Prevalence of stunting and its associated factors among children living with HIV/AIDS in Rwanda

Prevalence of stunting and its associated factors among children living with HIV/AIDS in Rwanda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of stunting and its associated factors among children living with HIV/AIDS in Rwanda Jean Luc Benimana, Placide Shema Niyonshuti, Pascal Mugemangango, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8639730/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Stunting, remains a major global public health problem, For children living with HIV, the burden is exacerbated, with prevalence rates ranging from 35% to 60% in Sub-Saharan Africa. While Rwanda has made progress in reducing general childhood stunting (from 38% in 2015 to 33% in 2020), specific data on factors associated with stunting among children living with HIV is limited, despite this vulnerable group is facing increased risks due to their condition. Methods A Retrospective cross-sectional study was conducted using secondary data from an existing health database of children living with HIV/AIDS in Rwanda for the year 2022. All eligible children under 15 years equal to 776 were included in the Analysis. Data on anthropometry, clinical, socio-economic and nutritional factors were extracted. Data were analysed using anthropometric references from WHO (Anthro& Anthro Plus), chi-square test, Bivariate and Multivariate logistic regression analysis was performed to identify independent factors associated with stunting, with statistical significance set at p < 0.05. Results The median age of study participants was 11 years (IQR: 8–13 years). female represented 53.35% (414), and males 46.65% (362). The overall prevalence of stunting was 45.49% Multivariate analysis revealed several factors independently associated with significantly increased odds of stunting. These included: Food insecurity (Adjusted Odds Ratio [AOR] = 9.26 (95% CI: 6.12–14.01, p < 0.001). Recent diarrhoea (AOR = 6.80, 95% CI: 4.16–11.12, p < 0.001). having taken ART for more than 5 years (AOR = 3.22, 95% CI: 1.63–6.34, p = 0.001), lacking health insurance (AOR = 2.53, 95% CI: 1.39–4.60, p = 0.002), Fair/poor ART adherence (3.81 CI:1.85–7.86,p < 0.001) (AOR = 1.97, 95% CI: 1.13–3.44, p = 0.017), and lack of vegetable consumption (AOR = 1.78, 95% CI: 1.15–2.76, p = 0.010). children in the 5–9-year age group had significantly lower odds of stunting compared to the reference group (AOR = 0.19, 95% CI: 0.09–0.41, p < 0.001). Conclusion Stunting remains a significant public health challenge among children living with HIV in Rwanda, driven by a complex interplay of clinical factors (ART adherence), and nutritional and socio-economic determinants (vegetable consumption, and household food insecurity, Lack of medical insurance). Effective interventions must be multi-faceted, integrating robust HIV clinical management with targeted nutritional support and comprehensive food security programs to improve growth outcomes and overall well-being in this vulnerable population. Stunting HIV Associated Factors Malnutrition ART Adherence Food Security Figures Figure 1 BACKGROUND Stunting, which is defined as low height-for-age (a height that falls more than two standard deviations away from the WHO child growth standards), is a measure of chronic under-nutrition, with long-term implications for health, cognition, educational attainment, and economic productivity ( 1 , 4 ). As highlighted by the World Health Organization (WHO) and UNICEF, stunting is an important indicator of chronic malnutrition that reflects cumulative deficits in growth ( 1 , 4 ). Stunted conditions correlate with higher morbidity, delayed cognitive development, and lower economic output in adult ages ( 6 ). This results in a long condition which has long-term effects on cognitive development, immune function, and health-related quality of life ( 12 ). Malnutrition (including stunting) is associated with nearly 45% of global childhood deaths ( 7 ). This is a significant burden, especially in low- and middle-income countries, where access to food, healthcare, and sanitation is often compromised. According to studies conducted around the globe, stunting is prevalent to different degrees in children that are HIV positive, depending on the context (region, rural/urban, household income, maternal education, clinical factors like ART access and viral suppression, and food security). Childhood stunting is disproportionately distributed across the world, with Africa home to nearly one-third of the world’s stunted children ( 6 , 7 ). In Sub-Saharan Africa, the most burdened region for both HIV/AIDS and childhood stunting, an estimated 1.2 million children younger than 15 lived with HIV in 2022, with the prevalence of stunting among HIV-positive children ranging from 35% up to 60% ( 8 ). The most vulnerable of groups are children who are living with HIV/AIDS. According to the Demographic and Health Surveys data, the prevalence of stunting among HIV-infected children in Africa was between 41% and 57%, as compared to HIV-negative children in whom the stunting prevalence ranged from 15% to 22% ( 8 ). The presence of HIV in children further amplifies the risk of growth faltering through various pathways, including the HIV infection itself (which might lead to immune suppression, increased energy expenditure, and malabsorption), opportunistic infections, poor appetite, and the nutritional demands of the HIV disease and associated anti-viral therapies ( 5 ). Evidence from cohort studies shows that early initiation of antiretroviral therapy improves growth outcomes among HIV-infected children. Studies from sub-Saharan Africa indicate that initiating antiretroviral therapy at an early age, particularly within the first six months of life, is associated with improved linear growth and accelerated growth recovery among children infected with HIV ( 24 ). Stunting continues to be a major public health issue among children living with HIV in East Africa, where high prevalence rates were reported in Ethiopia (37%), Tanzania (32%), and Uganda (28%) ( 9 ). Children living with HIV/AIDS are especially vulnerable to growth impairments. In meta-analysed studies conducted in East Africa, the prevalence among HIV positive children was found to be 56.81% in Uganda, 51.63% in Ethiopia, followed by 48.21% in Tanzania and 28.60% in Kenya, reinforcing the increased risk of malnutrition ( 12 ). Multiple factors can affect the rates of stunting for children living with HIV/AIDS such as socioeconomic status, levels of caregiver's education and dietary intake as well as adherence to antiretroviral therapy (ART) ( 14 ). Children at highest risk of stunting are those with poor ART adherence and low socioeconomic status, according to data from South Africa, Nigeria, and Uganda ( 9 ). The stunting prevalence among HIV-positive children is 36.6% in Tanzania, and the main reasons identified are low adherence to ART, maternal level of education, and associated infections ( 10 ). The study conducted in Uganda indicated that inappropriate practices, such as mixed feeding during the first six months, can increase the risk of malnutrition and stunting ( 11 ). HIV-positive mothers encounter barriers in following the recommended feeding practices that have detrimental effects on an infant's growth trajectory in Uganda ( 11 ). Households with at least one HIV-positive individual were more likely to have a child under five years old with stunted growth in Zimbabwe where the research was conducted ( 13 ). A study conducted in western Amhara, Ethiopia reported several factors that were associated with stunting among HIV/AIDS infected children, including poor ART adherence, non-use of co-trimoxazole prophylaxis, presence of opportunistic infections and low feeding frequency ( 14 ). Socio-demographic factors including orphans, infrequent feeding, and low birthweight were associated with stunting among children with HIV/AIDS in Dar es Salaam, Tanzania ( 10 ). However, research in Kenya, Uganda, and Tanzania show that stunting rates can be significantly reduced in HIV-infected children through nutritional supplementation and early ART initiation ( 5 , 12 ). Despite efforts such as the scale-up of ART, growth monitoring, and nutrition support to address the specific needs of this vulnerable population ( 16 ), stunting is still a public health issue, especially for children living with HIV/AIDS in resource-limited settings ( 5 ). The prevalence of stunting among children living with HIV/AIDS remains markedly higher than that of HIV-negative children, notwithstanding worldwide commitments to combat malnutrition ( 12 , 14 ). In Rwanda, national efforts to address child undernutrition are guided by the National Food and Nutrition Policy, which emphasizes multisectoral approaches to reduce stunting, particularly among vulnerable groups such as children living with HIV ( 3 ). Over the past years in Rwanda, childhood stunting has decreased from 38% in 2015 to 33% in 2020 ( 15 ). However, little is known about the prevalence and factors associated with stunting among children living with HIV/AIDS in Rwanda. There was limited recent evidence on the prevalence and specific factors for stunting among children living with HIV/AIDS in Rwanda, especially for children under fifteen years in the range of paediatric children in ART services, in the context of large-scale retrospective data utilising national health records. Such evidence is crucial for developing useful, evidence-based interventions for improved child health outcomes. This study, therefore, intended to estimate the prevalence of stunting and its associated factors among HIV/AIDS infected children in Rwanda using secondary data from existing health database of the study conducted by Rwanda Biomedical Centre (RBC), the study on nutrition, food security, and vulnerability of people living with HIV in Rwanda. The results will inform programs of action for policymakers, healthcare providers, and stakeholders for nutritional and clinical interventions, and thus stunting reduction and improved well-being of HIV infected children. Conceptual framework METHODOLOGY Research Design This study was a Retrospective cross-sectional, of data extracted from an existing health database of the study conduct by RBC, on Nutrition food security and venerability of people living with HIV in Rwanda. Study setting Primary data collection was conducted in 30 districts in Rwanda to ensure a national representation. In each district, a facility providing HIV care and treatment was randomly selected. In total, 30 health facilities were included in the study, which included both district hospitals and health centres with a high volume of patients on ART. The facilities provided ART, nutritional assessment and counselling, and a follow-up by staff for HIV positive children. The sites in this study reflected a combination of urban and rural settings and described a diverse geographical and socio-economic context in Rwanda. Overall, the study aimed to generate a broad and representative understanding of stunting and the key determinants in HIV-positive children in Rwanda. Study population All paediatric individuals diagnosed with HIV/AIDS and reported in the database during the study period. We considered paediatric individuals as those aged under 15 years, per MOH standards guideline ( 29 )and clinical staging of paediatric HIV. This cut-off would provide higher comparability with global HIV programs and reflect a time in development where stunting is most interpretable (as it comes before additional confounding factors). By categorizing those aged 15 years and above as adolescents and adults, it reflects distinct growth patterns, ART regimens and clinical monitoring, not to mention, and clinical monitoring differ. By 15 years, most children have reached late adolescence with stunting less reflective of HIV growth faltering, but more confounded by puberty in addition to adolescent nutritional dynamics. Inclusion Criteria We included all children aged children aged ≥ 2 and 14 years confirmed HIV/AIDS with available anthropometric and clinical data stored in the database. Exclusion Criteria We excluded children who have incomplete or missing key variables in the database and no meeting the inclusion criteria. Sample size A total population sampling method was used in this study. This method was used because the population of interest was relatively small and accessible, so it seemed logical to capture all eligible individuals to increase representativeness. As such, all children aged ≥ 2 and 14 years, equal to 776. during the study and who fulfilled the inclusion criteria, were included in the total population sample. Data collection method and procedure A structured data extraction form was developed in excel that helped the extraction of the Key variables of the study from an existing health data base of the study conducted by RBC, on Nutrition food security and venerability of people living with HIV in Rwanda then the selected records were exported into STATA version 17 for data cleaning and analysis. Data quality checks (i.e,. consistency checks and checks for outliers) were done before the statistical analysis. Variables Dependent variable The outcome variable used for our study was stunting (Growth Impairment) – Height-for-Age Z-score (HAZ), WHO Child Growth Standards( 30 , 31 ) which was categorized into Stunted: HAZ < -2 SD (Standard Deviations) Not Stunted: HAZ ≥ -2 SD. Independent variables: The study considers a range of independent variables grouped into three main categories: sociodemographic, clinical, and nutritional factors. The sociodemographic factors include characteristics related to the child and caregiver, such as the child’s age and sex, the caregiver’s education level, employment status, and marital status, as well as household-level indicators like the Ubudehe category, household food security status, religion, and health insurance coverage. These factors are critical in understanding the social context that may influence health outcomes. The clinical factors encompass biomedical indicators relevant to the child’s health status and treatment adherence. These include CD4 count, which reflects immune function; ART adherence categorized as good versus poor adherence; duration on antiretroviral therapy (ART) measured in years of exposure; history of opportunistic infections such as tuberculosis; and the latest viral load measurement. These variables provide insight into the clinical progression and management of the child’s condition. Lastly, nutritional factors focus on dietary intake and related behaviors, including consumption of specific food groups like cereals, vegetables, and pulses, meal frequency, and dietary diversity. Together, these variables form a comprehensive set of predictors to assess their influence on the study’s outcome. We determined adherence to antiretroviral therapy (ART) based on percentage of missed doses, measured by the question, in the last month/30 days, how many ART doses have you missed? Levels of adherence included: Good: Taking ≥ 95% of the prescribed ART doses. Fair: Taking 85–94% of the prescribed ART doses. Poor: Taking < 85% of the prescribed ART doses ( 32 ). For the calculation of food insecurity this study uses the Food Insecurity Experience Scale (FIES), which is a validated measure created by the Food and Agriculture Organization of the United Nations (FAO) ( 33 ). The FIES consists of eight yes or no questions about experiences over the prior 12 months. Responses are evaluated through Item Response Theory (IRT) to produce severity scores, which then place individuals into categories of food secure, moderately food insecure, and severely food insecure. These moderate and severe categories were combined into a binary indicator (food insecure: yes/no). Cereal Consumption (Yes/No):This variable was assessed on the basis of whether the child had consumed any cereal-based foods, including maize, rice, or bread, at least once in the seven ( 7 ) days prior to the survey. The response option "Yes" meant that this child consumed cereal-based foods during the reference period, whereas "No" meant that the child did not consume any cereal-based food during that period. Vegetable Consumption (Yes/No): This variable was measured based on whether the child consumed at least once any vegetable, including leafy green vegetables (e.g., spinach), roots (e.g., carrots), or any other non-starchy vegetable, in the seven ( 7 ) days prior to the interview. A "Yes" response meant that this child consumed vegetables in the reference period. Pulse (Beans) Consumption (Yes/No):This