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Physical and mental health for young children
Physical and mental health for young children

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6.1 Malnutrition in Rwanda: a low-income country

Rwanda is a small, land-locked African country where many children are affected by malnutrition.

A map of Africa, with a flag of Rwanda showing its position on the continent
Figure 6 Rwanda’s position in Africa
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A map of Africa, with a flag of Rwanda showing its position on the continent

Figure 6 Rwanda’s position in Africa

Activity 4 Battling malnutrition

Timing: 20 minutes

To learn more about the impact of malnutrition on children’s health, watch the video ‘Battling malnutrition’. As you watch the video, consider the following question:

What are the reasons given for malnutrition in Rwanda?

Download this video clip.Video player: Video 2 Battling malnutrition
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Transcript: Video 2 Battling malnutrition

[NON-ENGLISH SINGING]

BARBARA UMUHOZA
Jeannette, five years, old has experienced severe malnutrition. A year ago, she couldn't stand, neither play with other children. She was unable to eat nor to talk. Always crying, thin, and very weak. She was malnourished, struggling not to become one of the hundreds of children who die before their fifth birthdays.
Jeannette Imana Nogueira's parents understand the worst effects of malnutrition. 2 of their 12 children died of kwashiorkor. The five-year-old Jeannette is the family's second last born. Short for her age, she suffers from stunting.

[NON-ENGLISH SINGING]

BARBARA UMUHOZA
She lives in the rural Northern mountainous Rwanda in a village where 68% of all the children experience chronic malnutrition. The outstanding sight of the green land, waters in valleys, terraces on the mountains, fields of wheat and sorghum, and faces of smiling children is incomparable to the health condition in Gicumbi.

[NON-ENGLISH SINGING]

BARBARA UMUHOZA
This Northern East Rwanda District is one of the poorest areas with high levels of malnutrition in the country. Malnutrition is widespread. There is a shortage of land, big sized families without enough to eat.

[NON-ENGLISH SINGING]

BARBARA UMUHOZA
Esperance has seen armed conflicts and people’s tensions in her area, but thinks that malnutrition remains her most dangerous enemy. She recalls her children who died due to hunger, war, and malnutrition.

[NON-ENGLISH SINGING]

ESPERANCE IKIZANYE [NON-ENGLISH SPEECH - INTERPRETER]
I gave birth to 12 children. Two out of 12 children I gave birth to died of malnutrition. One, who was actually a young adolescent boy, died of an unknown disease. And the fourth child, a girl, died during the war. I now have eight children. One of them has gone to Kigali to look for a better life. In my home, I take care of seven people, excluding my husband and myself.
One of the two children who passed away of malnutrition, Mukagachinya, suffered from stomach ache and had a strong diarrhea. And after a while, she died. I felt very sad because even her sister, whom I had conceived in a refugee camp, followed her. She also suffered from malnutrition. She was swollen and she failed to eat. We tried to look for fishes and porridge for her, but we couldn't provide it enough and not regularly. She was sick for three years. And at the end, she died of malnutrition.
BARBARA UMUHOZA
In the last years, the family has been living in fear, sorrow, anger, bitterness, and mourning.

[DIGGING]

[OVERLAPPING NON-ENGLISH SPEECH]

BARBARA UMUHOZA
Today, close to 85% of Rwandans still practice subsistence agriculture in the most densely populated country in Africa.

[MUSIC PLAYING]

BARBARA UMUHOZA
Esperance's parents and her husband, Diogene Nagamatsu, are farmers. With their eight children, two boys and six girls, they hardly get 10,000 Rwandan francs per year, which is approximately $20. They survive on farming for money or renting neighbors fields. They grow sweet potatoes, wheat, beans, sorghum, and green vegetables.

[MUSIC PLAYING]

BARBARA UMUHOZA
Malnutrition is a critical problem in Rwanda, and it has had a bad impact on children.
AGNES MUKAMANA [NON-ENGLISH SPEECH - INTERPRETER]
Malnutrition is a critical problem in Rwanda. It is unfortunate that the incidence of stunting continues to rise. A recent research done by World Vision UNICEF and the World Food Program revealed that about 52% of children in Rwanda are stunting. 80% are underweight, and 3.2% are severely malnourished. The projections showed that if nothing is done to eradicate malnutrition, about 40,000 children might die between 2009 and 2012.

[MUSIC PLAYING]

BARBARA UMUHOZA
Despite other progresses made by Rwanda to attain the Millennium Development Goals, or MDGs, the country is still lagging behind to achieve MDG 4 to reduce child mortality.

