Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.
PLoS One. 2024 Mar 13;19(3):e0290919. doi: 10.1371/journal.pone.0290919. eCollection 2024.
Child stunting (chronic undernutrition) is a major public health concern in low- and middle-income countries. In Rwanda, an estimated 33% of children are affected. This study investigated the household living conditions and the impact of gender-related decision-making on child stunting. The findings contribute to ongoing discussion on this critical public health issue. In December 2021, a population-based cross-sectional study was conducted in Rwanda's Northern Province; 601 women with children aged 1-36 months were included. Stunting was assessed using low height-for-age criteria. The Multidimensional Poverty Index (MPI) was used to determine household socioeconomic status. Researcher-designed questionnaires evaluated gender-related factors such as social support and household decision-making. Multivariable logistic regression analysis identified risk factor patterns. Six hundred and one children were included in the study; 27.1% (n = 163) were diagnosed as stunted; there was a higher prevalence of stunting in boys (60.1%) than girls (39.9%; p<0.001). The MPI was 0.265 with no significant difference between households with stunted children (MPI, 0.263; 95% confidence interval [CI], 0.216-0.310) and non-stunted children (MPI, 0.265; 95% CI, 0.237-0.293). Most households reported a lack of adequate housing (78.9%), electricity (63.0%), good water sources (58.7%), and proper toilets (57.1%). Male-headed households dominated (92% vs. 8.0%; p = 0.018), and women often shared decision-making with their partners. However, 26.4% of women reported forced sexual intercourse within marriage (Odds Ratio [OR] 1.81; 95% CI, 1.15-2.85). Lack of support during illness ([OR], 1.93; 95% CI, 1.13-3.28) and absence of personal guidance (OR, 2.44; 95% CI, 1.41-4.26) were significantly associated with child stunting. Poverty contributes to child stunting in the Northern Province of Rwanda. Limited social support and women's lack of decision-making power in the household increase stunting rates. Interventions should empower women and address the broader social and economic context to promote both women's and children's health.
儿童发育迟缓（慢性营养不良）是低收入和中等收入国家的一个主要公共卫生问题。在卢旺达，估计有 33%的儿童受到影响。本研究调查了家庭生活条件以及与性别相关的决策对儿童发育迟缓的影响。研究结果有助于就这一关键公共卫生问题进行持续讨论。2021 年 12 月，在卢旺达北部省进行了一项基于人群的横断面研究；纳入了 601 名 1-36 月龄儿童的女性。使用低身高年龄标准评估发育迟缓。多维贫困指数（MPI）用于确定家庭社会经济地位。研究人员设计的问卷评估了社会支持和家庭决策等与性别相关的因素。多变量逻辑回归分析确定了危险因素模式。共有 601 名儿童纳入研究；27.1%（n=163）被诊断为发育迟缓；男孩（60.1%）的发育迟缓患病率高于女孩（39.9%；p<0.001）。MPI 为 0.265，有发育迟缓儿童家庭（MPI，0.263；95%置信区间[CI]，0.216-0.310）和无发育迟缓儿童家庭（MPI，0.265；95%CI，0.237-0.293）之间无显著差异。大多数家庭报告缺乏足够的住房（78.9%）、电力（63.0%）、良好的水源（58.7%）和适当的厕所（57.1%）。男性主导家庭占主导地位（92%比 8.0%；p=0.018），女性经常与伴侣共同决策。然而，26.4%的女性报告在婚姻中遭受强迫性行为（优势比[OR]1.81；95%CI，1.15-2.85）。患病期间缺乏支持（OR，1.93；95%CI，1.13-3.28）和缺乏个人指导（OR，2.44；95%CI，1.41-4.26）与儿童发育迟缓显著相关。贫困导致卢旺达北部省儿童发育迟缓。有限的社会支持和妇女在家庭中缺乏决策权增加了发育迟缓的发生率。干预措施应赋予妇女权力，并解决更广泛的社会和经济背景，以促进妇女和儿童的健康。
