Abstract
Undernutrition among children under five remains a major global public health concern. In Rwanda, 33% of children under five are stunted despite extensive nutrition programs. Limited evidence exists examining how infant and young child feeding (IYCF) patterns relate to nutritional outcomes among children aged 0–24 months using population-based data. This study assessed feeding patterns and their association with nutritional status among children aged 0–24 months in Rwanda. Secondary analysis of the 2019–2020 Rwanda Demographic and Health Survey included 1,581 children aged 0–24 months with complete anthropometric and IYCF indicators data. IYCF practices were assessed using WHO/UNICEF indicators. Nutritional status indicators (stunting, wasting, underweight) were calculated using WHO 2006 Child Growth Standards. Multivariable logistic regression identified independent predictors of child malnutrition. Among 1,581 children, the prevalence of stunting was 28%, underweight 6.6%, and wasting 1.6%. Breastfeeding practices were strong (early initiation 85.5% and exclusive breastfeeding 81.4%), but complementary feeding remained inadequate (34.2% met minimum dietary diversity, 46% minimum meal frequency, and 22.4% minimum acceptable diet). Independent predictors included rural residence, low household wealth, single maternal status, male sex, and low birth weight for stunting; male sex, low birth weight, and recent diarrhea for underweight; recent fever and paradoxically meeting the minimum acceptable diet for wasting. This study’s findings underscore the need for integrated interventions improving complementary feeding, healthcare access, childhood illness prevention, and targeted support for high-risk children to reduce stunting, underweight, and wasting in Rwanda.
Data availability
The datasets analyzed during the current study are publicly available from the DHS Program repository (https://dhsprogram.com/data/available-datasets.cfm) upon registration and reasonable request. Researchers interested in accessing the data must submit a request through the DHS Program website and agree to the data use terms and conditions. The specific dataset used is Rwanda DHS 2019-2020 Final Report (FR370).
Abbreviations
- ANC:
-
Antenatal care
- AOR:
-
Adjusted odds ratio
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- CMHS:
-
College of medicine and health sciences
- DHS:
-
Demographic and health survey
- ICF:
-
ICF international
- IYCF:
-
Infant and young child feeding
- LBW:
-
Low birth weight
- LMICs:
-
Low- and middle-income countries
- MAD:
-
Minimum acceptable diet
- MDD:
-
Minimum dietary diversity
- MMF:
-
Minimum meal frequency
- NISR:
-
National Institute of Statistics of Rwanda
- RDHS:
-
Rwanda demographic and health survey
- SD:
-
Standard deviation
- SSA:
-
Sub-Saharan Africa
- UNICEF:
-
United Nations International Children’s Fund
- WASH:
-
Water, sanitation, and hygiene
- WHO:
-
World Health Organization
References
Vaivada, T. et al. Stunting in childhood: An overview of global burden, trends, determinants, and drivers of decline. Am. J. Clin. Nutr. 112, 777S–791S (2020).
World Bank. Population, total - Low & middle income. World Development Indicators. [Internet]. Available from: https://data.worldbank.org/country/low-and-middle-income (2024).
WHO/UNICEF. Strengthening action to improve feeding of infants and young children 6–23 months of age in nutrition and child health in nutrition and child programmes. (2008).
WHO. UNICEF. Global Nutrition monitoring framework. Operational guidance for tracking progress in meeting targets for 2025. World Health Organ. 77 p. (2017).
Kambale, R. M. et al. Minimum acceptable diet among children aged 6–23 months in South Kivu, Democratic Republic of Congo: a community-based cross-sectional study. BMC Pediatr. 21 (1), 1–9 (2021).
Belay, D. G., Taddese, A. A. & Gelaye, K. A. Minimum acceptable diet intake and its associated factors among children age at 6–23 months in sub-Saharan Africa: a multilevel analysis of the sub-Saharan Africa demographic and health survey. BMC Public. Health. 22 (1), 1–18 (2022).
UNICEF/WHO/WORLD BANK. Levels and trends in child malnutrition UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates Key findings of the 2021. edition. World Health Organization [Internet]. 1–32. (2021). Available from: https://www.who.int/publications/i/item/9789240025257.
