BackgroundDespite progress, sub-Saharan African countries (SSA) face immunisation disparities. Rwanda has high rates, but the drivers of success are unclear. There's a gap in understanding inequalities and a lack of comparative equity analyses with other SSA countries.MethodsThis study analysed population-based survey data from 17 SSA countries, including Rwanda, among two-year-old children. Full immunisation included all recommended vaccines, according to age and the national immunisation schedule. For Rwanda, the coverage was assessed across six inequality dimensions using frequencies, percentages, and 95% CIs. Absolute (Difference, SII) and relative (Ratio, RCI) measures of inequalities were plotted over time. Population Attributable Risk (PAR) and Fraction (PAF) were estimated for public health impact. Equiplots visualised inequalities across countries.ResultsBetween 2000 and 2019, Rwanda’s full immunisation coverage rose from 76% to 96%. Despite substantial reductions in inequalities in full immunisation coverage in Rwanda between 2000 and 2019, subnational disparities remained the most pronounced, with PAR decreasing from 15.40% to 3.10%, while wealth and place of residence inequalities persisted at low levels (wealth PAR 1.53%; residence PAR 1.43% in 2019). Equiplots highlight that, while Rwanda made significant progress in narrowing gaps across all the equity dimensions, other SSA countries showed wide socioeconomic, educational, and geographic gaps.ConclusionRwanda’s experience with full child immunisation highlights the importance of strong primary healthcare systems and equity-focused delivery strategies, offering transferable lessons for reducing immunisation inequalities across sub-Saharan Africa.
Albert NDAGIJIMANA, Michael Habtu, Theoneste Mutsindashyaka et al.
Childhood malnutrition remains a major public health challenge in low- and middle-income countries, contributing substantially to morbidity and mortality among children under five. Although nutrition education is widely promoted to improve infant and young child feeding practices, evidence on its effects when delivered through routine health services in Kenya over a nine-month period remains limited. This study evaluated the effect of a structured facility-based nutrition education intervention comprising interactive group sessions with practical food demonstrations on the nutritional status of children aged 6-23 months in Nyeri County, Kenya. A longitudinal quasi-experimental study was conducted between May 2021 and March 2022 in two purposively selected Level IV hospitals (Karatina, intervention; Othaya, control). A total of 451 mothers, each paired with one child (220 intervention, 231 control), were enrolled and followed for nine months (360 retained). Mothers in the intervention arm attended three quarterly sessions of about 60-75 minutes, each pairing interactive learning with hands-on food demonstrations using locally available ingredients and content drawn from the Kenya Ministry of Health Infant and Young Child Nutrition counselling cards. Mothers in the control arm received the facility's routine maternal and child health education. Children's anthropometry was measured at baseline and at 3, 6, and 9 months, and weight-for-length, weight-for-age, and length-for-age Z-scores were derived against the WHO Child Growth Standards to classify wasting, underweight, and stunting. Because each child was measured repeatedly, intervention effects were assessed primarily using generalized estimating equations (GEE) modelling the arm × time interaction, supported by prevalence changes, net intervention effects, and chi-square or Fisher's exact tests, with significance set at 5%. The two arms were comparable in nutritional status at baseline. By nine months, the prevalence of wasting declined from 7.3% to 4.1% in the intervention arm compared with 8.5% to 8.3% in the control arm (net intervention effect − 3.0 percentage points). Generalized estimating equations that accounted for repeated measures within children showed no statistically significant arm × time interactions for wasting (OR 1.01, 95% CI 0.94–1.09, p = 0.73), underweight or stunting. A structured facility-based nutrition education programme integrating food demonstrations was associated with a favourable but non-significant reduction in wasting over the nine-month period. Nutrition education should be strengthened alongside nutrition-sensitive interventions, including improved household food security, water, sanitation and hygiene, and social protection programmes, to achieve sustained improvements in child nutritional status. Key words:nutrition education; facility-based; child nutritional status; quasi-experimental study; net-effect intervention; generalized estimating equations; Nyeri; Kenya
