CONTRIBUTION OF NUTRITION EDUCATION

CONTRIBUTION OF NUTRITION EDUCATION (FEEDING PRACTICES) ON FEEDING BEHAVIOUR CHANCE. A CASE STUDY OF MUSANZE DISTRICT, RWANDA
INTRODUCTION
Background
Linear growth failure, including stunting, is the most widespread form of undernutrition in children under 5 years old. According to UNICEF, WHO and the World Bank (2016), 155 million children under five were stunted (low height-for-age) globally in 2016; where 38% of them were from Africa and 56% from Asia. It was predicted that 127 million children under 5 years old will be stunted in 2025 if the current trend in stunting continue. That is, 27 million more than the target or a reduction of only 26% (Mercedes de Onis, 2013). Children are defined as stunted when they have a low height/length-for-age more than two standard deviations below the WHO Child Growth Standards median (Onis 2006).
Despite the targets of World Health Assembly to reduce worldwide stunting rates with 40% by 2025, Africa continues to be the only region where stunting rates are still increasing rather than decreasing, with a total of 58 million children under five years old being stunted or overweight (International Food Policy Research Institute, 2016).

Similar to many other African countries, Rwanda faces also nutritional challenges and has high rates of malnutrition. Rwanda Demographic Health Survey (RDHS, 2014-2015) reported that, 38% of children under the age of 5 are stunted, and 14% are severely stunted (DHS, 2015). According to UNICEF Conceptual Framework the causes, consequences and factors influencing stunting in children are grouped in: household and family factors, inadequate complementary feeding, breastfeeding, and infections (Stewart et al., 2013). However, in Rwanda, the most important factors associated with stunting are found to be: poor quality and availability of food, repeated illness and poor health care, lack of knowledge on feeding practices, and inadequate WASH “water, sanitation and hygiene” access (Lu et al., 2016).
According to Berti et al., (2004) the nutrition education (breastfeeding, complementary feeding practice, dietary diversification, hygiene and sanitation) alongside the implementation of nutritional gardens is essential for a reduction in the prevalence of stunting.
Therefore, the present study will identify the contribution of nutrition education (feeding practices) on feeding behaviour change in the community of Musanze district, Rwanda and more knowledge on this is essential to support effective interventions of Garden for Health on nutrition sensitive program and may contribute to provide lasting solutions to chronic malnutrition.

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Gardens for Health International (GHI)
Gardens for Health International (GHI) is an American non-profit organization that seeks to provide sustainable agricultural solutions to the problem of chronic childhood malnutrition. The organization partners with rural health centers in the Gasabo and Musanze districts of Rwanda to equip families facing malnutrition with seeds, livestock, and know-how, aiming to shift the paradigm of food aid dependency to one of prevention and self-sufficiency. GHI works at the nexus of health and agriculture, aiming to address the root causes of malnutrition and investing in the productivity of the families served. The program targets the caregivers of children under five who are suffering from malnutrition. In nearly every case, these caregivers are women (GHI, 2010).
GHI works with each family in the program to plant a home garden, and trained field staff visit each family in their home, where they help design a garden that meets the respective family’s specific needs, placing particular importance on increasing the dietary diversity of the household. In addition to targeted agricultural assistance, every family in GHI’s program participates in a fourteen-week health and nutrition training course including breastfeeding, complementary feeding practices, hygiene and dietary diversification (GHI, 2010).

Problem statement
Garden for Health International (GHI) seeks to fundamentally change the clinical treatment of malnutrition (stunting) by supporting families to establish nutritious kitchen gardens at their homes, while also equipping them with the knowledge they need to keep their children healthy in the long-term (GHI, 2010). It has been reported that nutrition education alongside the implementation of nutritional gardens is essential for a reduction in the prevalence of stunting (Berti et al.; 2004).
According to Musotsi et al. ; (2008), the impact of nutrition education and nutritional gardens has been proven positive and GHI also claims that nutrition garden activities is able to improve nutrition for mothers, children and other family members by enhancing household dietary diversity. Yet, there is knowledge gap on how nutritional education (feeding practices) are affecting people’s behaviours on feeding practices in this particular area (Musanze district).
Therefore, this study will focus on the effect of nutrition education (feeding practices) on feeding behavior change in Musanze District, Rwanda and the recommendation will be given to Garden for Health International for the future interventions on nutrition education.
Problem owner
Gardens for Health International: A NGO which works at the intersection of health and agriculture to reduce rates of chronic childhood malnutrition in Rwanda.
Research objective
To assess the impact of nutrition education (feeding practices) on feeding behaviour change in the community of Musanze district, Rwanda with the aim of recommending strategies for improving food security programs.
GHI will get the recommendation to make its food security interventions in the Musanze district community more effective. This knowledge will also be useful to GHI in its strategies for improving its monitoring and evaluation system.

Main question
How is nutritional education (feeding practices) affecting people’s behaviours on feeding practices in Musanze district, Muhoza sector?

Sub research questions:
1. What are the current feeding practice used by the trained and non-trained mothers/caregivers to feed the child?
2. What are the effects of nutrition training on breastfeeding of children between 0-2 years old?
3. What are the contribution of nutritional education to household hygienic condition?
4. What are the effects of nutrition training to complementary feeding practices?
5. What are the contribution of nutrition training to household dietary diversity?
6. What are the contribution of kitchen garden adoption to household dietary diversity?