variable was measured based on whether or not the child had eaten or consumed at least once any pulse or legume, such as beans, peas, or lentils, in the seven ( 7 ) days prior to this interview. Data analysis procedures Anthropometric data were used to estimate the prevalence of stunting. A child was classified as stunted if their Height-for-age Z-score (HAZ) was lower than − 2 standard deviations from the WHO reference median. This analysis was done in Stata, using the official macros from WHO Anthro and WHO Anthro Plus to accurately calibrate to the internationally accepted growth standards. For children aged 2–5 years, HAZ scores were derived to the WHO Child Growth Standards (2006)( 30 ) based on the study of healthy breastfed children living in a variety of contexts, including the developing world. For children between 5–15 years, the Health Organization Growth Reference for School-aged Children and Adolescents (2007) ( 31 )was used to facilitate a seamless monitoring of growth as children progressed into adolescence. After obtaining each child's HAZ score, a binary variable called stunting was created, with 1 indicating that a child met the criteria for stunting and 0 for normal (not stunted). This stunting variable was then entered into descriptive analyses to determine the prevalence of stunting and then into a logistic regression model as the dependent variable to determine risk factors. Statistical analysis was conducted in STATA 17, while Excel was used for initial data organization and visualization. In Bivariate analysis, variables (e.g., gender, HIV stage, ART adherence) were presented as frequencies and percentages. Bivariate analysis used Chi 2 test and simple logistic regression. Significant variables with p < 0.05 were sent to multiple logistic regression using backward stepwise techniques. Results were presented in the form of COR and AOR with 95% CIs were reported, with statistical significance set at p < 0.05. Prior to multiple logistic regression for analysis, multicollinearity among predictor variables was evaluated through Variance Inflation Factors (VIFs). A VIF value greater than 5 served as a cutoff point for recognizing possible multi-collinearity that would inflate the variance of regression coefficients and thus, their interpretability In this analysis, all VIF values were 1.03 to 2.45, with a mean VIF of 1.4. All the values were well below the more conservative cut-off point of 5 as shown previously and indicated that multi-collinearity was not a concern with respect to this model ( 34 ) In this study, a sample of 776 under fifteen years children were consecutively sampled from a dataset of 3567 Children Living with HIV/AIDS (CLHIV) in Rwanda. Because of the source dataset's features and the sampling process used, the analysis did not require any complex survey adjustments like (weighting, clustering or stratification). Ethical considerations Before undertaking any research activity, ethics approval with Ref N°CMHS/IRB/423/2025 was obtained from the UR Institutional Review Board (IRB) and we sought research permission to access the dataset in RBC. Because of the retrospective nature of the study, written informed consent was not a feasible option. There was not any effort to identify participants, the dataset was also anonymized and was only available to authorized researchers under secure conditions. Data were kept on a password-protected computer or on a secure, access-controlled server with sharing to unauthorized parties only. As a secondary analysis, no physical, psychological, or social risk was posed to participants by the study. Results were presented aggregated such that individuals could not be identified. RESULTS The analysis included 776 participants; the median age was 11 years (Interquartile Range [IQR]: 8–13 years). The overall prevalence of stunting for the study population was 45.49% (n = 353). Table 1 summarizes the characteristics by stunting status. (Table 1 ) Characteristics of Study Participants Based on the descriptive statistics in the tables overhead, it is evident that a sample of 776 individuals distributed across demographic, clinical, and nutritional factors is representative. The sample is reasonably split between sexes with 46.6% males and 53.4% females. The majority of participants (98.1%) are first-line ART treatment, and most (88.0%) have health insurance. The distribution by age group depicts that the largest percentage of individuals (59.79%) fall within the age bracket of > 10 years. This pattern of one large group is similarly observed for the duration of ART with over half of the individuals (54.8%) being on ART for greater than 5 years. This indicates that there is a concentration of older children who have been on ART for an extended period within this sample. In terms of socioeconomics, the majority of caregivers have completed primary education (75.4%) and the majority of households are in UBUDEHE Category 2 (53.9%) In terms of clinical factors, the majority of participants have a suppressed viral load (< 200) at 92.0%, and that the majority of CD4 account (≥ 500) are normal at 58.0%.and nearly 72.0% of participants report good ART adherence. There are some alarming trends in both food security and health outcomes. A large share of the household member reports eating cereals (n = 97.0%) and pulses (n = 91.6%), but one-third (33.2%) do not consume any vegetables. In addition, a large share of the households in this sample are food insecure (n = 42.1%), and almost one-third of individuals (n = 28.6%) report a bout of diarrhoea in the last two weeks. Taken together, these results suggest that while this sample population is achieving high rates of ART adherence and has achieved viral suppression, issues related to nutrition and household level health are still present. (Table 1 ). Table 1 Characteristics of the study participants (N = 776) Variable Category N (%) Stunting Yes 353(45.49) No 423(54.51) Sex of child Male 362 (46.6) Female 414 (53.4) Religion of care givers Catholic 254 (32.7) Muslim 28 (3.6) Other 238 (30.7) Protestant 256 (33.0) ART treatment line Second line 15 (1.9) Firstline 761 (98.1) Having Health insurance No 93 (12.0) Yes 683 (88.0) Age group of study participants 2–4 years 94 (12.1) 5–9 years 218 (28.0) > 10 years 464 (59.8) Duration on ART of care givers 5 years 425 (54.8) Marital status of caregiver Single 318 (41.0) Not single 458 (59.0) Level of education of caregiver Secondary & University 101 (13.0) Primary 585 (75.4) No level of education 90 (11.6) Viral load > 200 62 (8.0) < 200 714 (92.0) CD4 Account Very low ( 500) 450 (58.0) ART adherence Good 558 (72.0) Poor 135 (17.4) Fair 83 (10.7) Consume any food from Cereals, tubers and root crops Not consume 23 (3.0) Consume 753 (97.0) Consume Pulses (beans, peas, groundnuts, lentils) Not Pulse consume 65 (8.4) Pulse consume 711 (91.6) Consume any food from Vegetables No 258 (33.2) Yes 518 (66.8) UBUDEHE Category 1 189 (24.4) 2 418 (53.9) 3 169 (21.8) Treated for tuberculosis No 743 (95.7) Yes 33 (4.3) Presence of food insecurity Yes 327 (42.1) No 449 (57.9) Experienced diarrhea in the past 2 weeks No 554 (71.4) Yes 222 (28.6) Total number of people living in the household 1–2 members 268 (34.5) 3–4 members 429 (55.3) 5–6 members 79 (10.2) Travel time to clinic ≤ 30 minutes 488 (62.9) 31–60 minutes 282 (36.3) > 60 minutes 6 (0.8) Prevalence of stunting among children living with HIV/AIDS The study involved 776 children with HIV. Of those children, 353 (45.49%) were stunted, while 423 (54.51%) were not (Table 1 ). Almost one in every two children with HIV in the sample was stunted, based on their height-for-age Z-score being below − 2 standard deviations from the WHO growth reference standards. This prevalence indicates a significant burden of stunting among children infected with HIV/AIDS in Rwanda, and suggests an urgent need for integrated nutritional and clinical care interventions targeting children living with HIV/AIDS in pediatric HIV care programs. Bivariate analysis of factors associated with stunting among children living with HIV/AIDS The table provided outlines the unadjusted relationships using Chi-square tests of independent variables and stunting status in a total of 776 respondents. There were a number of significant factors associated with stunting status; where p < 0.05. The most significant factors associated with stunting were food insecurity (p < 0.001) and diarrhea in the past 2 weeks (p < 0.001) where stunting status was much higher among those who were food insecure (79.20%) and those who had diarrhoea (84.68%). Also, levels of ART adherence (p < 0.001) and a viral load greater than 200 (p < 0.001) had a much higher prevalence of stunting status (60.74% and 72.58%, respectively). Nutritional factors had an influence as well. There were 60.47% of those who did not consume vegetables either daily or otherwise were stunted status versus the 16.82% for those who did eat vegetables (p < 0.001). In addition, various demographic variables and clinically relevant variables were found to be significant including Age group (p < 0.001) and Duration on ART (p 10 years of age group 53.66%) and stunting prevalence was highest among individuals on ART for the longest duration (> 5 years of ART, 56.71%). Insurance coverage was also identified as a significant variable (p = 0.031). For example, Sex, Religion, treatment line for ART, marital status, educational level, CD4 count, and size of household were not statistically significantly associated with stunting in this univariate analysis (Table 2 ). Table 2 Bivariate analysis of factors associated with stunting among children living with HIV/AIDS Variables Stunted n (%) Not Stunted n (%) P-value* Sex 0.29 Male 172 (47.51%) 190 (52.49%) Female 181 (43.72%) 233 (56.28%) Religion 0.829 Catholic 112 (44.09%) 142 (55.91%) Muslim 11 (39.29%) 17 (60.71%) Other 110 (46.22%) 128 (53.78%) Protestant 120 (46.88%) 136 (53.13%) ART treatment line 0.926 Second line 7 (46.67%) 8 (53.33%) Firstline 346 (45.47%) 415 (54.53%) Having health insurance 0.031 No 52 (55.91%) 41 (44.09%) Yes 301 (44.07%) 382 (55.93%) Age group 10 years 249 (53.66%) 215 (46.34%) Duration on ART < 0.001 5 years 241 (56.71%) 184 (43.29%) Marital status of caregiver 0.624 Single 148 (46.54%) 170 (53.46%) Not single 205 (44.76%) 253 (55.24%) Level of education of caregiver 0.534 Secondary & University 51 (50.50%) 50 (49.50%) Primary 263 (44.96%) 322 (55.04%) No level of education 39 (43.33%) 51 (56.67%) Viral load 200 45 (72.58%) 17 (27.42%) < 200 308 (43.14%) 406 (56.86%) CD4 Account 0.401 Very low (< 200) 20 (37.04%) 34 (62.96%) Low (200–500) 128 (47.06%) 144 (52.94%) Normal (≥ 500) 205 (45.56%) 245 (54.44%) ART adherence < 0.001 Good 204 (36.56%) 354 (63.44%) Poor 82 (60.74%) 53 (39.26%) Fair 67 (80.72%) 16 (19.28%) Consume any food from Cereals, tubers and root crops 0.141 Not consume 7 (30.43%) 16 (69.57%) Consume 346 (45.95%) 407 (54.05%) Consume Pulses (beans, peas, groundnuts, lentils) 0.527 Not Pulse consume 32 (49.23%) 33 (50.77%) Pulse consume 321 (45.15%) 390 (54.85%) Consume any food from Vegetables < 0.001 No 156 (60.47%) 102 (39.53%) Yes 197 (38.03%) 321 (61.97%) UBUDEHE Category 0.326 1 94 (49.74%) 95 (50.26%) 2 188 (44.98%) 230 (55.02%) 3 71 (42.01%) 98 (57.99%) Treated for tuberculosis 0.286 No 335 (45.09%) 408 (54.91%) Yes 18 (54.55%) 15 (45.45%) Presence of food insecurity < 0.001 Yes 259 (79.20%) 68 (20.80%) No 94 (20.94%) 355 (79.06%) Experienced diarrhea in the past 2 weeks < 0.001 No 165 (29.78%) 389 (70.22%) Yes 188 (84.68%) 34 (15.32%) Total number of people living in the household 0.22 1–2 members 132 (49.25%) 136 (50.75%) 3–4 members 190 (44.29%) 239 (55.71%) 5–6 members 31 (39.24%) 48 (60.76%) Travel time to clinic 0.57 ≤ 30 minutes 220 (45.08%) 268 (54.92%) 31–60 minutes 129 (45.74%) 153 (54.26%) > 60 minutes 4 (66.67%) 2 (33.33%) Note: * P-value from the x 2 Multivariate analysis of factors associated with stunting among children living with HIV/AIDS The Variance Inflation Factor (VIF) was determined for each predictor to examine the potential for multicollinearity among the independent variables in the multivariate logistic regression model. The results indicated, multicollinearity was not a major issue in the model. The individual VIF values were all significantly lower than the common threshold of 5, with VIF values ranging from 1.03 to 2.45. Correspondingly. The mean VIF for the model was 1.4, suggesting that problematic multicollinearity is not present ( 34 ) Once adjusting for the other variables in the model, several factors remained independently significantly associated with an increase in odds of stunting: Children with fair ART adherence had 3.81, times higher odds of being stunted (AOR = 3.81, 95% CI: 1.85–7.86, p < 0.001) compared to good adherent children and Poor ART adherence (AOR = 1.96, 95% CI: 1.12–3.43, p = 0.017). Children from food insecure households had 9.26 times higher odds of being stunted (AOR = 9.26, 95% CI: 6.12-14.00, p < 0.001) compared to food secure children. Children form households who did not consume vegetables had 1.7 times higher odds of being stunted (AOR = 1.779, 95% CI: 1.148–2.757, p = 0.010), compared to children from households consuming vegetables. Recent diarrheal episode was associated with 6.8 times higher odds of being stunted (AOR = 6.80, 95% CI: 4.16–11.12, p 5 years) also significantly increases the odds of stunting (AOR = 3.21, 95% CI: 1.63–6.34, p = 0.001). Furthermore, the lack of health insurance (AOR = 2.53, 95% CI: 1.39–4.60, p = 0.002 .(Table 3 ). Table 3 Multivariate analysis of factors associated with stunting among children living with HIV/AIDS Variable & Category COR (95% CI) P-value AOR (95% CI) P-value Having health insurance Yes 1 1 No 1.610 (1.040–2.490) 0.033 2.53 (1.39–4.60) 0.002 Age group 2–4 years 1 1 5–9 years 0.345 (0.213–0.586) < 0.001 0.18 (0.08–0.41) 10 years 1.158 (0.743–1.804) 0.517 0.59 (0.28–1.21) 0.154 Duration on ART < 2 years 1 1 2–5 years 2.548 (1.515–4.286) 5 years 5.348 (3.290–8.694) < 0.001 3.21 (1.63–6.34) < 0.001 Viral load 200 3.489 (1.959–6.215) < 0.001 1.19 (0.544–2.607) 0.655 ART adherence Good 1 1 Poor 2.685 (1.825–3.950) < 0.001 1.96 (1.12–3.43) 0.017 Fair 7.267 (4.101–12.874) < 0.001 3.81 (1.85–7.86) < 0.001 Consume any vegetables Yes 1 1 No 2.492 (1.835–3.385) < 0.001 1.77 (1.14–2.75) 0.010 Food insecurity No 1 1 Yes 14.384 (10.129–20.427) < 0.001 9.26 (6.12–14.00) < 0.001 Experienced diarrhea No 1 1 Yes 13.036 (8.667–19.606) < 0.001 6.80 (4.16–11.12) < 0.001 Notes: *P value < 0.05 DISCUSSION The present study aimed to identify the factors associated with stunting among children living with HIV in Rwanda. This study reveals a stunting prevalence of 45.49%, which is slightly lower than the regional averages reported in similar studies conducted in Uganda (56.81%), Ethiopia (51.63%), and Tanzania (48.21%). However, the prevalence observed in Rwanda is higher compared to Kenya (28.60%), as indicated by a meta-analysis focusing on East Africa that reported a pooled stunting prevalence ( 12 ). This high burden underscores the ongoing vulnerability to undernutrition in HIV-positive children despite sustained efforts to improve nutritional and HIV care services in Rwanda. Comparison data from other studies supports the significance of this burden. Previous studies conducted among HIV-positive pediatric populations across sub-Saharan Africa indicate stunting prevalence of between 20% and 45% ( 10 , 12 , 14 ). A meta-analysis focusing on East Africa reported a pooled stunting prevalence of 24.65% among HIV-positive children, which is nearly half the level observed in our study population ( 12 ). However, specific research demonstrates immense variability, with reported prevalence of 51.63% in Ethiopia and 48.21% in Tanzania, signaling that stunting remains a persistent problem in the region ( 12 ). These findings are consistent with evidence from Rwanda indicating that socio-economic and environmental conditions remain key drivers of childhood stunting despite national progress in nutrition indicators ( 22 ). The heightened prevalence described in our study may be attributed to contextual variation in factors such as socioeconomic status, food insecurity, dietary diversity, and access to HIV and nutritional care services. HIV infection itself, in addition to opportunistic infections, chronic inflammation, and antiretroviral therapy (ART) side effects, can negatively affect growth outcomes. In particular, HIV-associated enteropathy has been documented among children living with HIV and is known to impair nutrient absorption, contributing to chronic growth faltering even among children receiving ART ( 18 ). Together, these findings highlight the critical importance of integrated HIV management strategies that incorporate nutritional and broader social determinants of health. We determined that children with poor or fair ART adherence had greater odds of stunting compared to children with good adherence. This is consistent with evidence from Ethiopia demonstrating that suboptimal ART adherence is independently associated with stunting among children living with HIV, alongside other modifiable factors such as missed cotrimoxazole prophylaxis and inadequate feeding frequency ( 14 ). Similar associations between ART adherence, disease severity, and stunting have also been reported in other pediatric HIV cohorts in Eastern Africa ( 23 ). Mechanistically, intermittent viremia resulting from missed doses may lead to sustained immune activation, recurrent infections, and disruption of growth hormone pathways, thereby impairing linear growth, whereas consistent ART use supports immune recovery and catch-up growth ( 35 ). Our cohort’s children aged 5–9 years showed significantly lower odds of stunting compared to those aged 2–5 years. This pattern aligns with national data for Rwanda, which indicate that stunting remains highest among under-five children, although gradual improvements have been observed ( 36 , 37 ). Stunting often peaks during early childhood due to weaning practices, cumulative nutritional deficits, and recurrent infections ( 38 ). Within pediatric HIV cohorts, several studies have demonstrated that the greatest decline in height-for-age Z-scores occurs during early childhood, with more stable growth trajectories observed in older children ( 39 , 40 ). This consistency suggests that early nutritional and ART interventions remain essential to prevent irreversible growth faltering. Surprisingly, our study revealed that children who had been on ART for more than five years had higher odds of stunting compared to those on ART for less than two years. This finding contrasts with many longitudinal studies that report progressive improvements in height-for-age Z-scores with prolonged ART exposure, particularly among children initiated on treatment early in life ( 40 ). However, other studies have shown persistent or worsening stunting among children who initiated ART later, after significant pre-treatment growth deficits had already occurred ( 39 ). Socioeconomic factors, chronic comorbidities, long-term ART toxicities, and sustained food insecurity may also contribute to these outcomes. Similar observations have been reported in studies examining long-term growth outcomes among HIV-infected children in resource-limited settings ( 25 ). Dietary factors, particularly vegetable intake, demonstrated strong independent associations with stunting. Households without vegetable consumption had higher odds of stunting, reinforcing findings from nutrition epidemiology studies that emphasize the importance of dietary diversity and micronutrient adequacy for linear growth ( 41 ). The strong association with cereal deprivation likely reflects its cultural and caloric importance in Rwanda, where food-insecure households may lack alternative calorie sources. Evidence from Rwanda and comparable settings shows that children from poorer households with limited dietary diversity are disproportionately affected by stunting ( 26 ). These findings highlight the potential benefits of integrating targeted food supplementation and nutrition-sensitive interventions into pediatric HIV care programs. Household food insecurity was also a strong predictor of stunting, with children from food-insecure households experiencing more than eightfold increased odds of stunting. This finding aligns with a growing body of literature describing the syndemic relationship between HIV and food insecurity ( 17 ). Food insecurity may influence stunting through multiple pathways, including reduced dietary quality, caregiver stress, and competing household expenditures. These findings further support national and regional evidence linking poverty and structural deprivation to persistent child undernutrition ( 26 ). Recent diarrheal illness was independently associated with a markedly increased risk of stunting, highlighting the powerful role of acute infections in growth faltering among HIV-positive children. Large cohort studies in sub-Saharan Africa demonstrate that repeated diarrheal episodes substantially increase the risk of stunting in early childhood ( 21 ). HIV-infected children are particularly vulnerable due to increased frequency and severity of diarrheal disease, compounded by impaired gut integrity and immune dysfunction ( 27 ). These findings support the WHO conceptual framework on child undernutrition, which emphasizes the role of infectious morbidity as an immediate cause of growth failure ( 28 ). Children without health insurance coverage had significantly greater odds of stunting compared to those with insurance, underscoring the importance of financial access to healthcare as a determinant of nutritional outcomes. Evidence from Rwanda indicates that enrollment in community-based health insurance schemes is associated with significantly lower odds of stunting, regardless of household poverty status ( 27 ). The challenges and solutions for financial sustainability of Rwanda’s universal health insurance further highlight the potential impact of insurance coverage on child nutritional outcomes ( 42 ). Similar findings across sub-Saharan Africa demonstrate that health insurance improves utilization of preventive and nutritional services, thereby reducing child undernutrition ( 17 ). These results align with broader frameworks identifying access to healthcare as a key underlying determinant of child malnutrition ( 19 , 20 ). Many variables that were significant in bivariate analysis lost significance in multivariate models, reflecting important mediating relationships. For example, caregiver marital status likely influenced stunting indirectly through socioeconomic pathways rather than direct caregiving practices. Similarly, the association between tuberculosis history and stunting appeared to be mediated by immune status ( 43 ). These findings emphasize the complexity of growth determinants among children living with HIV and the need for multidimensional intervention strategies. Overall, our findings support a conceptual model in which HIV-associated stunting arises from overlapping biological, nutritional, and socioeconomic vulnerabilities. They provide strong justification for integrating nutrition-specific and nutrition-sensitive interventions into pediatric HIV care and for strengthening social protection mechanisms to address food insecurity among vulnerable households. Future research should explore the cost-effectiveness of bundled interventions addressing both clinical and structural determinants of stunting among children living with HIV. Limitations Despite its contributions, the study has some limitations that should be noted. Because all primary data comes from a cross-sectional study, it captures data at just one point in time, and we could not determine causation. For this reason, while we noted associations, we cannot state that certain factors caused stunting. In order to see changes over time and determine causation, longitudinal studies would be required. In addition, the dietary consumption and food security data were all based on caregivers' recollection, which is affected by recall bias. For this reason, reporting of usual dietary patterns or food insecurity may have been inaccurate. Rwanda. The study emphasized on assessing household food security however not all-important socio-economic measures, like actual household income or Ubudehe categories, were assessed due to lack of information. These are known strong determinants of nutritional outcomes, as well as poverty within the Rwandan context. Their exclusion or lack of adequate detail may have restricted our understanding of socio-economic aspects that are impacting stunting, and increased chance of unmeasured confounding within the associations we observed. Additionally, key breastfeeding variables (e.g., exclusive breastfeeding duration, total breastfeeding duration) and antenatal mother services variables (e.g., number and timing of antenatal care visits, listed content of ANC services) were not captured through this project. These early life and maternal health aspects are considered to have strong effects on child nutritional status, and it is possible they confounded the associations we observed. Additionally, the analysis was further limited by the potential for other unmeasured confounding (e.g., the full range of opportunistic infections, specific micronutrient deficiency, and water, sanitation, breastfeeding status and hygiene (WASH). CONCLUSION The findings of the study indicate that stunting in HIV-positive children in Rwanda is a significant public health issue with a high prevalence of 45.49%. The analysis highlighted that stunting is not attributed to one or two risk factors, but rather a series of independent and inter-related risk factors that must be dealt with at the same time. The most prominent predictors were a recent diarrheal event and food insecurity, both of which are known to be strongly linked to malnutrition and impaired growth. Additionally, poor ART adherence was a vital predictor, with the analysis suggesting that the influence of adherence was not mediated by viral load, which itself was rendered statistically non-significant after controlling for ART adherence. Similarly, the socioeconomic variables played a more substantial role in predicting stunting, with both lack of health insurance and not eating vegetables found to independently increase the odds of stunting. These findings support the need for a comprehensive, multi-sectoral response that utilizes traditional clinical care alongside public health activities that promote improvements in nutrition, hygiene, and healthcare access. Recommendations In accordance with the findings of the study, the following recommendations are offered to policymakers, providers of healthcare, and future researchers in Rwanda.: Identified factors Recommendations Responsible Prevalence of stunting is high among children infected with HIV especially Develop and promote concrete and formalized mechanisms to coordinate the health, agriculture, social protection, and education sectors, as together they provide a holistic and coordinated response to child stunting. Target public health initiatives on young children since this may be an important time window for prevention of stunting, such as emphasizing routine growth monitoring at the community level, vaccinations, and acute illness early intervention. MOH MINALOC MINAGRI MOH Lack of Medical health insurance Strengthen Health Insurance Coverage for HIV‑Affected Households. To strengthen financial protection and health system access in order to optimize growth outcomes for children with HIV, while simultaneously exploiting access to financial protection and health system access to offer preventive and growth-enhancing services, integral to a continuum of care. MOH & PARTNERS Fair and Poor ART adherence review and improve existing and scale up innovative adherence support strategies including peer support groups, differentiated service delivery, and individualized follow-up for children and their caregivers with a concentration on achieving adherence and retention on ART. RBC/HIV Division Dietary factors, especially Lack of vegetables intake Highlight the importance of recognizing the importance of continuous vegetable consumption for micronutrients during nutritional counselling. Improve or integrate available nutrition prevention program in ARV pediatric services support, gardening initiatives to increase household access to varied vegetables. Health care providers RBC/HIV Division Food insecurity Develop and promote linkages between HIV care support services and household food security programmes (e.g., social protection schemes such as Ubudehe, livelihood support, microfinance, agricultural training) for under-resourced and vulnerable HIV-affected households. Place emphasis on nutritional support and education for vulnerable populations, especially food insecure populations and populations with extensive history of recurring illness. MOH/RBC &PARTNERS Health care providers Recent diarrhea To support integration of water, sanitation and hygiene (WASH) interventions within HIV care packages which included, as routine, oral rehydration salts and zinc, and strengthen community management of diarrhea. Emphasizing routine vaccinations, and acute illness early intervention. Health care providers in collaboration with RBC Long duration on ART (> 5 years) Conduct qualitative and quantitative research to better understand the pathways linking the uses of long-term ART and stunting. For qualitative investigations, it may investigate whether class of drugs are an influential factor or the role of co-existing conditions. MOH/RBC Missing of key variables of the Study Undertake longitudinal studies to identify causal links, empirical and economic evaluation of integrated intervention packages, and qualitative studies to further understand adherence and dietary barriers to change behaviour and practice in Rwanda. MOH/RBC ACRONYMS AND ABBREVIATIONS ART Antiretroviral therapy HIV Human Immunodeficiency Virus AIDS Acquired immunodeficiency syndrome IYCF Infant and young child feeding WHO World Health Organization UNICEF United Nations Children's Fund FAO Food and Agriculture Organization of the United Nations FIES Food Insecurity Experience Scale MOH Ministry of Health, Rwanda MINALOC Ministry of local Government, Rwanda MINAGRI Ministry of agriculture and Animal Resources, Rwanda RBC Rwanda biomedical center Declarations Consent for Publication Not applicable. Competing Interests The authors declare that they have no competing interests. Funding Statement This study did not receive any external funding. Author Contribution Jean Luc Benimana and Placide Shema Niyonshuti contributed to all components of the manuscript and acted as guarantors of the study. Pascal Mugemangango and Israel Cyubahiro Munyambaraga provided oversight and technical guidance to ensure the overall quality of the research. Pasteur Dushimimana made substantial contributions to the study conception, data collection, data analysis, interpretation of findings, and manuscript drafting. All authors critically reviewed and approved the final manuscript and accept responsibility for the integrity and accuracy of the work in its entirety. Acknowledgment We gratefully acknowledge the University of Rwanda and the Rwanda Biomedical Center for providing the support and conducive research environment that made this study possible. Their dedication to strengthening research capacity and improving public health in Rwanda was instrumental in the successful completion of this work. Data Availability The data used in this study were obtained from an existing national health database generated by the Rwanda Biomedical Center (RBC) as part of a study on nutrition, food security, and vulnerability among people living with HIV in Rwanda. The dataset contains sensitive health information and is therefore not publicly available. Access to the data may be granted upon reasonable request and with permission from the Rwanda Biomedical Center, subject to ethical approval and data-sharing regulations. References WHO. Stunting in a nutshell [Internet]. 2015 [cited 2025 Aug 7]. Available from: https://www.who.int/news/item/19-11-2015-stunting-in-a-nutshell#:~:text=Stunting%20is%20the%20impaired%20growth,WHO%20Child%20Growth%20Standards%20median. NIH. HIV Overview [Internet]. 2025 [cited 2025 Aug 7]. Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/stages-hiv-infection MINALOC. REPUBLIC OF RWANDA NATIONAL FOOD AND NUTRITION POLICY Rwanda National Food and Nutrition Policy [Internet]. 2014. Available from: http://www.minaloc.gov.rw/MinistryofHealthhttp://www.moh.gov.rw/MinistryofAgricultureandAnimalResourceshttp://www.minagri.gov.rw/ UNICEF. 2023 Global Annual Results Report NUTRITION, FOR EVERY CHILD. 2023. 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Mutawulira I, Nakachwa J, Muharabu L, Walekhwa AW, Kayina V. Exploring infant feeding practices and associated factors among HIV-positive mothers attending early infant diagnosis clinic in Northern Uganda. Epidemiol Infect. 2022 Jun 20;150. Abate BB, Aragie TG, Tesfaw G. Magnitude of underweight, wasting and stunting among HIV positive children in East Africa: A systematic review and meta-analysis. Vol. 15, PLoS ONE. Public Library of Science; 2020. Macheka L, Kembo G, Kairiza T. Gender dimensions of the impact of HIV/AIDS on stunting in children under five years in Zimbabwe. BMC Public Health. 