Household-Level Coverage of Iron-Biofortified Beans in the Northern Province of Rwanda.

Background: Biofortification, the process of enhancing the micronutrient content of staple crops, is a nutrition-sensitive agricultural intervention with the potential to increase micronutrient intakes and improve health outcomes, especially among vulnerable populations. Although data are available on the number of farming households that grow biofortified crops, information on the coverage of biofortified foods in the general population is limited. Such information is critical to assess the performance of biofortification programs and guide decisions related to program implementation while ascertaining progress toward achieving expected impacts. Objective: This study aimed to assess the household coverage of iron-biofortified beans (IBBs) in rural areas of the Northern Province of Rwanda. Methods: We applied methods previously used to assess coverage in large-scale food fortification programs to develop coverage indicators for IBBs. These indicators were 1) consumption of beans in any form; 2) awareness of IBBs; 3) availability of IBBs; 4) consumption of IBBs (ever); and 5) consumption of IBBs (current). Results: Of the 535 households surveyed, 98% consumed beans in any form and 79% were aware of IBBs. Among the 321 households that provided bean samples, only 40% of the samples were biofortified (as determined by a breeding specialist) and only 21% of respondents were able to correctly identify IBBs. Although 52% of households reported to be ever consuming biofortified beans, only 10% of households were currently consuming these beans. Conclusions: Despite relatively high awareness of IBBs among surveyed households, a few households currently consume IBBs, highlighting the need to explore strategies to promote consumption. More research is also required to investigate factors hindering the consumption of IBBs.

Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda.

BACKGROUND: Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities. METHODS: A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits. RESULTS: The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028). CONCLUSIONS: Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.

A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda.

The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6-23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12-23 months) were more likely to use MNP than those of younger children (aged 6-11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods.

An empirical study of factors associated with height-for-age z-scores of children aged 6-23 months in northwest Rwanda: the role of care practices related to child feeding and health.

We aimed to identify the factors influencing child height-for-age z-scores (HAZ) as a measure of child nutritional status in Rwanda, and to examine the role of child feeding and health practices. We conducted a cross-sectional study involving 379 children (aged 6-23 months) and their mothers in northwest Rwanda. Data were collected using a pre-tested, structured questionnaire. An infant and young child feeding practices index (ICFI) and health practices index (HPI) were developed and categorised into tertiles, and linear regression analyses were performed to assess their association with child HAZ. Overall, mothers of non-stunted children exhibited better feeding and health practices than those of stunted children. ICFI was positively associated with child HAZ. We found an adjusted mean HAZ difference of 0·14 between children whose mothers were in high ICFI tertile compared with those in low tertile. Neither HPI nor any of its components were significantly associated with child HAZ. Other factors that were positively associated with child HAZ were infant birth weight (P < 0·001) and maternal height (P < 0·001). Child age, sex (male) (P < 0·05) and altitude (P < 0·05) were negatively associated with child HAZ. Diarrhoea (P < 0·05) and respiratory infections (P < 0·05) were negatively associated with HAZ in younger children aged 6-11 months. Policies to reduce stunting in this population must focus on both pre- and postnatal factors. Appropriate child feeding practices, particularly breast-feeding promotion and improvement in children's dietary diversity combined with measures to control infections should be given priority.

A qualitative analysis of infant and young child feeding practices in rural Rwanda.

OBJECTIVE: To explore and gain an in-depth understanding of the factors influencing child feeding practices among rural caregivers in Rwanda. DESIGN: In-depth semi-structured qualitative interviews were conducted. Purposive sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and coded. Data were analysed inductively using thematic analysis. SETTING: Rutsiro District, Western Province, Rwanda. PARTICIPANTS: Participants included twenty-four mothers (median age 32 years) with children 6-23 months old. RESULTS: We identified five key themes: (i) breast-feeding practices and role in food supply; (ii) family v. children's food preparations; (iii) food classification systems and their influence on child feeding decisions; (iv) child feeding during diarrhoeal episodes and (v) influence of poverty on child feeding practices and child care. CONCLUSIONS: Mothers' infant and young child feeding decisions are informed by information both from health workers and from traditional/own knowledge. Navigating through this information sometimes creates conflicts which results in less than optimal child feeding. A nutrition educational approach that is cognisant of maternal perceptions should be employed to improve child feeding practices. Efforts to improve child feeding practices must be complemented by programmes that enhance household economic opportunities and access to foods.

Use of High Density Single Nucleotide Polymorphism (SNP) Arrays to Assess Genetic Diversity and Population Structure of Dairy Cattle in Smallholder Dairy Systems: The Case of Girinka Programme in Rwanda.

In most smallholder dairy programmes, farmers are not fully benefitting from the genetic potential of their dairy cows. This is in part due to the mismatch between the available genotypes and the environment, including management, in which the animals perform. With sparse performance and pedigree records in smallholder dairy farms, the true degree of baseline genetic variability and breed composition is not known and hence rendering any genetic improvement initiative difficult to implement. Using the Girinka programme of Rwanda as an exemplar, the current study was aimed at better understanding the genetic diversity and population structure of dairy cattle in the smallholder dairy farm set up. Further, the association between farmer self-reported cow genotypes and genetically determined genotypes was investigated. The average heterozygosity estimates were highest (0.38 ± 0.13) for Rwandan dairy cattle and lowest for Gir and N'Dama (0.18 ± 0.19 and 0.25 ± 0.20, respectively). Systematic characterization of the genetic variation and diversity available may inform the formulation of sustainable improvement strategies such as targeting and matching the genotype of cows to productivity goals and farmer profile and hence reducing the negative impact of genotype by environment interaction.