WHO, UNICEF. Global Nutrition monitoring framework. Operational guidance for tracking progress in meeting targets for 2025 [Internet]. World Health Organization. 77 p. (2017). Available from: http://apps.who.int/iris/bitstream/handle/10665/259904/9789241513609-eng.pdf;jsessionid=82B08433379C3E3E69B3F8D4F2690C34?sequence=1%0Awww.who.int/nutrition
WHO. Reducing stunting in children: equity considerations for achieving the Global Nutrition Targets 2025. (2018).
Aboagye, R. G. et al. Dietary diversity and undernutrition in children aged 6–23 months in sub-saharan africa. Nutrients 13(10). (2021).
Molani Gol, R., Kheirouri, S. & Alizadeh, M. Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review. J. Nutr. Educ. Behav. 54 (1), 65–83 (2022).
Ba, D. M. et al. Prevalence and determinants of meeting minimum dietary diversity among children aged 6–23 months in three sub-Saharan African Countries: The Demographic and Health Surveys, 2019–2020. Front. Public. Health 10. (2022).
Belay, D. G., Taddese, A. A. & Gelaye, K. A. Minimum acceptable diet intake and its associated factors among children age at 6–23 months in sub-Saharan Africa: a multilevel analysis of the sub-Saharan Africa demographic and health survey. BMC Public Health 22(1), 1–18. https://doi.org/10.1186/s12889-022-12966-8 (2022).
Rashidi Hussein, M. & Mostafa Darwish, A. Abd El Hakim Abdou R. Feeding Patterns Among Stunted Children Under-Five Years in Dodoma City in Tanzania. Egypt. J. Health Care. 13.
Masuke, R. et al. Effect of inappropriate complementary feeding practices on the nutritional status of children aged 6–24 months in urban Moshi, Northern Tanzania: Cohort study. PLoS One 16 (2021).
Khamis, A. G., Mwanri, A. W., Ntwenya, J. E. & Kreppel, K. The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatr. 19(1). (2019).
Udoh, E. E. & Amodu, O. K. Complementary feeding practices among mothers and nutritional status of infants in Akpabuyo Area, Cross River State Nigeria. Springerplus 5(1). (2016).
NISR, M. O. H. Rwanda Demographic and Health Survey 2019-20 Final report. 178 p. (2021).
ICF International. Demographic and Health Surveys Methodology: sampling and household listing manual [Internet]. (2012). Available from: https://dhsprogram.com/pubs/pdf/DHSM4/DHSM4.pdf.
WHO/UNICEF. Indicators for assessing infant and young child feeding practices: Definitions and measurement methods [Internet]. (2021). Available from: https://iris.who.int/handle/10665/340706.
Victora, C. G. et al. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda Vol. 397, p. 1388–1399 (Elsevier B.V., 2021). The Lancet.
Olakunle, A. A. Analysing the drivers of stunting reduction in twelve sub-saharan African countries using the RIF decomposition approach. BMC Public. Health 24(1). (2024).
Wasswa, G., Kizza, J. & Amwonya, D. Exploring the impact of maternal marital status on child health: insights from the 2022 Tanzanian Demographic and Health Survey. Afr. J. Reprod. Health. 28 (7), 91–101 (2024).
Kassaw, A. et al. Wasting and its associated factors among under-two years children in Ethiopia: a systematic review and meta-analysis. BMC Public. Health 24(1). (2024).
Levels and trends in child malnutrition-UNICEF_WHO _ World Bank Group Joint Child Malnutrition EstimatesKey findings of the 2025 edition.
Wali, N., Agho, K. E. & Renzaho, A. M. N. Wasting and associated factors among children under 5 years in five south asian countries (2014–2018): Analysis of demographic health surveys. Int. J. Environ. Res. Public. Health 18(9). (2021).
Ashworth, A. & Feachem, R. C. Interventions for the control of diarrhoeal diseases among young children: weaning education. Bull. World Health Organ. 63 (6), 1115–1127 (1985).
Wolde, D., Tilahun, G. A., Kotiso, K. S., Medhin, G. & Eguale, T. The Burden of Diarrheal Diseases and Its Associated Factors among Under-Five Children in Welkite Town: A Community Based Cross-Sectional Study. Int. J. Public. Health. 67 (October), 1–9 (2022).
Aguayo, V. M. Complementary feeding practices for infants and young children in South Asia. A review of evidence for action post-2015. Vol. 13, Maternal and Child Nutrition. Blackwell Publishing Ltd; (2017).
