Abstract
Background:Sufficient knowledge of the disproportionate burden of undernutrition among vulnerable children is required for accelerating undernutrition reduction in low-income countries.Objectives:We aimed to assess the prevalence of stunting, underweight and wasting and associated factors among high-risk children born preterm, with low birth weight or other birth and neurodevelopmental injuries, who received nutritional support and clinical care follow-up in a Pediatric Development Clinic (PDC) in rural Rwanda.Methods:This cross-sectional study included all children from rural areas enrolled in PDC between April 2014–September 2017 aged 6–59 months at their last visit during this period. Anthropometric measurements, socioeconomic and clinical characteristics were extracted from an electronic medical records system. We used the World Health Organization child growth standards to classify stunting, underweight and wasting. Factors associated with undernutrition were identified using logistic regression analysis.Results:Of 641 children, 58.8% were stunted, 47.5% were underweight and 25.8% were wasted. Small for gestational age was associated with increased odds of stunting [OR 2.63; 95% CI 1.58–4.36] and underweight (OR 2.33; 95% CI 1.46–3.71), while history of feeding difficulties was significantly associated with wasting (OR: 3.36; 95% CI: 2.20–5.13) and underweight (OR: 2.68; 95% CI: 1.78–4.04). Later age at PDC enrollment 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).Conclusions:The prevalence of stunting, underweight and wasting are high in this at-risk population, highlighting the need for specific interventions to address undernutrition among children with similar characteristics. Early PDC enrollment of high-risk infants may reduce undernutrition risk.
Highlights
Childhood undernutrition remains a global health challenge and more than 150 million children under five years of age, in low- and middle-income countries (LMICs), are affected [1]
Pediatric Development Clinic (PDC) was initiated at Rwinkwavu District Hospital (RDH) in April 2014 and later expanded to Kirehe District Hospital (KDH) in May 2016 with the aim to serve children born with prematurity, low birth weight (LBW), hypoxic ischemic encephalopathy (HIE), hydrocephalus, cleft lip and palate, trisomy 21, or other developmental delays
Median chronological age at enrollment in PDC was younger for children enrolled in PDC for prematurity or LBW (1.05 months; IQR: 0.69–1.71) and Hypoxic Ischemic Encephalopathy (HIE) (0.89 months; IQR: 0.62–6.67), and was oldest for children with developmental delays (13.17 months; IQR: 8.41–24.57)
Summary
Childhood undernutrition remains a global health challenge and more than 150 million children under five years of age, in low- and middle-income countries (LMICs), are affected [1]. A heavy burden of undernutrition disproportionately affects children from rural communities, with lower socioeconomic status, and medical vulnerabilities such as prematurity, small for gestational age (SGA), low birth weight (LBW) or other birth and neurodevelopmental injuries and disabilities [2, 3]. Objectives: We aimed to assess the prevalence of stunting, underweight and wasting and associated factors among high-risk children born preterm, with low birth weight or other birth and neurodevelopmental injuries, who received nutritional support and clinical care follow-up in a Pediatric Development Clinic (PDC) in rural Rwanda. PDC enrollment of high-risk infants may reduce undernutrition risk
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