Off-campus UNL users: To download campus access dissertations, please use the following link to log into our proxy server with your NU ID and password. When you are done browsing please remember to return to this page and log out.

Non-UNL users: Please talk to your librarian about requesting this dissertation through interlibrary loan.

Linking Child Stunting, Water Quality, and Pathogen Sharing at the Human-Animal-Environment Interface in Rwanda: A One Health Study

Benjamin Ndayambaje, University of Nebraska - Lincoln


Child stunting is a complex global health challenge. The prevalence of stunting remains high in Rwanda, impacting 33% of children under five years of age. Stunting can be associated with individual, family, and community factors as well as environmental factors such as water quality. Limited access to clean drinking water and reliance on surface water shared with livestock and wildlife can expose people to chemical and biological contaminants. Cohabitation of people and livestock can increase risk of zoonotic pathogen sharing, resulting in diarrheal diseases linked to child stunting. To examine relationships among stunting, water quality, and zoonotic pathogen sharing, we used primary data collected in Karongi district in western Rwanda, an area with high stunting prevalence, as well as country-level secondary data. We linked the 2019-2020 Rwanda Demographic and Health Survey with national water quality data and used generalized linear regression to assess demographic, socio-economic, livestock ownership, and water quality factors associated with stunting. Child factors (birth order, age, gender) and household factors (wealth status, mother’s education, location, number of children) were significantly associated with stunting. Water quality (pH) was marginally associated with stunting. We then paired household surveys with sample collection from children, livestock, and drinking water in upstream and downstream communities in the Musogoro River watershed. We assessed physical, biological, and chemical water quality from surface water, public taps, and household drinking water storage containers. We cultured potentially zoonotic pathogens (Campylobacter, E. coli, and Salmonella) from child stool, livestock feces, and drinking water. Surface water and household containers had high levels of chemical (iron and manganese) and biological contaminants. Campylobacter prevalence was high (>60%) across all child, livestock, and water samples. E. coli was detected across samples, with significantly higher prevalence in downstream children and livestock. Salmonella prevalence was significantly higher in downstream livestock. Our results highlight the need for integrated research to assess environmental and animal factors associated with stunting to facilitate development of more holistic household- and watershed-based intervention strategies to improve human, animal, and ecosystem health outcomes.

Subject Area

Epidemiology|Ecology|Environmental science

Recommended Citation

Ndayambaje, Benjamin, "Linking Child Stunting, Water Quality, and Pathogen Sharing at the Human-Animal-Environment Interface in Rwanda: A One Health Study" (2023). ETD collection for University of Nebraska-Lincoln. AAI30489423.