Rwanda

Project—National Micronutrient Survey

Objective

To determine the prevalence of micronutrient (vitamin and mineral) deficiencies among women of childbearing age and children aged 6 months to 5 years by integrating a micronutrient module into the 2019-2020 Rwanda Demographic Health Survey (RDHS).

Background

Prioritizing nutrition to improve child growth and survival and minimize the burden of diet-related noncommunicable diseases are public health priorities for Rwanda. The 2014–2015 RDHS reported anemia among 37% of children and 19% of women; the prevalence of child stunting was 38%. Anemia and stunting can indicate vitamin and mineral deficiencies, but micronutrient status nationally has not been assessed in Rwanda since the mid-1990s.

Although the Government of Rwanda has made significant investments to reduce micronutrient malnutrition, it needs data on micronutrient status to improve and develop public health programs. The government is interested in setting up a surveillance system to have timely, representative, high quality information on micronutrients of highest priority. The RDHS regularly gathers data on topics such as maternal deaths, infant and child illnesses, and malaria, but not micronutrients. The 2019–2020 RDHS is the first time any country has integrated a micronutrient module within its Demographic Health Survey.

The Government of Rwanda is investing in a lab at Rwanda Biomedical Center (RBC) National Reference Laboratory (NRL), Rwanda Bureau of Standards, and the Rwanda Food and Drug Administration Laboratory to help these groups measure micronutrients in biospecimens and food samples.

This work has financial and technical support from the US Agency for International Development, United Nations Children’s Fund (UNICEF), and the Demographic Health Survey (DHS) program. CDC’s International Micronutrient Malnutrition Prevention and Control (IMMPaCt) team provides technical assistance.

Activities

CDC helped design the micronutrient module, the laboratory manual and train survey staff. CDC will support data management, analysis, and writing reports. CDC’s Division of Laboratory Sciences is also providing technical assistance to staff in national laboratories to build local capacity.

The 2019–2020 RDHS included 3,500 households from 500 clusters for micronutrient assessment. CDC supported the following survey activities:

• Training 60 health technicians and 100 interviewers.
• Monitoring the data as it was collected and identified teams that needed supportive supervision.
• Connecting RBC and NRL staff with experts to receive training on urinary iodine, serum retinol, and folate assessment.

Potential Impact

With these data, the Government of Rwanda will be better positioned to evaluate their national nutrition policy, national fortification strategy, and target interventions. Also, this mode of data collection may be a viable method for collecting nationally representative micronutrient data in multiple countries.

Next Steps

CDC will continue to work with national stakeholders to:

• Develop capacity at RBC and NRL, who will report population estimates of micronutrient status.
• Analyze salt samples collected from households for the quantitative content of iodine in salt.
• Estimate coverage of national nutrition programs, such as micronutrient powders.
• Support timely data dissemination on micronutrient status and provide technical assistance for strategies to reduce any deficiencies detected.