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Background: In Northern Province, Rwanda, stunting is common among children aged under 5 years. However, previous studies on spatial analysis of childhood stunting in Rwanda did not assess its randomness and clustering, and none were conducted in Northern Province. We conducted a spatial-pattern analysis of childhood undernutrition to identify stunting clusters and hotspots for targeted interventions in Northern Province.

Methods: Using a household population-based questionnaire survey of the characteristics and causes of undernutrition in households with biological mothers of children aged 1–36 months, we collected anthropometric measurements of the children and their mothers and captured the coordinates of the households. Descriptive statistics were computed for the sociodemographic characteristics and anthropometric measurements. Spatial patterns of childhood stunting were determined using global and local Moran's I and Getis-Ord Gi* statistics, and the corresponding maps were produced.

Results: The z-scores of the three anthropometric measurements were normally distributed, but the z-scores of height-for-age were generally lower than those of weight-for-age and weight-for-height, prompting us to focus on height-for-age for the spatial analysis. The estimated incidence of stunting among 601 children aged 1–36 months was 27.1 %. The sample points were interpolated to the administrative level of the sector. The global Moran's I was positive and significant (Moran's I = 0.403, p < 0.001, z-score = 7.813), indicating clustering of childhood stunting across different sectors of Northern Province. The local Moran's I and hotspot analysis based on the Getis-Ord Gi* statistic showed statistically significant hotspots, which were strongest within Musanze district, followed by Gakenke and Gicumbi districts.

Conclusion: Childhood stunting in Northern Province showed statistically significant hotspots in Musanze, Gakenke, and Gicumbi districts. Factors associated with such clusters and hotspots should be assessed to identify possible geographically targeted interventions.

Objective: Childhood stunting is a significant health issue in Rwanda, particularly within the Northern Province. While demographic and socio-economic factors have been more extensively studied, the impact of environmental and climatic factors on stunting prevalence has received less attention. This study aimed to determine if these factors could be used to better predict localized variations in height-for-age z-scores (HAZ).

Study design: A population-based, cross-sectional study.

Methods: Data were collected on child and maternal characteristics, household socioeconomic status, climate, and environmental predictors. An eXtreme Gradient Boosting (XGBoost) algorithm was used, complemented by GeoShapley for spatial analyses, to explain the spatial variability between low height-for-age and its risk factors.

Results: The model performed well, with the coefficient of determination (R2) value of 0.83, the root mean standardized error (RMSE) of 0.13, and the mean absolute error (MAE) of 0.10. Key predictors of HAZ included rainfall, childcare practices, food insecurity, elevation, and soil fertility. Considering the location feature, environmental and climatic factors significantly contributed to the spatial variability in HAZ.

Conclusion: Many environmental, climatological, and socio-economic factors emerge as predictors for HAZ variability. It is essential to consider their complexity for comprehensive interventions targeting childhood stunting in Rwanda and similar settings.

Background: Childhood stunting, defined as height-for-age below − 2 standard deviations (SD), disproportionately affects the Northern Province of Rwanda. We investigated risk factors contributing to stunting in this region at individual, household, and societal/community levels to inform future interventions. Methods: We conducted a population-based, cross-sectional study using a quantitative questionnaire in households with children aged 1–36 months in the Northern Province. Anthropometric measurements of children and mothers were taken to estimate nutritional status. Multivariable logistic regressions were performed to identify independent risk factors of stunting, reporting odds ratios, 95% confidence intervals and p-values. Results: Overall, stunting prevalence was 27.1% in children aged 1–36 months. At the individual level, boys exhibited 82% higher risk of stunting compared to girls (aOR: 1.82, 95% CI: 1.19, 2.78). Household-level factors such as maternal height and BMI were inversely associated with the risk of childhood stunting (aOR: 0.94, 95% CI: 0.90, 0.97 and aOR: 0.92, 95% CI: 0.86, 0.99, respectively). Other risk factors included no breastfeeding at the time of interview (aOR: 2.00, 95% CI: 1.23, 3.25), presence of twins or triplets aged 1–36 months (aOR: 2.60, 95% CI: 1.21, 5.57), female-headed (single parent) households (aOR: 2.07, 95% CI: 1.00, 4.26), and absence of handwashing facilities near the toilet (aOR: 3.30, 95% CI: 1.36, 7.98). No societal/community factors were significantly associated with childhood stunting in the Northern Province. Conclusion: Childhood stunting in the Northern Province of Rwanda is associated with several factors that could lend themselves to interventions, e.g., improved handwashing facilities, improved childcare practices and targeting vulnerable groups such as boys, households with twins or single parents. Additionally, a thorough exploration of identified risk factors through qualitative approaches involving all stakeholders in child and maternal nutrition is warranted.

Background: Childhood stunting remains a public health challenge, especially in sub-Saharan Africa. In Rwanda, it is the highest in the Northern province, with a prevalence of 40.5% in children under five. Given that poverty is a key determinant of stunting, we aimed to investigate wealth inequalities in childhood stunting and to identify its contributing determinants in the province.

Methods: We included 601 children aged 1 to 36 months. We estimated the concentration index to quantify wealth-related inequalities in stunting, which we further decomposed it by applying the Wagstaff decomposition approach.

Results: The overall concentration index of child stunting was relatively high (-0.190; 95% CI: -0.295, -0.084), suggesting that stunting was concentrated in poorer households. Its decomposition revealed that socio-economic determinants (147.9%), namely wealth index, partner’s unemployment or non-skilled occupation, and household food insecurity, contributed most to the wealth inequalities of childhood stunting. The demographic determinants contributed in the second order, especially living in Musanze district. Psychosocial determinants came last, namely maternal social support.

Conclusion: This study revealed significant wealth inequalities in childhood stunting in the Northern Province of Rwanda, with socio-economic factors being the primary contributors to these inequalities. Targeted interventions, such as household economic strengthening programs, robust food security policies, improved conditions and salaries in non-skilled jobs, and social support programs for the most disadvantaged communities, are essential to reducing these disparities.

Background: Childhood stunting remains highly prevalent in the Northern Province of Rwanda. While many risk factors are documented, less is known about social and parenting processes in high-risk child conditions of undernutrition. We aimed to explore parental experiences and understandings of the risk of childhood stunting in the Northern Province of Rwanda. 

Methods: We conducted a qualitative study using gender‑segregated focus group discussions (FGDs) with 120 parents of children aged 1–36 months across all five districts of Northern Province. We analysed data using a reflexive thematic analysis approach.

Results: Parents’ narratives revealed four interconnected themes: “power struggles and broken car undermining child nutrition”, including gendered decision-making, resource diversion, and intimate partner violence; “vulnerabilities across the first 1,000 days shaping stunting trajectories”; “the paradox of plenty – where livestock and food do not nourish children”, but are instead diverted from them; and “fragile substitute care leaving children behind”, when mothers must go for work, leading to irregular feeding, neglect, and reduced responsive care.

Conclusion: In the Northern Province of Rwanda, stunting persists less because assets or advice are absent than because interlinked power–time–cash dynamics divert milk, money, and caregiving away from infants during the first 1,000 days. Policies should re-allocate decision-making power and resources toward infants by strengthening joint household decision-making, empowering mothers during and after pregnancy, aligning livestock and market incentives with infant intake, and restoring reliable substitute care through functioning publicly available platforms.