A Mixed-Methods Cohort Study Evaluating the Impact of a One-Day Well-Being Course for Anesthesia Providers Working in Low-Resource Settings.

BACKGROUND: Burnout, depression, and anxiety are increasingly recognized as common among health care providers. Risks for these conditions are exacerbated in low-resource settings by excessive workload, high disease burden, resource shortage, and stigma against mental health issues. Based on discussions and requests to learn more about burnout during the Vital Anaesthesia Simulation Training (VAST), our team developed VAST Wellbeing, a 1-day course for health care providers in low-resource settings to recognize and mitigate burnout and to promote personal and professional well-being. METHODS: This mixed-methods study used quantitative pre- and postcourse surveys using validated mental health measures and qualitative semistructured interviews to explore participants' experience of VAST Wellbeing during and after the course. Quantitative outcomes included burnout and professional fulfillment as measured by the Professional Fulfillment Index and general well-being as measured by the Warwick-Edinburgh Mental Wellbeing Scale. RESULTS: Twenty-six participants from 9 countries completed the study. In the immediate postcourse survey, study participants rated the course overall as "very good" (60.7%) and "excellent" (28.6%). Quantitative analysis showed no statistical differences in levels of work exhaustion, interpersonal disengagement, burnout, professional fulfillment, or general mental well-being 2 months after the course. Five themes on the impact of VAST Wellbeing were identified during qualitative analysis: (1) raising awareness, breaking taboos; (2) not feeling alone; (3) permission and capacity for personal well-being; (4) workplace empowerment; and (5) VAST Wellbeing was relevant, authentic, and needed. CONCLUSIONS: Causes of burnout are complex and multidimensional. VAST Wellbeing did not change measures of burnout and fulfillment 2 months postcourse but did have a meaningful impact by raising awareness, reducing stigma, fostering connection, providing skills to prioritize personal well-being, and empowering people to seek workplace change.

Clients' satisfaction of maternity care at a public referral teaching hospital, in Rwanda: case of University Teaching Hospital of Butare (CHUB).

Introduction: maternal satisfaction is the key in health facilities utilization and so improving the birth outcome and reducing maternal morbidity and mortality. The main objective of this study was to assess women´s satisfaction with perinatal care provided in maternity at CHUB with its associated factors. Methods: a cross-sectional study was done at maternity of CHUB on clients´ satisfaction of maternity care. With a sample size of 422 mothers who were admitted for labor and delivery from July 1st to October 31st 2020. Data were collected using a structured questionnaire and client's satisfaction (eight questions (CSQ-8). Every respondent had to answer all questions under guidance of a data collector. Excel, Stata and SPSS were used for data entry and data analysis. Chi-squared and multivariate regressions were used for analysis of the association. Results: eighty-nine point thirty four (89.34%) percent of our respondents reported that services they received helped them to deal more effectively with their problems; and they were most satisfied with a mean score of 3.9 (97.5%) and least satisfied with the fact that they were not allowed to decide themselves in their management, with a mean score of 3.1 (77.5%). The overall satisfaction of our respondent's equals to the mean score is 28.4/32= 88.75%. Factors found to affect mothers´ satisfaction were respecting mother´s privacy & values and allowing them to take decision and consenting before procedure. Conclusion: the majority of mothers were satisfied with received services. Respecting patients´ privacy and allowing them to participate in decision-making were two factors associated with high satisfaction.

Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality.

PURPOSE: Few studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda. MATERIALS AND METHODS: This was a retrospective cohort study in two public academic referral hospitals in Rwanda. Data was abstracted from paper medical records of adult patients who met our criteria for sepsis. RESULTS: Of the 181 subjects who met eligibility criteria, 111 (61.3%) met our criteria for sepsis without shock and 70 (38.7%) met our criteria for septic shock. Thirty-five subjects (19.3%) were known to be HIV positive. The vast majority of septic patients (92.7%) received intravenous fluid therapy (median = 1.0 L within 8 hours), and 94.0% received antimicrobials. Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation. In-hospital mortality for all patients with sepsis was 51.4%, and it was 82.9% for those with septic shock. Baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity. CONCLUSIONS: Septic patients in two public tertiary referral hospitals in Rwanda are young (median age = 40, IQR = 29, 59) and experience high rates of mortality. Predictors of mortality included baseline clinical characteristics and HIV seropositivity status. The majority of subjects were treated with intravenous fluids and antimicrobials. Further work is needed to understand clinical and management factors that may help improve mortality in septic patients in LICs.

Barriers and facilitators to postoperative pain management in Rwanda from the perspective of health care providers: A contextualization of the theory of planned behavior.