Inroduction Maternal perceptions of indigenous foods and dietary diversity are crucial in shaping infant nutrition and preserving cultural food practices. Addressing these perspectives is vital to overcoming local nutritional challenges. This study investigated mothers’ perception on indigenous foods and their inclusion in the diets of infants aged 6 to 23 months in Kitui County, Kenya. Study also, examined the association between infants’ dietary diversity and maternal perceptions on indigenous foods. Methods In this cross-sectional study, 402 infant-mother pairs were enrolled. Dietary diversity was assessed using a dietary diversity questionnaire. Mothers provided insights into their perceptions regarding indigenous foods. Results and discussion The average dietary diversity score for the infants was low at 2.47 ± 0.02, with only 30.3% consuming more than four food groups in the past 24 h. About 36.6% of mothers reported that their infants accepted/liked indigenous foods whereas 94.5% considered them expensive, 59.2% perceived them as nutritious/health. Additionally, only 4.7 and 17.4% of mothers indicated that indigenous foods were readily available and easy to prepare, respectively. Dietary diversity was significantly associated with infant acceptance of indigenous food ( p = 0.021), perceived nutrition/health benefit ( p < 0.001), availability ( p = 0.016) and ease of preparation ( p < 0.001). Key predictors of indigenous food consumption included infants’ acceptance of the foods, affordability, perceived nutritional benefits, availability, and ease of preparation. Multi-level interventions targeting food production, intrahousehold food security, and maternal nutrition behaviors, such as providing appropriate recipes, cooking training, and demonstrations, could promote the consumption of nutrient-rich indigenous foods. Enhancing the accessibility and availability of these foods is crucial. This can be achieved by supplying quality seeds, climate-resilient livestock breeds, essential farm inputs, water harvesting technologies, and providing extension support services. These measures could bolster indigenous food production and intake, thereby improving infant nutrition.
Renal biomarkers change rapidly in early childhood, but pediatric reference intervals used in African laboratories are often extrapolated from non-African populations and discrete age partitions. This study derived continuous age-dependent centile curves and preliminary reference intervals for body mass index (BMI), serum creatinine, urea, and electrolytes in healthy Kenyan children aged 0 to 60 months. In this cross-sectional study, 176 children (90 males, 86 females) were systematically recruited at Kitui County Referral Hospital between June 2024 and February 2025. Children underwent clinical screening, World Health Organization-standard anthropometry, and morning fasting venous blood sampling. Creatinine and urea were measured using isotope-dilution mass spectrometry-traceable enzymatic assays, and electrolytes by direct ion-selective electrode. Centiles (2.5th, 50th, 97.5th) were estimated non-parametrically with 90% bootstrap confidence intervals, and continuous age trends modeled using generalized additive models for location, scale, and shape or quantile regression. BMI showed modest age-related variation, with median values rising from 15.8 kg/m2 (2.5th-97.5th: 11.4-20.2) at 0 to 11 months to 16.5 kg/m2 (10.1-23.0) at 48 to 60 months, with dispersion narrowing after age 2. Median creatinine rose steeply in infancy and more gradually thereafter, from 17.4 to 31.2 µmol/L. Urea increased gradually from a median of 2.59 to 3.63 mmol/L, with overlapping centile limits across adjacent strata. Electrolytes were tightly regulated and largely age-invariant: sodium ranged from 135 to 147 mmol/L (median ~141), potassium 3.6 to 5.7 mmol/L (median declining from 4.9 to 4.5), and chloride 100 to 111 mmol/L (median ~105-106). Sex-specific partitions were supported only in early life (BMI in infancy, creatinine in toddlers); correlations between anthropometric z-scores and biomarkers were weak (|ρ| < 0.15; P > .10). These continuous centile curves provide the first preliminary age-dependent reference estimates for renal biomarkers in Kenyan children under 5, showing rapid early renal maturation alongside stable electrolyte homeostasis. As this cross-sectional design cannot capture within-subject variation, larger multicenter and longitudinal studies are needed to confirm these trajectories, refine intervals, and develop age-dependent z-score calculators for clinical use.
