Key determinants of malnutrition of children under five years of age in Rwanda: Simultaneous measurement of three anthropometric indices

Malnutrition of children is a serious problem to the public health, most especially in developing countries. Based on Rwanda Demographic and Health Survey Data, the joint model of a multivariate generalized linear mixed model is used to simultaneously identify the determinants of malnutrition of children under five years of age in Rwanda using height-for-age, weight-for-age and weight-for-height. Each anthropometric index has been categorized as malnourished (Z-score value <-2.0) and nourished (Z-score value . The study found that the age of the child, gender of the child, birth weights, mother’s knowledge of nutrition, birth order, incidence of recent fever, multiple births, education level of the mother, age of the mother at childbirth, body mass index, prevalence of anemia, province, source of drinking water and wealth quintiles are the key determinants of malnutrition of children under five years of age in Rwanda. A positive correlation between stunting and underweight and wasting and underweight was found. Therefore this study suggests that when eradicating malnutrition of children under five years of age, all three types of malnutrition should be corrected. It also suggests strengthening the policy on educating people in planning the number of children born to the

Determinants of Poverty of Households: Semi parametric Analysis of Demographic and Health Survey Data from Rwanda

The main objective of this research is to identify the key determinants of poverty of household in Rwanda based on asset index and semi parametric modeling. The asset index for each household is established and thereafter the generalized additive mixed model is used to ascertain the key determinants of poverty of households in Rwanda. The semi parametric generalized additive mixed model allowed us to study the impact of nonlinear predictors as nonparametric and categorical predictors as parametric to the asset index. Using the Rwanda Demographic and Health Survey (2010), the characteristics of households and household heads are considered. Our findings show that the level of education, gender and age of household head, region (province), size of the household (number of household members) and place of residence (urban or rural) are significant predictors of poverty of households in Rwanda

Measuring poverty and child malnutrition with their determinants from household survey data.

Doctor of Philosophy in Statistics. University of KwaZulu-Natal, Pietermaritzburg 2016.The eradication of poverty and malnutrition is the main objective of most societies and policy makers. But in most cases, developing a perfect or accurate poverty and malnutrition assessment tool to target the poor households and malnourished people is a challenge for applied policy research. The poverty of households and malnutrition of children under five years have been measured based to money metric and this approach has a number of problems especially in developing countries. Hence, in this study we developed an asset index from Demographic and Health Survey data as an alternative method to measure poverty of households and malnutrition and thereby examine different statistical methods that are suitable to identify the associated factors. Therefore, principal component analysis was used to create an asset index for each household which in turn served as response variable in case of poverty and explanatory (known as wealth quintile) variable in the case of malnutrition. In order to account for the complexity of sampling design and the ordering of outcome variable, a generalized linear mixed model approach was used to extend ordinal survey logistic regression to include random effects and therefore to account for the variability between the primary sampling units or villages. Further, a joint model was used to simultaneously measure the malnutrition on three anthropometric indicators and to examine the possible correlation between underweight, stunting and wasting. To account for spatial variability between the villages, we used spatial multivariate joint model under generalized linear mixed model. A quantile regression model was used in order to consider a complete picture of the relationship between the outcome variable (poverty index and weight-for-age index) and predictor variables to the desired quantiles. We have also used generalized additive mixed model (semiparametric) in order to relax the assumption of normality and linearity inherent in linear regression models, where categorical covariates were modeled by parametric model, continuous covariates and interaction between the continuous and categorical variables by nonparametric models. A composite index from three anthropometric indices was created and used to identify the association of poverty and malnutrition as well as the factors associated with them. Each of these models has inherent strengths and weaknesses. Then, the choice of one depends on what a research is trying to accomplish and the type of data being used. The findings from this study revealed that the level of education of household head, gender of household head, age of household head, size of the household, place of residence and the province are the key determinants of poverty of households in Rwanda. It also revealed that the determinants of malnutrition of children under five years in Rwanda are: child age, birth order of the child, gender of the child, birth weight of the child, fever, multiple birth, mother’s level of education, mother’s age at the birth, anemia, marital status of the mother, body mass index of the mother, mother’s knowledge on nutrition, wealth index of the family, source of drinking water and province. Further, this study revealed a positive association between poverty of household and malnutrition of children under five years

