Weighing in on Rwanda's child nutrition: A tale of two extremes

The Rwanda Demographic and Health Survey (RDHS) provides data to monitor the population and health situation in Rwanda. Specifically, this survey collects information on a broad range of demographic, health, and social issues such as household characteristics, maternal and child health among others. This survey, last carried out in 2020, showed that chronic childhood malnutrition or stunting stood at 33 per cent for children under five years of age in Rwanda. Nutritional stunting is caused by insufficient maternal nutrition, intrauterine undernutrition, lack of breastfeeding until six months of age, late introduction of complementary feeding, inadequate (quantity and quality) complementary feeding, and impaired absorption of nutrients owing to infectious diseases. Stunting has long-term effects on individuals and societies, including poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, and an increased risk of nutrition-related chronic diseases in adult life. In Rwanda much is being done to respond to childhood malnutrition but it seems like childhood obesity is a topic that we have neglected for quite a long time. Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate in many places. The world's less developed nations are now facing a growing problem with childhood obesity. Nutritional changes in children are being negatively impacted by changes in food and physical activity. Being overweight in children is linked to greater affluence, urbanisation, and use of technology in homes, such as televisions, gaming consoles and other screen-based entertainment. The opportunity to buy prepackaged, commercial fast food items is another benefit of wealth, which all too frequently has detrimental impacts on children's diets. Growing up in the 80s, we spent much of our time outdoors, engaging in various physical activities and games rather than being glued to screens and modern technologies. This outdoor playtime not only fostered physical fitness but also encouraged social interactions, creativity, and a deep connection with the natural world. We built treehouses, played tag until dusk, rode our bikes for hours, and explored the neighbourhood with our friends, all of which contributed to a healthy, active, and imaginative childhood that left lasting memories and valuable life skills. Sadly this has been lost and in recent times we have seen a marked reduction in outdoor play raising concerns about sedentary lifestyles, decreased social interaction, and a disconnect from nature which is quite alarming. Not much data is available in Rwanda about childhood obesity, but some studies suggest a prevalence of five per cent to eight per cent for children under five years of age. Although this may not seem high, we see a growing trend. The recent study published in The Lancet underscores the critical and alarming health implications of childhood obesity. It highlights that children who are overweight or obese face a heightened risk of carrying this condition into adulthood, which significantly increases their susceptibility to a range of serious non-communicable diseases. These health problems, such as diabetes and cardiovascular disease, tend to manifest at an earlier age among individuals with a history of childhood obesity, which not only diminishes their quality of life but also places a substantial burden on healthcare systems. Furthermore, the study points out that there is an elevated risk of developing cancer, experiencing premature death, and suffering from disabilities later in life among those who were overweight or obese as children. This emphasises the urgent need for comprehensive strategies and interventions aimed at preventing and addressing childhood obesity to safeguard the long-term health and well-being of future generations Scientists and researchers in Africa are now advocating for a holistic and coordinated approach in the region to address the complex issue of the ‘double burden’ of child malnutrition. This term refers to the simultaneous occurrence of child overnutrition, which includes conditions like overweight and obesity, alongside undernutrition, characterised by stunting (failure to grow to a normal height for age) and wasting (rapid weight loss). Recognising that malnutrition is not limited to just undernutrition but also encompasses overnutrition is crucial in the context of public health and nutrition policy. An integrated approach would involve strategies that not only tackle hunger and undernutrition but also aim to prevent and manage the rising problems of childhood overweight and obesity. Such an approach would likely include initiatives related to healthy diets, physical activity promotion, education, healthcare access, and broader social and economic factors to ensure a comprehensive response to the diverse nutritional challenges faced by children in the region Overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity therefore needs high priority. The common Kinyarwanda saying of “Irire kibondo” (Eat, my child) may encourage children to eat heartily, often in the belief that an over-fed child is a healthy child. Dr Vincent Mutabazi is an applied epidemiologist.

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Weighing in on Rwanda's child nutrition: A tale of two extremes