Rwanda: Before and after study of a national supplementary feeding programme

According to the National Institute of Statistics of Rwanda and the Ministry of Health, 33% of all Rwandan children aged under five years are stunted. Stunting prevalence rises from 23% in children aged under six months to 39% at 18–23 months of age, showing a marked increase during the window of time when complementary foods are typically introduced. Many households struggle to access energy- and nutrient-dense complementary foods and only 22% of children aged 6–23 months are fed in accordance with all recommended infant and young child feeding practices. 

To address the high burden of malnutrition among children from the most vulnerable households, and in addition to other ongoing nutrition-related interventions, the government initiated a national food supplementation programme. This study assessed the effectiveness of locally produced nutrient-dense fortified blended foods (FBF), which were provided to children aged 6–23 months and pregnant and lactating women living in vulnerable households in Rwanda, on stunting prevalence among children. This initiative was a unique example of the successful nationwide distribution of fully subsidised FBF products for poor households. 

Survey data collected in 2017, 2018, and 2021 included anthropometric and biochemical data, demographic and socioeconomic status, food security, and feeding practices – including the provision of FBF. Primary statistical analysis compared the nutritional status of children before and after FBF introduction. There was a reduction in stunting from 47% (2017–2018) to 35% (2021), equivalent to a 42% reduction in the odds of being stunted (p<0.001). At baseline, a high proportion of children were anaemic and iron deficient, and there was a significant reduction in the odds of these at endline.

The remarkable reduction in stunting over a five-year period can be attributed to several factors. Notably, the study highlights the use of a targeted approach to reach the most vulnerable children and a high rate of daily and weekly consumption of the FBF during the last three years of the evaluation (2018– 2021). General improvements over time to sociodemographic and household markers, as well as substantial efforts by the government to improve livelihoods, health, and wellbeing over the same period, were also important.

One of the study’s limitations was the absence of a control group for comparing the intervention effects, as it was deemed unethical to withhold FBF from households. Further, the study was only conducted in the lowest tier of Rwanda’s social support scheme households, limiting the generalisability of the results to only households with similar characteristics.