Malnutrition among children is a serious health problem in Rwanda, with 33 percent of children under five being stunted. Limited dietary diversity, especially fruits and vegetables, contributes to micronutrient deficiencies and growth retardation. This research examined fruit and vegetable intake trends and relationships with the nutritional status of 6-59-month-old children in Nyamagabe District, Southern Province, Rwanda. Data collection occurred between November 2025 and February 2026 using a mixed-method convergent parallel design. The quantitative element included a community survey of 513 mother-child pairs through multistage cluster sampling. Anthropometric values were recorded per WHO protocol, and dietary intake was collected through 24-hour recalls, food questionnaires, and diversity scores. Food security was measured using the Food Insecurity Access Scale. The qualitative element included 17 focus groups and 20 in-depth interviews. The stunting, wasting, and underweight prevalence were 39.2, 3.5, and 12.1, respectively. Only 28.7 percent of children had minimum dietary diversity, with daily fruit and vegetable intake at 1.6 servings (SD = 1.3). Children consuming three or more servings were less likely to be stunted (AOR = 0.38; 95% CI: 0.24-0.61; p < 0.001) and underweight (AOR = 0.47; 95% CI: 0.27-0.83; p = 0.009). Household food insecurity was strongly associated with increased stunting risk (AOR = 3.45; 95% CI: 2.18–5.47; p < 0.001), indicating that food-insecure households had nearly 3.5 times greater odds of having a stunted child compared to food-secure households. Absence of formal maternal education (AOR = 2.67; 95% CI: 1.58–4.51; p < 0.001) and belonging to the lowest wealth quintile (AOR = 2.89; 95% CI: 1.72–4.86; p < 0.001) were additional independent risk factors for stunting. Barriers included seasonal deficits, high prices, weak nutrition education, and a preference for starchy staples. Solutions require nutrition-sensitive agriculture, year-round food production, behavior change, and food security programs.
Gisubizo Fabien, Irène Médémè Mitchodigni, Evode Habimana et al.
Moderate acute malnutrition (MAM) among children under five remains a challenge in Tanzania, where the fortified blended foods used to manage it are almost entirely imported, expensive and inaccessible. This study developed and evaluated a grain amaranth-based extruded instant porridge as a locally sourced alternative. Five formulations were generated from grain amaranth, pro-vitamin A maize, soybean and sesame by two-stage linear programming using regional food composition data, with crude protein maximized subject to a technological fat ceiling of 11.0 g/100 g. Formulation 1, the least-cost solution, and Formulation 5, the most nutrient-dense within fat ceiling that is more economical than the non-compliant Formulation 3, were advanced to twin-screw extrusion. Proximate composition (AOAC 2005), mineral content (microwave plasma atomic emission spectrometry) and anti-nutritional factors (colorimetric methods) were determined; functional and sensory properties were evaluated; data were analyzed by ANOVA. Protein ranged from 18.14 g/100 g in Formulation 1 to 20.53 g/100 g in Formulation 5 reaching 98.0% of the WFP/UNICEF Super Cereal Plus (CSB++) minimum of 400 kcal/100 g. Formulation 5 showed the highest fat (11.95 g/100 g) and zinc (8.98 mg/100 g), all within CSB++ ranges, with only potassium below specification (37.1%). Extrusion significantly increased water absorption capacity ( p < 0.001), shifted the flour from the fair to good flowing category, and reduced tannins, oxalates and phytate by 50.2, 64.9 and 77.6% relative to raw grain amaranth. Sensory scores showed good overall acceptability (6.2–6.9), with significant differences for aroma ( p < 0.001) and flavor ( p = 0.002); SC(F5)-777 ranked highest among extruded samples. Food-to-food fortification using grain amaranth at 40–45% produced energy- and nutrient-dense instant porridge with improved mineral content, functional properties, and sensory characteristics, demonstrating strong potential for use as locally available supplementary food for managing MAM in children under five.
