Background: In recent years, Tanzania has made good progress in addressing the problem of chronic malnutrition in children, but the levels are still unsatisfactory, at almost three in ten of its children are stunted. The government of Tanzania has taken significant measures to establish and strengthen multi-sectoral governance as part of national efforts to reduce the unacceptably high level of malnutrition. However, few studies have qualitatively documented stakeholder's perspectives at sub-national and community level with regards to performance of multi-sectoral governance in improving nutrition status of children in Tanzania. Objective: This study aimed to explore the achievements, facilitating factors and challenges of multi-sectoral governance in improving child nutrition in Buhigwe District Council. Methods: This was cross-sectional study, which employed qualitative method of data collection whereby semi-structured interviews were used to conduct in-depth interviews with members of the multisectoral steering committee for nutrition in Buhigwe Council and parents/caregivers of under-five children. Results: There is significant improvement in allocating funds for multisectoral governance interventions targeting under five children across sectors, improved inter-sectoral coordination and increased knowledge on feeding practices among parents/caregivers. Strong leadership and political commitment, inter-sectoral linkage and Presence of Non-Governmental Organizations (NGOs) supporting nutrition were identified as factors for improving child nutrition in the context of multisectoral governance. The issue of insufficient funding, inadequate spending of allocated funds, inadequate capacity, lack of cross-sectional financial mechanism and tools to collect nutrition information were raised by stakeholders as factors hindering the implementation of multi-sectoral governance in improving child nutrition. Conclusion: Smooth implementation of multi-sectoral interventions targeting under-five children requires strong multi-sectoral governance, which is supported by adequate spending of the allocated funds, strong leadership and political commitment, presence of NGOs supporting nutrition and inter-sectoral linkage among line sectors. However, key stakeholders including central and local government authorities should address the challenge of insufficient funds, inadequate capacity, lack of cross-sectoral co-financing mechanism and tools to collect nutrition information, which were reported as barriers to the implementation of multi-sectoral governance in improving child nutrition.
Agriculture, and particularly livestock and animal source foods, has been closely linked to improvements in human nutrition. Production, income, and women’s empowerment improve household food security and child nutritional outcomes in interacting ways. Khat production in Eastern Ethiopia is changing the economic and livelihood landscape for communities that have traditionally relied upon small-scale mixed agriculture and livestock production. How this shifting livelihood landscape and the empowerment of women in these communities are affecting nutritional outcomes has not been investigated. Using cross-sectional data collected during formative research for the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) project, we developed models to examine the roles of livelihood activities, including livestock production, staple crop production, and khat production, and women’s empowerment in child nutrition outcomes. Survey participants were randomly selected mothers of children aged 10–15 months from Haramaya district, Eastern Hararghe, Oromia, Ethiopia. Nested logistic regression models were performed for each nutrition outcome: children’s animal source food consumption, children’s dietary diversity, and child stunting, wasting, and underweight. Explanatory variables included those for livelihood (tropical livestock unit, crop production, and khat production ladder) and women’s empowerment (as indicated by domains of the Women’s Empowerment in Agriculture Index), and covariates including child sex, mother’s age, mother’s education, assets, income, and kebele. Results indicated that khat production and tropical livestock units were not significantly associated with any of the child nutrition outcomes. However, results did indicate that the odds of reporting child animal source food consumption in households where the mother was empowered in the leadership domain was 3.33 times that in households where the mother wasn’t (p < 0.05). In addition, the odds of having a stunted child in households where the mother was empowered in the time domain was 2.68 times that in households where the mother wasn’t (p < 0.05). The results from this study both support and complicate the existing literature on the associations between women’s empowerment in agriculture and child nutrition outcomes, underscoring the important role that livelihood, contextual factors, and location may have on the complex relationship between empowerment domains and nutritional outcomes.
Under-nutrition causes approximately half of all deaths in young children every year globally which is exacerbated by the multiple malnutrition burden. Infant and young child feeding practices pose immediate effects on the nutrition status of under 2 years aged children and greatly influence the survival of a child. This study aimed at determining the implication of the infant and young child feeding practices in evaluating stunting in young children among other stunting risk factors. Analytical cross-section study was carried out in Musanze, a district of Rwanda and involved 241 mothers having children aged between 6 and 23 months. Data was collected using a validated semi-structured questionnaire with observations and check list guides. Chi-square test and logistic regressions were used to determine the associations and risk factors of various variables. The results show that minimum meal frequency (MMF) was attained at 83% rate, minimum dietary diversity (MDD) at 57%, minimum acceptable diet (MAD) at 53% with consumption of iron rich foods at 29%. Stunting prevalence was 28%. The MAD had a significant (p = 0.021) association with height-for-age Z-score of a child and was found to be the stunting's predictor. The child's sex, consumption of animal sourced foods, child underweight status and income type were revealed as other stunting risk factors. A holistic approach that promotes infant and young child feeding practices and complementary feeding in particular can contribute to the alleviation of the stunting burden in Rwanda. Further, other associated factors that influence child nutrition status should be taken into consideration by the policy decision makers and development partners when developing food and nutrition sensitive programs and interventions.
