Barriers and facilitators to the implementation of community health workers' nutrition intervention for stunting prevention in Burera District, Rwanda

Background: Childhood stunting remains a prevalent health issue globally, particularly in low- and middle-income countries including Rwanda. Despite ongoing efforts to improve child health, stunting persists, and there is limited research on the challenges and supports faced by Community Health Workers (CHWs) in addressing this issue. Objectives: The study aims to explore the barriers and facilitators encountered by CHWs in delivering nutrition interventions to prevent childhood stunting in Burera District, Rwanda, along with the perspectives of mothers and caregivers. Methods: Using a phenomenological qualitative research approach, the study collected data from five Focus Group Discussions and five Key Informant Interviews. Data were analyzed thematically to identify key themes and subthemes, with the sample size determined by data saturation Results: Three core themes emerged: barriers, facilitators, and mothers' perceptions. Barriers included technology skills, geography, cultural beliefs, financial constraints, domestic challenges. Facilitators are knowledge, commitment, government support, training, and community engagement. Mothers' perceptions highlighted trust in CHWs, increased nutritional awareness and economic hardships. Conclusions: CHWs remain resilient despite challenges. The study recommends government investment in CHW training, NGO support for cultural and economic programs, and community participation. Future research should assess the long-term and comparative effectiveness of CHW interventions for stunting reduction.