AIMS: Identify opportunities to improve knowledge translation for post-operative pain management in Rwanda by exploring clinician and environmental factors affecting this practice. METHODS: The theory of planned behavior (TPB) guided development of a questionnaire to measure intent to assess and treat postoperative pain. Focus groups and individual interviews were used to contextualize the final questionnaire and generate questions related to pain management practice. Health care providers from two Rwandan teaching hospitals involved in postoperative pain management completed the TPB questionnaire in May 2015. TPB subscale scores were analyzed to identify demographic and practice characteristics associated with intention to treat pain. The general linear model was used to test effect of attitudes, subjective norms, and perceived control on behavioral intent to treat pain. RESULTS: Forty-six percent of participants (N = 131) had training in acute pain management, 56% used a pain protocol, and 74% used pain scales. Tramadol (78%), morphine (79%), and paracetamol (75%) were used most often to treat pain. Drug availability was the most frequently reported barrier to treating pain. Though intention to treat pain was high, only attitudes and perceived control about assessing pain were associated with intention to treat pain. The theme of fear of the adverse effects of pain medications was consistent across focus groups and interviews in both sites. CONCLUSIONS: System and knowledge barriers exist: interventions to address these barriers may lead to improved postoperative pain care. Further validation of the TPB questionnaire is required to address cultural and language factors specific to the Rwandan context.

But: Améliorer le transfert des connaissances en matière de prise en charge de la douleur postopératoire au Rwanda en étudiant les facteurs environnementaux et les facteurs liés aux cliniciens qui affectent cette pratique.Méthodes: La théorie du comportement planifié (TCP) a guidé l'élaboration d'un questionnaire visant à mesurer l'intention d'évaluer et de traiter la douleur postopératoire. Des groupes de discussion et des entrevues individuelles ont été utilisées afin de contextualiser le questionnaire final et formuler des questions portant sur les pratiques en matière de gestion de la douleur. Les prestataires de soins de deux hôpitaux universitaires rwandais impliqués dans la prise en charge de la douleur postopératoire ont répondu au questionnaire fondé sur la TCP en mai 2015. Les scores obtenus pour les sous-échelles ont été analysés afin de cerner les caractérisriques démographiques et les caractéristiques liées aux pratiques qui étaient associées à l'intention de traiter la douleur. Le modèle linéaire général a été utilisé afin de tester l'effet des attitudes, des normes subjectives et du contrôle perçu sur l'intention comportementale de traiter la douleur.Résultats: Quarante-six pour cent des participants (N = 131) avaient une formation en prise en charge de la douleur aigue, 56 % utilisaient un protocole de prise en charge de la douleur et 74 % utilisaient des échelles d'évaluation de la douleur. Le tranadol (78 %), la morphine (79 %) et le paracétamol (75 %) étaient le plus souvent utilisés pour traiter la douleur. La disponibilité des médicaments était la barrière au traitement de la douleur la plus fréquemment citée. Bien que l'intention de traiter la douleur était élevée, seules les attitudes et le contrôle perçu au sujet de l'évaluation de la douleur étaient associés à l'intention de traiter la douleur. Le thème de la peur des effets indésirables des médicaments contre la douleur a été soulevé dans tous les groupes de discussions et les entrevues tenus dans les deux sites.Conclusions: Il existe des barrières systémiques et des barrières liées aux connaissances : des interventions visant à lever ces barrières pourraient mener à l'amélioration des soins postopératoires. Le questionnaire fondé sur la TCP doit être validé davantage afin d'aborder les facteurs liés à la culutre et au langage spécifiques au contexte rwandais.

Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda.

High rates of maternal mortality remain a widespread problem in the developing world. Skilled anesthesia providers are required for the safe conduct of Cesarean delivery and resuscitation during obstetrical crises. Few anesthesia providers in low-resource settings have access to continuing education. In Rwanda, anesthesia technicians with only three years of post-secondary training must manage complex maternal emergencies in geographically isolated areas. The purpose of this special article is to describe implementation of the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in Rwanda, a three-day refresher course designed to improve obstetrical anesthesia knowledge and skills for practitioners in low-resource areas. In addition, we describe how the course facilitated the knowledge-to-action (KTA) cycle whereby a series of steps are followed to promote the uptake of new knowledge into clinical practice. The KTA cycle requires locally relevant teaching interventions and continuation of knowledge post intervention. In Rwanda, this meant carefully considering educational needs, revising curricula to suit the local context, employing active experiential learning during the SAFE Obstetric Anesthesia course, encouraging supportive relationships with peers and mentors, and using participant action plans for change, post-course logbooks, and follow-up interviews with participants six months after the course. During those interviews, participants reported improvements in clinical practice and greater confidence in coordinating team activities. Anesthesia safety remains challenged by resource limitations and resistance to change by health care providers who did not attend the course. Future teaching interventions will address the need for team training.