In 2017, the Swiss Agency for Development and Cooperation (SDC) launched an action research in the Western Province of Rwanda to increase local understanding of the causes of chronic malnutrition or stunting and discover locally adapted and innovative ways to overcome them through a new horizontal learning approach. The action research was implemented by the Swiss Tropical and Public Health Institute (Swiss TPH) from October 2017 to December 2019. Following an horizontal learning approach, caretakers regularly met in community meetings to share knowledge and good practices related to hygiene and nutrition, support each other, and actively engage in educational sessions on stunting risk factors facilitated by community health workers. In parallel, the intervention supported quarterly measurement of children weight and height including systematic plotting of the anthropometric measurements on children’s individual growth curve cards. The results were explained to mothers by nutritionists/nurses.
The percentage of severely stunted children decreased by 3.1% (for age category 12 to 18 months) and by 6.1% (for 18 months and older) from the beginning of the project and the age-dependent stunting progression was slower among the children participating in the project compared to the control group. Caregivers significantly increased their knowledge in all covered topics and became aware of the importance of children’s growth monitoring. The action research demonstrated that the innate knowledge of caretakers can be used to create learning and stimulate behaviour change in the community and that regular growth monitoring is a successful strategy to reduce chronic malnutrition in the population.
The action research contributed to increase the engagement of community health workers in the fight against malnutrition, raised awareness of stunting among caregivers and communities, while emphasizing locally appropriate good practices which can help prevent chronic malnutrition.
