[Improving the management of a community based growth-monitoring program for children in rural Rwanda].
BACKGROUND
In order to improve the management of a community based nutrition program in the catchment area of Ruli District Hospital in Rwanda, we carried out a nutrition survey to determine the risk factors for childhood malnutrition in the area. Identifying the groups of children at risk of malnutrition and their risk factors allows the community nutrition workers to target the children who require close monitoring, and assists in the development of key messages for educational nutrition training.


METHODS
The prevalence of the three forms of malnutrition was estimated by using the Z-scores height for age, weight for age and weight for height with NCHS/OMS/2000 reference. Logistic regression was performed to identify the risk factors for malnutrition.


RESULTS
Our findings show that children from 12-35 months of age are at greatest risk of malnutrition. Risk factors for wasting include: low monthly income of the household, concurrent illness of the child and a household that does not practice breeding. Risk factors for underweight include: child being greater than 12 months of age, mother of the child being pregnant and history of malnutrition in the household. Finally, risk factors for stunting include the absence of a mosquito net in the household, an insufficient number of working adults in the household, the child being greater than 12 months of age and a household managed by a man alone or by an orphan.


CONCLUSIONS
Community based growth monitoring must focus its attention on the children from nine to 35 months of age. Children less than nine months of age are generally followed by the health centers through the immunization program, and the older children are generally followed in the child minder schools that need to be promoted in all the cells. Community messages must focus on the identified risk factors of malnutrition, and a positive deviance approach must be introduced in the entire zone.
Ngirabega
J D D
JD
Ministère de la Santé, hôpital de Ruli, BP 1285, Kigali, Rwanda. moonhuro@yahoo.fr <moonhuro@yahoo.fr>
Hakizimana
C
C
Wendy
L
L
Donnen
P
P
Dramaix-Wilmet
M
M
D017677:Age Distribution; D000886:Anthropometry; D002662:Child Health Services / Q000458:organization & administration*; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D006130:Growth Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D016015:Logistic Models; D015999:Multivariate Analysis; D020380:Needs Assessment / Q000458:organization & administration*; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D012432:Rwanda / Q000453:epidemiology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D017749:Total Quality Management / Q000458:organization & administration