Amos Steven Mwikwabe, Haikael David Martin, Benson Kusirie Mushi et al.
BACKGROUND: Severe acute malnutrition (SAM) is diagnosed based on bilateral edema, mid‑upper arm circumference (MUAC), and/or weight‑for‑height z‑score (WHZ). These criteria do not fully overlap and may identify children with distinct biological and clinical profiles. Understanding how children with SAM identified by different criteria differ in body composition during outpatient therapeutic program (OTP) treatment may help inform treatment and post‑discharge practices. METHODS: We conducted a prospective cohort study of children aged 6-59 months with uncomplicated SAM admitted by MUAC only (MUAC group), WHZ only (WHZ group), or combined MUAC and WHZ criteria (Combined group) in Aweil Centre, South Sudan. Anthropometry, triceps skinfold thickness, and bioelectrical impedance analysis were collected at admission (n = 194) and discharge (n = 127). Fat mass (FM), fat‑free mass (FFM), fat mass index (FMI), fat‑free mass index (FFMI), total body water percentage (TBW), and phase angle (PhA) were assessed. Between‑group differences and within‑child changes were analyzed using linear mixed effects models adjusted for age and sex. RESULTS: At admission, children in the MUAC and Combined groups were younger and more stunted, with the Combined group showing the most severe deficits across anthropometry, FMI, and PhA. During treatment, the WHZ group exhibited the fastest recovery, with predominantly FFM accretion (82% of weight gain) and the largest increases in FFMI. In contrast, the MUAC group accumulated mainly FM (78% of weight gain) with minimal FFM gain and a decline in PhA, while the Combined group showed mixed FM and FFM recovery patterns. CONCLUSIONS: Children admitted for outpatient SAM treatment by MUAC, WHZ, or combined criteria appeared to follow different recovery trajectories despite meeting standard anthropometric discharge thresholds. Body‑composition and impedance indicators suggested heterogeneity in tissue gain patterns and vulnerability profiles across admission groups, particularly in the MUAC and Combined groups. While exploratory, these findings suggest that anthropometric recovery alone may not uniformly capture the full recovery pattern across SAM admission groups, warranting the need for longitudinal studies evaluating whether body-composition differences at discharge predict subsequent clinical outcomes and post-discharge vulnerability.
Gabriele Rossi, Rachel M. Creighton, Patricia Ayebazibwe et al.
Abstract Gut microbiome composition has been suggested as a factor in the development of malnutrition, which affects one fifth of all children. The microbiome is dependent on environmental and dietary factors, therefore studies on the gut microbiota diversity and relative abundance of bacteria in children with and without malnutrition in different geographical regions are needed. In this study, rectal swabs were collected from 134 Rwandan children 1–36 months of age with (n = 66) or without (n = 68) malnutrition. DNA was extracted from rectal swabs and the full 16S rRNA gene deep sequenced using Nanopore sequencing for analysis of the gut microbiota. Gut microbiota alpha diversity correlated positively with age ( P < 0.0001). Neither alpha nor beta diversity differed between the study-defined malnourished and non-malnourished groups, however, participants with WAZ ≥ − 2 and < − 2 differed in beta diversity analysis ( P = 0.02). The most abundant species, Peptostreptococcaceae bacterium oral taxon 929, showed an association with WAZ, in mean 18% and 9% relative abundance among those with WAZ ≥ − 2 and < − 2, respectively ( p = 0.04). Results suggested that the gut microbiota might be associated with being underweight (WAZ < − 2), highlighting the need for future, larger studies of the gut microbiota in malnourished children.
Johan Ringlander, Maria E. Andersson, Albert Ndagijimana et al.
