Household Food Insecurity, Fruit and Vegetable Intake, and Child Nutritional Status in Nyamagabe District, Rwanda: A Convergent Parallel Mixed-Methods Study

Résumé

Malnutrition among children is a serious health problem in Rwanda, with 33 percent of children under five being stunted. Limited dietary diversity, especially fruits and vegetables, contributes to micronutrient deficiencies and growth retardation. This research examined fruit and vegetable intake trends and relationships with the nutritional status of 6-59-month-old children in Nyamagabe District, Southern Province, Rwanda. Data collection occurred between November 2025 and February 2026 using a mixed-method convergent parallel design. The quantitative element included a community survey of 513 mother-child pairs through multistage cluster sampling. Anthropometric values were recorded per WHO protocol, and dietary intake was collected through 24-hour recalls, food questionnaires, and diversity scores. Food security was measured using the Food Insecurity Access Scale. The qualitative element included 17 focus groups and 20 in-depth interviews. The stunting, wasting, and underweight prevalence were 39.2, 3.5, and 12.1, respectively. Only 28.7 percent of children had minimum dietary diversity, with daily fruit and vegetable intake at 1.6 servings (SD = 1.3). Children consuming three or more servings were less likely to be stunted (AOR = 0.38; 95% CI: 0.24-0.61; p < 0.001) and underweight (AOR = 0.47; 95% CI: 0.27-0.83; p = 0.009). Household food insecurity was strongly associated with increased stunting risk (AOR = 3.45; 95% CI: 2.18–5.47; p < 0.001), indicating that food-insecure households had nearly 3.5 times greater odds of having a stunted child compared to food-secure households. Absence of formal maternal education (AOR = 2.67; 95% CI: 1.58–4.51; p < 0.001) and belonging to the lowest wealth quintile (AOR = 2.89; 95% CI: 1.72–4.86; p < 0.001) were additional independent risk factors for stunting. Barriers included seasonal deficits, high prices, weak nutrition education, and a preference for starchy staples. Solutions require nutrition-sensitive agriculture, year-round food production, behavior change, and food security programs.

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