Normally, stunting manifests in delayed physical growth, impaired cognitive development, and increased vulnerability to illness. Prevention involves proper maternal nutrition, exclusive breastfeeding, good hygiene, and ensuring access to nutritious foods and healthcare during early childhood.
In Rwanda, efforts to address stunting and promoting maternal and child health through antenatal and early childhood interventions are intensely underway with an ambitious stunting prevention trial set to begin in 2025.
This impending trial is seen as a significant step forward in combatting stunting and improving maternal and child health especially in rural Rwanda by assessing whether providing comprehensive antenatal and postnatal care can reduce stunting and significantly enhance health outcomes for mothers and their children.
A recent stakeholders' meeting held in Kigali disclosed that the trial, involving 60 health centers in rural areas, will compare two groups; one receiving current antenatal and postnatal care and the other receiving a more comprehensive package, which includes advanced tools for pregnancy monitoring and additional nutritional support for children.
According to Dr. Edgar Kalimba, a senior consultant pediatrician at King Faisal Hospital and one of the key organizers of the trial, the study will focus on the first 1,000 days of lifeâ€"a crucial period for child development.
"We aim to measure various outcomes, including maternal weight gain during pregnancy, the prevalence of preterm births, low birth weight, and the number of children who are stunted by the age of two," Kalimba elaborated.
The trial will also monitor children's cognitive and social development, alongside maternal health indicators such as hemoglobin levels and pregnancy duration.
A unique aspect of the trial will be its sub-studies investigating the predisposing conditions of stunting, such as epigenetic factors and diving into the root causes to gain deeper insights.
It is planned that prenatal interventions will follow both national and international guidelines and include low-dose aspirin, calcium, omega-3 fatty acids, and L-arginine supplementation. Early enrollment in antenatal care will be strongly advocated to ensure timely intervention for pregnant mothers.
Postnatal care will align with the latest World Health Organization (WHO) and UNICEF recommendations which stipulate nine scheduled visits, including a home visit from birth to 24 months.
These visits will include health assessments, growth monitoring, and family support, supplemented by small-quantity lipid-based nutrient supplements for children aged 6 to 18 months.
"This trial could transform how we address stunting and maternal health in rural areas, potentially serving as a model for broader healthcare improvements across the country," Kalimba noted.
This initiative reinforces the importance of collaborative efforts to tackle stunting and improve maternal and child health in Rwanda. The results could shape future policies and interventions, offering a blueprint for stunting prevention not just in Rwanda but across similar settings globally according to officials from the Ministry of Health.
Dr. Aline Uwimana, Head of the Maternal, Child, and Community Health Division at the Rwanda Biomedical Center (RBC) says that Rwanda's intensity in combating child stunting is part of its National Strategy for Transformation 2 (NST2), which aims to reduce stunting rates from 33% to 15% by 2029.
One of the key initiatives is the upcoming stunting prevention trial, which is expected to bring significant advancements in understanding and addressing the root causes of stunting. The trial will focus on nutrition, maternal health, and innovative approaches to combat the socioeconomic inequalities that contribute to stunting.
'This upcoming stunting prevention trial will provide critical insights into the effectiveness of various interventions we have implemented. It will allow us to fine-tune our strategies, particularly in addressing the gaps that still exist among the most vulnerable communities,' she said.
Multiple Micronutrient Supplements (MMS), which have already shown promising results in other regions will be included and this is viewed as a game-changer for pregnant women and young children in Rwanda.
'The MMS has been proven to reduce adverse pregnancy outcomes, including low birth weight and preterm births. By starting this trial, we aim to gather concrete data that will help us scale up this intervention nationwide, ensuring that all pregnant mothers have access to the necessary supplements to protect their health and that of their children,' she explained.
The trial is also expected to benefit from Rwanda's multi-sectoral approach, which combines nutrition, healthcare, education, and water and sanitation improvements.
According to her, it's not about just distributing supplements; it's about creating an environment where every child has access to nutritious food, clean water, and quality healthcare. This will provide the evidence needed to strengthen these connections and improve the overall well-being of the Rwandan child.
One of the key goals of the trial is to address the socioeconomic inequalities that have contributed to stunting in Rwanda. Research shows that intergenerational transfer, including maternal health and nutrition, accounts for 31% of the inequality in stunting. Uwimana pointed out that the trial would focus on closing this gap.
'By targeting the most affected groups, we can ensure that the benefits of our programs reach every corner of the country. This trial will help us identify the most effective ways to reduce stunting, particularly among children whose families have been hardest hit by socioeconomic disparities,' she explained.
Dr. Uwimana is confident that this project will pave way for more extensive and sustainable programs not only for Rwanda but other countries facing challenges of child stunting.
'By investing in cutting-edge research and evidence-based strategies, we are ensuring that future generations of Rwandan children will grow up healthier, stronger, and ready to contribute to the country's development,' she emphasized.
The 2025 stunting prevention trial represents a crucial step in Rwanda's ongoing battle against child stunting. Through innovative approaches and a commitment to data-driven strategies, the country is setting a strong foundation for a healthier and more prosperous future.
Sam K Nkurunziza
