Study to identify the factors affecting the recovery from moderate acute malnutrition among children enrolled in a supplemental food program in a rural health center of Rwanda

Introduction: Malnutrition globally remains a public health concern affecting 206
million under-nutrition children that is complex and needs special attention. In
Rwanda, stunting continues to be a threat to the development in various ways,
including weakening the intellectual capacity of children. Moderate acute
malnutrition (MAM) is higher among under-five children than severe acute
malnutrition (SAM) and easy to manage through outpatient malnutrition programs,
but still receives less attention. Poor recovery of MAM is a leading factor in stunting,
however, the factors affecting the delayed recovery of MAM children remains
unknown.

Objective: To identify the factors affecting poor growth among MAM children
enrolled in the supplemental feeding program (SFP) in the rural health center of
Rwanda, and provides proper recommendations.

Methods: Mixed method study, with 24 participants, both caregivers and healthcare
workers working in the SFP in December 2017. The sample of eligible caregivers
were obtained from the nutrition register book available at the Health Center among
those whose children were enrolled in SFP from April to June 2017. A survey and
semi-structured interview guide were used. The quantitative data summarized using
descriptive statistics, and the qualitative data using content and thematic analysis
and presented as topics supported by quotes.

Results: Six factors affecting the delayed recovery of MAM children enrolled in the
SFP were identified, enrolled children do not consume the provided support due to
sharing/ selling, limited family planning, insufficient food and poverty, inadequate
child care, poor service, and low attendance at the community-based nutrition
program (CBNP). Furthermore, increasing the support or the length of SFP, the
involvement of local leaders, establishing early childhood development centers,
improving health service including communication and home visit, and
accountability of caregivers, were proposed as ways forward. The major benefit of
the SFP was the knowledge of nutrition practices.

Conclusion: Gaps in households and health facilities continue to affect MAM
Children enrolled in the SFP. Interventions based on the identified contributing
factors and suggestions obtained may improve the SFP and nutrition status of underfive
children in Rwanda.

Keywords: Malnutrition, Moderate acute malnutrition, Supplementary food program,
delay recovery, Rwanda