Child disciplining practices and their association with child stunting in Rwanda: insights from a population-based study

This study investigated the prevalence of physical and non-physical disciplining methods used by mothers of young children in Rwanda and examined their association with child stunting. The role of disciplining practices in child linear growth remains largely overlooked in interventions across low- and middle-income countries, including Rwanda, despite growing attention to psychosocial factors. This cross-sectional study, conducted between November 15 and December 31, 2021, included 601 mother-child pairs selected through systematic random sampling. Child disciplining practices were assessed using the UNICEF Multiple Indicator Cluster Surveys questionnaire. Stunting, defined as chronic undernutrition during critical growth periods that leads to impaired growth and development, was measured using WHO standards (height-for-age Z score <-2 SD). Child disciplining methods were categorized into two types: physical (e.g., hitting or spanking) and non-physical (e.g., shouting or yelling). Multivariable logistic regression assessed the association between disciplining methods and stunting, adjusting for socioeconomic factors, IPV, and social support. The study included predominantly low-income, married mothers, >30 years old, with low educational attainment, and working in unskilled jobs as defined by the national occupational classification. Physical disciplining methods were used by 76.5% (n=449) of mothers, while 38.3% (n=225) used non-physical methods. Younger mothers used physical methods more than older ones (p=0.002). Mothers exposed to physical and sexual intimate partner violence (IPV) had a higher likelihood of using physical methods (p<0.001 and p=0.036, respectively). Exposure to psychological IPV was significantly associated with both non-physical (p=0.025) and physical methods (p=0.004). Of the 601 children, 27.1% (n=163) were stunted; 88.3% (n=144) were >1 year old. The odds of stunting were higher in older children subjected to both physical and non-physical methods (odds ratio [OR], 1.92; 95% confidence interval, 1.08-3.41). Using both disciplining methods was most strongly associated with stunting, with adjusted ORs ranging from 1.96 to 2.04.Findings suggest disciplining methods may contribute to the risk of stunting, especially in older children in Rwanda. These findings highlight the urgent need for positive parenting education, child abuse prevention, and the integration of child protection screening into routine healthcare services in Rwanda.