[Influence of malnutrition on childhood mortality in a rural hospital in Rwanda]. / Influence de la malnutrition sur la mortalité des enfants dans un hôpital rural au Rwanda.

BACKGROUND: Recent estimates of the role of malnutrition on childhood mortality have led to a call for action by decision makers in the fight against child malnutrition. Further evaluation is needed to assess the burden of malnutrition in terms of morbidity and mortality, as well as to assess the impact of various interventions. The objective of this study is to determine the effect of malnutrition on mortality in a pediatric service of a rural hospital in Rwanda. METHODS: A prospective cohort study included children aged 6-59 months coming from the catchment area of the hospital and admitted to the pediatric ward between January 2008 and June 2009. Anthropometric, clinical and biological data were gathered at the time of admission. The effect of malnutrition at the time of admission on mortality during hospitalization was analyzed by using logistic regression. RESULTS: At the time of admission, the prevalences of wasting, underweight and stunting among children was 14.2%, 37.5% and 57.3% respectively. Fifty-six children died during hospitalization. The period mortality rate was 6.9%. After adjustment for age, sex, malaria thick smear and breathing with chest retractions, death was associated with underweight and stunting with adjusted odds rations of 4.6 (IC95% 2.5-8.4) and 4.0 (IC95% 2.0-8.2) respectively. CONCLUSION: The study confirmed the influence of malnutrition on child mortality in pediatrics wards. These results can be of great help for improving the awareness of the community decision-makers in the fight to prevent malnutrition.

[Reliability of anthropometric measurements performed by community nutrition workers in a community-based pediatric growth-monitoring program in rural Rwanda]. / Fiabilité des mesures anthropométriques dans le suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda.

BACKGROUND: In Rwanda, the community-based growth-monitoring program is implemented via volunteer community nutrition workers. These volunteers are recruited from within their communities, and receive basic training prior to providing services. Utilizing local volunteers improves access to basic nutrition services, and allows the local health jurisdictions to use qualified health care staff more efficiently. In addition to concerns raised in regards to the accountability of unpaid workers, some question the relevance of the data that is collected. We carried out a nutritional survey in the catchment area of Ruli District Hospital to evaluate the reliability of the community nutrition workers' measurements of anthropometric standards collected within the growth-monitoring framework. METHODS: A nutritional survey was recently organized in the catchment area of the hospital in December 2006. The prevalence rates of malnutrition from the survey were compared with those from the existing community-based growth-monitoring program. Z-test was used to compare the prevalence rate of underweight from the survey with the prevalence rate determined by data collected from community nutrition workers. The concordance of children classified with moderate and severe underweight in each data set was determined by the coefficient Kappa of Cohen. RESULTS: Our findings show that the recent survey reported an overall underweight prevalence rate of 27.2%. Community data calculated a prevalence rate of 28.8% for the same population. The difference is not statistically significant (P=0.294). Of 724 children evaluated, the survey and the community were in agreement in regards to 454 children classified in the category of good nutritional status, 143 children classified in moderate underweight and 11 children classified in the severe underweight category. The Kappa of Cohen coefficient of 0.636 indicates strong concordance between data sets. CONCLUSION: Anthropometric measurements provided by the community are reliable. Information gathered from the community can be used for epidemiologic monitoring of malnutrition. To ensure continued reliability, health centers must provide sufficient and permanent training to community nutrition workers. In addition, continued access to essential materials used for measuring nutritional status and maintenance of these materials will be crucial to the program's ongoing success.

[Improving the management of a community based growth-monitoring program for children in rural Rwanda]. / Amélioration de la gestion d'un programme de suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda.

BACKGROUND: In order to improve the management of a community based nutrition program in the catchment area of Ruli District Hospital in Rwanda, we carried out a nutrition survey to determine the risk factors for childhood malnutrition in the area. Identifying the groups of children at risk of malnutrition and their risk factors allows the community nutrition workers to target the children who require close monitoring, and assists in the development of key messages for educational nutrition training. METHODS: The prevalence of the three forms of malnutrition was estimated by using the Z-scores height for age, weight for age and weight for height with NCHS/OMS/2000 reference. Logistic regression was performed to identify the risk factors for malnutrition. RESULTS: Our findings show that children from 12-35 months of age are at greatest risk of malnutrition. Risk factors for wasting include: low monthly income of the household, concurrent illness of the child and a household that does not practice breeding. Risk factors for underweight include: child being greater than 12 months of age, mother of the child being pregnant and history of malnutrition in the household. Finally, risk factors for stunting include the absence of a mosquito net in the household, an insufficient number of working adults in the household, the child being greater than 12 months of age and a household managed by a man alone or by an orphan. CONCLUSION: Community based growth monitoring must focus its attention on the children from nine to 35 months of age. Children less than nine months of age are generally followed by the health centers through the immunization program, and the older children are generally followed in the child minder schools that need to be promoted in all the cells. Community messages must focus on the identified risk factors of malnutrition, and a positive deviance approach must be introduced in the entire zone.