Marriott, B. P., White, A., Hadden, L., Davies, J. C. & Wallingford, J. C. World Health Organization (WHO) infant and young child feeding indicators: Associations with growth measures in 14 low-income countries. Matern Child. Nutr. 8 (3), 354–370 (2012).
Abdulla, F., Id, A. R. & Id, M. H. Prevalence and risk predictors of childhood stunting in Bangladesh. 1–20. (2023).
Asmare, A. A. & Agmas, Y. A. Multilevel multivariate modeling on the association between undernutrition indices of under-five children in East Africa countries: evidence from recent demographic health survey (DHS) data. BMC Nutr. 9(1). (2023).
Azizah, A. M., Nurmala, I. & Devy, S. R. The Effect of Mother’s Educational Level and Stunting Incidence on Toddler: A Meta-analysis. Amerta Nutr. 6 (4), 369–375 (2022).
Bater, J. et al. et a. Predictors of low birth weight and preterm birth in rural Uganda: Findings from a birth cohort study. PLoS One 15(7). (2020).
Murekatete, F., Muteteli, C., Mujawamariya, F. & Chironda, G. Low Birth Weight Newborns and Associated Factors at Selected Referral Hospital in Rwanda. Rwanda J. Med. Health Sci. 3 (2), 214–224 (2020).
Mukabutera, A. et al. Risk factors associated with underweight status in children under five: an analysis of the 2010 Rwanda Demographic Health Survey (RDHS). BMC Nutr. 2, 40 (2016).
Ilinde Niyigena, D. et al. Feeding Practices and Nutritional Status among Children Aged from Six to 23 Months in Western Province, Rwanda: A cross-sectional study. Rwanda J. Med. Health Sci. 6 (2), 228–238 (2023).
Asferie, W. N. et al. Association Between Maternal Undernutrition During Pregnancy and Newborn Low Birth Weight in Ethiopia: A Systematic Review and Meta-Analysis Vol. 21 (John Wiley and Sons Inc, 2025). Maternal and Child Nutrition.
Namiiro, F. B. et al. Nutritional status of young children born with low birthweight in a low resource setting: an observational study. BMC Pediatr. ;23(1). (2023).
Ndahimana, R. et al. Prevalence and associated risk factors of stunting too early: analysis of the 2020 Rwanda demographic and health survey. BMJ Nutr. Prev. Health (2025).
Acknowledgements
The authors express sincere gratitude to the National Institute of Statistics of Rwanda (NISR) and the Ministry of Health for conducting the Rwanda DHS 2019-2020 and making the data publicly available for research purposes. We acknowledge the DHS Program (ICF International) for granting permission to use the Rwanda DHS 2019-2020 dataset. We thank the University of Rwanda, College of Medicine and Health Sciences, School of Public Health for providing institutional support and resources that made this research possible. We are grateful to all the women who participated in the original survey and the data collection teams who ensured high-quality data collection. We also thank the families and communities across Rwanda who welcomed the survey teams into their homes.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The study was conducted as part of academic requirements at the University of Rwanda, College of Medicine and Health Sciences.
Author information
Authors and Affiliations
Contributions
EU conceptualized and designed the study, performed data extraction and statistical analysis, interpreted the results, and wrote the manuscript. MH, GA contributed to the statistical analysis and interpretation of results and critically reviewed the manuscript. MH, JC supervised the study, provided expert input on study design and interpretation, and critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript for submission.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
This secondary analysis utilized publicly available, de-identified DHS data obtained with permission from the DHS Program (Rockville, MD, USA). The original Rwanda DHS 2019–2020 survey received ethical approval from the Rwanda National Ethics Committee and the ICF Institutional Review Board. Ethical approval for this secondary analysis was obtained from the College of Medicine and Health Sciences Institutional Review Board, University of Rwanda (Ref: CMHS/IRB/525/2024). All participants in the original survey provided informed consent prior to participation.
Consent for publication
Not applicable. This study used de-identified secondary data from a publicly available dataset. No individual person’s data in any form (including individual details, images, or videos) are presented in this manuscript.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Uwamahoro, E., Habtu, M., Absolomon, G. et al. Feeding patterns and nutrition status of children aged 0–24 months in Rwanda: a secondary data analysis of Rwanda DHS 2019–2020. Sci Rep (2026). https://doi.org/10.1038/s41598-026-46969-x
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-46969-x
