rwanda nutrition, markets & gender analysis

338 Pages·2016·13.76 MB·English

RWANDA NUTRITION, RWANDA NUTRITION,
MARKETS & GENDER
MARKETS & GENDER
ANALYSIS 2015
An integrated approach towards ANALYSIS An integrated approach
alleviating malnutrition among 1 towards alleviating
vulnerable populations in Rwanda 2015 malnutrition among
vulnerable populations
in Rwanda
Main_Doc_Synthesis With Embedded Tables.indd 1 4/13/2016 9:44:50 AM

RWANDA NUTRITION, MARKETS &
GENDER ANALYSIS 2015
An integrated approach towards alleviating malnutrition among
vulnerable populations in Rwanda
Main_Doc_Synthesis With Embedded Tables.indd 3 4/13/2016 9:44:50 AM
Copyright © Government of Rwanda: Ministry of Agriculture/Ministry of Health,
Rwanda.
October 2015
The Rwanda Agriculture Board (RAB) works to improve the food security and
livelihoods of all Rwandans by transforming agriculture from subsistence into
sustainable modern farming. RAB achieves this through research, extension
innovations and training of farmers. www.rab.gov.rw
Citation: Lung’aho M, Birachi E, Butare L, Musoni A, Muhinda M JJ, Ngabo
F, and Buruchara R. 2015. Rwanda Nutrition, Markets and Gender Analysis
2015. Nairobi: Government of Rwanda/International Center for Tropical
Agriculture (CIAT).
Front cover photos: © Stephanie Malyon / CIAT
Editing and proofreading:
Maryanne Wachira, Edited Expression
Design and layout:
Tim Mwaura and Esther Karemeri, Edited Expression
The information appearing in this publication may be freely quoted and
reproduced provided the source is acknowledged. No use of this publication may
be made for resale or other commercial purposes.
For information about the NMG Analysis, contact [email protected]
For questions or comments concerning any aspect of the survey and this report
please contact:
Mercy Lung’aho ([email protected]) or Eliud Birachi (e.birachi@cgiar.
org), CIAT
This work was undertaken by the International Center for Tropical Agriculture
(CIAT), which forms part of CGIAR. The work was led by the Government of
Rwanda and supported by the One UN organisations – WHO, UNICEF, WFP, and
FAO. The views expressed in this document cannot be taken to reflect the official
opinions of CGIAR.
The International Center for Tropical Agriculture (CIAT) – a member of the CGIAR
Consortium – develops technologies, innovative methods, and new knowledge
that better enable farmers, especially smallholders, to make agriculture eco-
efficient – that is, competitive and profitable as well as sustainable and resilient.
Headquartered near Cali, Colombia, CIAT conducts research for development in
tropical regions of Latin America, Africa, and Asia.
www.ciat.cgiar.org
CGIAR is a global research partnership for a food-secure future. Its science
is carried out by the 15 research Centers that are members of the CGIAR
Consortium in collaboration with hundreds of partner organisations. www.
cgiar.org
Main_Doc_Synthesis With Embedded Tables.indd 4 4/13/2016 9:44:51 AM
PARTNERS

An intergovernmental organization, FAO has 194 member nations, two associate
members and one member organization, the European Union. Its employees
come from various cultural backgrounds and are experts in the multiple fields
of activity FAO engages in. FAO’s staff capacity allows it to support improved
governance inter alia, generate, develop and adapt existing tools and
guidelines and provide targeted governance support as a resource to country
and regional level FAO offices. Headquartered in Rome, Italy, FAO is present
in over 130 countries.
Achieving food security for all is at the heart of FAO’s efforts – to make
sure people have regular access to enough high-quality food to lead
active, healthy lives.
The Pan Africa Bean Research Alliance (PABRA) is a network of
more than 350 partners in 30 countries in sub-Saharan Africa. The
network is coordinated by the International Center for Tropical
Agriculture (CIAT) and aims to enhance the food security, income
and health of smallholder farmers and urban dwellers in Africa
through integrated bean research for development.

The United Nations World Food Programme (WFP) is the
largest humanitarian agency fighting hunger worldwide.
WFP’s goal is to end hunger in our lifetime.

The World Health Organization is the United Nation’s
specialised agency for global health. World Health
Organization supports countries efforts to address
health issues and advise on health norms, standards
and guidelines. It is made up of 194 member states,
supported by a secretariat with over 8000 staff
based in 147 countries, six regional offices and
headquarters in Geneva, Switzerland.

