Oral health-related quality of life among people living with HIV and HIV-negative adults in Kigali, Rwanda: a comparative cross-sectional study.

BACKGROUND: Assessing health-related quality of life has become integral to people living with HIV (PLHIV) follow-up. However, there is a lack of data regarding the impact of oral health on quality of life, known as Oral health-related quality of life (OHRQoL) among PLHIV compared to HIV-negative individuals in Rwanda. AIM: The study aimed to assess OHRQoL among PLHIV compared to HIV-negative counterparts in Kigali, Rwanda. METHODS: The Oral Health Impact Profile short version (OHIP-14) questionnaire was interviewer-administered to 200 PLHIV and 200 HIV-negative adults (≥ 18 years old) at an HIV clinic of Kigali Teaching Hospital (CHUK). Socio-demographic characteristics, including age, sex, occupation, and socioeconomic status (SES) of participants, were collected using a survey questionnaire. A 4-point Likert scale was used to assess the frequency of oral impacts for all 14 items within 7 domains of the OHIP tool. The descriptive statistics were used to see frequencies and percentages of OHRQoL among PLHIV and HIV-negative persons, respectively. The Chi-square test was used to determine the association of OHRQoL with caries (DMFT) and periodontal disease (CPITN) among PLHIV compared to HIV-negative individuals. RESULTS: The results revealed a higher prevalence of PLHIV with poor OHRQoL than HIV-negative individuals in 5 domains and almost all items of OHIP-14 except for the OHIP 3 (found it uncomfortable to eat any foods because of problems with teeth or mouth) and OHIP-14 (being totally unable to function because of problems with teeth or mouth). The findings showed statistically significant results (p ≤ 0.05) for the OHIP1 item "trouble pronouncing any word," with a prevalence of 2.5% (n = 11) and 2.25% (n = 9) in PLHIV and HIV-negative, respectively. Also, PLHIV had a significantly higher prevalence, 2.75% (n = 11) for the OHIP 13 item "life not satisfying due to teeth and mouth problems compared to HIV-negative individuals 2% (8) p ≤ 0.05. Moreover, dental caries was significantly associated with poor OHRQoL among PLHIV and HIV-negative adults and for all 14 items of the OHIP tool. Periodontal disease was not significantly associated with OHRQoL among PLHIV and HIV-negative adults. CONCLUSION: This study revealed poor OHRQoL among PLHIV compared to HIV-negative adults. There is a need for further longitudinal studies to investigate the OHRQoL in Rwanda, especially among PLHIV. It is essential to include oral health care as one of the components of the medical health care programs for PLHIV in Rwanda.

Spatio-temporal dynamic of the COVID-19 epidemic and the impact of imported cases in Rwanda.

INTRODUCTION: Africa was threatened by the coronavirus disease 2019 (COVID-19) due to the limited health care infrastructure. Rwanda has consistently used non-pharmaceutical strategies, such as lockdown, curfew, and enforcement of prevention measures to control the spread of COVID-19. Despite the mitigation measures taken, the country has faced a series of outbreaks in 2020 and 2021. In this paper, we investigate the nature of epidemic phenomena in Rwanda and the impact of imported cases on the spread of COVID-19 using endemic-epidemic spatio-temporal models. Our study provides a framework for understanding the dynamics of the epidemic in Rwanda and monitoring its phenomena to inform public health decision-makers for timely and targeted interventions. RESULTS: The findings provide insights into the effects of lockdown and imported infections in Rwanda's COVID-19 outbreaks. The findings showed that imported infections are dominated by locally transmitted cases. The high incidence was predominant in urban areas and at the borders of Rwanda with its neighboring countries. The inter-district spread of COVID-19 was very limited due to mitigation measures taken in Rwanda. CONCLUSION: The study recommends using evidence-based decisions in the management of epidemics and integrating statistical models in the analytics component of the health information system.

Barriers to access of maternal health commodities among pregnant women in public health facilities in Ubungo Municipal Council, Tanzania.

