High burden of undernutrition among at-risk children in neonatal follow-up clinic in Rwanda

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Research snapshot¹

A Paediatric Development Clinic (PDC) in rural Rwanda provides a medical home model for the medical, nutritional and developmental care of high-risk children up to the age of five after their discharge from specialised neo­natal care services. To gain a better understanding of nutritional outcomes among children enrolled at the PDC and to better design targeted interventions to accelerate the reduction of undernutrition in Sub-Saharan Africa, this study explored the prevalence of stunting, underweight and wasting and assessed associated factors among high-risk children (defined as born preterm, low birth weight or other birth and neurodevelopmental injuries) who received nutritional support and clinical care follow-up at the PDC.

This cross-sectional study included all children aged 6 to 59 months who had been enrolled at the PDC between 2014 and 2017. An assessment of the age and anthropometric measurements was taken at the child’s last visit to the PDC during this period and the records of 641 children were included. The study found a high prevalence of stunting (58.8%), underweight (47.5%) and wasting (25.8%) among children who received nutrition, development and medical follow-up at the PDC between 2014 and 2017. While the odds of wasting were par­ticularly high among younger children, being born small for gestational  age was asso­ciated with increased odds of stunting (odds ratio (OR) 2.63; 95% confidence interval (CI) 1.58–4.36) and underweight (OR 2.33; 95% CI 1.46–3.71). The history of feeding difficulties was significantly associ­ated with wasting (OR: 3.36; 95% CI: 2.20–5.13) and with underweight (OR: 2.68; 95% CI: 1.78–4.04). Importantly, late PDC intervention was associated with increased odds of stunting (OR: 1.06; 95% CI: 1.01–1.11), underweight (OR: 1.09; 95% CI: 1.05–1.14) and wasting (OR: 1.07; 95% CI: 1.04–1.10).

Although children at the PDC received additional nutrition, devel­opmental and medical support, the heavy burden of undernutrition in this population indicates that even more specialised services are needed for the high­est risk children beyond that which is currently provided within the PDC. For instance, children with feeding difficulties require specialised interventions that may be beyond the scope of management by general nurses and social workers in the PDC, or infants aged six to eight months transitioning from exclusive breastfeeding to complementary feeding (the highest risk group) may require interventions such as caregiver education and counselling on exclusive breastfeeding under six months of age, maternal nutrition among lactating women and support for timely tran­sition to and adequate complementary feeding.

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