This story was originally published in a longer form by USAID.

Every day, Josephine Mukamana* straps her 18-month-old daughter to her back and walks the short distance from her home to the market. During the walk, she composes a grocery list in her head. There was a time when Josephine’s list would not have included locally grown fruits such as bananas, oranges, pineapple, and passion fruit, but that was before she participated in a nutrition education program at Kibagabaga Hospital in Rwanda’s Gasabo District.

The 11-month program—the first of its kind in the country—was launched in August 2011 in response to survey findings, which showed many children in the district are underweight and malnourished. Malnutrition in children can cause irreversible, long-term damage such as stunted growth and impaired cognitive development, anemia, goiter, and night-blindness.

In Rwanda, 44% of children younger than five-years-old are chronically malnourished, according to 2010 Demographic and Health Survey preliminary results. Many of these children’s diets are too heavy in grains, roots, and tubers. Malnutrition from inadequate protein and calorie intake is the second leading cause of death among Rwandan children, ages one to 14, and the fourth leading cause of death among children less than one-year-old.

“After hospital staff conducted a small survey of malnutrition in the Gasabo area, we discovered that the problem is not so much a lack of food, but rather the choices being made about what to eat. The biggest problem is knowledge. Understanding which foods keep the body healthy and help it grow,” says Dr. Christian Ntizimira, acting director at Kibagabaga Hospital.

The nutrition education program that Josephine participated in aims to combat malnutrition by teaching the Gasabo community about the importance of nutrient-rich foods and how to prepare these foods in the most nutritious way.  At the program launch, Josephine along with 50 mothers accompanied by their children under five received a lesson on nutrition and fruit—the theme of that day’s program. During the program, the women learned about the relationship between nutrition and child growth from birth, the importance of hygiene when preparing food (i.e., hand washing), and the need to include carbohydrates, proteins, and fats—three essential nutrients—in our daily diets.

“I learned that I’m not always preparing nutrient-rich foods like vegetables and fish,” Josephine says, adding that she now regularly includes small fish from the market in the meals she prepares, in addition to carrots, cauliflower, spinach, peppers, and onions.

As part of the program, Josephine also participated in a demonstration of how to prepare a fruit salad using locally available produce. On her way home that evening, Josephine stopped at the market to buy pineapple, bananas, and milk with the 1,000 Rwandan francs (USD 1.70) the hospital gave each woman to bring home the lessons they learned in the classroom.

Although Josephine says she and her husband cannot afford to purchase all the fruits needed to make a salad every day, they buy enough produce to make sure everyone at home eats a banana, an orange, or a piece of pineapple after every meal, in addition to consuming more vegetables and protein on a daily basis—small changes that are starting to make a difference.

“My daughter is happier now [that she’s eating healthier]. She has more energy, and her skin is improving,” Josephine says. Vitamin-deficient skin is prone to developing rashes or becoming dry and thick.

“When others learn more about nutrition it will change the way they live and eat,” Josephine says. “People will realize that their children can be healthy, too.”

In September, the nutritionist at Kibagabaga Hospital took the program to another health center in Gasabo District to give a second educational session. As part of this session, a group of mothers was taught how to make a vitamin-rich stew. The program will offer a third classroom session in October for district community health workers with the aim of encouraging them to talk more about nutrition with their clients. The program aims to reach a different group every month and educate as many families in the district as possible.

In the future, hospital staff also wants to reach schools, local leaders, and public institutions with essential nutritional information to prevent malnutrition and the kinds of non-communicable diseases like diabetes that it can lead to.

The nutrition education program in Rwanda’s Gasabo District was made possible with funding from the USAID-financed HIV/AIDS Clinical Services Program, led by IntraHealth International. For more than 20 years, IntraHealth has been an integral part of USAID’s effort to reduce malnutrition in Rwanda.