Influence of maternal knowledge of causes and consequences of stunting on infant and young child feeding practices in Rwanda

Stunting affects 149.2 million children globally, with Rwanda experiencing 33% prevalence among children under five years. Poor infant and young child feeding (IYCF) practices driven by maternal knowledge gaps exacerbate this challenge. Limited nationally representative data exist examining the comprehensive relationships between maternal knowledge and feeding practices in Rwanda. This study assessed mothers' and caregivers' knowledge of stunting causes and consequences and their association with IYCF practices. A cross-sectional study among 2286 mothers and caregivers across 10 districts assessed knowledge of stunting causes (19 items), understanding of consequences (12 items), and IYCF practices (12 items) using WHO/UNICEF guidelines. Three-stage stratified cluster sampling ensured national representativeness. Multivariable logistic regression identified factors associated with inadequate IYCF practices. Among participants (99.0% response rate), 46.4% had low knowledge of stunting causes, particularly infection-related factors. Additionally, 43.5% showed an inappropriate understanding of consequences, especially developmental impacts. IYCF practices were suboptimal: 60.5% demonstrated inadequate practices, and only 29.6% achieved a minimum acceptable diet. Significant predictors included rural residence (AOR = 2.30, 95% CI 1.95-2.91), no formal education (AOR = 4.36, 95% CI 3.04-6.26), young maternal age (AOR = 1.40, 95% CI 1.05-1.85), widowhood (AOR = 4.94, 95% CI 2.28-10.72), and lower socioeconomic status (AOR = 1.59-1.60, 95% CI 1.28-2.20). Low knowledge increased odds 2.43-fold (95% CI 1.81-3.27), while poor understanding increased odds 2.31-fold (95% CI 1.85-2.89) of inadequate practices. Among caregivers of stunted children, substantial knowledge gaps regarding stunting causes and consequences persist, particularly among vulnerable rural populations. The strong associations between maternal knowledge deficits and inadequate feeding practices provide compelling evidence for targeted health and nutrition education interventions addressing specific knowledge gaps, combined with structural support to reduce childhood stunting in Rwanda.