Oral health knowledge, attitude and oral hygiene practices among adults in Rwanda

Introduction: oral diseases (OD), commonly dental caries and periodontitis are a major public health problem. Poor oral hygiene has been associated with OD, causing tooth loss, which leads to disability and compromised patients' oral health. In Rwanda, OD is among the leading causes of morbidity at the health center level. Therefore, the purpose of this study was to assess the knowledge, attitude, and oral health practices among adult participants in Rwanda Methods: a descriptive cross-sectional study was done among participants attending public health facilities in Nyarugenge District, Rwanda. Participants were interviewed using a structured questionnaire. The data were analyzed using frequency distribution, percentage distribution, and bivariate and multivariate logistic regression at a 5% significant level. Results: among 426 participants who were interviewed, 39.44% (n=168) were 18-27 years old and the majority, 61.5% (n=262) were female. Poor oral health knowledge was found in 42% (n=179) of the participants, whilst 12.44% (n=53) showed poor oral health attitudes, and 67.37% (n=287) were found to have poor oral health practice. Participants with a high school level of education were more likely to have better oral health knowledge and the results were statistically significant aOR: 1.79, 95% CI 1.14; 2.82; p = 0.011 Conclusion: the findings of our study showed that almost half of the participants had poor oral health knowledge. Oral health attitude and oral hygiene practices were also lacking. There is a need to enhance oral health education in this community to improve their oral health knowledge, attitudes, and practices.

Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study

Physical rehabilitation interventions address functional deficits caused by impairments that affect someone's performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector).Objectives: This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation. Method: Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organizations or faith-based organizations. Results: Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities' catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier. Conclusion: Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families. Contribution: Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda

Insights into vaccine hesitancy from systems thinking, Rwanda

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff ); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings/ A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidencebuilding social structures and context-dependent challenges that affect vaccine uptake were also identified.

Rwandan primary healthcare providers' perception of their capability in the diagnostic practice

Background: Skill-mix imbalance is a global concern for primary healthcare in low-income countries. In Rwanda, primary healthcare facilities (health centres, HCs) are predominantly led by nurses. They have to diagnose a multitude of health complaints. Whether they feel capable of undertaking this responsibility has yet to be explored. Aim: This study explored how healthcare providers (HPs) at Rwandan HCs perceived their capability in the diagnostic practice. Setting: Rural and urban HCs in Muhanga district, Rwanda. Method: Qualitative, semi-structured interviews with nurses and clinical officers, and observations of consultations were made. Findings were analysed thematically. Results: Rwandan HPs were confident in their competences to perform diagnostic procedures although nurses felt that the responsibilities lay beyond their professional training. Clinical officers believed that their professional training prepared them to function competently and autonomously in the diagnostic practice, although all HPs experienced a high dependency on medical history taking, physical examination and laboratory tests for reaching a diagnosis. Resource constraints (time, rooms and laboratory tests) were seen as a barrier to perform diagnostic tasks optimally, and HPs experienced in-service training and supervision as insufficient. They increased their diagnostic competences through work experience, self-learning and supportive peer collaboration. Conclusion: Clinical officers perceived themselves as capable in the diagnostic practice. Nurses may compensate for insufficient school training through in-service learning opportunities and feel capable in the diagnostic practice. Formative mentorship schemes and tailored education may prove valuable, but further research on how to improve HPs' diagnostic capability in Rwanda's primary healthcare sector is needed

Evaluation of a modified South African Triage Score as a predictor of patient disposition at a tertiary hospital in Rwanda

