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Background <p>Childhood stunting, defined as a height-for-age Z-score below − 2 standard deviations, remains a major public health issue in Rwanda, with one in three children under-five affected. Although national prevalence of stunting has declined over the past two decades, less is known about how trends compare across population groups. This study assessed trends in childhood stunting inequalities in Rwanda from 2000 to 2019 using absolute and relative inequality measures across five equity dimensions (wealth, women’s education, place of residence, sex, and regions or provinces).</p> Methods <p>We analyzed data from five rounds of the Rwanda Demographic and Health Surveys (2000–2019). Stunting prevalence was disaggregated by wealth quintiles, women’s education, place of residence, child’s gender, and region/province. Absolute and relative inequality measures included the slope index of inequality (SII), concentration index (CIX), absolute difference, and the weighted mean difference to the mean (WMDM). Population attributable risk (PAR) and population attributable fraction (PAF) were estimated to assess public health impact.</p> Results <p>Stunting prevalence in Rwanda decreased by 31.0% from 2000 (47.9%) to 2019 (33.1%). However, inequalities widened, with faster progress among the wealthiest, reaching their peak in 2019 (SII = -41.7, CIX = -21.9). Women’s education inequalities persisted in favor of the highly educated (SII = − 29.7 and CIX worsening to -9.2 in 2019), urban areas (16-point absolute difference), and boys (7.8-point absolute difference). Regional disparities were relatively stable, with WMDM around 5.0% points, Kigali having the lowest rate. The measures of impact show wealth had the strongest effect, with a PAR of 23.2% points and PAF of 69.0%; respectively reflecting the amount of stunting rates that are attributable to being in the poorest categories and what could be eliminated if all children were in the wealthiest categories.</p> Conclusion <p>Despite overall national progress in reducing stunting, social and economic inequalities remained apparent and widened between 2000 and 2019. Children from the poorest households and those with less educated mothers remain disproportionately affected. To achieve the global nutrition target by 2030, Rwanda must strengthen equity-focused interventions to reach the most vulnerable groups.</p>

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Socio-Economic Inequalities of Childhood Stunting in Rwanda: Time Trend Analysis of Demographic and Health Surveys, 2000 to 2019

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Albert Ndagijimana,
  • Leonardo Z. Ferreira,
  • Torbjörn Lind,
  • Aluisio J. D. Barros

摘要

Background

Childhood stunting, defined as a height-for-age Z-score below − 2 standard deviations, remains a major public health issue in Rwanda, with one in three children under-five affected. Although national prevalence of stunting has declined over the past two decades, less is known about how trends compare across population groups. This study assessed trends in childhood stunting inequalities in Rwanda from 2000 to 2019 using absolute and relative inequality measures across five equity dimensions (wealth, women’s education, place of residence, sex, and regions or provinces).

Methods

We analyzed data from five rounds of the Rwanda Demographic and Health Surveys (2000–2019). Stunting prevalence was disaggregated by wealth quintiles, women’s education, place of residence, child’s gender, and region/province. Absolute and relative inequality measures included the slope index of inequality (SII), concentration index (CIX), absolute difference, and the weighted mean difference to the mean (WMDM). Population attributable risk (PAR) and population attributable fraction (PAF) were estimated to assess public health impact.

Results

Stunting prevalence in Rwanda decreased by 31.0% from 2000 (47.9%) to 2019 (33.1%). However, inequalities widened, with faster progress among the wealthiest, reaching their peak in 2019 (SII = -41.7, CIX = -21.9). Women’s education inequalities persisted in favor of the highly educated (SII = − 29.7 and CIX worsening to -9.2 in 2019), urban areas (16-point absolute difference), and boys (7.8-point absolute difference). Regional disparities were relatively stable, with WMDM around 5.0% points, Kigali having the lowest rate. The measures of impact show wealth had the strongest effect, with a PAR of 23.2% points and PAF of 69.0%; respectively reflecting the amount of stunting rates that are attributable to being in the poorest categories and what could be eliminated if all children were in the wealthiest categories.

Conclusion

Despite overall national progress in reducing stunting, social and economic inequalities remained apparent and widened between 2000 and 2019. Children from the poorest households and those with less educated mothers remain disproportionately affected. To achieve the global nutrition target by 2030, Rwanda must strengthen equity-focused interventions to reach the most vulnerable groups.