High Burden of Undernutrition among At-Risk Children in Neonatal Follow-Up Clinic in Rwanda

Theoneste Mutsindashyaka; Alphonse Nshimyiryo; Kathryn Beck; Catherine M. Kirk; Kim Wilson; Christine Mutaganzwa; Jessica D. Bradford; Silas Havugarurema; Vianney Bihibindi; Patient K. Ngamije; Joel M. Mubiligi; Ann C. Miller

doi:10.5334/aogh.2636

Figures & Tables

Table 1

Associations between selected demographic and clinical characteristics of Pediatric Development Clinic (PDC) participants and their families with malnutrition outcomes; rural Rwanda, 2017^a. n = 641 unless there were missing data.

Variable	Total	Stunted (n = 597)			Underweight (n = 619)			Wasted (n = 613)
	Total	No	Yes	p-value	No	Yes	p-value	No	Yes	p-value
	n (%)	n (%)	n (%)	p-value	n (%)	n (%)	p-value	n (%)	n (%)	p-value
All children	641 (100.0)	246 (41.2)	351 (58.8)		325 (52.5)	294 (47.5)		455 (74.2)	158 (25.8)
Child’s sex				0.056			0.024			0.405
Female	305 (47.6)	131 (45.3)	158 (54.7)		170 (57.2)	127 (42.8)		221 (76.0)	70 (24.0)
Male	336 (52.4)	115 (37.3)	193 (62.7)		155 (48.1)	167 (51.9)		234 (72.7)	88 (27.3)
Child’s chronological age at enrollment in PDC (months), median [IQR]	1.25 [0.72–7.36]	1.02 [0.66–2.53]	1.51[0.79–8.90]	<0.001	0.92[0.62–1.83]	1.97 [0.92–10.94]	<0.001	1.02 [0.66–2.83]	2.89 [1.05–14.13]	<0.001
Child’s age at last PDC visit, corrected for prematurity days (in months)				<0.001			0.002			0.007
6–8	121 (18.9)	66 (56.9)	50 (43.1)		69 (59.0)	48 (41.0)		84 (71.2)	34 (28.8)
9–11	79 (12.3)	39 (51.3)	37 (48.7)		41 (52.6)	37 (47.4)		56 (72.7)	21 (27.3)
12–23	274 (42.7)	102 (39.5)	156 (60.5)		149 (56.4)	115 (43.6)		205 (77.4)	60 (22.6)
24–35	116 (18.1)	31 (30.1)	72 (69.9)		53 (47.3)	59 (52.7)		85 (80.2)	21 (19.8)
36–59	51 (8.0)	8 (18.2)	36 (81.8)		13 (27.1)	35 (72.9)		25 (53.2)	22 (46.8)
Gestational age (weeks)				0.529			0.836			0.103
≥37	172 (42.2)	67 (43.0)	89 (57.0)		99 (60.0)	66 (40.0)		123 (75.0)	41 (25.0)
<37	236 (57.8)	102 (46.4)	118 (53.6)		134 (58.5)	95 (41.5)		186 (81.9)	41 (18.1)
Birth weight (kg)				0.020			0.193			0.108
≥2.5	240 (42.5)	105 (46.9)	119 (53.1)		131 (57.5)	97 (42.5)		163 (71.5)	65 (28.5)
<2.5	325 (57.5)	112 (36.6)	194 (63.4)		165 (51.7)	154 (48.3)		245 (77.8)	70 (22.2)
Small for gestational age (SGA)				<0.001			<0.001			0.001
No	191 (29.8)	103 (58.5)	73 (41.5)		124 (68.1)	58 (31.9)		149 (82.3)	32 (17.7)
Yes	180 (28.1)	49 (29.0)	120 (71.0)		90 (51.1)	86 (48.9)		134 (76.1)	42 (23.9)
Unknown GA/birth weight	270 (41.1)	94 (37.3)	158 (62.7)		111 (42.5)	150 (57.5)		172 (67.2)	84 (32.8)
Relationship to primary caregiver				0.214			0.166			0.753
Mother	489 (97.4)	182 (39.9)	274 (60.1)		243 (51.6)	228 (48.4)		344 (73.5)	124 (26.5)
Other	13 (2.6)	2 (18.2)	9 (81.8)		4 (30.8)	9 (69.2)		9 (69.2)	4 (30.8)
Age of primary caregiver(years), median [IQR]	27 [23–33]	27 [23–32]	27 [23–34]	0.363	26 [23–31]	28 [23–35]	0.007	27 [23–32]	30 [23–35]	0.028
Caregiver marital status				0.862			0.267			0.026
Married	408 (69.7)	153 (40.5)	225 (59.5)		214 (54.2)	181 (45.8)		301 (77.8)	86 (22.2)
Living with partner (not married)	115 (19.7)	48 (42.9)	64 (57.1)		56 (50.0)	56 (50.0)		80 (70.2)	34 (29.8)
Divorced/widowed	17 (2.9)	5 (38.5)	8 (67.5)		6 (42.9)	8 (57.1)		7 (46.7)	8 (53.3)
Single	45 (7.7)	20 (46.5)	23 (53.5)		29 (65.9)	15 (34.1)		34 (79.1)	9 (20.9)
Caregiver years of schooling, median [IQR]	5 [3–6]	5 [3–6]	5 [3–6]	0.874	5 [3–6]	5 [2–6]	0.136	5 [3–6]	5 [3–6]	0.659
Mutuelle de Santé				0.083			0.096			0.407
Yes	473 (84.8)	185 (41.9)	257 (58.1)		247 (54.3)	208 (45.7)		341 (75.8)	109 (24.2)
No	85 (15.2)	25 (31.2)	55 (68.8)		37 (44.0)	47 (56.0)		59 (71.1)	24 (28.9)
Ubudehe category				0.188			0.202			0.715
Category 1	27 (5.4)	6 (24.0)	19 (76.0)		9 (36.0)	16 (64.0)		18 (69.2)	8 (30.8)
Category 2	379 (76.6)	138 (39.0)	216 (61.0)		189 (51.4)	179 (48.6)		271 (74.7)	92 (25.3)
Category 3+	89 (18.0)	37 (44.6)	46 (55.4)		49 (56.3)	38 (43.7)		62 (72.1)	24 (27.9)
Total number of children/dependents in household, median [IQR]	2 [1–4]	2 [1–4]	2 [1–4]	0.850	2 [1–4]	3 [1–5]	0.023	2 [1–4]	3 [1–5]	0.080
Reason for referral: Preterm/low birth weight				0.677			0.294			0.003
No	350 (54.6)	137 (42.0)	189 (58.0)		168 (50.4)	165 (49.6)		230 (69.3)	102 (30.7)
Yes	291 (45.4)	109 (40.2)	162 (59.8)		157 (54.9)	129 (45.1)		225 (80.1)	56 (19.9)
Reason for referral: Hypoxic Ischemic Encephalopathy (HIE)				0.042			0.106			0.412
No	460 (71.8)	165 (38.6)	263 (61.4)		226 (50.4)	222 (49.6)		323 (73.2)	118 (26.8)
Yes	181 (28.2)	81 (47.9)	88 (52.1)		99 (57.9)	72 (42.1)		132 (76.7)	40 (23.3)
Reason for referral: Developmental delay				0.598			0.009			<0.001
No	572 (89.2)	221 (41.6)	310 (58.4)		300 (54.3)	252 (45.7)		419 (76.6)	128 (23.4)
Yes	69 (10.8)	25 (37.9)	41 (62.1)		25 (37.3)	42 (62.7)		36 (54.6)	30 (45.4)
Reason for referral: Other conditions				0.808			0.192			0.173
No	555 (86.6)	214 (41.5)	302 (58.5)		288 (53.5)	250 (46.5)		400 (75.2)	132 (24.8)
Yes	86 (13.4)	32 (39.5)	49 (60.5)		37 (45.7)	44 (54.3)		55 (67.9)	26 (32.1)
Reason for referral: Multiple conditions				0.576			0.074			0.084
No	579 (90.3)	220 (40.8)	319 (59.2)		301 (53.8)	259 (46.2)		417 (75.3)	137 (24.7)
Yes	62 (9.7)	26 (44.8)	32 (55.2)		24 (40.7)	35 (59.3)		38 (64.4)	21 (35.6)
Number of total visits in PDC, median [IQR]	9 [5–13]	8 [5–12]	9 [5–13]	0.065	9 [6–13]	8 [5–12]	0.086	9 [6–13]	7 [5–11]	<0.001
History of feeding difficulties				0.103			<0.001			<0.001
No	417 (71.5)	166 (43.2)	218 (56.8)		242 (59.8)	163 (40.2)		325 (82.1)	71 (17.9)
Yes	166 (28.5)	56 (35.4)	102 (64.6)		56 (35.0)	104 (65.0)		92 (56.4)	71 (43.6)