2021 Dec 1;21(1). Dagnew Z, Mengist Z, Tesema C, Temesgen T, Kumlachew L, Teym A, et al. Stunting and its associated factors among children living with HIV/AIDS: a cross-sectional study. Annals of Medicine & Surgery. 2024 May;86(5):2579–85. NISR. Rwanda Demographic and Health Survey. 2019. Nshimyiryo A, Hedt-Gauthier B, Mutaganzwa C, Kirk CM, Beck K, Ndayisaba A, et al. Risk factors for stunting among children under five years: A cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health. 2019 Feb 11;19(1). Nigussie J, Girma B, Molla A, Mareg M, Mihretu E. Under-nutrition and associated factors among children infected with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis. Vol. 80, Archives of Public Health. BioMed Central Ltd; 2022. Blaauw J, Chikwana J, Chaima D, Khoswe S, Samikwa L, de Vries I, et al. The presence of enteropathy in HIV infected children on antiretroviral therapy in Malawi. PLoS One. 2024 Feb 1;19(2 February). WHO. Childhood Stunting: Context, Causes and Consequences WHO Conceptual framework [Internet]. 2013 [cited 2025 Aug 3]. Available from: https://cdn.who.int/media/docs/default-source/nutritionlibrary/events/2013_childhoodstunting_colloquium_14oct_conceptualframework_bw.pdf?sfvrsn=7a0f8766_5 Unicef. UNICEF Conceptual Framework. 2021; Toledo G, Landes M, van Lettow M, Tippett Barr BA, Bailey H, Crichton S, et al. Risk factors for stunting in children who are HIV-exposed and uninfected after Option B+ implementation in Malawi. Matern Child Nutr. 2023 Jan 1;19(1). Kalinda C, Phri M, Albin Qambayot M, Consolatrice Sage Ishimwe M, Gebremariam A, Bekele A, et al. Socio-demographic and environmental determinants of under-5 stunting in Rwanda: Evidence from a multisectoral study. 2023. Gezahegn D, Egata G, Gobena T, Abebaw B. Predictors of stunting among pediatric children living with HIV/AIDS, Eastern Ethiopia. Int J Publ Health Sci. 2020;9(2):82–9. Shiau S, Arpadi S, Strehlau R, Martens L, Patel F, Coovadia A, et al. Initiation of antiretroviral therapy before 6 months of age is associated with faster growth recovery in South African children perinatally infected with human immunodeficiency virus. Journal of Pediatrics. 2013;162(6). Echendu ST, Ugochukwu EF, Okeke KN, Onubogu CU, Ebenebe JC, Umeadi EN, et al. Socio-demographic Determinants of Undernutrition In HIV-Infected Under-Five Children. 2021;2. Available from: www.ej-clinicmed.orgDOI:http://dx.doi.org/10.24018/ Habimana J de D, Uwase A, Korukire N, Jewett S, Umugwaneza M, Rugema L, et al. Prevalence and Correlates of Stunting among Children Aged 6–23 Months from Poor Households in Rwanda. Int J Environ Res Public Health. 2023 Mar 1;20(5). Sunday FX, Ilinde DN, Izabayo Rudatinya P, Kwizera P, Kanimba P, Rutayisire R, et al. Factors affecting nutritional status among children aged below five years in Rwanda’s Western and Southern Provinces. BMC Public Health. 2024 Dec 1;24(1). WHO. Concurrent problems and short-term consequences Long-term consequences Child Consequences. 2017. MOH. REPUBLIC OF RWANDA MINISTRY OF HEALTH. 2022. WHO. Child growth standards. 2006. WHO. Growth reference data for 5-19 years [Internet]. 2007 [cited 2025 Aug 16]. Available from: https://www.who.int/tools/growth-reference-data-for-5to19-years/application-tools Patient monitoring guidelines for HIV care and antiretroviral therapy (ART). World Health Organization; 2006. FAO. The Food Insecurity Experience Scale [Internet]. 2016 [cited 2025 Aug 3]. Available from: https://www.fao.org/in-action/voices-of-the-hungry/fies/en/ Michael Kutner, Christopher, J.C. Nachtsheim, John Neter. In Applied Linear Statistical Models. 2005. Wu F, Simonetti FR. Learning from Persistent Viremia: Mechanisms and Implications for Clinical Care and HIV-1 Cure. Vol. 20, Current HIV/AIDS Reports. Springer; 2023. p. 428–39. Kalinda C, Qambayot MA, Ishimwe SMC, Regnier D, Bazimya D, Uwizeyimana T, et al. Leveraging multisectoral approach to understand the determinants of childhood stunting in Rwanda: a systematic review and meta-analysis. Vol. 13, Systematic Reviews. BioMed Central Ltd; 2024. Nshimyiryo A, Hedt-Gauthier B, Mutaganzwa C, Kirk CM, Beck K, Ndayisaba A, et al. Risk factors for stunting among children under five years: A cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health. 2019 Feb 11;19(1). Soliman A, De Sanctis V, Alaaraj N, Ahmed S, Alyafei F, Hamed N, et al. Early and long-term consequences of nutritional stunting: From childhood to adulthood. Acta Biomedica. 2021 Mar 5;92(1). Simms V, McHugh G, Dauya E, Bandason T, Mujuru H, Nathoo K, et al. Growth improvement following antiretroviral therapy initiation in children with perinatally-acquired HIV diagnosed in older childhood in Zimbabwe: a prospective cohort study. BMC Pediatr. 2022 Dec 1;22(1). Sutcliffe CG, van Dijk JH, Munsanje B, Hamangaba F, Sinywimaanzi P, Thuma PE, et al. Weight and height z-scores improve after initiating ART among HIV-infected children in rural Zambia: A cohort study. BMC Infect Dis. 2011 Mar 1;11. Morales F, Montserrat-de la Paz S, Leon MJ, Rivero-Pino F. Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children’s Health Status: A Literature Review. Vol. 16, Nutrients. Multidisciplinary Digital Publishing Institute (MDPI); 2024. Nyandekwe M, Nzayirambaho M, Kakoma JB. Universal health insurance in rwanda: Major challenges and solutions for financial sustainability case study of rwanda community-based health insurance part i. Pan African Medical Journal. 2020;37:1–12. Gupta KB, Gupta R, Atreja A, Verma M, Vishvkarma S. Tuberculosis and nutrition. Vol. 26, Lung India •. 2009. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8639730","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591031138,"identity":"d1a070b4-a72b-4424-a4d3-9dd294815044","order_by":0,"name":"Jean Luc Benimana","email":"","orcid":"","institution":"Ministry of health","correspondingAuthor":false,"prefix":"","firstName":"Jean","middleName":"Luc","lastName":"Benimana","suffix":""},{"id":591031139,"identity":"dd8ccd7c-51be-426f-83a6-c5d869e5b012","order_by":1,"name":"Placide Shema Niyonshuti","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACZjB5AMRgY2CoAIkwNxCnhQes5QxIhJGAFgaYFgagFsY2EIeAFnN2HsPHBX/uJO5nZ3/24OO82mj+dqCWHxXbcGqxbOYxNp7Z9iyxh5nH3HDmtuO5Mw4zNjD2nLmNU4vBYR4zad6GwyAtbNK8247lNgC1MDO2EdDC8wekhf2Z9N85x3LnE6eFDaSFwUyasaEmdwNhLWzFxrxth417gHole44dyN0I1HIQr1/OH974GOgw2fb+488kftTU5c47f/jggx8VuLUwMHAYIPMOg8kDeNQDAfsDZF4dfsWjYBSMglEwIgEAZCtZT7yMLukAAAAASUVORK5CYII=","orcid":"","institution":"University of Rwanda","correspondingAuthor":true,"prefix":"","firstName":"Placide","middleName":"Shema","lastName":"Niyonshuti","suffix":""},{"id":591031140,"identity":"ea6ae522-4a71-46e6-b7b4-c1dc27d90787","order_by":2,"name":"Pascal Mugemangango","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Pascal","middleName":"","lastName":"Mugemangango","suffix":""},{"id":591031141,"identity":"7c849707-f407-48c7-ba64-4e7c97cec122","order_by":3,"name":"Pasteur Dushimimana","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Pasteur","middleName":"","lastName":"Dushimimana","suffix":""},{"id":591031142,"identity":"de0c3f30-fb9f-47d0-b1cd-57c300fd0cd2","order_by":4,"name":"Israel Cyubahiro Munyambaraga","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Israel","middleName":"Cyubahiro","lastName":"Munyambaraga","suffix":""}],"badges":[],"createdAt":"2026-01-19 12:57:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8639730/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8639730/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102763374,"identity":"89916641-f98e-4de8-a4c6-06f9cab706ad","added_by":"auto","created_at":"2026-02-16 10:58:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":115067,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Background section.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8639730/v1/c8023234685d1f36b952d08a.png"},{"id":102962681,"identity":"44589bb7-7ee1-4fed-97bd-22acaf06d3cf","added_by":"auto","created_at":"2026-02-19 04:10:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1336054,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8639730/v1/cb9ba8f5-0469-4c91-968c-fc4a68eef50a.pdf"},{"id":102763375,"identity":"3d15552d-a47c-44e0-9a1c-0f35d6dafbda","added_by":"auto","created_at":"2026-02-16 10:58:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1739111,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDICES.docx","url":"https://assets-eu.researchsquare.com/files/rs-8639730/v1/29093c19fb64a8eb00be176c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of stunting and its associated factors among children living with HIV/AIDS in Rwanda","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eStunting, which is defined as low height-for-age (a height that falls more than two standard deviations away from the WHO child growth standards), is a measure of chronic under-nutrition, with long-term implications for health, cognition, educational attainment, and economic productivity (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). As highlighted by the World Health Organization (WHO) and UNICEF, stunting is an important indicator of chronic malnutrition that reflects cumulative deficits in growth (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Stunted conditions correlate with higher morbidity, delayed cognitive development, and lower economic output in adult ages (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This results in a long condition which has long-term effects on cognitive development, immune function, and health-related quality of life (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Malnutrition (including stunting) is associated with nearly 45% of global childhood deaths (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This is a significant burden, especially in low- and middle-income countries, where access to food, healthcare, and sanitation is often compromised. According to studies conducted around the globe, stunting is prevalent to different degrees in children that are HIV positive, depending on the context (region, rural/urban, household income, maternal education, clinical factors like ART access and viral suppression, and food security).\u003c/p\u003e \u003cp\u003eChildhood stunting is disproportionately distributed across the world, with Africa home to nearly one-third of the world\u0026rsquo;s stunted children (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In Sub-Saharan Africa, the most burdened region for both HIV/AIDS and childhood stunting, an estimated 1.2\u0026nbsp;million children younger than 15 lived with HIV in 2022, with the prevalence of stunting among HIV-positive children ranging from 35% up to 60% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The most vulnerable of groups are children who are living with HIV/AIDS. According to the Demographic and Health Surveys data, the prevalence of stunting among HIV-infected children in Africa was between 41% and 57%, as compared to HIV-negative children in whom the stunting prevalence ranged from 15% to 22% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe presence of HIV in children further amplifies the risk of growth faltering through various pathways, including the HIV infection itself (which might lead to immune suppression, increased energy expenditure, and malabsorption), opportunistic infections, poor appetite, and the nutritional demands of the HIV disease and associated anti-viral therapies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Evidence from cohort studies shows that early initiation of antiretroviral therapy improves growth outcomes among HIV-infected children. Studies from sub-Saharan Africa indicate that initiating antiretroviral therapy at an early age, particularly within the first six months of life, is associated with improved linear growth and accelerated growth recovery among children infected with HIV (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStunting continues to be a major public health issue among children living with HIV in East Africa, where high prevalence rates were reported in Ethiopia (37%), Tanzania (32%), and Uganda (28%) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Children living with HIV/AIDS are especially vulnerable to growth impairments. In meta-analysed studies conducted in East Africa, the prevalence among HIV positive children was found to be 56.81% in Uganda, 51.63% in Ethiopia, followed by 48.21% in Tanzania and 28.60% in Kenya, reinforcing the increased risk of malnutrition (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultiple factors can affect the rates of stunting for children living with HIV/AIDS such as socioeconomic status, levels of caregiver's education and dietary intake as well as adherence to antiretroviral therapy (ART) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Children at highest risk of stunting are those with poor ART adherence and low socioeconomic status, according to data from South Africa, Nigeria, and Uganda (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The stunting prevalence among HIV-positive children is 36.6% in Tanzania, and the main reasons identified are low adherence to ART, maternal level of education, and associated infections (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The study conducted in Uganda indicated that inappropriate practices, such as mixed feeding during the first six months, can increase the risk of malnutrition and stunting (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). HIV-positive mothers encounter barriers in following the recommended feeding practices that have detrimental effects on an infant's growth trajectory in Uganda (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Households with at least one HIV-positive individual were more likely to have a child under five years old with stunted growth in Zimbabwe where the research was conducted (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A study conducted in western Amhara, Ethiopia reported several factors that were associated with stunting among HIV/AIDS infected children, including poor ART adherence, non-use of co-trimoxazole prophylaxis, presence of opportunistic infections and low feeding frequency (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Socio-demographic factors including orphans, infrequent feeding, and low birthweight were associated with stunting among children with HIV/AIDS in Dar es Salaam, Tanzania (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, research in Kenya, Uganda, and Tanzania show that stunting rates can be significantly reduced in HIV-infected children through nutritional supplementation and early ART initiation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Despite efforts such as the scale-up of ART, growth monitoring, and nutrition support to address the specific needs of this vulnerable population (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), stunting is still a public health issue, especially for children living with HIV/AIDS in resource-limited settings (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The prevalence of stunting among children living with HIV/AIDS remains markedly higher than that of HIV-negative children, notwithstanding worldwide commitments to combat malnutrition (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Rwanda, national efforts to address child undernutrition are guided by the National Food and Nutrition Policy, which emphasizes multisectoral approaches to reduce stunting, particularly among vulnerable groups such as children living with HIV (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Over the past years in Rwanda, childhood stunting has decreased from 38% in 2015 to 33% in 2020 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, little is known about the prevalence and factors associated with stunting among children living with HIV/AIDS in Rwanda. There was limited recent evidence on the prevalence and specific factors for stunting among children living with HIV/AIDS in Rwanda, especially for children under fifteen years in the range of paediatric children in ART services, in the context of large-scale retrospective data utilising national health records. Such evidence is crucial for developing useful, evidence-based interventions for improved child health outcomes.