Before and after study of a national complementary and supplementary feeding programme in Rwanda, 2017-2021.

To address high rates of malnutrition among children from vulnerable households in Rwanda, the government initiated a national food supplementation programme. A before and after evaluation, using repeat cross-sectional surveys in randomly selected villages was conducted; aimed at assessing the effectiveness of providing fortified blended food (FBF) to children 18-23 months of age, pregnant and lactating women in the lowest tier of Rwanda's social support system. Data were collected in 2017, 2018 and 2021 through interviews with caregivers; anthropometric measurements and a capillary blood sample were obtained from children. The primary statistical analysis compared the nutritional status of children before and after the introduction of FBF. We enroled 724 children during each survey. The prevalence of stunting declined from 47% to 35% between 2017 and 2021; in 2018, the prevalence of stunting was 43%. Children had a 42% reduction in the odds of being stunted (adjusted odds ratio [AOR]: 0.58, 95% confidence interval [CI]: 0.47-0.74, p < 0.001) from 2017 to 2021 even after adjusting for inherent, distal, proximal, and intermediate covariates. The reduction in stunting observed within the first year of the programme was not statistically significant (AOR: 0.83, 95% CI: 0.67-1.03, p < 0.091). We observed meaningful reductions in the prevalence of stunting among children which coincided with the introduction of Government-led initiative to reduce malnutrition. The Rwandan Government has committed to improving the living conditions of vulnerable households and has made strong investments in reducing malnutrition. The impact of these investments can be seen in the overall trend towards improved nutritional status highlighted in this evaluation.

Engaging fathers to support child nutrition increases frequency of children's animal source food consumption in Rwanda.

Although social support from fathers is associated with improved child feeding practices, evidence on feasible, acceptable, and effective ways to involve fathers in supporting child nutrition, including animal source food (ASF) consumption, is limited. This study was a follow-on to a trial that tested the effects of social and behavior change communication (SBCC) targeted mainly at mothers to promote ASF consumption by children in households that received an exotic or crossbred cow through the government of Rwanda's Girinka "One Cow Per Poor Family" program (NCT0345567). A delayed SBCC intervention was provided to mothers in the non-intervention arms prior to the present pre/post study, which targeted fathers in households across the trial study arms. Baseline and endline surveys with a cohort of 149 fathers with a child <5 years were used to evaluate the effects of a SBCC intervention for fathers on their children's ASF consumption and on fathers' knowledge, awareness, and support for children's ASF consumption. Qualitative data collected from fathers, mothers, and program implementers were used to assess feasibility and acceptability of the intervention for fathers. The SBCC intervention comprised group meetings led by model fathers, text messages, print materials, and megaphone blasts. The odds of children consuming any type of ASF ≥2 times in the last week increased from baseline to endline (OR 4.9, 95% CI 1.9, 12.3), as did the odds consuming milk, eggs, and beef, but not fish. Fathers' mean ASF knowledge and awareness scores increased from baseline to endline (knowledge: 2.3 to 3.5 out of 4 items, P<0.001; awareness: 2.5 to 3.0 out of 3 items, P<0.001), with the largest changes observed in knowledge of timing of introduction of milk and other ASFs. The percentage of fathers who offered two or more supportive actions for their children's milk and other ASF consumption increased from baseline to endline (milk: 19.5% to 31.5%, P = 0.017; other ASFs: 18.8% to 37.6%, P<0.001). Fathers appreciated gaining knowledge on child nutrition in a setting specifically for men and liked the print materials that offered clear actions they could take to support their children's ASF consumption. This study shows that an SBCC intervention for fathers can improve children's ASF consumption and increase fathers' knowledge, awareness, and support for children's nutrition.

Animal Source Food Social and Behavior Change Communication Intervention Among Girinka Livestock Transfer Beneficiaries in Rwanda: A Cluster Randomized Evaluation.

Animal source foods (ASFs), including cow's milk, contain essential nutrients and contribute to a healthy diet, but frequency of intake is low among children in low- and middle-income countries. We hypothesized that an ASF social and behavior change communication (SBCC) intervention implemented by community health workers (CHWs) would increase child milk consumption and dietary diversity in households that received a cow from the Government of Rwanda's Girinka livestock transfer program. We tested the 9-month SBCC intervention among children aged 12-29 months at baseline in administrative cells randomly assigned to the intervention or control. Most mothers in the intervention group were exposed to CHWs' home visits (90.7%) or community-level activities (82.8%). At endline, more mothers in the intervention group compared with the control group knew that cow's milk was an ASF (90.1% vs. 81.7%, P=.03) and could be introduced to children at 12 months (41.7% vs. 18.7%, P<.001). More mothers in the intervention group compared with the control group knew they should feed their children ASFs (76.2% vs. 62.1%, P=.01) and give them 1 cup of cow's milk per day (20.6% vs. 7.8%, P<.001). Children's consumption of fresh cow's milk 2 or more times per week increased in the intervention group, although not significantly (8.0 percentage points, P=.17); minimum dietary diversity was unchanged. Children in the intervention group had increased odds of consuming cow's milk 2 or more times per week if their mothers recalled hearing that children should drink 1 cup of cow's milk per day during a CHW's home visit [odds ratio (OR) 2.1, 95% confidence interval (CI) (1.1, 3.9)] or a community activity [OR 2.0, 95% CI (1.2, 3.5)]. Approximately half of the children had no milk during the past week because their households produced too little or sold what was produced. In poor households receiving a livestock transfer, strategies to further tailor SBCC and increase cow's milk production may be needed to achieve larger increases in children's frequency of milk consumption.