Determinants of Domestic Violence in Women of Reproductive Age in Rwanda

Domestic violence is a global public health problem. It is prevalent in both the developed world and developing countries. The objective of this study is to identify the factors that are associated with domestic violence against women of reproductive age in Rwanda. The data from the 2014/2015 Rwanda demographic and health survey were used. Generalized linear mixed model was used to account for random effects, overdispersion of residual and heterogeneity. The findings of this study revealed that wealth quintiles, education level of the husband or partner, polygamy, alcohol status of husband or partner, size of the family, number of sexual partners including the husband in the last 12 months, the province the victim lived in, the ownership of an asset in the form of a house or land and the societal attitude towards wife-beating, were the determinants of domestic violence in women of reproductive age. The findings of the risk factors in the current study can help the policy makers, public health workers and institutions in charge of gender monitoring in Rwanda to come up with effective strategies to reduce the domestic violence levels directed against women.&nbsp

Prevalence and Risk Factors Associated with Anemia among Women of Childbearing Age in Rwanda

Anemia among women of child bearing age is a global public health problem. In developing countries such as Rwanda, women and their children may be particularly susceptible to anemia. The main objectives of this study were to assess the prevalence of anemia among women of reproductive age in Rwanda and to identify the risk factors associated therewith. The current study considered socio-economic, demographic and environmental factors and the 2014/2015 Rwanda Demographic and Health Survey data was used for this purpose. Due to the complexity of the sampling design, the present study used survey logistic model that takes account of sampling weight, stratification and clustering. The SAS statistical software was used for the analysis of the results. The anemia status was assessed among 6 680 women aged between 15 and 49 years old and the prevalence of anemia among women of this child bearing age group, was found to be 19.2%. The study also revealed that body mass index, contraceptive use, use of mosquito bed nets, marital status, wealth quintile of the household, size of the household, literacy, tobacco use, type of cooking fuel, type of toilet facilities, type of source of drinkable water, and province of residence, were all factors associated with anemia among women of reproductive age in Rwanda. Hence the current study highlights several health, geographical and socio-economic issues that can assist health care professionals and other relevant authorities in fostering an environment that reduces the risk of anemia for women and children. Keywords: Anemia, women, survey logistic, Rwanda, RDHS 2014/15 L'anémie chez les femmes en âge de procréer est un problème de santé publique mondial. Dans les pays en développement comme le Rwanda, les femmes et leurs enfants peuvent être particulièrement sensibles à l'anémie. Les principaux objectifs de cette étude étaient d'évaluer la prévalence de l'anémie chez les femmes en âge de procréer au Rwanda et d'identifier les facteurs de risque qui y sont associés. La présente étude a pris en compte les facteurs socio-économiques, démographiques et environnementaux et les données de l'enquête démographique et sanitaire du Rwanda 2014/2015 ont été utilisées à cette fin. En raison de la complexité du plan d'échantillonnage, la présente étude a utilisé un modèle logistique d'enquête qui tient compte du poids d'échantillonnage, de la stratification et du regroupement. Le logiciel statistique SAS a été utilisé pour l'analyse des résultats. Le statut anémique a été évalué chez 6 680 femmes âgées de 15 à 49 ans et la prévalence de l'anémie chez les femmesde ce groupe d'âge en âge de procréer s'est avérée être de 19,2%. L'étude a également révélé que l'indice de masse corporelle, l'utilisation de contraceptifs, l'utilisation de moustiquaires, l'état matrimonial, le quintile de richesse du ménage, la taille du ménage, l'alphabétisation, l'usage du tabac, le type de combustible de cuisson, le type de toilettes, le type de source d'eau potable et la province de résidence, étaient tous des facteurs associés à l'anémie chez les femmes en âge de procréer au Rwanda. Par conséquent, la présente étude met en évidence plusieurs problèmes de santé, géographiques et socio-économiques qui peuvent aider les professionnels de la santé et d'autres autorités compétentes à favoriser un environnement qui réduit le risque d'anémie pour les femmes et les enfants. Mots-clés: Anémie, femmes, logistique d'enquête, Rwanda, RDHS 2014/1

Joint Modeling of Poverty of Households and Malnutrition of Children Under Five Years from Demographic and Health Survey Data: Case of Rwanda

The main objective of this study was to identify the risk factors associated to malnutrition of children under five years and poverty and assess the correlation between them. We created a composite index from three anthropometric indictors (stunting, underweight and wasting).A multivariate joint model using the generalized linear mixed model was utilized for the analyses of the data. Child age, birth order of the children, the gender of children, birth weights of the children, multiple birth of the child, fever, anemia of the mother, body mass index of the mother, mother’s education level, mother’s knowledge on nutrition, age of household head, source of drinking water, toilet facilities, place of residence of household, source of drinking water and province were found to be significantly related to poverty and malnutrition. The study revealed a positive correlation between poverty of household and malnutrition of children less than five year

Joint modelling of malaria and anaemia in children less than five years of age in Malawi.

