At Byumba Level 2 Teaching Hospital, Clementine Mukandayishimiye gently adjusts the blanket around her child’s narrow shoulders.

Another toddler is strapped to her back, fast asleep as nurses make their rounds. The ward is quiet, but for Mukandayishimiye, the anxiety is constant.

The 25-year-old mother of two from Muko Sector in Gicumbi District has spent days moving between her child’s bed and the nutrition desk, listening carefully to instructions on feeding, supplements, and follow-up care.

Covered by Mutuelle de santé, she is able to access treatment. But treatment, she knows, is only part of the struggle.

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"I don’t always know how to prepare balanced meals for my children. Sometimes I lack the knowledge, and sometimes the resources. When the child is sick, it becomes even harder to ensure proper nutrition,” she says.

A broader pattern

"The knowledge is there. Health workers explain what to feed the child and how to prepare it. But at home, putting it into practice every day is very difficult. There are days when food is not enough, or when the child refuses to eat. You try your best, but life is complicated.”

Her experience reflects a broader pattern playing out quietly across Gicumbi.

In Rugarama Village, Nyarutarama Cell, 86-year-old Elias Gashugi and his wife Saverina Mukamurangira, 76, sit outside their home watching over their one-year-old grandson. The child eats with the family, they say, yet his growth has faltered.

"The child eats like the others,” Gashugi explains. "But after the first baby, another pregnancy came quickly. Maybe the mother’s body had not yet recovered. I do not see conflict in that home, but I wonder if the spacing contributed,”

"We are old now; we no longer attend the trainings. The parents are the ones who must understand these things,” he says.

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Mukamurangira believes knowledge has reached the community, but practice does not always follow.

"We were told that stunting is caused by poor and unbalanced diets. Community health workers and teachers explained it,” she says. "But sometimes parents do not put it into practice. The child has been sick for some time. They try to cook vegetables, but illness also affects appetite.”

A few kilometres away, the Sentaniye household presents another dimension of the challenge. The home is locked, and children wait outside under the supervision of their eight-year-old sister, who holds the keys. When asked if they have eaten lunch, they hesitate before answering softly, "Not yet.”

Their father, Sérestien Sentaniye, insists by phone that food is available and shared equally. Yet neighbours describe frequent disputes within the home. Meals often consist of beans, sweet potatoes, and occasionally small silver fish. While filling, the diet lacks the diversity required to support healthy growth in young children.

These lived realities echo concerns raised at national level.

During the 20th edition of Umushyikirano, Rwanda’s National Dialogue Council, Gicumbi District emerged as a paradox. Known for its rolling hills, fertile valleys, and lakeside vistas including Lake Muhazi, the district has long been considered relatively stable economically. Poverty levels stand below the national average, and agricultural productivity continues to rise.

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Yet despite these indicators, child stunting remains high, with nearly four in ten children under five affected.

The contradiction between visible prosperity and chronic malnutrition prompted reflection during the national dialogue, where leaders were challenged to examine why growth in income and food production has not translated into consistent improvements in child nutrition.

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Leadership and community action

At his office in Byumba, the Gicumbi District Mayor, Emmanuel Nzabonimpa, speaks with measured determination about the district’s potential and challenges.

"Gicumbi is a district of rolling hills and beauty. We have 28 sectors, each with its own challenges, yet the potential is enormous. Our communities are hardworking, with increasing agricultural productivity and livestock ownership,” he says.

Nzabonimpa highlights the impact of government initiatives like Girinka, which has distributed over 32,000 cows to households, with about 80 per cent of families now owning cows – providing both nutritional and livelihood support. Yet, he is candid about the programme’s limitations.

"Even with these efforts, about eight per cent of households still struggle to access the benefits fully. Some families lack the capacity to manage the cows or turn the milk into meals that can improve child nutrition,” he acknowledges.

Addressing stunting requires a multi-pronged approach, he explains.

"We have realised that household conflict malnutrition is not just about food availability, misuse of resources, and insufficient knowledge about preparing balanced diets are major contributors. Families may have food, but they do not always know how to convert it into proper nutrition for children.”