Background: Triage is essential for efficient and effective delivery of care in emergency centers (ECs) where numerous patients present simultaneously with varying acuity of conditions. Implementing EC triage systems provides a method of recognizing which patients may require admission and are at higher risks for poor health outcomes. Rwanda is experiencing increased demand for emergency care; however, triage has not been well studied. The University Teaching Hospital of Kigali (UTH-K) is an urban tertiary care health center utilizing a locally modified South African Triage Score (mSATS) that classifies patients into five color categories. Our study evaluated the utility of the mSATS tool at UTH-K. Methods: UTH-K implemented mSATS in April 2013. All patients aged 15 years or older from August 2015 to July 2016 were eligible for inclusion in the database. Variables of interest included demographic information, mSATS category, patient case type (trauma or medical), disposition from the ED and mortality. Results: 1438 cases were randomly sampled; the majority were male (61.9%) and median age was 35 years. Injuries accounted for 56.7% of the cases while medical conditions affected 43.3%. Admission likelihood significantly increased with higher triage color category for medical patients (OR: Yellow=3.61, p<.001 to Red (with alarm)=7.80, p<.01). Likelihood for trauma patients, however, was not significantly increased (OR:Yellow=.84, p=.75 to Red (with alarm)=1.50, p=.65). Mortality rates increased with increasing triage category with the red with alarm category having the highest mortality (7.7%, OR 18.91). Conclusion: The mSATS tool accurately predicted patient disposition and mortality for the overall ED population. The mSATS tool provided useful clinical guidance on the need for hospital admission for medical patients but did not accurately predict patient disposition for injured patients. Further trauma-specific triage studies are needed to improve emergency care in Rwanda

Transfusion, mortality and hemoglobin level: associations among emergency department patients in Kigali, Rwanda

Background: Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda. Methods: This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013­16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL. Results: Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p=0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51­3.21) as compared to those ≤5.0 mg/dL. Conclusions: No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice

Medical student satisfaction and confidence in simulation-based learning in Rwanda ­ Pre and post-simulation survey research

Introduction: Simulation-based learning (SBL) has been shown to effectively improve medical knowledge, procedural proficiency, comfort with undertaking taught tasks, inter-professional communication, teamwork and teaching skills. This study aimed to evaluate Rwandan medical students' attitudes, satisfaction and confidence level with SBL. Methods: Fifth year medical students at the University of Rwanda were given a short course on paediatric acute care using simulation. The simulation sessions were locally developed cases based on the pRRAPID materials, developed at the University of Leeds (UK). Equipment included low fidelity infant mannequins, basic airway devices, IV access, and monitoring. A four-part, Likert-scale questionnaire was distributed to medical students before and after their four-week simulation program. Results: 57 pre-simulation and 49 post-simulation questionnaires were completed. Confidence in skills increased in all fifteen domains of the questionnaire with the total skill confidence score rising from 44.0 (±12.3) to 56.2 (±8.8) after the simulation-based intervention (p<0.001). Satisfaction and attitudes towards simulation-based learning in this setting were very positive. Conclusion: The simulation-based intervention was well received by students in this setting. Satisfaction was high and the simulation exercise increased the students' confidence. Previous research has demonstrated that SBL is effective and the results of this study now demonstrate that it is well received in our setting. As we move from knowledge-based education to a competency-based education culture, faculties in this setting should invest in providing SBL opportunities throughout the medical school curriculum

An assessment of Nurses' knowledge, attitude and practice of emergency care related to road traffic accident victims at three selected hospitals in Rwanda

Introduction:Quality emergency nursing care is an important variable in reducing death and disability due to road traffic accidents (RTA), yet little is known about emergency nursing care within the Rwandan context. This study aims to describe the knowledge, attitude and practice (KAP) of nurses of the emergency care of RTA patients.Method:We employed a cross sectional design to survey the full cohort of nurses working in Accident and Emergency (A&E) units in three selected Rwandan hospitals (N = 51). Results:This study revealed that the knowledge and practice of nurses is either high or very high and the majority of them (73.657%) had a positive attitude towards emergency management of RTA patients. Being trained before working in A&E units was associated with a significant increase in the likelihood of being at thelevel of practice which is (1) very high (OR = 5.35, 95%, CI = 5.20­5.50), (2) high (OR = 1.60, 95%,CI = 1.17­2.19) (3), moderate (OR = 5.35,95%, CI = 4.15­6.88) and (4) low (OR = 1.33,95%, CI = 1.33­133)and it decreased more than 99.9% the likelihood of being at low level of practice in all levels.Discussion:The study showed that training had a significant effect on practice and this is supported by previousstudies. Training interventions to improve the management of RTA patients by nurses working in A&E should beregularly audited to ensure ongoing quality of care

Clinical and demographic profile of end stage kidney disease hemodialysis patients at University Teaching Hospital of Kigali