Stunting affects over 151 million children worldwide with 58 million residing in Africa and 26% from Kenya. It reflects a state of chronic malnutrition with adverse effects on child survival, cognitive development and health. This study aimed at establishing the prevalence and determinants of stunting among children aged two years and below in Migori County. This was a cross-sectional study design that sampled 92 children. Child’s age and length were obtained. ENA for SMART software computed stunting indice based on Height-for-Age (HAZ) WHO Z -scores. A total of 25% of children were stunted and 28% were girls. Those aged between 12 and 18 months recorded a prevalence of 31%. Only 45% of children were exclusively breastfed while 3% of them stopped breastfeeding at age between 19 and 24 months. Bivariate analysis showed that mother’s marital status (p=0.036), fathers’ income (p=0.025) and monthly house rent paid (p=0.042) were linked to child stunting. Logistic regression analysis revealed that fathers who were earning more than Ksh 3,000.00 per month had 4 times higher odds [OR: 4.48: 95% CI: 1.05-19.04; p=0.042] of their children being stunted while parents paying less than Ksh 3,000.00 per month for house rent had 4 times higher odds [OR: 4.46: 95% CI: 0.95-21.00; p=0.049] of their children being stunted. In conclusion, 25% of children were stunted with 28% being girls. Fathers’ monthly income and renting a house were key links to child stunting in the county. Research on determinants of child stunting with nutrition interventions targeting children aged below two years is recommended. Keywords: Determinants, stunting, Z-score, cross-sectional, age.
Sawe C.J., Kogi Makau W., Grace Adisa Ettyang et al.
Background: Interventions aimed at improving dietary intake and feeding practices have alone proven insufficient for combatting stunting resulting from poor nutrition and repeated infections. Objectives: To support the development of an integrated water, sanitation, and hygiene (WASH) and nutrition, social, and behavior change strategy aimed at reducing stunting, formative research was conducted in 2 program sites in western Kenya. Methods: Twenty-nine key informant interviews were conducted with community leaders, health workers, and project staff, and 24 focus group discussions with caregivers of children under 2 y on topics related to feeding, sanitation, and hygiene behaviors. Three frameworks informed the study design and analysis of our formative research: the Capabilities, Opportunities, and Motivations model for behavior change, which identifies what needs to change in order for behavior change interventions to be effective; the Grandmother Project's Change Through Culture Approach, which values the important role of influential household and community members in producing household health; and Starr and Fornoff's approach to Theory of Change development. Results: Caregivers exhibited sufficient psychological capabilities (knowledge and skills) for many of the key maternal and infant nutrition behaviors. However, reflective motivation to perform optimal behaviors was undermined by limitations in physical and social opportunities, including limited time and competing priorities for mothers, limited accessibility and availability of diverse foods, low self-efficacy for exclusive breastfeeding, and fears of negative consequences related to specific foods and recommended practices. Conclusions: Interventions that aim to improve maternal and child diets should address the underlying social, cultural, and environmental determinants that contribute to motivations and opportunities to perform recommended practices.
Emilie E. McClintic, Anna S. Ellis, Emily Awino Ogutu et al.
BACKGROUND: Childhood malnutrition remains a public health concern in Rwanda, with stunting rates at 33%, underweight at 8%, and wasting at 1%. These rates are particularly high in rural areas. As primary caregivers, women play a central role in child nutrition, their financial inclusion may significantly influence child health outcomes. This study investigated the relationship between women's financial inclusion and the nutritional status of children aged under five in Rulindo District, Rwanda. METHODS: A cross-sectional study was conducted in February 2024 among 315 women with children aged under 5 years. Financial inclusion data were collected using structured questionnaire. Children's nutritional status was assessed using anthropometric tools. WHO Anthro software, and SPSS version 25.0 were used to analyze the collected data. Bivariate and binary logistic regression analyses were conducted to identify associations between financial inclusion variables and child nutrition outcomes. RESULTS: Among children, 29.5% were stunted, 7.6% underweight, and 4.1% wasted. Bivariate analysis showed significant associations between financial practices (saving for future use and microfinance membership) and child nutritional status. Women who saved for the future were significantly less likely to have stunted children (p = 0.008) or wasted (p = 0.028). Additionally, microfinance membership was associated with a lower prevalence of stunting (p = 0.07), but a higher risk of underweight (p = 0.035). Logistic regression confirmed the association: women with stable income had children with lower odds of stunting (Adjusted Odds Ratio [AOR] = 4.039, p = 0.022), and those in microfinance groups were less likely to have stunted children (AOR = 2.587, p = 0.009), but more likely to report underweight (Crude Odd Ratio [COR] = 4.711, p = 0.029). Saving behavior was protective in the crude model, though it was not statistically significant in the adjusted model. CONCLUSION: Women's financial inclusion is positively associated with improved child nutritional outcomes, particularly regarding stunting and wasting. However, financial literacy and targeted support are needed to ensure that economic tools translate into measurable health benefits. Integrated strategies addressing both financial capacity and nutrition education are essential for long-term child health improvement.
