutrition. If a child is stunted, you cannot expect them to perform well in school and they will be a burden when they grow up. So, that is what we tell parents when we visit them.”