BACKGROUND: End stage kidney disease (ESKD) has become a major public health problem and is associated with considerable co-morbidity and mortality. In Rwanda, the extent and the distribution of ESKD have not been reported despite provision of dialysis services. This paper describes the clinical and demographic characteristics of ESKD patients in at a tertiary referral hospital in Rwanda. METHODS: This was a retrospective descriptive study of ESKD hemodialysis patients treated at a tertiary referral hospital from January 2014 to December 2017, start of hemodialysis services to date. Demographic and clinical data were obtained regarding all eligible patients treated. Descriptive statistics were reported using frequency and percent for categorical data; median and Interquartile range (IQR) for continuous data. Analysis of survivors versus non-survivors was performed using Chi-square test for categorical variables and Wilcoxon rank sum test for continuous, nonparametric variables. RESULTS: Over a three-year period, there were 64 patients with ESKD. Median age was 48 years (IQR: 35 to 57.5) and 42 (66%) were male. Edema (n=50, 78%) and anuria (n=40, 63%) were the most common presenting symptoms. Underlying comorbidities of ESKD included hypertension (n= 50, 78%), diabetes (n=24, 38%). Urea (n=52, 81%) and creatinine (n=57, 89%) were elevated in most patients. CONCLUSION: ESKD is a the leading cause of hemodialysis in young adults who would otherwise be contributing to the national development. It is a challenging to clearly establish etiologies as the majority present with more than one comorbidity. Hence healthcare providers should be proactive in prevention and prompt management of chronic kidney disease

Complications in pregnant women with autoimmune diseases

BACKGROUND: Autoimmune diseases complicate pregnancy in several manners. This study aimed at describing the most common complications in pregnant women with autoimmune diseases. METHODS: This was a descriptive and retrospective study. Two groups of pregnant women with autoimmune diseases were included: 1) Those who since the beginning of gestation received obstetrical care at a tertiary-level hospital and 2) Women who were treated first in a medical unit not specialized in rheumatological diseases. Odds ratio, logistic regression and multinomial logistic regression were used to determine risk of complicated pregnancy. RESULTS: The distribution of autoimmune diseases in our sample is as follows: systemic lupus erythematosus (SLE): 6, rheumatoid arthritis (RA): 4, primary anti-phospholipid syndrome (APS): 4, systemic sclerosis (SS): 2, mixed connective tissue disease (MCTD): 1. Eight patients were seen throughout their gestation at a tertiary-level hospital and nine were referred from other non-specialized hospitals. Patients in the first group had four complications, and those of the second group, 28. The Odds Ratio (OR) of having a complication in the hospitals of reference compared to the "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital (HMPMPS) was of 29.8 (95% CI: 1.29-692.46; Z statistic 2.11, p = 0.03). In relation to the logistic regression, this test was not significant neither for the group nor the treatment scheme for the presence of at least one complication. The multinomial logistic regression did not show significant predictive probabilities of the different possible outcomes for the group and drug treatment scheme. CONCLUSION: Pregnant women with autoimmune diseases can have an OR up to 29.8 to develop complications when they are not cared for by specialized personnel

Factors influencing risky sexual behaviours of HIV-infected people on first-line antiretroviral therapy in Kigeme District Hospital, Rwanda: A cross-sectional study

INTRODUCTION: Evidence suggests that improved quality of life that follow antiretroviral therapy (ART) may be accompanied by increased sexual activity and risky sexual behaviour. Thus, this study aimed to determine the proportion of HIV infected people on first line ART who were sexually active, the prevalence of risky sexual behaviour defined as unprotected vaginal sex and factors influencing risk sexual behaviour among HIV-infected people on first -line ART in Kigeme District Hospital. METHODS: A cross-sectional study with a quantitative survey method was conducted among 358 HIV infected people on first line ART and an adopted structured questionnaire was used for data collection. STATA version 13 was used for data analysis and binary logistic regression was used to obtain adjusted odd ratio (AOR) with a 95% CI. RESULTS: Findings revealed that 68% of respondents were sexually active in the last 12 months of the interview and the prevalence of risky sexual behaviour among HIV infected people on the first line ART was 38%. Risky sexual behaviour was found to be significantly associated with age range of 30-40 year olds (AOR: 2.468, 95%CI: 1.007-2.046, P=0.048), having sex with HIV-positive partner ( AOR: 2.830, 95%CI: 1.351-5.928, P=0.006) and alcohol use prior to sexual activity (AOR: 2.347, 95%CI: 1.216-4.528, P=0.011). CONCLUSION: The majority of HIV infected people receiving the first-line ART are sexually active and the prevalence of risky sexual behaviour is significant hence effort should be put forth to target this group. Reinforcing behaviour change communication and discouraging alcohol use among HIV infected people receiving the first-line ART is recommended