\u003c/p\u003e \u003cp\u003eThis study, therefore, intended to estimate the prevalence of stunting and its associated factors among HIV/AIDS infected children in Rwanda using secondary data from existing health database of the study conducted by Rwanda Biomedical Centre (RBC), the study on nutrition, food security, and vulnerability of people living with HIV in Rwanda. The results will inform programs of action for policymakers, healthcare providers, and stakeholders for nutritional and clinical interventions, and thus stunting reduction and improved well-being of HIV infected children.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConceptual framework\u003c/strong\u003e\u003c/p\u003e\n"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eResearch Design\u003c/h2\u003e \u003cp\u003eThis study was a Retrospective cross-sectional, of data extracted from an existing health database of the study conduct by RBC, on Nutrition food security and venerability of people living with HIV in Rwanda.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting\u003c/h3\u003e\n\u003cp\u003ePrimary data collection was conducted in 30 districts in Rwanda to ensure a national representation. In each district, a facility providing HIV care and treatment was randomly selected. In total, 30 health facilities were included in the study, which included both district hospitals and health centres with a high volume of patients on ART. The facilities provided ART, nutritional assessment and counselling, and a follow-up by staff for HIV positive children.\u003c/p\u003e \u003cp\u003eThe sites in this study reflected a combination of urban and rural settings and described a diverse geographical and socio-economic context in Rwanda. Overall, the study aimed to generate a broad and representative understanding of stunting and the key determinants in HIV-positive children in Rwanda.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eAll\u0026ensp;paediatric individuals diagnosed with HIV/AIDS and reported in the database during the study period.\u003c/p\u003e \u003cp\u003eWe considered paediatric individuals as those aged under 15 years, per MOH standards guideline (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)and clinical staging of paediatric HIV. This cut-off would provide higher comparability with global HIV programs and reflect a time in development where stunting is most interpretable (as it comes before additional confounding factors). By categorizing those aged 15 years and above as adolescents and adults, it reflects distinct growth patterns, ART regimens and clinical monitoring, not to mention, and clinical monitoring differ.\u003c/p\u003e \u003cp\u003eBy 15 years, most children have reached late adolescence with stunting less reflective of HIV growth faltering, but more confounded by puberty in addition to adolescent nutritional dynamics.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eWe included all children aged children aged\u0026thinsp;\u0026ge;\u0026thinsp;2 and 14 years confirmed HIV/AIDS with available anthropometric and clinical\u0026ensp;data stored in the database.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eExclusion Criteria\u003c/h2\u003e \u003cp\u003eWe excluded children\u0026ensp;who have incomplete or missing key variables in the database and no meeting the inclusion criteria.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eA total population sampling method was used in this study. This method was used because the population of interest was relatively small and accessible, so it seemed logical to capture all eligible individuals to increase representativeness. As such, all children aged\u0026thinsp;\u0026ge;\u0026thinsp;2 and 14 years, equal to 776. during the study and who fulfilled the inclusion criteria, were included in the total population sample.\u003c/p\u003e\n\u003ch3\u003eData collection method and procedure\u003c/h3\u003e\n\u003cp\u003eA structured data extraction form was developed in excel that helped the extraction of the Key variables of the study from an existing health data base of the study conducted by RBC, on Nutrition food security and\u0026ensp;venerability of people living with HIV in Rwanda then the selected records were exported into STATA version 17 for data cleaning and analysis. Data quality checks (i.e,. consistency checks and checks for outliers) were done before the statistical analysis.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003eThe outcome variable used for our study was stunting (Growth Impairment) \u0026ndash; Height-for-Age Z-score (HAZ), WHO Child Growth\u0026ensp;Standards(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) which was categorized into Stunted: HAZ\u0026ensp;\u0026lt; -2 SD (Standard Deviations) Not Stunted: HAZ \u0026ge; -2 SD.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variables:\u003c/h2\u003e \u003cp\u003eThe study considers a range of independent variables grouped into three main categories: sociodemographic, clinical, and nutritional factors. The sociodemographic factors include characteristics related to the child and caregiver, such as the child\u0026rsquo;s age and sex, the caregiver\u0026rsquo;s education level, employment status, and marital status, as well as household-level indicators like the Ubudehe category, household food security status, religion, and health insurance coverage. These factors are critical in understanding the social context that may influence health outcomes.\u003c/p\u003e \u003cp\u003eThe clinical factors encompass biomedical indicators relevant to the child\u0026rsquo;s health status and treatment adherence. These include CD4 count, which reflects immune function; ART adherence categorized as good versus poor adherence; duration on antiretroviral therapy (ART) measured in years of exposure; history of opportunistic infections such as tuberculosis; and the latest viral load measurement. These variables provide insight into the clinical progression and management of the child\u0026rsquo;s condition. Lastly, nutritional factors focus on dietary intake and related behaviors, including consumption of specific food groups like cereals, vegetables, and pulses, meal frequency, and dietary diversity. Together, these variables form a comprehensive set of predictors to assess their influence on the study\u0026rsquo;s outcome.\u003c/p\u003e \u003cp\u003eWe determined adherence to antiretroviral therapy (ART) based on percentage of missed doses, measured by the question, in the last month/30 days, how many ART doses have you missed? Levels of adherence included: Good: Taking\u0026thinsp;\u0026ge;\u0026thinsp;95% of the prescribed ART doses. Fair: Taking 85\u0026ndash;94% of the prescribed ART doses. Poor: Taking\u0026thinsp;\u0026lt;\u0026thinsp;85% of the prescribed ART doses (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). For the calculation of food insecurity this study uses the Food Insecurity Experience Scale (FIES), which is a validated measure created by the Food and Agriculture Organization of the United Nations (FAO) (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The FIES consists of eight yes or no questions about experiences over the prior 12 months. Responses are evaluated through Item Response Theory (IRT) to produce severity scores, which then place individuals into categories of food secure, moderately food insecure, and severely food insecure. These moderate and severe categories were combined into a binary indicator (food insecure: yes/no). Cereal Consumption (Yes/No):This variable was assessed on the basis of whether the child had consumed any cereal-based foods, including maize, rice, or bread, at least once in the seven (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) days prior to the survey. The response option \"Yes\" meant that this child consumed cereal-based foods during the reference period, whereas \"No\" meant that the child did not consume any cereal-based food during that period.\u003c/p\u003e \u003cp\u003eVegetable Consumption (Yes/No): This variable was measured based on whether the child consumed at least once any vegetable, including leafy green vegetables (e.g., spinach), roots (e.g., carrots), or any other non-starchy vegetable, in the seven (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) days prior to the interview. A \"Yes\" response meant that this child consumed vegetables in the reference period.\u003c/p\u003e \u003cp\u003ePulse (Beans) Consumption (Yes/No):This variable was measured based on whether or not the child had eaten or consumed at least once any pulse or legume, such as beans, peas, or lentils, in the seven (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) days prior to this interview.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData analysis procedures\u003c/h2\u003e \u003cp\u003eAnthropometric data were used to estimate the prevalence of stunting. A child was classified as stunted if their Height-for-age Z-score (HAZ) was lower than \u0026minus;\u0026thinsp;2 standard deviations from the WHO reference median. This analysis was done in Stata, using the official macros from WHO Anthro and WHO Anthro Plus to accurately calibrate to the internationally accepted growth standards. For children aged 2\u0026ndash;5 years, HAZ scores were derived to the WHO Child Growth Standards (2006)(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) based on the study of healthy breastfed children living in a variety of contexts, including the developing world. For children between 5\u0026ndash;15 years, the Health Organization Growth Reference for School-aged Children and Adolescents (2007) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)was used to facilitate a seamless monitoring of growth as children progressed into adolescence. After obtaining each child's HAZ score, a binary variable called stunting was created, with 1 indicating that a child met the criteria for stunting and 0 for normal (not stunted). This stunting variable was then entered into descriptive analyses to determine the prevalence of stunting and then into a logistic regression model as the dependent variable to determine risk factors.\u003c/p\u003e \u003cp\u003eStatistical analysis was conducted in STATA 17, while Excel was used for initial data organization and visualization. In Bivariate analysis, variables (e.g., gender, HIV stage, ART adherence) were presented as frequencies and percentages. Bivariate analysis used Chi\u003csup\u003e2\u003c/sup\u003e test and simple logistic regression. Significant variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were sent to multiple logistic regression using backward stepwise techniques. Results were presented in the form of COR and AOR with 95% CIs were reported, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Prior to multiple logistic regression for analysis, multicollinearity among predictor variables was evaluated through Variance Inflation Factors (VIFs). A VIF value greater than 5 served as a cutoff point for recognizing possible multi-collinearity that would inflate the variance of regression coefficients and thus, their interpretability\u003c/p\u003e \u003cp\u003eIn this analysis, all VIF values were 1.03 to 2.45, with a mean VIF of 1.4. All the values were well below the more conservative cut-off point of 5 as shown previously and indicated that multi-collinearity was not a concern with respect to this model (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this study, a sample of 776 under fifteen years children were consecutively sampled from a dataset of 3567 Children Living with HIV/AIDS (CLHIV) in Rwanda. Because of the source dataset's features and the sampling process used, the analysis did not require any complex survey adjustments like (weighting, clustering or stratification).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e Before undertaking any research activity, ethics approval with Ref N\u0026deg;CMHS/IRB/423/2025 was obtained from the UR Institutional Review Board (IRB) and we sought research permission to access the dataset in RBC. Because of the retrospective nature of the study, written informed consent was not a feasible option. There was not any effort to identify participants, the dataset was also anonymized and was only available to authorized researchers under secure conditions. Data were kept on a password-protected computer or on a secure, access-controlled server with sharing to unauthorized parties only. As a secondary analysis, no physical, psychological, or social risk was posed to participants by the study. Results were presented aggregated such that individuals could not be identified.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe analysis included 776 participants; the median age was 11 years (Interquartile Range [IQR]: 8\u0026ndash;13 years). The overall prevalence of stunting for the study population was 45.49% (n\u0026thinsp;=\u0026thinsp;353). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the characteristics by stunting status. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of Study Participants\u003c/h2\u003e \u003cp\u003eBased on the descriptive statistics in the tables overhead, it is evident that a sample of 776 individuals distributed across demographic, clinical, and nutritional factors is representative. The sample is reasonably split between sexes with 46.6% males and 53.4% females. The majority of participants (98.1%) are first-line ART treatment, and most (88.0%) have health insurance.\u003c/p\u003e \u003cp\u003eThe distribution by age group depicts that the largest percentage of individuals (59.79%) fall within the age bracket of \u0026gt;\u0026thinsp;10 years. This pattern of one large group is similarly observed for the duration of ART with over half of the individuals (54.8%) being on ART for greater than 5 years. This indicates that there is a concentration of older children who have been on ART for an extended period within this sample.\u003c/p\u003e \u003cp\u003eIn terms of socioeconomics, the majority of caregivers have completed primary education (75.4%) and the majority of households are in UBUDEHE Category 2 (53.9%) In terms of clinical factors, the majority of participants have a suppressed viral load (\u0026lt;\u0026thinsp;200) at 92.0%, and that the majority of CD4 account (\u0026ge;\u0026thinsp;500) are normal at 58.0%.and nearly 72.0% of participants report good ART adherence.\u003c/p\u003e \u003cp\u003eThere are some alarming trends in both food security and health outcomes. A large share of the household member reports eating cereals (n\u0026thinsp;=\u0026thinsp;97.0%) and pulses (n\u0026thinsp;=\u0026thinsp;91.6%), but one-third (33.2%) do not consume any vegetables. In addition, a large share of the households in this sample are food insecure (n\u0026thinsp;=\u0026thinsp;42.1%), and almost one-third of individuals (n\u0026thinsp;=\u0026thinsp;28.6%) report a bout of diarrhoea in the last two weeks. Taken together, these results suggest that while this sample population is achieving high rates of ART adherence and has achieved viral suppression, issues related to nutrition and household level health are still present. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study participants (N\u0026thinsp;=\u0026thinsp;776)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStunting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e353(45.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e423(54.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex of child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e362 (46.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e414 (53.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion of care givers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e254 (32.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e238 (30.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e256 (33.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART treatment line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirstline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e761 (98.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving Health insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (12.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e683 (88.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group of study participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94 (12.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218 (28.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e464 (59.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration on ART of care givers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122 (15.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229 (29.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e425 (54.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status of caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e318 (41.