Effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices: A cluster-randomized trial.

AIM: The aim of this trial was to evaluate the effects of the Informed Health Choices intervention on the ability of students in Rwandan to think critically and make Informed Health Choices. METHODS: We conducted a two-arm cluster-randomized trial in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools to the intervention or control. One class in each intervention school had ten 40-min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed within 2 weeks after the intervention. We conducted an intention-to-treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts. RESULTS: Between February 25 and March 29, 2022, we recruited 3,212 participants. We assigned 1,572 students and 42 teachers to the intervention arm and 1,556 students and 42 teachers to the control arm. The proportion of students who passed the test in the intervention arm was 915/1,572 (58.2%) compared to 302/1,556 (19.4%) in the control arm, adjusted odds ratio 10.6 (95% CI: 6.3-17.8), p < 0.0001, adjusted difference 37.2% (95% CI: 29.5%-45.0%). CONCLUSIONS: The intervention is effective in helping students think critically about health choices. It was possible to improve students' ability to think critically about health in the context of a competence-based curriculum in Rwanda, despite challenging postpandemic conditions.

Research Participants' Preferences for Individual Results of Pharmacogenomics Research: A Case of a Ugandan HIV Research Institute.

Little is known about whether people living with HIV would like to receive their results from pharmacogenomics research. This study explored the factors influencing participants' preferences and the reasons for their desire to receive individual results from pharmacogenomics research. We employed a convergent parallel mixed methods study design comprising a survey of 225 research participants and 5 deliberative focus group discussions with 30 purposively selected research participants. Almost all (98%) participants wanted to receive individual pharmacogenomics research results. Reasons for the desire to receive results were reciprocity for valuable time and effort, preparing for future eventualities, and the right to information about their health. Overall, participants desire to receive feedback from pharmacogenomics research, particularly if results are well established and clinically actionable.

Proportion of HIV exposed infants aged 0-6 months that missed nevirapine prophylaxis in Mulago National Referral Hospital, Uganda: a cross-sectional study.

Background: Nevirapine prophylaxis has been found to lower the risk of HIV transmission in breast-fed infants. While about 95% of pregnant and lactating mothers use Antiretroviral therapy in Uganda, a smaller percentage of HIV exposed infants (HEI)receive nevirapine (NVP)prophylaxis. This study aimed to determine the proportion of HEI whomissed NVP prophylaxis and associated factors. Methods: This was a cross-sectional study done using quantitative methods. It was conducted at Mulago National Referral Hospital. A total of 228mother-infant pairs were enrolled.The proportion of HEI who missed NVP, maternal, infant and health facility factors associated were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the proportion and factors associated with missing NVP prophylaxis. Results: The proportion of HEI who missed NVP prophylaxis was 50/228(21.9%). Factors significantly associated with HEI missing NVP prophylaxis included; delivery from outside government health facilities [AOR=8.41 95% (CI 3.22-21.99)], mothers; not undergoing PMTCT counselling [AOR=12.01 95% (CI 4.53-31.87)], not on ART[AOR=8.47 95% (CI 2.06-34.88)] and not having disclosed their HIV status to their partners [AOR=2.80 95% (CI 1.13-6.95)].The HEI that missed nevirapine and were HIV positive were 35(70.0%). Conclusion: One in five HEI missed NVP prophylaxis and nearly three quarters of those who missed NVP prophylaxis were HIV infected. Improving uptake of nevirapine by HEI will require interventions tostrengthen PMTCT counselling, assisted partner notification, reduction of HIV stigma and support to the private sector in the provision of PMTCT services.

Teaching critical thinking about health using digital technology in lower secondary schools in Rwanda: A qualitative context analysis.

INTRODUCTION: Adolescents encounter misleading claims about health interventions that can affect their health. Young people need to develop critical thinking skills to enable them to verify health claims and make informed choices. Schools could teach these important life skills, but educators need access to suitable learning resources that are aligned with their curriculum. The overall objective of this context analysis was to explore conditions for teaching critical thinking about health interventions using digital technology to lower secondary school students in Rwanda. METHODS: We undertook a qualitative descriptive study using four methods: document review, key informant interviews, focus group discussions, and observations. We reviewed 29 documents related to the national curriculum and ICT conditions in secondary schools. We conducted 8 interviews and 5 focus group discussions with students, teachers, and policy makers. We observed ICT conditions and use in five schools. We analysed the data using a framework analysis approach. RESULTS: Two major themes found. The first was demand for teaching critical thinking about health. The current curriculum explicitly aims to develop critical thinking competences in students. Critical thinking and health topics are taught across subjects. But understanding and teaching of critical thinking varies among teachers, and critical thinking about health is not being taught. The second theme was the current and expected ICT conditions. Most public schools have computers, projectors, and internet connectivity. However, use of ICT in teaching is limited, due in part to low computer to student ratios. CONCLUSIONS: There is a need for learning resources to develop critical thinking skills generally and critical thinking about health specifically. Such skills could be taught within the existing curriculum using available ICT technologies. Digital resources for teaching critical thinking about health should be designed so that they can be used flexibly across subjects and easily by teachers and students.