PDF(Pubmed)
Abstract：
The double burden of malnutrition (DBM) is escalating in low- and middle-income countries (LMICs), including in Rwanda, most notably in urbanizing areas. The 2019-2020 Rwanda Demographic Health Survey (DHS) revealed that 33% of children under 5 years old are stunted while 42% of women in urban areas are overweight or obese. This coexistence has contributed to a surge in non-communicable diseases (NCDs), particularly in secondary cities. Using the World Health Organization\'s (WHOs) \"double-duty action\" (DDA) concept, this study aims to identify and evaluate interventions with double-duty potential in Rwanda\'s Rusizi and Rubavu districts and generate key recommendations for their improvement. A desk review of national policies pinpointed four programs with the greatest DDA potential: early childhood development (ECD) centers, the school feeding program, farmer field schools (FFS), and the provision of nutrition-sensitive direct support. In-person interviews with key stakeholders assessed the implementation of each program and a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was used to generate context-specific recommendations for their improvement. The main finding of this research is that Rwanda\'s potential to address the DBM can be improved across multiple sectors by implementing a few key changes: targeting beliefs surrounding nutrition, improving trainings for community educators, enhancing parent-particularly father-involvement, and engaging in close monitoring and follow-up. These findings offer actionable streps that governments and nutrition stakeholders can take to improve similar interventions in other rapidly urbanizing LMICs.
摘要：
在低收入和中等收入国家（LMICs），营养不良（DBM）的双重负担正在升级。包括在卢旺达，尤其是在城市化地区。2019-2020年卢旺达人口健康调查(DHS)显示，33%的5岁以下儿童发育迟缓，而城市地区42%的女性超重或肥胖。这种共存导致非传染性疾病(NCDs)激增,尤其是在二级城市。使用世界卫生组织（WHO）的“双重行动”（DDA）概念，本研究旨在确定和评估卢旺达Rusizi和Rubavu地区具有双重潜在责任的干预措施,并提出改进措施的关键建议.对国家政策的案头审查指出了四个具有最大DDA潜力的计划：幼儿发展（ECD）中心，学校供餐计划,农民田间学校（FFS），以及提供对营养敏感的直接支持。与主要利益相关者的面对面访谈评估了每个计划的实施情况和优势，弱点,机遇,和威胁(SWOT)分析用于生成针对具体情况的改进建议。这项研究的主要发现是，卢旺达解决DBM的潜力可以通过实施一些关键变化在多个部门得到改善：针对围绕营养的信念，改善对社区教育工作者的培训，加强父母，特别是父亲的参与，密切监测和跟踪。这些发现提供了可操作的链球菌，政府和营养利益相关者可以采取这些措施来改善其他快速城市化的低收入国家的类似干预措施。