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot single\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e458 (59.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of education of caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary \u0026amp; University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101 (13.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e585 (75.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo level of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (11.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViral load\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e714 (92.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD4 Account\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery low (\u0026lt;\u0026thinsp;200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow (200\u0026ndash;500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272 (35.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal (\u0026gt;\u0026thinsp;500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e450 (58.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e558 (72.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135 (17.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume any food from Cereals, tubers and root crops\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot consume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e753 (97.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume Pulses (beans, peas, groundnuts, lentils)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Pulse consume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65 (8.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulse consume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e711 (91.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume any food from Vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258 (33.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e518 (66.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUBUDEHE Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189 (24.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e418 (53.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169 (21.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreated for tuberculosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e743 (95.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of food insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327 (42.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e449 (57.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperienced diarrhea in the past 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e554 (71.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222 (28.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal number of people living in the household\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e268 (34.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e429 (55.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;6 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79 (10.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTravel time to clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e488 (62.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e282 (36.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of stunting among children living with HIV/AIDS\u003c/h2\u003e \u003cp\u003eThe study involved 776 children with HIV. Of those children, 353 (45.49%) were stunted, while 423 (54.51%) were not (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlmost one in every two children with HIV in the sample was stunted, based on their height-for-age Z-score being below \u0026minus;\u0026thinsp;2 standard deviations from the WHO growth reference standards. This prevalence indicates a significant burden of stunting among children infected with HIV/AIDS in Rwanda, and suggests an urgent need for integrated nutritional and clinical care interventions targeting children living with HIV/AIDS in pediatric HIV care programs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eBivariate analysis of factors associated with stunting among children living with HIV/AIDS\u003c/h2\u003e \u003cp\u003eThe table provided outlines the unadjusted relationships using Chi-square tests of independent variables and stunting status in a total of 776 respondents. There were a number of significant factors associated with stunting status; where p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThe most significant factors associated with stunting were food insecurity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and diarrhea in the past 2 weeks (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) where stunting status was much higher among those who were food insecure (79.20%) and those who had diarrhoea (84.68%). Also, levels of ART adherence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a viral load greater than 200 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) had a much higher prevalence of stunting status (60.74% and 72.58%, respectively). Nutritional factors had an influence as well. There were 60.47% of those who did not consume vegetables either daily or otherwise were stunted status versus the 16.82% for those who did eat vegetables (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, various demographic variables and clinically relevant variables were found to be significant including Age group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and Duration on ART (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Stunting prevalence in the oldest age group (\u0026gt;\u0026thinsp;10 years of age group 53.66%) and stunting prevalence was highest among individuals on ART for the longest duration (\u0026gt;\u0026thinsp;5 years of ART, 56.71%). Insurance coverage was also identified as a significant variable (p\u0026thinsp;=\u0026thinsp;0.031). For example, Sex, Religion, treatment line for ART, marital status, educational level, CD4 count, and size of household were not statistically significantly associated with stunting in this univariate analysis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of factors associated with stunting among children living with HIV/AIDS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStunted n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot Stunted n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172 (47.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e190 (52.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e181 (43.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e233 (56.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (44.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142 (55.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (39.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (60.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110 (46.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128 (53.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e120 (46.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136 (53.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART treatment line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (46.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (53.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirstline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e346 (45.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e415 (54.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving health insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (55.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (44.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e301 (44.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e382 (55.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (26.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e161(73.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e249 (53.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e215 (46.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration on ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (19.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98 (80.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88 (38.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141 (61.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e241 (56.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184 (43.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status of caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148 (46.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e170 (53.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot single\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e205 (44.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e253 (55.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of education of caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary \u0026amp; University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (50.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (49.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e263 (44.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e322 (55.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo level of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (43.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (56.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViral load\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (72.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (27.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e308 (43.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e406 (56.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD4 Account\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery low (\u0026lt;\u0026thinsp;200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (37.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (62.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow (200\u0026ndash;500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128 (47.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144 (52.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal (\u0026ge;\u0026thinsp;500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e205 (45.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e245 (54.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e204 (36.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e354 (63.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (60.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (39.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67 (80.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (19.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume any food from Cereals, tubers and root crops\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot consume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (30.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (69.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e346 (45.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e407 (54.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume Pulses (beans, peas, groundnuts, lentils)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Pulse consume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (49.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (50.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulse consume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e321 (45.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e390 (54.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume any food from Vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156 (60.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102 (39.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e197 (38.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321 (61.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUBUDEHE Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (49.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95 (50.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188 (44.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e230 (55.02%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (42.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98 (57.99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreated for tuberculosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e335 (45.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e408 (54.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (54.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (45.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of food insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e259 (79.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (20.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (20.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e355 (79.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperienced diarrhea in the past 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165 (29.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e389 (70.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188 (84.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (15.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal number of people living in the household\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e132 (49.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136 (50.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e190 (44.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e239 (55.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;6 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (39.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (60.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTravel time to clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220 (45.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e268 (54.92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129 (45.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (54.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (66.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eNote: * P-value from the x\u003csup\u003e2\u003c/sup\u003e\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eMultivariate analysis of factors associated with stunting among children living with HIV/AIDS\u003c/h2\u003e \u003cp\u003eThe Variance Inflation Factor (VIF) was determined for each predictor to examine the potential for multicollinearity among the independent variables in the multivariate logistic regression model. The results indicated, multicollinearity was not a major issue in the model. The individual VIF values were all significantly lower than the common threshold of 5, with VIF values ranging from 1.03 to 2.45. Correspondingly. The mean VIF for the model was 1.4, suggesting that problematic multicollinearity is not present (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOnce adjusting for the other variables in the model, several factors remained independently significantly associated with an increase in odds of stunting: Children with fair ART adherence had 3.81, times higher odds of being stunted (AOR\u0026thinsp;=\u0026thinsp;3.81, 95% CI: 1.85\u0026ndash;7.86, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to good adherent children and Poor ART adherence (AOR\u0026thinsp;=\u0026thinsp;1.96, 95% CI: 1.12\u0026ndash;3.43, p\u0026thinsp;=\u0026thinsp;0.017). Children from food insecure households had 9.26 times higher odds of being stunted (AOR\u0026thinsp;=\u0026thinsp;9.26, 95% CI: 6.12-14.00, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to food secure children. Children form households who did not consume vegetables had 1.7 times higher odds of being stunted (AOR\u0026thinsp;=\u0026thinsp;1.779, 95% CI: 1.148\u0026ndash;2.757, p\u0026thinsp;=\u0026thinsp;0.010), compared to children from households consuming vegetables.\u003c/p\u003e \u003cp\u003eRecent diarrheal episode was associated with 6.8 times higher odds of being stunted (AOR\u0026thinsp;=\u0026thinsp;6.80, 95% CI: 4.16\u0026ndash;11.12, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001compared to children with no recent diarrhoea.\u003c/p\u003e \u003cp\u003eA longer duration on ART (\u0026gt;\u0026thinsp;5 years) also significantly increases the odds of stunting (AOR\u0026thinsp;=\u0026thinsp;3.21, 95% CI: 1.63\u0026ndash;6.34, p\u0026thinsp;=\u0026thinsp;0.001). Furthermore, the lack of health insurance (AOR\u0026thinsp;=\u0026thinsp;2.53, 95% CI: 1.39\u0026ndash;4.60, p\u0026thinsp;=\u0026thinsp;0.002 .(Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of factors associated with stunting among children living with HIV/AIDS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable \u0026amp; Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving health insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.610 (1.040\u0026ndash;2.490)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.53 (1.39\u0026ndash;4.