Increasing access to pediatric surgical care: Assessing district hospital readiness in rural Rwanda.

Introduction/Background: Safe and quality surgery is crucial for child health. In Rwanda, district hospitals serve as primary entry points for pediatric patients needing surgical care. This paper reports on the organizational readiness and facility capacity to provide pediatric surgery in three district hospitals in rural Rwanda. Methods: We administered the Children's Surgical Assessment Tool (CSAT), adapted for a Rwandan district hospital, to assess facility readiness across 5 domains (infrastructure, workforce, service delivery, financing, and training) at three Partners in Health supported district hospitals (Kirehe, Rwinkwavu, and Butaro District Hospitals). We used the Safe Surgery Organizational Readiness Tool (SSORT) to measure perceived individual and team readiness to implement surgical quality improvement interventions across 14 domains. Results: None of the facilities had a dedicated pediatric surgeon, and the most common barriers to pediatric surgery were lack of surgeon (68%), lack of physician anesthesiologists (19%), and inadequate infrastructure (17%). There were gaps in operating and recovery room infrastructure, and information management for pediatric outpatients and referrals. In SSORT interviews (n=47), the highest barriers to increasing pediatric surgery capacity were facility capacity (mean score=2.6 out of 5), psychological safety (median score=3.0 out of 5), and resistance to change (mean score=1.5 out of 5 with 5=no resistance). Conclusions: This study highlights challenges in providing safe and high-quality surgical care to pediatric patients in three rural district hospitals in Rwanda. It underscores the need for targeted interventions to address facility and organizational barriers prior to implementing interventions to expand pediatric surgical capacity.

Cardiac Surgery: Increasing Access in Low- and Middle-Income Countries.

PURPOSE OF THE REVIEW: Low- and middle-income countries (LMICs) have long-battled communicable diseases, and now, a rise in non-communicable diseases (NCD) is conferring tremendous burden in these areas. Cardiovascular disease (CVD) remains the number one cause of death among NCDs across the globe. The current review provides insight regarding this disease burden and highlights challenges as well as strategies for establishing functional cardiac surgery centers and sustainable access to comprehensive cardiovascular care within LMICs. RECENT FINDINGS: Without effective prevention and treatment strategies, estimates suggest that deaths from CVDs will reach 24 million by the year 2030. Surgery exists as a limited option for selected patients with advanced cardiac disease in LMICs in comparison with its availability in developed countries. Multi-lateral or public-private initiatives, government investment, philanthropic efforts, innovative financing systems to strengthen Universal Health Coverage, and expansion of training options through centers of excellence appear to be the way forward to broadening the availability of cardiovascular services, inclusive of surgery, to LMICs.

Factors associated with tungiasis among primary school children: a cross-sectional study in a rural district in Rwanda.

BACKGROUND: Tungiasis is a relatively frequent ectoparasitosis in low-income settings, yet its morbidity and social impact are still not well understood due to the scarcity of information. In Rwanda, data on the magnitude and conditions leading to the tungiasis is rare. This study sought to determine the prevalence and factors associated with tungiasis among primary school children in Rwandan setting. METHOD: A descriptive cross-sectional study utilising systematic random sampling method was adopted to select 384 children from three primary schools. From July to October 2018, data were collected on socio-demographic characteristics of children, parents, and households. Logistic regression was applied to analyse socio-demographic factors associated with tungiasis with a level of significance set at P-value< 0.05. RESULTS: Prevalence of tungiasis among three primary schools was 23%. Factors associated with tungiasis included walking barefoot (AOR: 78.41; 95% CI: 17.91-343.10), irregular wearing of shoes (AOR: 24.73; 95% CI: 6.27-97.41), having dirty feet (AOR: 12.69; 95% CI: 4.93-32.64), wearing dirty clothes (AOR: 12.69; 95% CI: 4.18-38.50), and living in a house with earthen plastered floor (AOR: 28.79; 95% CI: 7.11-116.57). Children infected with tungiasis attended class less frequently (AOR: 19.16, 95%CI: 7.20-50.97) and scored lower (AOR: 110.85, 95%CI: 43.08-285.20) than those non-infected. The low school attendance and poor performance could be partly explained by difficulty of walking, lack of concentration during school activities, and isolation or discrimination from classmates. CONCLUSION: Tungiasis was a public health challenge among school going children in a rural Rwandan setting. This study revealed that children affected with tungiasis had poor hygiene, inadequate housing environments and consequently poor school attendance and performance. Improving socio-economic conditions of households with special emphasis on hygiene of family members and housing conditions, would contribute to preventing tungiasis.

Write-up and dissemination of undergraduate and postgraduate research at the University of Rwanda: a cross-sectional study.

INTRODUCTION: Research is essential in all areas of health development. However, medical students and residents frequently lack the time and training on performing research. This is especially prevalent in resource-limited settings. We aimed to compare the word counts of undergraduate and postgraduate dissertations with published projects in Rwanda, and to identify the proportion of postgraduate pediatric research projects that have been published since 2012. METHODS: Retrospective, cross-sectional study of undergraduate and postgraduate research dissertations at the University of Rwanda. Dissertations were then compared to randomly selected published papers of Rwandan research. Each IMRaD (Introduction, Methodology, Results and Discussion) section word count was compared using Student's t-test. RESULTS: 19/190 (10%) undergraduate dissertations and 22/41 (54%) postgraduate dissertations, were available in electronic format for word-count analysis. The mean total word count for postgraduate dissertations (5163 words) was significantly longer (p<0.001) than the randomly selected peer-reviewed journal articles (2959 words). Each section of the IMRaD structure of postgraduate dissertations was significantly longer than those of the control group. Undergraduates used a similar number of words to published papers, but used significantly more tables and figures. Of the 41 postgraduate dissertations, only four (10%), were published in peer-reviewed journals. CONCLUSION: This is the first study to assess the writing style of Rwandan medical students and pediatric postgraduate residents. A simple step to increase dissemination of research findings would be for institutions to modify academic regulations so that students write-up in manuscript form rather than dissertation format.

Perceived attitudes of the importance and barriers to research amongst Rwandan interns and pediatric residents - a cross-sectional study.

BACKGROUND: Globally, interns and residents face significant challenges with respect to research activity. Despite this, they are motivated and have an interest in undertaking research. To date, there has been no research regarding the perceived attitudes towards research activities amongst Rwandan residents and interns. OBJECTIVES: The primary objective of this study was to describe the perceived attitudes regarding the educational benefits and barriers surrounding research activity amongst interns and residents, and to identify any differences between these groups. The secondary objective was to describe the research methods used by interns and residents in Rwanda. METHODS: A cross-sectional descriptive study of interns and pediatric trainees at the University of Rwanda. An online questionnaire using Likert scale questions was sent electronically to eligible participants. RESULTS: A total of sixty participants (38 interns and 22 pediatric residents) responded to the survey. Both groups acknowledged the educational importance of undertaking research, with interns reporting this more than residents. Both groups identified the following as barriers to research: faculty lacking time to mentor, lack of funding, lack of statistical support, and lack of faculty experienced in conducting research. Interns (87%) were much more likely to have undertaken retrospective research than pediatric residents (14%). Few interns or residents submitted their research for publication (27%). CONCLUSIONS: Both interns and residents understood the importance of research, but many barriers exist. Increasing the time available for experienced faculty members to supervise research is challenging due to low faculty numbers. Novel solutions will need to be found as well as expanding the time for trainees to perform research.