HEARD, 2021.Background: Malaria and anaemia jointly remain a public health problem in developing countries of which Malawi is one. Although there is an improvement along with intervention strategies in fighting against malaria and anaemia in Malawi, the two diseases remain significant problems, especially in children 6–59 months of age. The main objective of this study was to examine the association between malaria and anaemia. Moreover, the study investigated whether socio-economic, geographic, and demographic factors had a significant impact on malaria and anaemia. Data and methodology: The present study used a secondary cross-sectional data set from the 2017 Malawi Malaria Indicator Survey (MMIS) with a total number of 2 724 children 6–9 months of age. The study utilized a multivariate joint model within the ambit of the generalized linear mixed model (GLMM) to analyse the data. The two response variables for this study were: the child has either malaria or anaemia. Results: The prevalence of malaria was 37.2% of the total number of children who were tested using an RDT, while 56.9% were anaemic. The results from the multivariate joint model under GLMM indicated a positive association between anaemia and malaria. Furthermore, the same results showed that mother's education level, child's age, the altitude of the place of residence, place of residence, toilet facility, access to electricity and children who slept under a mosquito bed net the night before the survey had a significant effect on malaria and anaemia. Conclusion: The study indicated that there is a strong association between anaemia and malaria. This is interpreted to indicate that controlling for malaria can result in a reduction of anaemia. The socio-economic, geographical and demographic variables have a significant effect on improving malaria and anaemia. Thus, improving health care, toilet facilities, access to electricity, especially in rural areas, educating the mothers of children and increasing mosquito bed nets would contribute in the reduction of malaria and anaemia in Malawi

Prevalence and Risk Factors Associated with Malaria among Children Aged Six Months to 14 Years Old in Rwanda: Evidence from 2017 Rwanda Malaria Indicator Survey

Malaria is a major public health risk in Rwanda where children and pregnant women are most vulnerable. This infectious disease remains the main cause of morbidity and mortality among children in Rwanda. The main objectives of this study were to assess the prevalence of malaria among children aged six months to 14 years old in Rwanda and to identify the factors associated with malaria in this age group. This study used data from the 2017 Rwanda Malaria Indicator Survey. Due to the complex design used in sampling, a survey logistic regression model was used to fit the data and the outcome variable was the presence or absence of malaria. This study considered 8209 children in the analysis and the prevalence of malaria was 14.0%. This rate was higher among children aged 5–9 years old (15.6%), compared to other age groups. Evidently, the prevalence of malaria was also higher among children from poor families (19.4%) compared to children from the richest families (4.3%). The prevalence of malaria was higher among children from rural households (16.2%) compared to children from urban households (3.4%). The results revealed that other significant factors associated with malaria were: the gender of the child, the number of household members, whether the household had mosquito bed nets for sleeping, whether the dwelling had undergone indoor residual spraying in the 12 months prior to the survey, the location of the household’s source of drinking water, the main wall materials of the dwelling, and the age of the head of the household. The prevalence of malaria was also high among children living in houses with walls built from poorly suited materials; this suggests the need for intervention in construction materials. Further, it was found that the Eastern Province also needs special consideration in malaria control due to the higher prevalence of the disease among its residents, compared to those in other provinces

Spatial Analysis of Socio-Economic and Demographic Factors Associated with Contraceptive Use among Women of Childbearing Age in Rwanda

Contraceptive use is considered as essential for protecting women’s health and rights, influencing fertility and population growth, and helping to promote economic development. The main objective of this study was to analysis the factors and spatial correlates of contraceptive use among women of childbearing age. The 2015 Rwanda Demographic and Health Survey (RDHS) data were used to identify the factors associated with contraceptive use in Rwanda. A Bayesian geo-additive model was used in order to account for fixed effects, nonlinear effects, spatial and random effects inherent in the data. The overall prevalence of use of any contraceptive method among married women of childbearing age in Rwanda was 52.7%. A woman’s age, wealth quintile, level of education, working status, number of living children, and exposure to the media was found to increase contraceptive use. The findings from the study also found disparities in contraceptive use at provincial and district level, where prevalence was higher in districts of Northern provinces and lower in districts of western provinces. The findings of this study suggest that exposure to information on contraceptive use in health centres, empowerment of women to access quality contraceptive-use services and religions to play an important role in explaining and informing their adherents on the importance of using a contraceptive method