Background: Access to maternal health commodities improves maternal outcome and reduce maternal deaths. Tanzania has put in place the fee exemption policy for mothers to access maternal health commodities for free, however, the implementation of user fee exemption has been challenging. Therefore, this study explored the barriers to access of maternal health commodities among pregnant women in public health facilities at Ubungo Municipal Council, Tanzania. Methods: This was a descriptive qualitative study conducted from January to February 2023. Both focus group discussions and key informant interviews were conducted. These involved 72 pregnant women and 40 health care providers respectively. A purposive sampling technique was used to selected facilities and study participants. Thematic analysis was used to analysis data. Results: Findings from this study indicated that fear of stigma and discrimination, decision-making autonomy, additional costs and stock out of health commodities were the main barriers to accessing maternal health commodities. Furthermore, both pregnant women and health care providers reported that shortage of health commodities and the inadequacy of service providers, which led to long waiting times, also hinder access to health commodities. Conclusion: Improving health commodities availability, and increasing the number of service providers are important factors to consider to improve access to maternal health commodities. In addition, factors such as fear of stigma and discrimination should also be addressed to improve maternal health.

Spatio-Temporal Bayesian Models for Malaria Risk Using Survey and Health Facility Routine Data in Rwanda.

INTRODUCTION: Malaria is a life-threatening disease ocuring mainly in developing countries. Almost half of the world's population was at risk of malaria in 2020. Children under five years age are among the population groups at considerably higher risk of contracting malaria and developing severe disease. Most countries use Demographic and Health Survey (DHS) data for health programs and evaluation. However, malaria elimination strategies require a real-time, locally-tailored response based on malaria risk estimates at the lowest administrative levels. In this paper, we propose a two-step modeling framework using survey and routine data to improve estimates of malaria risk incidence in small areas and enable quantifying malaria trends. METHODS: To improve estimates, we suggest an alternative approach to modeling malaria relative risk by combining information from survey and routine data through Bayesian spatio-temporal models. We model malaria risk using two steps: (1) fitting a binomial model to the survey data, and (2) extracting fitted values and using them in the Poison model as nonlinear effects in the routine data. We modeled malaria relative risk among under-five-year old children in Rwanda. RESULTS: The estimation of malaria prevalence among children who are under five years old using Rwanda demographic and health survey data for the years 2019-2020 alone showed a higher prevalence in the southwest, central, and northeast of Rwanda than the rest of the country. Combining with routine health facility data, we detected clusters that were undetected based on the survey data alone. The proposed approach enabled spatial and temporal trend effect estimation of relative risk in local/small areas in Rwanda. CONCLUSIONS: The findings of this analysis suggest that using DHS combined with routine health services data for active malaria surveillance may provide provide more precise estimates of the malaria burden, which can be used toward malaria elimination targets. We compared findings from geostatistical modeling of malaria prevalence among under-five-year old children using DHS 2019-2020 and findings from malaria relative risk spatio-temporal modeling using both DHS survey 2019-2020 and health facility routine data. The strength of routinely collected data at small scales and high-quality data from the survey contributed to a better understanding of the malaria relative risk at the subnational level in Rwanda.

Analysis of pharmaceutical inventory management based on ABC-VEN analysis in Rwanda: a case study of Nyamagabe district.

