Perceptions of the mothers on the determinants of undernutrition in Rwanda: a qualitative study.

Background: Undernutrition is a serious public health concern that, despite numerous efforts to overcome, continues to persist. An integrated nutrition-specific and nutrition-sensitive intervention was implemented in Rwanda over a period of 5 years to combat undernutrition. Following this intervention, quasi-experimental quantitative studies revealed improvements in mothers' practice regarding Infant and Young Child Feeding (IYCF), resulting in increased achievement of the Minimum Acceptable Diet (MAD). The purpose of this study was to provide qualitative data on mothers' perceptions of the determinants of undernutrition to identify whether they understand what the determinants of undernutrition are, and what the possible barriers experienced are. By obtaining this information, the authors plan to use it to improve the integrated nutrition-specific and nutrition-sensitive intervention and to re implement this improved intervention in future. This qualitative study aimed to explore mothers' perceived understandings of the determinants of undernutrition and identify mothers' perceived barriers in addressing it.

Methods: This was a qualitative study carried out in four Districts, namely, Nyarugenge, Gasabo, Nyabihu and Ngororero. Data was obtained through Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). Overall six FGDs with ten mothers each and thirty KIIs were considered. Both deductive and inductive approaches were utilized to identify codes, with Atlas ti 7.5.18 as the software.

Results: Two themes were generated from the data namely, mothers' perceived understandings of the determinants of undernutrition and mothers' perceived barriers related to the determinants of undernutrition. (1) Mothers had a good understanding of the determinants of undernutrition. (2) Knowledge was lacking in terms of practices related to IYCF, specifically complementary feeding initiation and practice. (3) Mothers were unsure of the association between hygiene and vaccination with undernutrition. (4) Participants from FGDs were likely less knowledgeable on the determinants of undernutrition. (5) Perceived barriers: poverty, ignorance, negative beliefs, maternal and child health issues, illnesses and inappropriate parental care practices.

Conclusion: Nutrition education programme is needed to address knowledge gaps, and barriers identified should guide the improvement of nutrition interventions.