Community-Based Health Financing and Child Stunting in Rural Rwanda

Bibliographic Data

ID11038669
AuthorsChunling Lu (0000-0002-4780-9451, Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women’s Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences,...), Iván Mejía-Guevara (0000-0002-6205-6072, Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women’s Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences,...), Kenneth Hill (Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women’s Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences,...), Paul Farmer (Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women’s Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences,...), V Subramanian (0000-0003-2365-4165, Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women’s Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences,...), S V Subramanian (0009-0009-8336-0274, Harvard Global Health Institute), Agnes Binagwaho (0000-0002-6779-3151, Chunling Lu and Paul Farmer are with the Division of Global Health Equity, Brigham and Women’s Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Iván Mejía-Guevara is with the Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. Kenneth Hill is with the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston. S. V. Subramanian is with the Department of Social and Behavioral Sciences,...)
Year2016
Volume106
Issue1
Pages49-55
Publication date2016-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAmerican Journal of Public Health (JOURNAL)
Journal identifiersISSN: 0090-0036 • E-ISSN: 1541-0048
PublisherAmerican Public Health Association (PUBLISHER • US)
DOI10.2105/ajph.2015.302913
PMID26562109
OpenAlexW2152137519
LanguageEN
Citations received13
References cited30

Objectives. We analyzed the likelihood of rural children (aged 6–24 months) being stunted according to whether they were enrolled in Mutuelles, a community-based health-financing program providing health insurance to rural populations and granting them access to health care, including nutrition services. Methods. We retrieved health facility data from the District Health System Strengthening Tool and calculated the percentage of rural health centers that provided nutrition-related services required by Mutuelles’ minimum service package. We used data from the 2010 Rwanda Demographic and Health Survey and performed multilevel logistic analysis to control for clustering effects and sociodemographic characteristics. The final sample was 1061 children. Results. Among 384 rural health centers, more than 90% conducted nutrition-related campaigns and malnutrition screening for children. Regardless of poverty status, the risk of being stunted was significantly lower (odds ratio = 0.60; 95% credible interval = 0.41, 0.83) for Mutuelles enrollees. This finding was robust to various model specifications (adjusted for Mutuelles enrollment, poverty status, other variables) or estimation methods (fixed and random effects). Conclusions. This study provides evidence of the effectiveness of Mutuelles in improving child nutrition status and supported the hypothesis about the role of Mutuelles in expanding medical and nutritional care coverage for children

Community health · Economic growth · Economics · Environmental health · Health care · Logistic regression · Malnutrition · Odds · Odds ratio · Poverty · Public health · Child Nutrition and Water Access · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing

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