[MUSIC PLAYING]

BARBARA UMUHOZA
The Demographic Health Survey 2005 showed that the main causes of malnutrition in Rwanda is lack of knowledge rather than poverty. For example, only 41% of women breastfeed their newborn babies within one hour of birth. This is far below the international target of 100% for their indicator. Agnes says that malnutrition ravages not only the body, but also affects the children psychologically.
AGNES MUKAMANA [NON-ENGLISH SPEECH - INTERPRETER]
Malnutrition has a negative impact on all levels of life. The child mortality rate in Rwanda is high with 103 deaths per 1,000 live births. 33% of these deaths are linked to malnutrition. The situation becomes worse when a malnourished child suffers from another disease, such as malaria.
Malnutrition also affects children's studies. Children with empty stomachs can't follow very well in a class. They fell asleep during class. And sometimes, they drop out and they don't pursue their education. Malnutrition makes people economically poor, and it has an adverse effect on the country's progress. We should all work in partnership to eradicate malnutrition.
BARBARA UMUHOZA
World Vision works hard to reduce prevalence of malnutrition and child mortality in all its projects.
GEORGE GITAU
Looking at the progress we have made for the last two years, we have rehabilitated 7,000 children in the communities where we work.
BARBARA UMUHOZA
World Vision uses the approach of positive deviance hearth to address the problem of malnutrition. It trains and assists a network of community mothers, and the latter trained their neighbors as well. This approach is successful and made easier the peer-to-peer learning and nutrition follow up at the household level.
The trainings are practical, and use the local available food. Mothers meet to cook and feed their children at least six days a week under the supervision of a nutritionist. Within 12 weeks, mothers are able now to prepare balanced diets for their homes using the local food. Mothers are also trained on family planning, HIV/AIDS, hygiene and sanitation, infant diseases and on first aid emergency for children.

[MUSIC PLAYING]

BARBARA UMUHOZA
Louise Nabada, a 29-year-old mother of three, is a community health worker in Khajuraha village. She has been following up the life of Jeannette and partners with World Vision in its endeavor to fight malnutrition.

[MUSIC PLAYING]

BARBARA UMUHOZA
Louise went to every Hill, as communities are called in Rwanda, to meet with malnourished children and sensitize their parents to go to maziko, which is a Kinyarwanda word that translates to stove. It is used to mean the positive deviance cooking and child feeding session.
LOUISE NABADA [NON-ENGLISH SPEECH - INTERPRETER]
I saw a big transformation in the life of Jeannette. Before she was weighting 10 kilograms, which is about 22 pounds. I took her to the nutrition program that we call maziko several times. And it was only for the fourth time that I saw her standing and playing with other children. She gained weight, and I'm very thankful for the training we have received. Now Jeannette weights almost kilograms.

[MUSIC PLAYING]

BARBARA UMUHOZA
Food that contains proteins, energies, fat, minerals, and vitamins are available in the area. Louise was trained and explains to the mothers what type of food they should prepare.

[MUSIC PLAYING]

BARBARA UMUHOZA
In the past few months, things have gotten better for Jeannette.
ESPERANCE IKIZANYE [NON-ENGLISH SPEECH - INTERPRETER]
When the community health worker advised me how to cook for Jeannette and follow up with her growth, Jeannette started to gain more weight every day. Her appetite increased. Now as she is becoming strong, she will start nursery school soon. I'm very grateful for the training I have received.
BARBARA UMUHOZA
Esperance has become an active campaigner for that nutrition program. She's very happy for the progress seen in the life of Jeannette. Inside their three room mud house, Esperance has hanged two big pieces of papers. She knows she can't read neither, or write. But on the papers, there are important instructions. Her son, Ildefonse, who is in primary six reads for her. If the baby has diarrhea, put two spoons of salt and one spoon of sugar in a liter of water. Give your child that water as often as you can and hurry him to the hospital.

[MUSIC PLAYING]

BARBARA UMUHOZA
She got these papers from one of the trainings she attended.

[MUSIC PLAYING]

BARBARA UMUHOZA
Wild Vision is determined to ensure the fullness of life to all Rwandan children.

[MUSIC PLAYING]

GEORGE GITAU
Children should not be dying in the 21st century given that we can be able to partner together and do something to be able to save the lives of our children. Enough is enough.

[MUSIC PLAYING]

End transcript: Video 2 Battling malnutrition
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Discussion

In Rwanda, as many as 80 per cent of children are underweight and as many as 33 per cent of deaths are linked to malnutrition.

The reasons given in the film to explain the reasons for these high numbers reflect the factors that influence children’s health that have been discussed in this course, in particular in Session 1.

The film explored how societal factors have contributed to the high levels of malnutrition in children. Such factors include the geography of the country, that is, it is small and densely populated with limited agricultural space to grow food. The country has also endured many years of conflict and war. Poverty isn’t the main reason given for the high levels of malnutrition in Rwanda, despite the fact it is a low-income country. The film states that ‘ignorance’ is one of the main reasons for the persistence of malnutrition. This is linked to the fact that education isn’t widely available, and when children do attend school, they aren’t able to concentrate and learn at school, and are more likely to be illiterate. Therefore, lack of education compounds the problems associated with malnutrition and poor health.

The content of this film highlights the difficulties that the people in Rwanda have in relation to providing nourishment to children, and many of the challenges outlined here are not faced in other countries, especially high-income ones such as England. However, many children experience dietary deficiency which contributes to poor health, and you will look at this in the following sections.