Kenyan youth increasingly seek psychosocial support through digital environments, yet little Kenya-specific evidence explains how online help-seeking unfolds as an ecosystem rather than as use of a single platform or intervention. This study adopts an exploratory, ecosystem-mapping approach to examine digital help-seeking pathways, trust dynamics, and ethical risks shaping youth psychosocial wellbeing in Kenya. The study triangulated three evidence streams: (i) a structured scan of commonly accessed digital platforms and web resources used by youth (including Google Search, YouTube, TikTok, Instagram, Facebook, WhatsApp communities, X/Twitter spaces, and institutional/NGO websites), (ii) rapid qualitative interviews with youth and mental health stakeholders (n = 28), and (iii) structured expert forum discussions involving practitioners and programme leads engaged in youth mental health and digital support. Findings show that youth help-seeking occurs within a distributed online support ecosystem dominated by mainstream commercial platforms rather than purpose-built mental health services. Five pathway typologies were identified: search-first self-triage, feed-based discovery and identity framing, peer-first confidential disclosure, influencer-guided meaning-making, and crisis-to-professional referral. Trust emerged as the primary determinant of sustained engagement, structured around confidentiality, relatability, non-judgment tone, responsiveness, cultural alignment, and community endorsement, often outweighing formal professional credentials or institutional affiliation. Ethical risks were pervasive and ecosystem-level, including privacy leakage (especially via forwarding and screenshots), misinformation and diagnostic confusion, unregulated counselling, exploitation through direct messaging, cyberstigma, algorithmic amplification of distress content, and safeguarding gaps for minors. Rather than evaluating intervention effectiveness, the study maps everyday digital practices and governance gaps, and proposes ecosystem governance priorities including credibility cues, moderation and peer-group norms, boundary standards for semi-formal counselling, and platform-integrated referral pathways. These findings reposition youth digital help-seeking in Kenya as both a psychosocial coping infrastructure and a risk environment, underscoring the need for youth-centred, ethics-informed governance rather than reliance on standalone digital mental health applications.
BACKGROUND AND OBJECTIVES: Of 50 million people with epilepsy globally, up to 10 million with lesional drug resistance epilepsy may be able to achieve seizure control with surgical options. Although multidisciplinary surgical care for epilepsy is available in high-income countries, few programs exist in low- and middle-income countries (LMICs). In 2019, a global collaboration between CURE Uganda and Ann & Robert H. Lurie Children's Hospital in the United States established a surgical epilepsy program in Uganda for the pediatric population. This study identifies key pillars for sustainable neurosurgical program development in LMICs. METHODS: Interdisciplinary health care providers from CURE and Lurie Children's who participated in the development of the surgical epilepsy program from 2019 to 2024 underwent semistructured qualitative interviews. A thematic analysis framework was used to identify themes from interviews related to program development, sustainability, and targets for future work. RESULTS: Nine participants were interviewed, with representation from roles of pediatric neurologist, pediatric neuroradiologist, electroencephalogram technologists, medical officer, and pediatric neurosurgeon. Thematic analysis revealed 4 themes (with subthemes) related to sustainable global surgical program development: (1) Intentional planning (integrating global policies into program development, rigorous case selection for great outcomes to build confidence for public/administrative support, defining barriers and optimizing solutions); (2) interdisciplinary collaboration (communication and trust are vital, new initiatives may require sacrifice, true partnerships allow for bidirectional learning, creative problem solving is crucial); (3) skill transfer and education (on-the-ground skill transfer needed, technology integration facilitates continuous learning, enable development opportunities for teammates); and (4) targets for future work (public education, expanding clinical capacity in LMICs, sustainable education centers, research dissemination). CONCLUSION: Global collaborations create opportunities to increase access to neurosurgical care. Creating interdisciplinary programs across borders requires trust and open communication by all members. Sustainable programs can be further enabled with intentional planning, humility, and bidirectional skill transfer.
Rya Muller, Omolabake Oyetayo, Emmanuel Wegoye et al.