[i] ^a All variables were evaluated at the child’s last PDC visit.

Table 2

Results of the multivariable analysis of factors associated with stunting in Pediatric Development Clinic (PDC) participants, Rwanda, 2017.

Variable	Full model		Final model
Variable	OR [95%CI]	p-value	OR [95%CI]	p-value
Child’s sex
Female	1.00		1.00
Male	1.69 [1.10–2.60]	0.016	1.85 [1.23–2.79]	0.003
Child’s chronological age at enrollment in PDC (months)	1.06 [1.00–1.11]	0.034	1.06 [1.01–1.11]	0.016
Child’s age at last PDC visit, corrected for prematurity days (in months)
6–8	1.00		1.00
9–11	1.14 [0.54–2.44]	0.726	1.35 [0.66–2.77]	0.416
12–23	1.36 [0.71–2.59]	0.350	1.45 [0.79–2.66]	0.236
24–35	1.87 [0.72–4.87]	0.197	1.75 [0.71–4.31]	0.224
36–59	1.62 [0.29–9.16]	0.583	1.23 [0.26–5.78]	0.790
Birth weight (kg)
≥2.5	1.00		1.00
<2.5	2.12 [1.14–3.96]	0.018	1.71 [1.06–2.75]	0.027
Small for gestational age (SGA)
No	1.00		1.00
Yes	2.84 [1.68–4.82]	< 0.001	2.63 [1.58–4.36]	< 0.001
Unknown gestational age/birth weight	2.36 [1.35–4.12]	0.003	2.25 [1.33–3.81]	0.003
Mutuelle de Santé
Yes	1.00		1.00
No	1.71 [0.91–3.21]	0.093	2.05 [1.14–3.66]	0.016
Reason for referral: Hypoxic Ischemic Encephalopathy (HIE)
No	1.00
Yes	1.16 [0.63–2.13]	0.641
Number of total visits in PDC	1.08 [1.01–1.15]	0.029	1.08 [1.01–1.15]	0.017
History of feeding difficulties
No	1.00
Yes	1.36 [0.83–2.24]	0.222

