Evaluating Double-Duty Actions in Rwanda's Secondary Cities.

Area of Science:

• Public Health and Nutrition
• International Development
• Health Policy

Background:

• The double burden of malnutrition (DBM), characterized by undernutrition and overnutrition, is a growing concern in low- and middle-income countries (LMICs).
• Rwanda exhibits significant DBM, with high rates of child stunting and adult overweight/obesity, particularly in urbanizing regions, contributing to a rise in non-communicable diseases (NCDs).

Purpose of the Study:

• To identify and evaluate interventions with "double-duty action" (DDA) potential to address the DBM in Rwanda.
• To generate context-specific recommendations for improving nutrition programs in the Rusizi and Rubavu districts.

Main Methods:

• Desk review of national policies to identify programs with DDA potential (ECD centers, school feeding, farmer field schools, nutrition-sensitive direct support).
• In-person interviews with key stakeholders to assess program implementation.
• Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis to inform recommendations.

Main Results:

• Four programs identified with high DDA potential: early childhood development centers, school feeding programs, farmer field schools, and nutrition-sensitive direct support.
• Key areas for improvement include addressing nutrition beliefs, enhancing community educator training, increasing parental (especially paternal) involvement, and strengthening monitoring and follow-up.

Conclusions:

• Rwanda can enhance its capacity to address the DBM by implementing targeted changes across multiple sectors.
• Recommendations focus on improving existing nutrition interventions to better tackle both undernutrition and overnutrition simultaneously in urbanizing LMICs.