Leisure-time physical activity practices and the influencing factors among government office employees in Kigali, Rwanda

Background: Physical inactivity is one of the major risk factors of non-communicable diseases (NCDs), such as type 2 diabetes, cardiovascular diseases, obesity, certain cancers, and all-cause mortality. Office employees are particularly exposed to such diseases, due to the nature of their work, which mainly involves passive activities that require less energy expenditure. Objectives: The objective of the study was to assess the leisure-time physical activity participation (LTPAP) among government employees in Kigali, Rwanda, as well as to highlight the factors that motivate, or hinder their participation. Methods: A cross-sectional, descriptive quantitative study was conducted with 600 participants. A stratified sampling technique was used to determine the study sample from the Government of Rwanda's Sports Policy stakeholder institutions. Then, a convenience sample of participants was selected from each stratum to form the final study sample. Data were collected using a three-part customised, self-administered questionnaire to capture demographic data, leisure-time physical activity levels (LTPA) using the Godin-Shephard questionnaire, and the factors that influenced participation. Analysis was done using the Statistical Package for the Social Sciences (SPSS). Descriptive and inferential statistics were employed to summarise and draw meaningful associations between different variables. Results: More than half (61.1%) of the participants were not sufficiently active. Physical activity levels declined significantly with advancing age (p = 0.004) and increasing working experience (p = 0.002); female participants were less active than males. The prevention of diseases and maintenance of good health were the most frequently reported contributors (48.8%) to physical activity participation, while time and tight work schedules were the most frequently reported hindrances (62.2%). Conclusion: The majority of government office employees in Kigali did not engage in sufficient leisure-time physical activity, hence they may be at high risk of developing NCDs. Strategies to increase LTPA among employees should be implemented

Risk factors associated with hepatitis B and C in rural population of Burera district, Rwanda

Introduction: several studies have shown that older people have a higher risk of exposure to viral hepatitis B and C than younger people. This study aimed to determine the seroprevalence of hepatitis B and C and their associated factors in people aged 45+ years old in Burera, a rural district of Rwanda.Methods: a cross sectional study was conducted from July to December 2017 during a mass campaign of hepititis B (HBV) and hepititis C (HCV) screening and vaccination of eligible populations against HBV in Burera District. Blood samples were collected and hepatitis B surface antigen (HBsAg) and an antibody against hepatitis C (Anti-HCV) were detected using an Enzyme-Linked Immuno-Sorbent Assay (ELISA). The associated factors were identified using a structured questionnaire and the data was analyzed using SPSS software.Results: of the 374 people included in this study, 53.2% were females. The median age was 56 years old with an Interquartile range (IQR) of 50 - 63 years old. The prevalence of HBV and HCV infection was 6.4% and 9.4%, respectively, with 0.3% co-infection rate. Age, social economic level, history of blood transfusion, history of never using a condom, as well as a history of injury with a used sharp material were significantly associated with HCV infection.Conclusion: the study showed a high seroprevalence of both HBV and HCV in Burera's elderly population aged 45+ years. Several factors associated with HBV and HCV in this study could be prevented through education and improved hygiene

Indoor air pollution from cooking with biomass fuels is a major cause of chronic bronchitis among women in a rural district of Rwanda