Nzabonimpa emphasises partnerships as a central part of tackling stunting.

"We work with UNICEF, World Vision, and other partners, including the Joint Action Forum (JAF), to educate communities, monitor growth, and implement social protection programmes. These collaborations are critical because addressing stunting requires multisectoral coordination.”

The mayor cites concrete strategies implemented across sectors: "We have village kitchens, household nutrition training, and campaigns promoting hygiene and sanitation.

Clean water initiatives, the FRESH programme in schools, and campaigns to reduce alcohol abuse all contribute indirectly to reducing stunting. But long-term change depends on the mindset of households. Leadership alone cannot impose nutrition practices; families must adopt them.”

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At the 2026 Umushyikirano, Rwanda’s national dialogue council, the paradox of Gicumbi’s stunting was underscored by Ivan Murenzi, Director General of the National Institute of Statistics of Rwanda.

"While poverty stands at 13 per cent here, below the national average of 27 per cent, stunting among children under five is 40 per cent,” he reported. Murenzi stressed that mindset, leadership, and prioritisation of child nutrition are critical.

President Paul Kagame reinforced the message: "When a district has wealth – milk, chickens, and eggs, and children are still stunted, leadership must take responsibility. Development challenges that persist for five to ten years without resolution are often a result of failures in leadership and accountability.”

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Families on the frontlines

Gashugi thinks family planning may have contributed. "The main issue might be that they had another child before the firstborn was old enough – she was still just a baby. Even though I see the child eating like the others, I cannot understand why he remains stunted,”

"I am old now and no longer have the energy to attend family planning and nutrition sessions to educate my children on how to feed their own properly, so they can grow healthy and strong.”

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Mukamurangira emphasises the gap between knowledge and practice. "The community has been educated about proper nutrition. We were told that stunting is caused by a poor, unbalanced diet. The parents are informed, but we don’t think they put it into practice. Illness has affected the child. They try to prepare greens, but the child has been sick.”

Nearby, the Sentaniye household presents another dimension of the challenge. The house is locked, and children are outside under the supervision of their eight-year-old sister, who holds the keys. When asked if they had eaten lunch, the children answer hesitantly, "...Not yet.”

A phone conversation with their father, Sérestien Sentaniye, paints a picture of adequacy: "He shares food with his siblings and receives all the necessary food,” he insists. However, neighbours describe a home marked by frequent conflict.

"They are always fighting. The children are the ones paying the price,” a neighbour report. Diet diversity is limited, with beans, sweet potatoes, and occasionally silver fish forming the bulk of meals – a pattern insufficient to support healthy growth in young children.

Health workers: The frontline of nutrition

At Byumba Level 2 Teaching Hospital, nutritionists and paediatricians confront these challenges daily. Chantal Mukamunyurwa, a nutritionist in the Department of Human Nutrition, explains: "We see children suffering from acute malnutrition and stunting. Some cases are spontaneous; others relate to broader household factors,”

"Our first step is to stabilise the child using F75 therapeutic milk according to protocol. We counsel parents on preparing nutrient-rich foods and advise them on continuing care at home or local health centres. Awareness is growing, but adherence to nutritional guidance remains uneven.”

Dr. Eric Hakizimana, a paediatrician and Acting Director of the hospital, notes: "Children we receive often have immediate malnutrition issues. We check whether it is due to household neglect, family separation, or lack of knowledge,”

"While we can treat acute malnutrition in the hospital, chronic stunting requires community-based interventions.”

He explains that many families rely on a single staple, like cassava or potatoes, without providing a balanced diet, and even when parents are educated, implementation remains inconsistent.

Gashugi and Mukamurangira echo the health workers’ concerns: "Even when the knowledge is available, execution at home is inconsistent. Poverty, illness, and family conflict all play a role. We try to support our grandchildren, but our capacity is limited.”

Multisectoral drivers of stunting

Experts like Samson Melesse Desie, a Nutrition Specialist at UNICEF Rwanda, emphasize that Gicumbi’s stunting problem reflects complex and interconnected factors. "While Rwanda has made remarkable national progress in reducing stunting over the past two decades, disparities remain. Gicumbi, for example, improved from 47 per cent in 2005 to 42.2 per cent in 2020 and 38.8 per cent in 2025, yet rates remain high,” he explains.