BACKGROUND: Pharmaceuticals account for a large portion of healthcare spending in healthcare organizations. Their effective inventory management is required to match the cost of stocks with the customer demand and avoid shortage of supplies at any health facility level. This study aimed to analyze pharmaceuticals' inventory management using ABC-VEN analysis. METHODS: The study was conducted at Rwanda Medical Supply (RMS) Ltd, Nyamagabe Branch for products distributed to health facilities in Nyamagabe District catchment area from the financial years 2017-2018 to 2019-2020. It consisted of a descriptive retrospective study of 457 items. The latter are generic essential medicines distributed to public health facilities during the study period. Products were arranged according to a descending order of importance, and we performed a breakdown of products according to the Pareto Principle. Following an ABC analysis of distribution data for such drugs billed to healthcare facilities, a VEN analysis was performed to identify high-value vital products that require more attention. RESULTS: During the ABC analysis, 76 products were classified in group A. These accounted for 19.84% and had a value of 74.91% of the total cost of all products. Group B included 116 products, representing 30.29% with a value of 20% of the total cost, while Group C had 191 products, representing 49.87% with a value of only 5.09% of the total cost. During the VEN analysis, 202 products (44.20%) were classified as vital, 231 (50.54%) as essential, and 24 products (75.26%) as non-vital. The analysis with ABC-VEN resulted in Class I representing 55.80% of all medicines that cost 87.88% of all total cost, Class II representing 40.70% with a total cost of 11.82%, and Class III representing 3.50% with a cost of 0.3%. CONCLUSIONS: This study results show that inventory management of vital and expensive products, such as antibiotics, antihypertensive pharmaceuticals, consumables, and massive solutions would be carefully monitored to prevent a shortage of such products at health facility levels. The ABC-VEN analysis is one of the practical and affordable method to achieve their optimized supply chain.

A cross-sectional analysis of the impact of health insurance on the use of health care in Rwanda.

Although the policy in Rwanda aims at ensuring quality healthcare, a portion of the Rwandan population still does not have access to it due to the lack of health insurance. This study investigates the impact of health insurance on healthcare utilization in all 30 administrative districts of Rwanda, using secondary data from the 5th Integrated Household Living Conditions Survey (EICV 5) in Rwanda, with a total of 14,580 households. A logistic regression model was used to evaluate the effects of health insurance on healthcare utilization, and a decision tree model was adopted to categorize districts based on the use of health services. This study has made a novel contribution to the existing research by classifying districts based on similarities in the use of health care services, regarding households with or without health insurance. The results showed a significant age effect on the use of health care services for household heads with an age range of 56-65, a significant increase was observed with an adjusted odds ratio of AO = 1.308, (95% CI: 1.044-1.639). It was the same for the household heads whose age range is 66-75 with an adjusted odds ratio of A0 = 1.589 with (95% CI: 1.244-2.028) and those aged 76 and older with an adjusted odds ratio of AO = 1.524, with (95% CI: 1.170-1.985). Households with health insurance interacted with districts (A0 = 2.76) increased health service use threefold compared to households without health insurance, female-headed households increased health service use (AO = 1.423, 95% CI:1.293-1.566) 1.4-fold compared to male-headed households, while households in the third quintile (AO = 1.198, 95% CI: 1.035-1.385) used health services 1.2 times compared to those in the first quintile; households in the fourth quintile (AO = 1.307, 95% CI: 1.134-1.506) and in the fifth quintile (AO = 1.307, 95% CI: 1.136 1.504) used health services 1.3 times compared to those in the first quintile. Similarly, for the households located in the main district group 4 variable had an odds ratio of 1.386 with (95% CI: 1.242-1.547), indicating that the households located in the main district group 4 use the health care services 1.4 times higher compared to those located in Ruhango district. Households in Rwanda who lack health insurance do not utilize health services to their full capacity, which has a negative influence on the wellbeing of the country's population. The researchers recommend that future policies target households in rural areas with an elderly head of household and those without health insurance that have a low usage of health care services in Rwanda. They also recommend that health insurance fees are reduced in order to increase health coverage rate as recommended by the World Health Organization.

Prevalence of dental caries and associated risk factors among People Living with HIV/AIDS and HIV uninfected adults at an HIV clinic in Kigali, Rwanda.

