Peer-reviewed article

Wealth inequalities in childhood stunting in the northern province of rwanda: a decomposition analysis.

Ndagijimana A, Sebastian MS, Elfving K, Umubyeyi A, Lind T · 29 Sept 2025

Abstract

BACKGROUND: Childhood stunting remains a public health challenge, especially in sub-Saharan Africa. In Rwanda, it is the highest in the Northern province, with a prevalence of 40.5% in children under five. Given that poverty is a key determinant of stunting, we aimed to investigate wealth inequalities in childhood stunting and to identify its contributing determinants in the province. METHODS: We included 601 children aged 1 to 36 months. We estimated the concentration index to quantify wealth-related inequalities in stunting, which we further decomposed it by applying the Wagstaff decomposition approach. RESULTS: The overall concentration index of child stunting was relatively high (-0.190; 95% CI: -0.295, -0.084), suggesting that stunting was concentrated in poorer households. Its decomposition revealed that socio-economic determinants (147.9%), namely wealth index, partner’s unemployment or non-skilled occupation, and household food insecurity, contributed most to the wealth inequalities of childhood stunting. The demographic determinants contributed in the second order, especially living in Musanze district. Psychosocial determinants came last, namely maternal social support. CONCLUSION: This study revealed significant wealth inequalities in childhood stunting in the Northern Province of Rwanda, with socio-economic factors being the primary contributors to these inequalities. Targeted interventions, such as household economic strengthening programs, robust food security policies, improved conditions and salaries in non-skilled jobs, and social support programs for the most disadvantaged communities, are essential to reducing these disparities.