Table 3

Results of the multivariable analysis of factors associated with underweight in Pediatric Development Clinic (PDC) participants, Rwanda, 2017.

Variable	Full model		Final model
Variable	OR [95%CI]	p-value	OR [95%CI]	p-value
Child’s sex
Female	1.00		1.00
Male	1.53 [1.02–2.30]	0.041	1.39 [0.97–1.99]	0.073
Child’s chronological age at enrollment in PDC (months)	1.10 [1.05–1.15]	<0.001	1.09 [1.05–1.14]	<0.001
Child’s age at last PDC visit, corrected for prematurity days (in months)
6–8	1.00		1.00
9–11	0.95 [0.45–2.01]	0.902	0.96 [0.51–1.82]	0.903
12–23	0.72 [0.37–1.38]	0.318	0.70 [0.40–1.21]	0.201
24–35	0.70 [0.28–1.75]	0.450	0.65 [0.30–1.42]	0.282
36–59	0.19 [0.04–0.99]	0.049	0.29 [0.07–1.16]	0.080
Small for gestational age (SGA)
No	1.00		1.00
Yes	2.13 [1.25–3.61]	0.005	2.33 [1.46–3.71]	<0.001
Unknown gestational age/birth weight	1.85 [1.07–3.22]	0.028	1.90 [1.20–3.02]	0.006
Age of primary caregiver(years)	1.02 [0.98–1.05]	0.395
Mutuelle de Santé
Yes	1.00
No	1.43 [0.79–2.57]	0.237
Total number of children/dependents in Household	0.98 [0.86–1.11]	0.698
Reason for referral: Developmental delay
No	1.00
Yes	0.71 [0.30–1.66]	0.432
Reason for referral: Multiple conditions
No	1.00
Yes	1.07 [0.46–2.48]	0.872
Number of total visit in PDC	1.07 [1.01–1.14]	0.021	1.06 [1.01–1.11]	0.030
History of feeding difficulties
No	1.00		1.00
Yes	2.92 [1.81–4.70]	<0.001	2.68 [1.78–4.04]	<0.001

Table 4

Results of the multivariable analysis of factors associated with wasting in Pediatric Development Clinic (PDC) participants, Rwanda, 2017.

Variable	Full model		Final model
Variable	OR [95%CI]	p-value	OR [95%CI]	p-value
Child’s chronological age at enrollment in PDC (months)	1.13 [1.03–1.23]	0.009	1.07 [1.04–1.10]	<0.001
Child’s age at last PDC visit, corrected for prematurity days (in months)
6–8	1.00		1.00
9–11	0.58 [0.20–1.66]	0.312	0.69 [0.34–1.40]	0.304
12–23	0.27 [0.10–0.73]	0.010	0.55 [0.32–0.96]	0.034
24–35	0.15 [0.02–0.79]	0.025	0.35 [0.16–0.76]	0.007
36–59	0.50 [0.03–7.93]	0.620	0.25 [0.08–0.78]	0.017
Gestational age (weeks)
≥ 37	1.00
< 37	0.60 [0.25–1.43]	0.251
Small for gestational age (SGA)
No	1.00
Yes	1.31 [0.63–2.69]	0.468
Unknown gestational age/birth weight	0.87 [0.25–3.10]	0.836
Age of primary caregiver(years)	0.98 [0.92–1.04]	0.444
Caregiver marital status
Married	1.00
Living with partner (not married)	0.66 [0.27–1.60]	0.360
Divorced/widowed	3.06 [0.35–26.58]	0.311
Single	0.65 [0.15–2.73]	0.552
Total number of children/dependents in Household	1.17 [0.99–1.39]	0.071
Reason for referral: Preterm/low birth weight
No	1.00
Yes	1.56 [0.59–4.11]	0.373
Reason for referral: Developmental delay
No	1.00
Yes	3.60 [0.58–22.23]	0.168
Reason for referral: Multiple conditions
No	1.00
Yes	0.65 [0.14–3.04]	0.581
Number of total visits in PDC	1.03 [0.93–1.14]	0.567
History of feeding difficulties
No	1.00		1.00
Yes	2.78 [1.37–5.62]	0.004	3.36 [2.20–5.13]	<0.001