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.345 (0.213\u0026ndash;0.586)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18 (0.08\u0026ndash;0.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.158 (0.743\u0026ndash;1.804)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.59 (0.28\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration on ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.548 (1.515\u0026ndash;4.286)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.31 (0.64\u0026ndash;2.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.348 (3.290\u0026ndash;8.694)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.21 (1.63\u0026ndash;6.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViral load\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.489 (1.959\u0026ndash;6.215)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.19 (0.544\u0026ndash;2.607)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.685 (1.825\u0026ndash;3.950)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.96 (1.12\u0026ndash;3.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.267 (4.101\u0026ndash;12.874)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.81 (1.85\u0026ndash;7.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume any vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.492 (1.835\u0026ndash;3.385)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.77 (1.14\u0026ndash;2.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.384 (10.129\u0026ndash;20.427)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.26 (6.12\u0026ndash;14.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperienced diarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.036 (8.667\u0026ndash;19.606)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.80 (4.16\u0026ndash;11.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eNotes: *P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/h2\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study aimed to identify the factors associated with stunting among children living with HIV in Rwanda. This study reveals a stunting prevalence of 45.49%, which is slightly lower than the regional averages reported in similar studies conducted in Uganda (56.81%), Ethiopia (51.63%), and Tanzania (48.21%). However, the prevalence observed in Rwanda is higher compared to Kenya (28.60%), as indicated by a meta-analysis focusing on East Africa that reported a pooled stunting prevalence (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This high burden underscores the ongoing vulnerability to undernutrition in HIV-positive children despite sustained efforts to improve nutritional and HIV care services in Rwanda.\u003c/p\u003e \u003cp\u003eComparison data from other studies supports the significance of this burden. Previous studies conducted among HIV-positive pediatric populations across sub-Saharan Africa indicate stunting prevalence of between 20% and 45% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A meta-analysis focusing on East Africa reported a pooled stunting prevalence of 24.65% among HIV-positive children, which is nearly half the level observed in our study population (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, specific research demonstrates immense variability, with reported prevalence of 51.63% in Ethiopia and 48.21% in Tanzania, signaling that stunting remains a persistent problem in the region (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These findings are consistent with evidence from Rwanda indicating that socio-economic and environmental conditions remain key drivers of childhood stunting despite national progress in nutrition indicators (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe heightened prevalence described in our study may be attributed to contextual variation in factors such as socioeconomic status, food insecurity, dietary diversity, and access to HIV and nutritional care services. HIV infection itself, in addition to opportunistic infections, chronic inflammation, and antiretroviral therapy (ART) side effects, can negatively affect growth outcomes. In particular, HIV-associated enteropathy has been documented among children living with HIV and is known to impair nutrient absorption, contributing to chronic growth faltering even among children receiving ART (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Together, these findings highlight the critical importance of integrated HIV management strategies that incorporate nutritional and broader social determinants of health.\u003c/p\u003e \u003cp\u003eWe determined that children with poor or fair ART adherence had greater odds of stunting compared to children with good adherence. This is consistent with evidence from Ethiopia demonstrating that suboptimal ART adherence is independently associated with stunting among children living with HIV, alongside other modifiable factors such as missed cotrimoxazole prophylaxis and inadequate feeding frequency (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Similar associations between ART adherence, disease severity, and stunting have also been reported in other pediatric HIV cohorts in Eastern Africa (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Mechanistically, intermittent viremia resulting from missed doses may lead to sustained immune activation, recurrent infections, and disruption of growth hormone pathways, thereby impairing linear growth, whereas consistent ART use supports immune recovery and catch-up growth (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur cohort\u0026rsquo;s children aged 5\u0026ndash;9 years showed significantly lower odds of stunting compared to those aged 2\u0026ndash;5 years. This pattern aligns with national data for Rwanda, which indicate that stunting remains highest among under-five children, although gradual improvements have been observed (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Stunting often peaks during early childhood due to weaning practices, cumulative nutritional deficits, and recurrent infections (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Within pediatric HIV cohorts, several studies have demonstrated that the greatest decline in height-for-age Z-scores occurs during early childhood, with more stable growth trajectories observed in older children (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). This consistency suggests that early nutritional and ART interventions remain essential to prevent irreversible growth faltering.\u003c/p\u003e \u003cp\u003eSurprisingly, our study revealed that children who had been on ART for more than five years had higher odds of stunting compared to those on ART for less than two years. This finding contrasts with many longitudinal studies that report progressive improvements in height-for-age Z-scores with prolonged ART exposure, particularly among children initiated on treatment early in life (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). However, other studies have shown persistent or worsening stunting among children who initiated ART later, after significant pre-treatment growth deficits had already occurred (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Socioeconomic factors, chronic comorbidities, long-term ART toxicities, and sustained food insecurity may also contribute to these outcomes. Similar observations have been reported in studies examining long-term growth outcomes among HIV-infected children in resource-limited settings (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDietary factors, particularly vegetable intake, demonstrated strong independent associations with stunting. Households without vegetable consumption had higher odds of stunting, reinforcing findings from nutrition epidemiology studies that emphasize the importance of dietary diversity and micronutrient adequacy for linear growth (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The strong association with cereal deprivation likely reflects its cultural and caloric importance in Rwanda, where food-insecure households may lack alternative calorie sources. Evidence from Rwanda and comparable settings shows that children from poorer households with limited dietary diversity are disproportionately affected by stunting (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). These findings highlight the potential benefits of integrating targeted food supplementation and nutrition-sensitive interventions into pediatric HIV care programs.\u003c/p\u003e \u003cp\u003eHousehold food insecurity was also a strong predictor of stunting, with children from food-insecure households experiencing more than eightfold increased odds of stunting. This finding aligns with a growing body of literature describing the syndemic relationship between HIV and food insecurity (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Food insecurity may influence stunting through multiple pathways, including reduced dietary quality, caregiver stress, and competing household expenditures. These findings further support national and regional evidence linking poverty and structural deprivation to persistent child undernutrition (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent diarrheal illness was independently associated with a markedly increased risk of stunting, highlighting the powerful role of acute infections in growth faltering among HIV-positive children. Large cohort studies in sub-Saharan Africa demonstrate that repeated diarrheal episodes substantially increase the risk of stunting in early childhood (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). HIV-infected children are particularly vulnerable due to increased frequency and severity of diarrheal disease, compounded by impaired gut integrity and immune dysfunction (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). These findings support the WHO conceptual framework on child undernutrition, which emphasizes the role of infectious morbidity as an immediate cause of growth failure (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChildren without health insurance coverage had significantly greater odds of stunting compared to those with insurance, underscoring the importance of financial access to healthcare as a determinant of nutritional outcomes. Evidence from Rwanda indicates that enrollment in community-based health insurance schemes is associated with significantly lower odds of stunting, regardless of household poverty status (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The challenges and solutions for financial sustainability of Rwanda\u0026rsquo;s universal health insurance further highlight the potential impact of insurance coverage on child nutritional outcomes (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Similar findings across sub-Saharan Africa demonstrate that health insurance improves utilization of preventive and nutritional services, thereby reducing child undernutrition (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These results align with broader frameworks identifying access to healthcare as a key underlying determinant of child malnutrition (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMany variables that were significant in bivariate analysis lost significance in multivariate models, reflecting important mediating relationships. For example, caregiver marital status likely influenced stunting indirectly through socioeconomic pathways rather than direct caregiving practices. Similarly, the association between tuberculosis history and stunting appeared to be mediated by immune status (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). These findings emphasize the complexity of growth determinants among children living with HIV and the need for multidimensional intervention strategies.\u003c/p\u003e \u003cp\u003eOverall, our findings support a conceptual model in which HIV-associated stunting arises from overlapping biological, nutritional, and socioeconomic vulnerabilities. They provide strong justification for integrating nutrition-specific and nutrition-sensitive interventions into pediatric HIV care and for strengthening social protection mechanisms to address food insecurity among vulnerable households. Future research should explore the cost-effectiveness of bundled interventions addressing both clinical and structural determinants of stunting among children living with HIV.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eDespite its contributions, the study has some limitations that should be noted.\u003c/p\u003e \u003cp\u003eBecause all primary data comes from a cross-sectional study, it captures data at just one point in time, and we could not determine causation. For this reason, while we noted associations, we cannot state that certain factors caused stunting. In order to see changes over time and determine causation, longitudinal studies would be required. In addition, the dietary consumption and food security data were all based on caregivers' recollection, which is affected by recall bias. For this reason, reporting of usual dietary patterns or food insecurity may have been inaccurate.\u003c/p\u003e \u003cp\u003eRwanda.\u003c/p\u003e \u003cp\u003eThe study emphasized on assessing household food security however not all-important socio-economic measures, like actual household income or Ubudehe categories, were assessed due to lack of information. These are known strong determinants of nutritional outcomes, as well as poverty within the Rwandan context. Their exclusion or lack of adequate detail may have restricted our understanding of socio-economic aspects that are impacting stunting, and increased chance of unmeasured confounding within the associations we observed. Additionally, key breastfeeding variables (e.g., exclusive breastfeeding duration, total breastfeeding duration) and antenatal mother services variables (e.g., number and timing of antenatal care visits, listed content of ANC services) were not captured through this project. These early life and maternal health aspects are considered to have strong effects on child nutritional status, and it is possible they confounded the associations we observed. Additionally, the analysis was further limited by the potential for other unmeasured confounding (e.g., the full range of opportunistic infections, specific micronutrient deficiency, and water, sanitation, breastfeeding status and hygiene (WASH).\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe findings of the study indicate that stunting in HIV-positive children in Rwanda is a significant public health issue with a high prevalence of 45.49%. The analysis highlighted that stunting is not attributed to one or two risk factors, but rather a series of independent and inter-related risk factors that must be dealt with at the same time. The most prominent predictors were a recent diarrheal event and food insecurity, both of which are known to be strongly linked to malnutrition and impaired growth. Additionally, poor ART adherence was a vital predictor, with the analysis suggesting that the influence of adherence was not mediated by viral load, which itself was rendered statistically non-significant after controlling for ART adherence. Similarly, the socioeconomic variables played a more substantial role in predicting stunting, with both lack of health insurance and not eating vegetables found to independently increase the odds of stunting. These findings support the need for a comprehensive, multi-sectoral response that utilizes traditional clinical care alongside public health activities that promote improvements in nutrition, hygiene, and healthcare access.\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eIn accordance with the findings of the study, the following recommendations are offered to policymakers, providers of healthcare, and future researchers in Rwanda.:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eIdentified factors\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eRecommendations\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eResponsible\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePrevalence of stunting is high among children infected with HIV especially\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eDevelop and promote concrete and formalized mechanisms to coordinate the health, agriculture, social protection, and education sectors, as together they provide a holistic and coordinated response to child stunting.