UNICEF promotes the rights and wellbeing of
every child, in everything we do. Together
with our partners, we work in 190 countries
and territories to translate that commitment
into practical action, focusing special
effort on reaching the most vulnerable
and excluded children, to the benefit
of all children, everywhere. For more
information about UNICEF Rwanda and
its work visit: www.unicef.org/rwanda/
Follow us on Twitter and Facebook
Main_Doc_Synthesis With Embedded Tables.indd 5 4/13/2016 9:44:53 AM
ADMINISTRATIVE MAP
OF RWANDA
CITY OF KIGALI WESTERN PROVINCE
EASTERN PROVINCE DISTRICT BOUNDARY
NORTHERN PROVINCE LAKE/DAM
SOUTHERN PROVINCE NATIONAL PARK
Rwanda Nutrition, Markets & Gender Analysis. 2015
vi
Main_Doc_Synthesis With Embedded Tables.indd 6 4/13/2016 9:44:53 AM
Copyright © Neil Palmer, CIAT
vii
Main_Doc_Synthesis With Embedded Tables.indd 7 4/13/2016 9:44:53 AM
ACKNOWLEDGEMENTS
The Nutrition, Markets, and Gender Analysis 2015 was led by the MOH
Rwanda Agricultural Board (RAB) and the Rwanda Ministry of Dr. Fidele Ngabo
Health. Data were collected from October to December 2014.
We gratefully acknowledge the important contributions made by UNICEF
the staff members of RAB/ Ministry of Agriculture, the Division Solrun Engilbertsdottir
of Maternal and Child Health (under the Ministry of Health),
the World Health Organization of the United Nations, the WHO
United Children’s Fund of the United Nations, the World Food Chantal Gegout
Programme of the United Nations, the Food and Agricultural
Organization of the United Nations; and the International WFP
Center for Tropical Agriculture offices in Rwanda. Jean Paul Dushimumuremyi
Jules Rugwiro
Special appreciation to RAB sub-offices in the different
districts, and community health workers in the different FAO
sectors, for the survey organisation and efficient Gaetan Heri
logistics without which the survey would not be Maria Eleonora d’Andrea
possible; and to the following:
CIAT
Rwanda Ministry of Agriculture (MinAgri) Mercy Lung'aho
Rwanda National Institute of Statistics (NISR) Eliud Birachi
Rwanda National Resources Authority Wanjiku Chiuri
Kigali Military Hospital–Kanombe Rodah Zulu
Robin Buruchara
Survey Leadership Mercy Mutuku
Prof. J. J. Mbonigaba Muhinda – former Christine Chege
Director General, RAB (Rwanda Ministry
of Agriculture) Operational Coordination
Dr. Fidele Ngabo – former Director, Augustine Musoni
Division for Maternal and Child Health Louis Butare
(Rwanda Ministry of Health) Mercy Lung’aho
Eliud Birachi
Survey Technical Team Members Emerence Mukangabo
RAB Yvan Butare
Augustine Musoni, Louis Butare, Magnifique Irakoze
Leonidas Dusengemungu, Jean Baptiste Kamanzi
Alice Kabeja, Domitile
Mukantabana, Robert
Ackatia-Armah
Rwanda Nutrition, Markets & Gender Analysis. 2015
viii
Main_Doc_Synthesis With Embedded Tables.indd 8 4/13/2016 9:44:53 AM
FOREWORD
The decision to undertake the ‘Nutrition, Markets and Gender Survey’ was
made with national government authorities and international development
partner agencies. Led by the Rwandan Agricultural Board (RAB) under the
Ministry of Agriculture and co-led by the Division of Maternal and Child
Health (MCH) under the Ministry of Health, development partners under
the One UN, and CIAT came together in a unique partnership to conduct
a comprehensive study into the links between agriculture, nutrition,
gender and markets called the ‘Nutrition, Markets and Gender Survey’.
The three-pronged survey is the first of its kind to be conducted on such
a large scale and to bring together such a cross-section of partners.
Originally slated to cover three of 30 districts as a joint RAB/CIAT survey
under the Pan-Africa Bean Research Alliance (PABRA), it expanded to
nine districts as new partners came on board. The aim of the survey was
to determine the specific causes of stunting in children under two, while
validating the conceptual framework of key pathways between agriculture
and nutrition outcomes.
The study findings will be a basis for nutrition education in the country
to improve the health of under-five children, to set strategies to reduce
poverty, to promote the consumption of nutritious foods and fortified
staples, and to build strategies that tackle the causes
of malnutrition.
His Excellency the President of the Republic of Rwanda has recommended
that greater emphasis be given to fight stunting and malnutrition. The
focus and synergy between all key players should be linked toward the
overall goal of improving household food security, and access and use of
nutritious food.
Dr. Louis Butare
Director General
Rwanda Agricultural Board
ix
Main_Doc_Synthesis With Embedded Tables.indd 9 4/13/2016 9:44:54 AM
TABLE OF
CONTENTS
Partners v
Administrative Map Of Rwanda vi
Acknowledgements viii
Foreword ix
List of Tables xiv
List of Figures xxii
Acronyms xxiv
Glossary xxv
Executive Summary xxvi
CHAPTER 1.0
SURVEY DESIGN &
IMPLEMENTATION 34

1.1 Synopsis 35
1.2 Survey Justification 35
1.3 Survey Phases 36
34
1.4 Survey Objectives 38
1.5 Survey Methodology 38
1.6 Survey Data Collection and
Entry 48
CHAPTER 2.0
NUTRITION 58

2.1 Case Control Study Design: A
Review 59
2.2 Prevalence Data 60
2.3 Comparison of Cases versus
Controls and Establishment of
Risk Factors for Malnutrition 69
58
2.4 Household Resources 77
2.5 Health 86
2.6 Water, Hygiene, and Sanitation
(WASH) 91
2.7 Information 96
2.8 Care 98
2.9 Food 106
2.10 24-hour Dietary Recall: Data
Analysis 123
2.11 Summary of Risk Factors 146
Main_Doc_Synthesis With Embedded Tables.indd 10 4/13/2016 9:44:55 AM