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stunting.html
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<!DOCTYPE html>
<html>
<!-- HEAD -->
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width initial-scale=1" />
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<title>Stunting in Rwanda</title>
<meta name="description" content="The Geocenter's analysis of factors influencing stunting in Rwanda">
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<div class="container">
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<div class="row" id='graphic'>
<!-- SECTIONS (sidebar commentary on each scroll) -->
<div class="col-xs-4" id='sections'>
<div id="intro">
<section class="step">
<div class="title">Stunting in Rwanda</div>
<div class="subtitle">sous-titres</div>
<div class="paragraph"> We just looked at <a href="fp.html">Rwanda's increasing population</a>. One downstream effect of an increasing population is pressure on household-level resources, including nutrition.</div>
<div class="paragraph">Stunting is one measure of chronic malnutrition in children. When a child is chronically malnourished, he or she often has long-term,
lifetime effects, including poor physical growth, impaired cognitive development, and poor economic development. Additionally, one study
estimates that stunting is responsible for almost <a href="">40% of all childhood deaths</a> worldwide.</div>
<div class="paragraph">To help alleviate malnutrition in Rwanda, we wanted to understand the trends over time,
where within the country is the greatest need, and who is most affected by malnutrition.
</div>
<div class="paragraph" id="intro-sum">
<div class="subtitle accent-green">What did we find?</div>
<ul class="summary-list">
<li><a href="#geo" id="intro-link">Geography matters:</a> Stunting prevalence has decreased markedly in the eastern portion of the country. However,
the northwest isn't improving as quickly.</li>
<li><a href="#loopy" id="intro-link">Malnutrition is complex:</a> Stunting crosses sectors and is influenced by health, economic growth, and education.</li>
<li><a href="usaid" id="intro-link">What we do:</a> USAID | Rwanda is tackling chronic malnutrition with an integrated approach.</li>
</ul>
</div>
<div class="paragraph accent-green">Scroll to find out more about stunting in Rwanda.
</div>
</section>
</div>
<!-- #2 2010 -->
<section class="step">
<div class="title">How much of an issue is stunting in Rwanda?</div>
<div class="paragraph">Let's start by looking at stunting in 2010.</div>
<div class="paragraph">Nationally, <mark>44%</mark> of children under 5 are stunted, meaning they have have abnormally low height for their age
<a href="">(learn more about how stunting is calculated)</a>.</div>
<div class="paragraph">If we just look at the national average, though, or even a distribution of the national scores,
we miss any variation across geography.</div>
<div class="paragraph">Are children across the country equally likely to be stunted?</div>
</section>
<!-- #3 2010 by LZ map -->
<section class="step">
<div class="title">Stunting varies across the country</div>
<div class="paragraph">We can group the children into <a href="http://www.fews.net/east-africa/rwanda/livelihood-description/september-2015" target="_blank">FEWS NET livelihood zones</a>, which are geographic regions grouped by where households have similar ways of making a living.</div>
<div class="paragraph">We begin to see that stunting is quite different across the country.</div>
<div class="paragraph">In the <span class="highlight" id="beans-wheat">Northen Highland Beans and Wheat zone</span>, stunting is 57% – 13% over the national average. Kigali City, on the other hand, has the lowest stunting prevalence at 22%.</div>
</section>
<!-- #4 2010 map -->
<section class="step">
<div class="title">High stunting in the east and northwest, low in urban areas</div>
<div class="paragraph">Looking at the values on a map, the urban areas pop out as being low compared to the rest of the country.</div>
<div class="pdf paragraph"><a href="/pdf/Rwanda_stunting_DHS2010.pdf" target="_blank" title="Stunting, 2010 (DHS)">View the 2010 map as a .pdf</a></div>
<div class="paragraph">Do these patterns still hold today? How have the areas changed over time?</div>
</section>
<!-- #5 2010-2014 dotplot changes -->
<section class="step">
<div class="title">Stunting drops in 2014/2015</div>