Philomene Niyibizi, Augustave Rukundo Micomyiza, Pacifique Ishimwe et al.
Eggs are highly nutritious foods, yet intake by children in Ethiopia is low. We hypothesized that a nutrition-sensitive poultry intervention improves nutritional status of children 6–18 months using a 6-month cluster randomized controlled community trial. Intervention group (IG) children received a gift of two egg-laying hens in a ceremony where children’s ownership of the chickens was declared by community leaders. Parents promised to add more hens and feed the owner-child one-egg-a-day. Trained community workers reinforced egg feeding, environmental sanitation and poultry husbandry. Control group (CG) mothers received usual nutrition education on child feeding. At baseline 29.6% of children were stunted, 19.4% underweight and 8.6% wasted. Egg consumption significantly increased only in IG, at 6 months. The intervention increased weight-for-age and weight-for-height z-scores by 0.38 (95% CI = 0.13–0.63) and 0.43 (95% CI = 0.21–0.64), respectively. Binary logit model indicated IG children were 54% (Odds ratio [OR] = 0.46; 95% CI = 0.26–0.84) and 42% (OR = 0.58; 95% CI = 0.37–0.91) less likely to be underweight and stunted, respectively, compared to CG. IG children attained the milestone of running (p = 0.022; AHR = 1.43; 95% CI = 1.05–1.95), kicking a ball (p = 0.027; AHR = 1.39; 95% CI = 1.04–1.87) and throwing a ball (p = 0.045; AHR = 1.37; 95% CI = 1.01–1.86) earlier than CG. This nutrition-sensitive child-owned poultry approach should be implemented where animal-source food intake is low.
Abstract In this paper, we investigate the relationship between household drinking water quality and irrigation and child nutrition using primary household survey data and microbiological water sample testings in two rural districts of Ethiopia. Anthropometric measures such as height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), and weight-for-height z-scores (WHZ) were used to measure stunting, underweight, and wasting, respectively. Our survey results show that 41% of the children are stunted, 26% underweight, and 8% wasted. More than 58% of household's stored drinking water samples were also contaminated with Escherichia coli bacteria. The multivariate regression results suggest that irrigation farming and on-premises water sources are significantly associated with lower HAZ, while uncontaminated household stored drinking water quality is correlated with higher WAZ. The results also reveal that dietary diversity score and the number of antenatal care visits by the primary caretaker are statistically significant predictors of child nutritional status. These findings, however, cast doubt on the hypothesis that irrigated agriculture exclusively has a positive effect on child nutrition outcomes.
In many developing countries, supermarkets are spreading rapidly at the expense of traditional food markets and shops. Changing retail environments and food choices may affect consumer diets and nutritional outcomes. Previous research suggested that supermarkets may contribute to rising rates of obesity. However, most existing research looked at adult populations. Here, we analyze effects of supermarkets on child nutrition with panel data from medium-sized towns in Kenya. Instrumental variable regressions show that supermarket food purchases significantly increase child height-for-age and weight-for age Z-scores. The effects on height are larger than the effects on weight. These are welcome findings, because child stunting continues to be a major nutrition problem in developing countries that is declining more slowly than child underweight. Supermarkets do not seem to be a driver of childhood obesity in Kenya. The positive effects of supermarkets on child nutrition are channeled through improvements in food variety and dietary quality.
Bethelhem Legesse Debela, Kathrin Demmler, Stephan Klasen et al.
When children lose one or both their parents/care givers, they may present with profound and lifelong psychosocial well-being problems. This study aimed to examine the association between current living place and the psychosocial well-being of child orphans. A proportional stratified sample of 240 Ethiopian orphan children (female = 44.2%; institutional care = 42.9%; mean age = 15 years, SD = 6.78 years, range = 11 to18 years) completed measures of psychosocial well-being including the strengths and difficulties questionnaire and the multidimensional scale of perceived social support. Following multiple regression analysis, results indicated that institutional living is associated higher emotional symptoms and hyperactivity symptoms, and lower pro-social behaviour. An orphan’s living situation appears to affect the orphan’s well-being.