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Samson highlights chronic food insecurity and poverty: "Despite livestock and subsistence agriculture, many families rely on seasonal crops vulnerable to climate shocks. Diet diversity remains limited, particularly for children under two, the critical window for growth and brain development.”

He notes gaps in infant and young child feeding practices, with many families struggling to introduce complementary foods at six months, provide meals frequently enough, include animal-source foods, and maintain adequate maternal nutrition during pregnancy and lactation.

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He further emphasises that stunting often begins within the first 1,000 days, from conception to a child’s second birthday, and that nutritional deficiencies during this period can have lifelong consequences.

Maternal health and intergenerational factors are central. "Maternal undernutrition, adolescent pregnancies, and short birth intervals contribute to low birth weight and impaired early growth. Stunting can be intergenerational, malnourished mothers are more likely to have growth-restricted children,” Samson says.

Environmental and geographic conditions exacerbate the problem. "Limited access to safe water and sanitation increases exposure to infections, which hinder nutrient absorption. Gicumbi’s terrain and settlement patterns restrict access to markets, services, and diverse foods, slowing progress despite national-level gains,” he adds.

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Samson stresses that slower progress does not indicate lack of effort but reflects the complexity of chronic malnutrition. UNICEF’s approach combines health system support, community-level interventions, and social protection programs to reach the most vulnerable.

UNICEF’s community interventions

UNICEF Rwanda works closely with the Ministry of Health and the National Child Development Agency to strengthen both systems and community-level action.

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In Gicumbi, interventions focus on supporting community health workers for growth monitoring, promoting breastfeeding, complementary feeding, and maternal nutrition, through early childhood development programmes, and fathers and caregivers are engaged to improve household nutrition practices. Nutrition-sensitive food systems are promoted through kitchen gardens, fortified foods, and dietary diversity initiatives.

Vulnerable households are linked to government social protection programmes, with intensified counselling and follow-up for high-risk families. Data-driven targeting ensures interventions prioritise the most at-risk communities and monitor growth faltering early.

Samson emphasises, "Stunting reduction requires sustained political commitment, multisectoral coordination, and community ownership. High-burden districts like Gicumbi need integrated food systems transformation, adolescent nutrition programs, climate-resilient agriculture, and strengthened early childhood development platforms. UNICEF remains committed to ensuring every child achieves their full potential.”

The community at a crossroads

Walking through the villages of Gicumbi, the complexity of stunting becomes tangible. In Rugarama and Muko, households are challenged not just by food scarcity but by economic constraints, illness, and family dynamics.

Grandparents like Gashugi and Mukamurangira try to fill gaps where parents fall short, while health workers provide both treatment and education. Families like Sentaniye’s struggle to translate guidance into practice due to conflict, absence, or lack of resources.

Nutritionists like Mukamunyurwa, and doctors like Hakizimana highlight that while hospital care can address acute malnutrition, chronic stunting requires community-level interventions. Complementary feeding, dietary diversity, hygiene, and maternal care all converge to shape a child’s growth trajectory.

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Clementine Mukandayishimiye shares a final reflection: "It is a constant challenge. Some days, I follow all advice and meals go well. Other days, life gets in the way. I wish every family could have the support and resources to make it easier. Children deserve the chance to grow strong and healthy.”

What next?

Gicumbi’s experience demonstrates that stunting is not simply a matter of food. It is a complex social, economic, and behavioural challenge. Addressing it requires coordinated effort across sectors, committed leadership, community engagement, and sustained support.

Rwanda has made tremendous progress in healthcare, infrastructure, and social programmes – proving that transformation is possible.

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Yet, for districts like Gicumbi, success hinges not just on wealth or resources but on the application of knowledge, consistent caregiving, and the empowerment of families.

As UNICEF and local authorities continue their work, the hope is that no child will bear the silent burden of stunting, and that every child can grow to their full potential, strong and healthy.