<div class="paragraph">In Rwanda stunting has decreased in the past five years— dropping from <mark>44%</mark> of children under 5 in 2010 to <mark>38%</mark> in 2014/2015 nationally. </div>
</section>
<!-- #6 2010-2014 dotplot changes -->
<section class="step">
<div class="title">Improvements haven't been equal everywhere</div>
<div class="title">Alt: Though the East has improved markedly, gains lag in the Northwest</div>
<div class="paragraph">Though the regions in the Northwest improved, they didn't change as fast as the East.</div>
<div class="paragraph">Indeed, the stunting incidence in the northwest 2014/2015 is essentially where it was in 2010 in the East.</div>
</section>
<!-- #9 2014 dotplot -->
<section class="step">
<div class="title">Which areas still lag in 2014/2015?</div>
<div class="paragraph">Focusing just on the most recent stunting data, children in the West Congo-Nile Crest Tea region now have the highest incidence of stunting in Rwanda.</div>
<div class="paragraph">Why do these patterns exist? Are they the result of some intrinsic difference in the people who live there; for instance,
are the people in the West Congo-Nile Crest Tea region less wealthy, less educated, or have poorer diets?</div>
<div class="paragraph">Or is there something more closely tied to that region that explains this phenomenon?</div>
</section>
<!-- #10 2014 geo regressions -->
<section class="step">
<div class="title">Geography matters</div>
<div class="paragraph">Using the household-level data from the <a href="http://dhsprogram.com/what-we-do/survey/survey-display-468.cfm" target = "_blank">Demographic and Health Surveys</a>
and the <a href="https://www.wfp.org/content/rwanda-comprehensive-food-security-and-vulnerability-analysis-march-2016" target="_blank">Comprehensive Food Security and Vulnerability Analysis</a>, we ran regressions — statistical tests for whether there's a relationship between stunting and various related factors.</div>
<div class="paragraph">The power of regressions is their ability to test whether there's an effect of a particular factor (like geography) on whether a child is stunted.</div>
<div class="paragraph">So, accounting for other factors that we think might influence malnutrition – like age and sex of the child or the education and wealth of the household –
we can examine whether any of the livelihood zones are different than the rest of the country.
</div>
<div class="paragraph">We will use the Lake Kivu region as a reference point to see if the other regions are better or worse than it.</div>
</section>
<!-- #11 2014 geo regressions -->
<section class="step">
<div class="title">Stunting improvements lag in the northwest 2014</div>
While stunting has improved across the country, geo data more clear!
<div class="paragraph">Stunting is significantly higher in the Northwestern Volcanic Irish Potato and Eastern Congo-Nile Highland Subsistence Farming zones compared to the Lake Kivu Coffee belt.</div>
<div class="paragraph">Interestingly, the changes we observed in the geographic distribution of stunting are also bourne out in the regressions: the east
(Eastern Plateau Mixed Agricultural and Eastern Agropastoral zones) were worse than the coffee belt in 2010, but in 2015 they were actually slightly better, all other things equal.</div>
<div class="paragraph">In 2010, even accounting for differences in demographics, E. Blah and E. blah2 are significantly worse than the Lake Kivu region.
However, in 2014/2015, the eastern regions become more like Lake Kivu, while the NW and E Congo Nile regions are now the worst areas of the country, after accounting to any differences due to demographics.
Lastly, in both years, the altitude of the household dwelling influenced whether a child was stunted, suggesting that accessibility may be partially driving high stunting in the northwest.</div>
</section>
<!-- #12 2014 geo regressions: summary -->
<section class="step">
<div class="title">Summary: How geography influences stunting in Rwanda</div>
<div class="paragraph">
<ul class="summary-list">
<li>While stunting rates have improved across the country, gains have lagged in the northwest.</li>
<li></li>
<li></li>
</ul>
</div>
<div class="paragraph">Now that we understand how geography influences stunting, what non-geographic factors are driving stunting?</div>
</section>
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