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Spatial heterogeneity and spatially varying determinants of childhood stunting in Northern Rwanda: A cross-sectional study to inform targeted interventions

Kagoyire, Clarisse LU ; Ndagijimana, Albert ; Nduwayezu, Gilbert LU orcid ; Utumatwishima, Jean Nepo ; Mpatswenumugabo, Jean Pierre ; Mukasafari, Marie Anne ; Rinda, Diane ; Ndahindwa, Vedaste ; Elfving, Kristina and Krantz, Gunilla , et al. (2026) In PLoS ONE 21(2).
Abstract
Despite national progress, stunting remains prevalent in specific regions of Rwanda, highlighting the limitations of coarse-resolution data for effective mapping and intervention planning. This study explored optimal spatial resolution and analytical approach to capture localised dynamics and the multifactorial nature of stunting. A cross-sectional, population-based study was conducted in the Northern Province of Rwanda, focusing on children aged 1–36 months. Data were collected using structured questionnaires covering socio-demographic, economic, health, childcare, livestock factors and anthropometric measurements. Environmental characteristics were obtained from national datasets, while household geographic coordinates were captured... (More)
Despite national progress, stunting remains prevalent in specific regions of Rwanda, highlighting the limitations of coarse-resolution data for effective mapping and intervention planning. This study explored optimal spatial resolution and analytical approach to capture localised dynamics and the multifactorial nature of stunting. A cross-sectional, population-based study was conducted in the Northern Province of Rwanda, focusing on children aged 1–36 months. Data were collected using structured questionnaires covering socio-demographic, economic, health, childcare, livestock factors and anthropometric measurements. Environmental characteristics were obtained from national datasets, while household geographic coordinates were captured using a customized mobile geodata platform (emGeo). After data cleaning, predictors were analysed using univariable and multivariable logistic regression as well as geographically weighted logistic regression (GWLR) to account for spatial heterogeneity. Among 601 children, stunting prevalence was 27% (boys 33.8%; girls 20.9%). GWLR improved model fit, increasing adjusted deviance explained from 34% to 39%. Significant predictors included child age (adjusted OR = 2.46; 95% CI: 1.78–3.39), male sex (OR = 2.83; 95% CI: 1.65–4.86), birthweight (OR = 0.71; 95% CI: 0.54–0.94), maternal autonomy (ability to refuse sexual intercourse; OR = 0.48; 95% CI: 0.27–0.86), inconsistent maternal social support (OR = 2.30; 95% CI: 1.20–4.42), household electricity access (OR = 0.48; 95% CI: 0.27–0.84) and handwashing facilities (OR = 0.21; 95% CI: 0.07–0.67). GWLR revealed substantial spatial heterogeneity in these factors, delineating areas where each factor matters most. This household-level, spatially explicit analysis reveals localised risk patterns often masked by aggregated national data. Prioritising context-specific interventions (such as electrification, hygiene promotion, and enhanced maternal social support), can enhance effectiveness. The proposed analytical workflow provides a model for addressing persistent stunting in other resource-limited settings. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLoS ONE
volume
21
issue
2
article number
e0343772
pages
22 pages
publisher
Public Library of Science (PLoS)
external identifiers
  • pmid:41746957
  • scopus:105031140817
ISSN
1932-6203
DOI
10.1371/journal.pone.0343772
language
English
LU publication?
yes
id
00e77372-44cc-4e87-97ab-71a2984b1067
date added to LUP
2026-03-06 12:43:56
date last changed
2026-03-09 11:44:38
@article{00e77372-44cc-4e87-97ab-71a2984b1067,
  abstract     = {{Despite national progress, stunting remains prevalent in specific regions of Rwanda, highlighting the limitations of coarse-resolution data for effective mapping and intervention planning. This study explored optimal spatial resolution and analytical approach to capture localised dynamics and the multifactorial nature of stunting. A cross-sectional, population-based study was conducted in the Northern Province of Rwanda, focusing on children aged 1–36 months. Data were collected using structured questionnaires covering socio-demographic, economic, health, childcare, livestock factors and anthropometric measurements. Environmental characteristics were obtained from national datasets, while household geographic coordinates were captured using a customized mobile geodata platform (emGeo). After data cleaning, predictors were analysed using univariable and multivariable logistic regression as well as geographically weighted logistic regression (GWLR) to account for spatial heterogeneity. Among 601 children, stunting prevalence was 27% (boys 33.8%; girls 20.9%). GWLR improved model fit, increasing adjusted deviance explained from 34% to 39%. Significant predictors included child age (adjusted OR = 2.46; 95% CI: 1.78–3.39), male sex (OR = 2.83; 95% CI: 1.65–4.86), birthweight (OR = 0.71; 95% CI: 0.54–0.94), maternal autonomy (ability to refuse sexual intercourse; OR = 0.48; 95% CI: 0.27–0.86), inconsistent maternal social support (OR = 2.30; 95% CI: 1.20–4.42), household electricity access (OR = 0.48; 95% CI: 0.27–0.84) and handwashing facilities (OR = 0.21; 95% CI: 0.07–0.67). GWLR revealed substantial spatial heterogeneity in these factors, delineating areas where each factor matters most. This household-level, spatially explicit analysis reveals localised risk patterns often masked by aggregated national data. Prioritising context-specific interventions (such as electrification, hygiene promotion, and enhanced maternal social support), can enhance effectiveness. The proposed analytical workflow provides a model for addressing persistent stunting in other resource-limited settings.}},
  author       = {{Kagoyire, Clarisse and Ndagijimana, Albert and Nduwayezu, Gilbert and Utumatwishima, Jean Nepo and Mpatswenumugabo, Jean Pierre and Mukasafari, Marie Anne and Rinda, Diane and Ndahindwa, Vedaste and Elfving, Kristina and Krantz, Gunilla and Lind, Torbjörn and Mansourian, A and Båge, Renée and Wredle, Ewa and Nyandwi, Elias and Umubyeyi, Aline and Ndahetuye, Jean Baptiste and Pilesjö, Petter}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{2}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Spatial heterogeneity and spatially varying determinants of childhood stunting in Northern Rwanda: A cross-sectional study to inform targeted interventions}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0343772}},
  doi          = {{10.1371/journal.pone.0343772}},
  volume       = {{21}},
  year         = {{2026}},
}