Prevalence and factors associated with stunting among children aged 0–59 months in ten districts of Rwanda: a community-based cross-sectional study

Background Stunting remains a major public health concern among children under five. This study assessed the prevalence of stunting and its associated factors among children aged 0–59 months in ten districts of Rwanda, with preparatory field activities conducted in November 2021 and primary data collection conducted from December 2021 to January 2022 following institutional ethical approval. Methods A community-based cross-sectional study was conducted among 2,286 pairs of children and their caregivers using a multistage stratified cluster sampling design. Anthropometric measurements and a structured questionnaire assessed child, caregiver, household, feeding, morbidity, and WASH characteristics. Data were analyzed using EpiData 3.1, ENA 2011, and IBM SPSS version 25.0. Associations with stunting were estimated as odds ratios with conventional 95% confidence intervals, calculated from tabulated counts to ensure reproducibility. Results Stunting prevalence was 34.3% (784/2,286; conventional 95% CI 32.4–36.3, not adjusted for clustering), with similar prevalence among boys (34.6%) and girls (34.0%). Prevalence was 26.5% among children aged 0–11 months, 37.3% at 12–23 months, and 38.1% at 24–59 months. In unadjusted analyses, stunting was associated with caregiver occupation, no maternal education (OR 4.20, 95% CI 3.08–5.74), household food insecurity (OR 3.23, 95% CI 2.68–3.89), lack of clean water (OR 2.31, 95% CI 1.89–2.83), Ubudehe Category I (OR 2.21, 95% CI 1.66–2.95), travel time of 1 hour or more to a health facility, recent illness and older child age. Conclusion Stunting remained a major public health concern in the 10 surveyed districts during 2021–2022. Unadjusted associations with socioeconomic disadvantage, lower maternal education, food insecurity, recent illness, and inadequate water access support the implementation of multisectoral interventions and further prospective evaluation. Because severe stunting exceeded moderate stunting and original anthropometric quality-control records could not be reconstructed, measurement or age-reporting error cannot be excluded; prevalence estimates should be interpreted with caution. Given the cross-sectional design and the lack of design-based variance adjustments, findings should not be interpreted causally or as design-adjusted.