Linking Nutrition with HIV/AIDS and Other Health Services
For the past 10 years, Rwanda has made significant achievements in scaling up its health system to address the HIV/AIDS epidemic and maternal and child mortality. As the Rwanda Country Officer for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), I have witnessed many of these transformations firsthand. While Rwanda is often cited as a success story for infectious diseases – deaths from tuberculosis, malaria, and HIV/AIDS dropped by 80 percent in the past decade – not enough people know about the remarkable improvements in reducing the country’s high malnutrition rate.
Malnutrition is a state resulting from too little food, inadequate nutrient intake, and frequent infections or disease. It can manifest in a number of ways, but the most common is stunting, or low height for age, which affects 165 million children under-5 worldwide. In 2005, more than half of Rwanda’s under-5 population was stunted. Just five years later, the stunting rate had dropped to 44 percent. This number is still high, but due to concerted efforts by the national government and its partners, progress is expected to continue.
The first 1,000 days of a child’s development – from pregnancy to 2 years of age – are a critical period for health and survival. Adequate maternal and child nutrition during this period is crucial for both cognitive and physical development. Stunting, in particular, affects brain development and is associated with lower cognitive abilities, poor school performance, and lower earnings throughout the lifetime.
In response to the country’s high malnutrition rate, the Rwandan Ministry of Health developed the National Multi-sectoral Strategy to Eliminate Malnutrition in Rwanda. One of the key strategies outlined was the scale-up of community-based interventions to prevent and manage malnutrition in children under five years of age and in pregnant and lactating mothers. In this intervention, community health workers use behavior change communication to teach women about optimal feeding practices through a package that EGPAF and PATH harmonized with Rwanda’s national plan. The health workers counsel mothers, fathers, and other caregivers to promote social and behavior changes, including improved maternal diet, early initiation of breastfeeding, exclusive breastfeeding for six months, safe water and hygiene, how to care for a sick child, and growing kitchen gardens and learning small animal husbandry for diet diversity.
Counselors also discuss nutrition in the context of HIV, since malnutrition threatens the health of HIV-positive mothers and their children. Malnutrition weakens the immune system and causes faster disease progression. Inadequate food intake can affect adherence to antiretroviral medication and drug effectiveness. Because HIV progresses faster in children than it does in adults, the risks posed by malnutrition make them even more vulnerable to mortality. Moreover, because HIV-positive pregnant women are less likely to gain adequate weight than non-infected women, counseling on maternal nutrition during pregnancy enables them to give birth to normal weight babies, increasing their chances of survival.
Malnutrition has more detrimental effects than hungry bellies, and efforts to reduce stunting rates also improve maternal and child survival, decrease HIV-related mortalities, and increase economic productivity. Rwanda’s success in reducing malnutrition, and eventually eliminating it altogether, is due to a number of factors, including a strong health system with universal health coverage, integrated health services, and an emphasis on vulnerable populations. In addition, the importance of the government’s political and financial commitment cannot be underestimated. With more families being reached at the community level through the concerted efforts of the Government of Rwanda, EGPAF, and other partners, I have no doubt we can achieve the elimination of malnutrition and new HIV infections in children in Rwanda.
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Lior Miller is Country Officer for Rwanda for the Foundation, based in Los Angeles, CA.