Abstract

BackgroundMalnutrition remains a serious concern in Rwanda, particularly among children under-5 years. Performance-based financing (PBF), an innovative health systems financing strategy, has been implemented at the national level since 2008. This study aimed to assess the impact of PBF and other factors associated with the prevalence of three classifications of malnutrition (stunting, wasting and underweight) in children under-5 years in Rwanda.MethodsThe study is a cross-sectional study comprising of 713 children under five years old from 557 households, whose anthropometric measurements (height, weight and age) had been obtained as part of the 2008 Rwanda General Health and HIV household survey. Z-scores for height-for-age, weight-for-age, weight-for-height, and body mass index-for-age were analyzed according to the World Health Organization 2006 Child Growth Standards. Random intercept logistic regression models were used to regress each anthropometric measure (WAZ, HAZ and WHZ) against child, maternal and household characteristics.ResultsChild participants ranged in age from 0 to 60 months, 20.2% of children were under 12 months and 5.1% were HIV positive. The prevalence of wasting was 8.8%; of stunting was 58.4%; and of underweight status was 20.7%. Maternal emotional and social wellbeing was protective of wasting in children under-5 years of age. Living in districts implementing PBF was protective of wasting (Adjusted Odds Ratio: 0.43; 95% confidence interval: 0.19-0.97). Living in a district with PBF was not found to be associated with either stunting or underweight status among children under-5.ConclusionsPBF may have a protective association with particular forms of malnutrition among children under-5 years in Rwanda. These findings warrant further investigation in relation to the impact of implementing innovative financing schemes on health outcomes.

Highlights

  • Malnutrition remains a serious concern in Rwanda, among children under-5 years

  • This study investigated the impact of Performance-based financing (PBF) and other factors associated with three forms of malnutrition among children under-5 years in Rwanda

  • Our study found that children born to HIVinfected mothers were no more likely to be malnourished than children born to HIV-negative mothers and that children residing in districts that had implemented the PBF scheme were significantly less likely to meet the criteria for wasting

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Summary

Introduction

Malnutrition remains a serious concern in Rwanda, among children under-5 years. Performance-based financing (PBF), an innovative health systems financing strategy, has been implemented at the national level since 2008. This study aimed to assess the impact of PBF and other factors associated with the prevalence of three classifications of malnutrition (stunting, wasting and underweight) in children under-5 years in Rwanda. Malnutrition remains a serious concern in Rwanda, like many regions in Africa. The sequelae of underweight status among children has been well-defined in recent decades, Following the genocide against the Tutsi in 1994, Rwanda faced a massive loss of health professionals and a destruction of health infrastructure [3]. Over the past two decades since the genocide, health outcomes in Rwanda have improved drastically. Child malnutrition has persisted in Rwanda and serious investigation into the causes is warranted

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