In the developing world, households are using biomass fuel for cooking and heating this leads to high concentration of toxic pollutants indoor causing several respiratory diseases. The aim of this study was to assess the association between biomass fuels and chronic bronchitis among women leaving in a rural district of Rwanda.Methods: A prospective study was conducted for a period of 15 months between March 2015 and May 2016 and all patients willing to participate were recruited from test villages selected randomly in the district of Gisagara. Obtained data were compared with those from control villages from the distric Huye. 448 women aged 20 years and above were recruited for the study, among them 302 were using biomass fuel for cooking and there was a control group of 146 age-matched women who were using either liquefied gas petroleum or had not been cooking the last 3 years.Results: Out of 448 women recruited for the study, 12 (2.6%) were excluded for various reasons, among them 298 (68.3%) were using biomass fuel for cooking and 138 (31.7%) belonged to the control group. Using our case definition of chronic bronchitis the overall prevalence was 10.7% of all participants. Chronic bronchitis was significantly associated with cooking indoor (OR: 8.14; 95%, CI 3.45 to 16.84), age (OR: 2.32; 95% CI 1.93 to 3.59) and education level (OR: (OR: 1.66; 95% CI , 0.90 to 3.11).Conclusion: This study showed that cooking indoor with biomass fuel, age and the level of education are the main risk factors for chronic bronchitis

The outcome of patients on hemodialysis at university teaching hospital of Kigali (CHUK) in a period of september 2014 to march 2017 - A retrospective study on patients with acute and chronic renal failure

Background: Kidney dysfunction is both a national and international problem. Its incidence is increasing in the general population, mostly due to the high prevalence of diabetes, hypertension and the long-term consequences of acute kidney injury. The incidence and prevalence of kidney dysfunction necessitating dialysis are unknown in Rwanda as studies are lacking.Methodology: This study describes the outcomes of the patients who received hemodialysis at CHUK. Data was retrospectively collected and statistically analyzed for 152 patients treated in the hemodialysis unit at CHUK between September 2014 and March 2017.Results: The results have shown that 51.3% and 48.7% of the population being studied were identified to have acute kidney injury and chronic kidney failure respectively. The main risk factors for hemodialysis treatment were hypertension (48%), diabetes mellitus (46.7%), eclampsia (13.2%), and volume deficit (15.8%). Hyperkalemia, pulmonary edema, encephalopathy, and other uremic symptoms were present in 39-43% of patients and were the most common indications for hemodialysis. Encephalopathy and poor oxygen saturation were independent risk factors for death. 20.6% could not afford the usual provision of three sessions of hemodialysis per week and therefore didn't receive dialysis as frequently as recommended. Forty-five patients (20.6%) could not afford the usual provision of three sessions of hemodialysis per week and received less frequent dialysis.Conclusion: There is high mortality in patients referred for hemodialysis in CHUK. Almost half of the patients have chronic renal failure and require permanent renal replacement therapy. Many patients limit therapy due to financial reasons

Description and early clinical outcome of patients with omphalocele admitted to a tertiary hospital in Kigali, Rwanda over a three-year period ­ a cross-sectional study

BACKGROUND: Studies suggest that patients with omphalocele have poor outcomes which are associated with the high rate of associated congenital abnormalities. A variety of surgical management techniques have been described, with some requiring equipment not available in resource-limited countries. OBJECTIVES: This study aimed to describe associated abnormalities, management and early hospital outcomes of patients with omphalocele.METHODS: A retrospective study of newborns diagnosed with omphalocele hospitalized from January 2014 to December 2016 at a tertiary level facility, the University Hospital of Kigali (CHUK) in Kigali, Rwanda. Case-file review of included newborns and analysis of the data collected was performed with SPSS version 16.0. RESULTS: Thirty-one patients were hospitalized with omphalocele during the three-year study period. A limited number of investigations were done to diagnose possible associated congenital abnormalities. Three patients (9.7%) were found to have cardiac abnormalities, nine (27.0%) had suspected genetic abnormalities including Trisomy 13, 18 and Beckwith Wiedemann Syndrome. In terms of management, ten patients (32.3%) underwent primary closure. Sixteen patients (51.6%) developed sepsis during hospitalization. Of the thirty-one patients hospitalized, nine (27.0%) died in the hospital. The only factor found to be associated with increased mortality was the size of the omphalocele, with small omphaloceles associated with lower mortality than large omphaloceles (OR 0.909, P-value 0.028).CONCLUSION: Mortality of these patients is significant and slightly higher in patients with larger omphalocele. Newborns with omphalocele should receive appropriate investigations to diagnose associated congenital abnormalities and have early recognition and prompt management of complications, especially sepsis. The results are limited by the small sample size and limited investigations performed to detect associated abnormalities

