title: Community-Based Health Financing and Child Stunting in Rural Rwanda.
abstract: OBJECTIVE
  We analyzed the likelihood of rural children (aged 6-24 months) being stunted according to whether they were enrolled in Mutuelles, a community-based health-financing program providing health insurance to rural populations and granting them access to health care, including nutrition services.
  
  
  METHODS
  We retrieved health facility data from the District Health System Strengthening Tool and calculated the percentage of rural health centers that provided nutrition-related services required by Mutuelles' minimum service package. We used data from the 2010 Rwanda Demographic and Health Survey and performed multilevel logistic analysis to control for clustering effects and sociodemographic characteristics. The final sample was 1061 children.
  
  
  RESULTS
  Among 384 rural health centers, more than 90% conducted nutrition-related campaigns and malnutrition screening for children. Regardless of poverty status, the risk of being stunted was significantly lower (odds ratio = 0.60; 95% credible interval = 0.41, 0.83) for Mutuelles enrollees. This finding was robust to various model specifications (adjusted for Mutuelles enrollment, poverty status, other variables) or estimation methods (fixed and random effects).
  
  
  CONCLUSIONS
  This study provides evidence of the effectiveness of Mutuelles in improving child nutrition status and supported the hypothesis about the role of Mutuelles in expanding medical and nutritional care coverage for children.
authors.affiliation: Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health. Agnes Binagwaho is with the Ministry of Health, Government of Rwanda, Kigali, Rwanda.
authors.forename: Chunling
authors.initials: C
authors.lastname: Lu
authors.affiliation: Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health. Agnes Binagwaho is with the Ministry of Health, Government of Rwanda, Kigali, Rwanda.
authors.forename: Iván
authors.initials: I
authors.lastname: Mejía-Guevara
authors.affiliation: Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health. Agnes Binagwaho is with the Ministry of Health, Government of Rwanda, Kigali, Rwanda.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hill
authors.affiliation: Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health. Agnes Binagwaho is with the Ministry of Health, Government of Rwanda, Kigali, Rwanda.
authors.forename: Paul
authors.initials: P
authors.lastname: Farmer
authors.affiliation: Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health. Agnes Binagwaho is with the Ministry of Health, Government of Rwanda, Kigali, Rwanda.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health. Agnes Binagwaho is with the Ministry of Health, Government of Rwanda, Kigali, Rwanda.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D004045:Dietary Services / Q000191:economics* / Q000600:supply & distribution; D006130:Growth Disorders / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006297:Health Services Accessibility / Q000191:economics*; D061889:Healthcare Financing; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D015995:Prevalence; D012423:Rural Health / Q000191:economics / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics* / Q000592:standards / Q000600:supply & distribution; D012432:Rwanda / Q000453:epidemiology