Spatial heterogeneity and spatially varying determinants of childhood stunting in Northern Rwanda: A cross-sectional study to inform targeted interventions

by Clarisse Kagoyire, Albert Ndagijimana, Gilbert Nduwayezu, Jean Nepo Utumatwishima, Jean Pierre Mpatswenumugabo, Marie Anne Mukasafari, Diane Rinda, Vedaste Ndahindwa, Kristina Elfving, Gunilla Krantz, Torbjörn Lind, Ali Mansourian, Renée Båge, Ewa Wredle, Elias Nyandwi, Aline Umubyeyi, Jean Baptiste Ndahetuye, Petter Pilesjö

Despite national progress, stunting remains prevalent in specific regions of Rwanda, highlighting the limitations of coarse-resolution data for effective mapping and intervention planning. This study explored optimal spatial resolution and analytical approach to capture localised dynamics and the multifactorial nature of stunting. A cross-sectional, population-based study was conducted in the Northern Province of Rwanda, focusing on children aged 1–36 months. Data were collected using structured questionnaires covering socio-demographic, economic, health, childcare, livestock factors and anthropometric measurements. Environmental characteristics were obtained from national datasets, while household geographic coordinates were captured using a customized mobile geodata platform (emGeo). After data cleaning, predictors were analysed using univariable and multivariable logistic regression as well as geographically weighted logistic regression (GWLR) to account for spatial heterogeneity. Among 601 children, stunting prevalence was 27% (boys 33.8%; girls 20.9%). GWLR improved model fit, increasing adjusted deviance explained from 34% to 39%. Significant predictors included child age (adjusted OR = 2.46; 95% CI: 1.78–3.39), male sex (OR = 2.83; 95% CI: 1.65–4.86), birthweight (OR = 0.71; 95% CI: 0.54–0.94), maternal autonomy (ability to refuse sexual intercourse; OR = 0.48; 95% CI: 0.27–0.86), inconsistent maternal social support (OR = 2.30; 95% CI: 1.20–4.42), household electricity access (OR = 0.48; 95% CI: 0.27–0.84) and handwashing facilities (OR = 0.21; 95% CI: 0.07–0.67). GWLR revealed substantial spatial heterogeneity in these factors, delineating areas where each factor matters most. This household-level, spatially explicit analysis reveals localised risk patterns often masked by aggregated national data. Prioritising context-specific interventions (such as electrification, hygiene promotion, and enhanced maternal social support), can enhance effectiveness. The proposed analytical workflow provides a model for addressing persistent stunting in other resource-limited settings.

Association between poor mental health in mothers and child stunting: a population-based cross-sectional study in Rwanda

Objective

Child undernutrition is linked to substantial national economic and health losses in low- and middle-income countries, including Rwanda. Although the causal and contextual factors contributing to chronic malnutrition in children in Rwanda have been explored, the role of the mothers’ mental health has not been fully investigated. This study aims to determine the prevalence of major depressive disorders, generalised anxiety and suicide risk among mothers in Rwanda and to explore their association with child stunting.

Design

This study used a cross-sectional, population-based design.

Setting and participants

Participants included children aged 1–36 months (n=601) and their mothers (n=601) in Rwanda’s Northern Province. Mothers’ mental health was assessed using four modules from the Mini International Neuropsychiatric Interview, based on the Diagnostic and Statistical Manual of Mental Disorders. Child anthropometric measurements followed WHO guidelines.

Primary and secondary outcomes

The primary outcome of the study was child stunting that was defined as a height-for-age Z (HAZ) score

Results

Among the 601 mothers assessed, generalised anxiety disorder had the highest prevalence (36.6%), followed by recurrent major depressive disorder (27.3%), current major depressive disorder (22.7%) and current suicide risk (18.2%). Among the children, 27.1% were stunted, with prevalence rising from 9.8% in infants (1–12 months) to 39.9% in toddlers (25–36 months). Current major depressive disorders in mothers were associated with child stunting (adjusted OR 1.67; 95% CI 1.06 to 2.61). Affected children had lower HAZ scores (–1.68±1.36 vs –1.30±1.09; p=0.004), and excess relative risk (ERR) analysis confirmed depression as a significant risk factor (ERR: 1.56; p=0.005).

Conclusions

Mental health disorders in mothers, especially depression, showed a significant association with child stunting. Addressing mental health disorders in mothers is essential for improving child nutritional outcomes.