\u003c/p\u003e \u003cp\u003eTarget public health initiatives on young children since this may be an important time window for prevention of stunting, such as emphasizing routine growth monitoring at the community level, vaccinations, and acute illness early intervention.\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eMOH\u003c/p\u003e \u003cp\u003eMINALOC\u003c/p\u003e \u003cp\u003eMINAGRI\u003c/p\u003e \u003cp\u003eMOH\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eLack of Medical health insurance\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eStrengthen Health Insurance Coverage for HIV‑Affected Households.\u003c/p\u003e \u003cp\u003eTo strengthen financial protection and health system access in order to optimize growth outcomes for children with HIV, while simultaneously exploiting access to financial protection and health system access to offer preventive and growth-enhancing services, integral to a continuum of care.\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eMOH \u0026amp; PARTNERS\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eFair and Poor ART adherence\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003ereview and improve existing and scale up innovative adherence support strategies including peer support groups, differentiated service delivery, and individualized follow-up for children and their caregivers with a concentration on achieving adherence and retention on ART.\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eRBC/HIV Division\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eDietary factors, especially Lack of vegetables intake\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eHighlight the importance of recognizing the importance of continuous vegetable consumption for micronutrients during nutritional counselling.\u003c/p\u003e \u003cp\u003eImprove or integrate available nutrition prevention program in ARV pediatric services support, gardening initiatives to increase household access to varied vegetables.\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eHealth care providers\u003c/p\u003e \u003cp\u003eRBC/HIV Division\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eFood insecurity\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eDevelop and promote linkages between HIV care support services and household food security programmes (e.g., social protection schemes such as Ubudehe, livelihood support, microfinance, agricultural training) for under-resourced and vulnerable HIV-affected households.\u003c/p\u003e \u003cp\u003ePlace emphasis on nutritional support and education for vulnerable populations, especially food insecure populations and populations with extensive history of recurring illness.\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eMOH/RBC\u003c/p\u003e \u003cp\u003e\u0026amp;PARTNERS\u003c/p\u003e \u003cp\u003eHealth care providers\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eRecent diarrhea\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eTo support integration of water, sanitation and hygiene (WASH) interventions within HIV care packages which included, as routine, oral rehydration salts and zinc, and strengthen community management of diarrhea.\u003c/p\u003e \u003cp\u003eEmphasizing routine vaccinations, and acute illness early intervention.\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eHealth care providers in collaboration with RBC\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eLong duration on ART (\u0026gt; 5 years)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eConduct qualitative and quantitative research to better understand the pathways linking the uses of long-term ART and stunting. For qualitative investigations, it may investigate whether class of drugs are an influential factor or the role of co-existing conditions.\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eMOH/RBC\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMissing of key variables of the Study\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eUndertake longitudinal studies to identify causal links, empirical and economic evaluation of integrated intervention packages, and qualitative studies to further understand adherence and dietary barriers to change behaviour and practice in Rwanda.\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eMOH/RBC\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"ACRONYMS AND ABBREVIATIONS","content":"\u003cp\u003e \u003cstrong\u003eART\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAntiretroviral therapy\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eHIV\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eAIDS\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAcquired immunodeficiency syndrome\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eIYCF\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eInfant and young child feeding\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eWHO\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eUNICEF\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eUnited Nations Children's Fund\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eFAO\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eFood and Agriculture Organization of the United Nations\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eFIES\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eFood Insecurity Experience Scale\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eMOH\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eMinistry of Health, Rwanda\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eMINALOC\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eMinistry of local Government, Rwanda\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eMINAGRI\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eMinistry of agriculture and Animal Resources, Rwanda\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eRBC\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eRwanda biomedical center\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConsent for Publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Statement\u003c/h2\u003e \u003cp\u003eThis study did not receive any external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJean Luc Benimana and Placide Shema Niyonshuti contributed to all components of the manuscript and acted as guarantors of the study. Pascal Mugemangango and Israel Cyubahiro Munyambaraga provided oversight and technical guidance to ensure the overall quality of the research. Pasteur Dushimimana made substantial contributions to the study conception, data collection, data analysis, interpretation of findings, and manuscript drafting. All authors critically reviewed and approved the final manuscript and accept responsibility for the integrity and accuracy of the work in its entirety.\u003c/p\u003e\u003ch2\u003eAcknowledgment\u003c/h2\u003e \u003cp\u003eWe gratefully acknowledge the University of Rwanda and the Rwanda Biomedical Center for providing the support and conducive research environment that made this study possible. Their dedication to strengthening research capacity and improving public health in Rwanda was instrumental in the successful completion of this work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003e The data used in this study were obtained from an existing national health database generated by the Rwanda Biomedical Center (RBC) as part of a study on nutrition, food security, and vulnerability among people living with HIV in Rwanda. The dataset contains sensitive health information and is therefore not publicly available. Access to the data may be granted upon reasonable request and with permission from the Rwanda Biomedical Center, subject to ethical approval and data-sharing regulations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. Stunting in a nutshell [Internet]. 2015 [cited 2025 Aug 7]. 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Available from: www.ej-clinicmed.orgDOI:http://dx.doi.org/10.24018/\u003c/li\u003e\n\u003cli\u003eHabimana J de D, Uwase A, Korukire N, Jewett S, Umugwaneza M, Rugema L, et al. Prevalence and Correlates of Stunting among Children Aged 6\u0026ndash;23 Months from Poor Households in Rwanda. Int J Environ Res Public Health. 2023 Mar 1;20(5).\u003c/li\u003e\n\u003cli\u003eSunday FX, Ilinde DN, Izabayo Rudatinya P, Kwizera P, Kanimba P, Rutayisire R, et al. Factors affecting nutritional status among children aged below five years in Rwanda\u0026rsquo;s Western and Southern Provinces. BMC Public Health. 2024 Dec 1;24(1).\u003c/li\u003e\n\u003cli\u003eWHO. Concurrent problems and short-term consequences Long-term consequences Child Consequences. 2017.\u003c/li\u003e\n\u003cli\u003eMOH. REPUBLIC OF RWANDA MINISTRY OF HEALTH. 2022.\u003c/li\u003e\n\u003cli\u003eWHO. Child growth standards. 2006.\u003c/li\u003e\n\u003cli\u003eWHO. Growth reference data for 5-19 years [Internet]. 2007 [cited 2025 Aug 16]. Available from: https://www.who.int/tools/growth-reference-data-for-5to19-years/application-tools\u003c/li\u003e\n\u003cli\u003ePatient monitoring guidelines for HIV care and antiretroviral therapy (ART). World Health Organization; 2006.\u003c/li\u003e\n\u003cli\u003eFAO. The Food Insecurity Experience Scale [Internet]. 2016 [cited 2025 Aug 3]. Available from: https://www.fao.org/in-action/voices-of-the-hungry/fies/en/\u003c/li\u003e\n\u003cli\u003eMichael Kutner, Christopher, J.C. Nachtsheim, John Neter. In Applied Linear Statistical Models. 2005.\u003c/li\u003e\n\u003cli\u003eWu F, Simonetti FR. Learning from Persistent Viremia: Mechanisms and Implications for Clinical Care and HIV-1 Cure. Vol. 20, Current HIV/AIDS Reports. Springer; 2023. p. 428\u0026ndash;39.\u003c/li\u003e\n\u003cli\u003eKalinda C, Qambayot MA, Ishimwe SMC, Regnier D, Bazimya D, Uwizeyimana T, et al. Leveraging multisectoral approach to understand the determinants of childhood stunting in Rwanda: a systematic review and meta-analysis. Vol. 13, Systematic Reviews. BioMed Central Ltd; 2024.\u003c/li\u003e\n\u003cli\u003eNshimyiryo A, Hedt-Gauthier B, Mutaganzwa C, Kirk CM, Beck K, Ndayisaba A, et al. Risk factors for stunting among children under five years: A cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health. 2019 Feb 11;19(1).\u003c/li\u003e\n\u003cli\u003eSoliman A, De Sanctis V, Alaaraj N, Ahmed S, Alyafei F, Hamed N, et al. Early and long-term consequences of nutritional stunting: From childhood to adulthood. Acta Biomedica. 2021 Mar 5;92(1).\u003c/li\u003e\n\u003cli\u003eSimms V, McHugh G, Dauya E, Bandason T, Mujuru H, Nathoo K, et al. Growth improvement following antiretroviral therapy initiation in children with perinatally-acquired HIV diagnosed in older childhood in Zimbabwe: a prospective cohort study. BMC Pediatr. 2022 Dec 1;22(1).\u003c/li\u003e\n\u003cli\u003eSutcliffe CG, van Dijk JH, Munsanje B, Hamangaba F, Sinywimaanzi P, Thuma PE, et al. Weight and height z-scores improve after initiating ART among HIV-infected children in rural Zambia: A cohort study. BMC Infect Dis. 2011 Mar 1;11.\u003c/li\u003e\n\u003cli\u003eMorales F, Montserrat-de la Paz S, Leon MJ, Rivero-Pino F. Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children\u0026rsquo;s Health Status: A Literature Review. Vol. 16, Nutrients. Multidisciplinary Digital Publishing Institute (MDPI); 2024.\u003c/li\u003e\n\u003cli\u003eNyandekwe M, Nzayirambaho M, Kakoma JB. Universal health insurance in rwanda: Major challenges and solutions for financial sustainability case study of rwanda community-based health insurance part i. Pan African Medical Journal. 2020;37:1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eGupta KB, Gupta R, Atreja A, Verma M, Vishvkarma S. Tuberculosis and nutrition. Vol. 26, Lung India \u0026bull;. 2009.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Stunting, HIV, Associated Factors, Malnutrition, ART Adherence, Food Security","lastPublishedDoi":"10.21203/rs.3.rs-8639730/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8639730/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eStunting, remains a major global public health problem, For children living with HIV, the burden is exacerbated, with prevalence rates ranging from 35% to 60% in Sub-Saharan Africa. While Rwanda has made progress in reducing general childhood stunting (from 38% in 2015 to 33% in 2020), specific data on factors associated with stunting among children living with HIV is limited, despite this vulnerable group is facing increased risks due to their condition.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA Retrospective cross-sectional study was conducted using secondary data from an existing health database of children living with HIV/AIDS in Rwanda for the year 2022. All eligible children under 15 years equal to 776 were included in the Analysis. Data on anthropometry, clinical, socio-economic and nutritional factors were extracted. Data were analysed using anthropometric references from WHO (Anthro\u0026amp; Anthro Plus), chi-square test, Bivariate and Multivariate logistic regression analysis was performed to identify independent factors associated with stunting, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe median age of study participants was 11 years (IQR: 8\u0026ndash;13 years). female represented 53.35% (414), and males 46.65% (362). The overall prevalence of stunting was 45.49% Multivariate analysis revealed several factors independently associated with significantly increased odds of stunting. These included: Food insecurity (Adjusted Odds Ratio [AOR]\u0026thinsp;=\u0026thinsp;9.26 (95% CI: 6.12\u0026ndash;14.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Recent diarrhoea (AOR\u0026thinsp;=\u0026thinsp;6.80, 95% CI: 4.16\u0026ndash;11.12, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). having taken ART for more than 5 years (AOR\u0026thinsp;=\u0026thinsp;3.22, 95% CI: 1.63\u0026ndash;6.34, p\u0026thinsp;=\u0026thinsp;0.001), lacking health insurance (AOR\u0026thinsp;=\u0026thinsp;2.53, 95% CI: 1.39\u0026ndash;4.60, p\u0026thinsp;=\u0026thinsp;0.002), Fair/poor ART adherence (3.81 CI:1.85\u0026ndash;7.86,p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (AOR\u0026thinsp;=\u0026thinsp;1.97, 95% CI: 1.13\u0026ndash;3.44, p\u0026thinsp;=\u0026thinsp;0.017), and lack of vegetable consumption (AOR\u0026thinsp;=\u0026thinsp;1.78, 95% CI: 1.15\u0026ndash;2.76, p\u0026thinsp;=\u0026thinsp;0.010). children in the 5\u0026ndash;9-year age group had significantly lower odds of stunting compared to the reference group (AOR\u0026thinsp;=\u0026thinsp;0.19, 95% CI: 0.09\u0026ndash;0.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eStunting remains a significant public health challenge among children living with HIV in Rwanda, driven by a complex interplay of clinical factors (ART adherence), and nutritional and socio-economic determinants (vegetable consumption, and household food insecurity, Lack of medical insurance). Effective interventions must be multi-faceted, integrating robust HIV clinical management with targeted nutritional support and comprehensive food security programs to improve growth outcomes and overall well-being in this vulnerable population.\u003c/p\u003e","manuscriptTitle":"Prevalence of stunting and its associated factors among children living with HIV/AIDS in Rwanda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 10:58:30","doi":"10.21203/rs.3.rs-8639730/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-27T18:51:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"292586799667356582536528874661976762032","date":"2026-02-17T11:27:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T12:06:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"141835282626440784859071191324007883742","date":"2026-02-13T16:35:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169000937391601755325496819706789106321","date":"2026-02-12T09:38:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336933943021257805380410203963267593259","date":"2026-02-11T16:34:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T06:38:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-23T12:33:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-23T08:42:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-23T08:39:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2026-01-19T12:37:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c7b96379-d1e0-40bc-bdb7-8c46617fc989","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T10:58:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 10:58:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8639730","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8639730","identity":"rs-8639730","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}