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

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.