Impact of implementing performance-based financing on childhood malnutrition in Rwanda

BMC Public Health

Jean de Dieu Bizimana⁷  Jamie I Forrest⁵  Steve Kanters⁵  Corine Karema⁶  Fidele Ngabo³  Claire Wagner¹  Jeanine Condo²  Agnes Binagwaho⁴ 

[1] Global Health Delivery Partnership, Boston, USA;University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda;Ministry of Health, Government of Rwanda, Kigali, Rwanda;Geisel School of Medicine, Dartmouth College, Hanover, USA;School of Population and Public Health, University of British Columbia, Vancouver, Canada;Malaria & Other Parasitic Diseases Division- RBC, Kigali, Rwanda;World Bank, Washington, DC, USA

关键词: Performance-based financing;    HIV/AIDS;    Child health;    Maternal health;    Malnutrition;   

Others  :  1125917
DOI  :  10.1186/1471-2458-14-1132

 received in 2014-06-25, accepted in 2014-10-24,  发布年份 2014

【 摘 要 】

Background

Malnutrition remains a serious concern in Rwanda, particularly among children under-5 years. Performance-based financing (PBF), an innovative health systems financing strategy, has been implemented at the national level since 2008. This study aimed to assess the impact of PBF and other factors associated with the prevalence of three classifications of malnutrition (stunting, wasting and underweight) in children under-5 years in Rwanda.

Methods

The study is a cross-sectional study comprising of 713 children under five years old from 557 households, whose anthropometric measurements (height, weight and age) had been obtained as part of the 2008 Rwanda General Health and HIV household survey. Z-scores for height-for-age, weight-for-age, weight-for-height, and body mass index-for-age were analyzed according to the World Health Organization 2006 Child Growth Standards. Random intercept logistic regression models were used to regress each anthropometric measure (WAZ, HAZ and WHZ) against child, maternal and household characteristics.

Results

Child participants ranged in age from 0 to 60 months, 20.2% of children were under 12 months and 5.1% were HIV positive. The prevalence of wasting was 8.8%; of stunting was 58.4%; and of underweight status was 20.7%. Maternal emotional and social wellbeing was protective of wasting in children under-5 years of age. Living in districts implementing PBF was protective of wasting (Adjusted Odds Ratio: 0.43; 95% confidence interval: 0.19-0.97). Living in a district with PBF was not found to be associated with either stunting or underweight status among children under-5.

Conclusions

PBF may have a protective association with particular forms of malnutrition among children under-5 years in Rwanda. These findings warrant further investigation in relation to the impact of implementing innovative financing schemes on health outcomes.

【 授权许可】

   
2014 Binagwaho et al.; licensee BioMed Central Ltd.

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