Globally, wasting or acute malnutrition (moderate and severe) affects nearly 52 million of under five years and among these wasted children, 17 million are suffering Severe Acute Malnutrition (SAM). Seventy-five (75%) of all those children suffering from malnutrition live in low to middle income countries while only one percent (1%) live in high income countries. These statistics show that malnutrition is a public health problem in Africa.East Africa was among three UN Sub regions with highest prevalence of MAM among all Nations Sub regions in 2011 and the second UN sub region with higher prevalence of stunting was South-Central Asia with 42% 12.

The 2015 survey on Comprehensive Food Security and Vulnerability Analysis and Nutrition Survey (CFSVA) conducted in Rwanda showed that 1.7% of under five years are wasted which show an improvement compared to 3.6% in 2012. The CHSVA results show that 36.7% of under five children are stunted, down from 43% in 2012 and 8.1% of underweight compared to 12% in 2012 3. According to the Kirehe District Development Plan (2013-2018), chronic malnutrition is at 50.7% but the acute malnutrition is 1% 4.

The treatment of acute malnutrition using supplement foods could help malnourished children recovering and could reduce the risk of becoming seek 5. In Rwanda, all children with moderate acute malnutrition are receiving cow milk and Corn Soy Beans as treatment in health centers for a period of 3 months before being discharged from nutrition program. The socio-workers in charge of nutrition and community health workers are following the use of those food supplements in malnourished families during this period of treatment of acute malnutrition especially in humanitarian emergencies 6.

The present study assessed factors influencing the recovery of children with MAM treated in health centers of Kirehe.

By referring on weight for height (WFH) measurements, children who achieved nutrition recovered was 77.5%. By running the bivariate and multivariate analysis, it was documented that factors identified to influence MAM recovery were being male; earning monthly greater than RWF 5000 and micronutrients and deworming provided apart from foods supplements at health facilities were associated to the recovery of children from MAM.

A recent study conducted in Malawi 8 showed that children with moderately wasted had significantly higher recovery rates after only 8 weeks using Ready to Use Foods (RUF) treatment (80%) than did those receiving CSB (72%) this could be due to sharing practices more pronounced in CSB than RUF who was a recent product with specific guides. If we compared those results with our findings in Kirehe District where the recovery rate was 77.5 using WFH, this higher recovery could due by home visits conducted which were conducted on weekly basis by socio workers in charge of nutrition and community health workers based in each village went to see how food supplements were using at each family with malnutrition and advised them on better used. The percentage of recovery in this study met the require minimum nutrition standards (sphere goals) which recovered over 75% of recovery.

A controlled comparative trial done in Malawi among moderately wasted children establish that 58% of children recovered when consuming Ready to Use Therapeutic Foods (RUTF), although only 22% recovered when using Corn Soy Beans (CSB) 9. But another study conducted by Medecins Sans Frontieres (MSF) in Niger reported that of 59.698 had moderate acute malnutrition and were treated by RUTF, the recovery rate was 95% and it offered curative services for some complicated illnesses such as HIV, malaria, endemic illnesses, whereas the Malawi trial didn’t do it 10. These contrasts between the Malawi and Niger interventions give to the higher recovery rate in Niger. This result from the study conducted in Niger reinforces what we find in Kirehe District where treatment got at health facilities contributed in recovery rate at 89.1%.

A study conducted in Indonesia 11 and other conducted in Nigeria 12 shown that children whose mothers did not work had worse evolution when compared to those whose mothers worked. These studies had evidence that, quite often, mothers of malnourished children do not perform paid jobs. However, when women have jobs, they improve family income, which have a positive impact on nutritional status of under five children. The findings from these studies demonstrated an association betweenmaternal unemployment and child recovery from malnutrition. This could due to lack of resources to take care of a child , before and after supplementation, suggested the effect of maternal unemployment adversely effects nutritional recovery. The results are similar to our research in Kirehe District where the monthly income of parents was associated with recovered of children with MAM at 77.5%. This might be explained by the transactional model where the lack of income lead to negative impact the development of child. Parents with less monthly income might not be able to provide balanced diet to their children or buy health insurance for the family.

A study conducted by Christine in 2013 13 in South of Asia documented the importance of gendered effects of siblings on child under nutrition. For wasted cases, the form of malnutrition most likely to result in higher order heightened risk, child mortality, higher birth where birth spacing low was protective, with no impact seen for number or sex of siblings.

The sex stratified analyses revealed that, through similar findings were retained for males, female wasting was more likely among girls with brothers. Such findings may be explained by preferential feeding or better hygiene of brothers as compared to their sisters, which may indicate low value placed on girls.

A recent published series on maternal and child nutrition by the Lancet medical journal hypothesizes that improving women’s empowerment is an important point of intervention for improving nutrition. The series explain that women’s empowerment is the mechanism through which increase in income and yield for agricultural inputs affect intra household resource allocation and children’s nutrition 141516. Also transactional model stipulated that employment which is one of the means to empowerment and income brings to positives aspects in children development.

The aim of the study was to assess factors that influence recovery among under five years’ children treated for MAM at Kirehe District health centers. The findings showed the proportion of 77.5% of recovery from MAM. It was revealed that small proportion of respondents feed on animal protein source. Male gender (AOR=16.19, p<0.001, 95% CI: 5.39-48.63), provision of micronutrients (AOR=2.9, p=0.027, 95% CI=1.13-7.58) and monthly income greater than RWF 5000 (AOR=2.8, p=0.029, 95% CI=1.11-7.51) where found to be associated with MAM recovery. In order to monitor the growth status of malnourished children under nutrition feeding program,community health workers need to visit families with malnourished children more often. The government should continue to provide micronutrients and nutrient food package to the poor families with malnourished children. There is a need to increase direct and indirect support received by poor families in Rwanda.