Renal replacement therapy (RRT) in Rwanda: benefits, challenges and recommendations

Worldwide, non-communicable diseases (NCDs) are a global health problem as they contribute to approximately 60% of deaths. There is limited data on the management of NCDs including kidney diseases at all levels of health care delivery in Rwanda. Yet renal replacement therapy (RRT), which seems to be the only option to provide an acceptable quality of life to patients with end stage renal disease (ERSD), is yet to be well established in Rwanda. Although there are policies and guidelines on renal replacement modalities in Rwanda, inadequate human and financial resources in the area of nephrology care remains a challenge. The purpose of the paper is to document an overview of kidney diseases and Renal Replacement Therapy (RRT) in Rwanda and highlight the benefits, challenges and recommendations to provide future directions for nephrology care. Improved knowledge about renal conditions and their risk factors is the initial step to create major interventions for improved kidney quality of life (KQoL) among patients with end stage renal disease. Notwithstanding, the Government of Rwanda has established several dialysis centers intended to provide services and for maintenance of the health status of patients with renal conditions. Further studies are necessary to provide evidence on the outcomes of RRT

Assessment of self-medication practices with antibiotics among undergraduate university students in Rwanda

Introduction: antimicrobial Resistance (AR) is on a rise as one of the major global public health threats. It is therefore important to assess contributory factors to the rise in the cases of resistance reported. The main objective of this study was to assess the nself-medication practices with antibiotics among the University of Rwanda students in Huye Campus.Methods: a sample of 570 students from all levels and colleges of the University of Rwanda in Huye Campus were selected using a simple random sampling to participate in this study. A questionnaire was administered to be answered individually by the consented respondents where the self-medication practices with antibiotics in the past 6 months were assessed. The results were statistically analyzed using SPSS v.16.Results: the study showed that 12.1% (n=69) practiced self-medication with antibiotics. The major reason for self medication with antibiotics was illness not serious to have a consultation (50.72%). The main diseases being treated were common cold/fever/cough (47.83%). The antibiotic that was mostly used was Amoxicillin capsules (59.42%), while the main source of antibiotics was community pharmacy (72.42%).Conclusion: the prevalence of self medication is considerably high among university students. Regarding the main reasons of self-medication with antibiotics, diseases being treated, and the antibiotics used, it was found that all these may be related to the students' lack of knowledge about the need for rational use of antibiotics and a study was needed to confirm it

Involvement in decision-making processes and retention of health workers: findings from a cross-sectional study in the Rwandan Public District Hospitals

Introduction: the contribution of the health workforce for better health care service provision is undoubtedly of great merit to any health system. However, the public district hospitals in Rwanda have been faced with the challenges of retaining the health personnel. This study looks into the management approach to address this challenge by investigating into the effect of employee involvement in the hospital decision-making processes on the retention of professional health workers.Methods: a cross-sectional design with quantitative approach was used. With a population of 469 health workers from 3 hospitals, a sample of 252 respondents was considered. Data collection was done by use of survey questionnaire. For data analysis, we used descriptive statistics to report perceived levels of involvement of health workers and intents to stay, and multiple logistic regression at 95% of confidence intervals to assess the effect of health workers? involvement in the hospital decision-making processes on the retention.Results: the findings revealed that health workers who perceived a high level of involvement in the hospital decision-making processes through the determination of teams for quality improvement in the health care service delivery were more likely to stay in the hospital (OR=100.111; P=0.001; CI=5.984-16.747) than those who perceived this function as low. It was also found that while an average level of involvement of health workers in the establishment of systems for suggestion in the hospital was associated with 6 odds of staying (OR=6.005; P=0.010; CI=1.529-23.571), health workers who perceived a high level of involvement were nearly 11 times more likely to stay (OR=10.952; P=0.001; CI=7.730-15.519) than their counterparts with low levels of perceptions.Conclusion: although there are positive associations between involvement of health workers in the hospitals decision-making processes and the intentions to stay, the existing level of staff involvement may have a negative effect on retention capacity in the public district hospitals