BACKGROUND: Dental caries is among the most frequent oral conditions in People Living with HIV/AIDS (PLWHA). There is a lack of baseline information on dental caries prevalence and associated risk factors among PLWHA in comparison to HIV uninfected people in Rwanda. OBJECTIVE: This study was conducted to determine the prevalence of dental caries and associated risk factors among PLWHA and HIV uninfected adults at an HIV clinic of Kigali Teaching Hospital (CHUK) in Kigali, Rwanda. METHODS: A comparative cross-sectional study was conducted among 200 PLWHA and 200 HIV uninfected adults aged 18 years and above attending an HIV clinic of CHUK. An oral examination was performed by a calibrated examiner. Dental caries were assessed using the WHO Decayed (D), Missing (M), and Filled Teeth (F) index (DMFT). Descriptive statistics, Chi-square, t-tests, and multiple binary logistic regression were used to analyze data. RESULTS: Overall, a higher prevalence (50.5%) of PLWHA had experienced dental caries (DMFT>0) compared to HIV uninfected counterparts (40.5%) (p = 0.045). The prevalence of Decayed teeth (D) was also higher (23.5%) among PLWHA compared to HIV uninfected persons (13.6%) (p = 0.011). The Mean(SD) DMFT scores among PLWHA and HIV uninfected participants were 2.28 (3.68) and 1.29 (2.21) respectively (p = 0.001). After performing multiple binary logistic regression analysis, the predictors of dental caries in PLWHA were being female (OR = 2.33; 95%CI = 1.14-4.75), frequent dental visits (OR = 4.50; 95% CI = 1.46-13.86) and detectable RNA viral load (OR = 4.50; 95% CI = 1.46-13.86). In HIV uninfected participants, the middle age range (36-45 years), and frequent dental visits were significantly associated with dental caries (OR = 6.61; 95%CI = 2.14-20.37) and (OR = 3.42; 95%CI: 1.337-8.760) respectively. CONCLUSION: The prevalence of dental caries was higher in PLWHA than in HIV uninfected counterparts. The reported higher prevalence of caries in PLWHA was associated with being female, detectable viral load, and frequent dental visits. Therefore, there is a need for effective oral health interventions specific to PLWHA in Rwanda to raise awareness of the risk of dental caries and provide preventive oral health services among this population. To ensure timely oral health care amongPLWHA, there is a need for an effort from policymakers and other stakeholders to integrate oral health care services within the HIV treatment program in Rwanda.

Child stunting prevalence determination at sector level in Rwanda using small area estimation.

BACKGROUND: Stunting among children under 5 years of age remains a worldwide concern, with 148.1 million (22.3%) stunted in 2022. The recent 2019/2020 Rwanda Demographic Health Survey (RDHS) revealed that the prevalence of stunting in Rwanda among under five children was 33.5%. In Rwanda, there is no sufficient evidence on stunting status to guide prioritized interventions at the sector level, the lowest administrative unit for implementing development initiatives. This study aimed to provide reliable estimates of stunting prevalence in Rwanda at the sector level. METHODS: In this article, Small Area Estimation (SAE) techniques were used to provide sector level estimates of stunting prevalence in children under five in Rwanda. By plugging in relevant significant covariates in the generalized linear mixed model, model-based estimates are produced for all sectors with their corresponding Mean Square Error (MSE). RESULTS: The findings showed that, overall, 40 out of 416 sectors had met the national target of having a stunting rate less than or equal to 19%, while 194 sectors were far from meeting this target, having a stunting rate higher than the national prevalence of 33.5% in the year 2020. The majority of the sectors with stunting prevalence that were higher than the national average of 33.5% were found in the Northern Province with 68 sectors out of 89 and in Western Province with 64 sectors out of 96. In contrast, the prevalence of stunting was lower in the City of Kigali where 14 out of 35 sectors had a stunting rate between 0 and 19%, and all sectors were below the national average. This study showed a substantial connection between stunting and factors such as household size, place of residence, the gender of the household head, and access to improved toilet facilities and clean water. CONCLUSION: The results of this study may guide and support informed policy decisions and promote localised and targeted interventions in Rwanda's most severely affected sectors with a high stunting prevalence in Rwanda.

Child stunting and associated risk factors in selected food-insecure areas in Rwanda: an analytical cross-sectional study.

Introduction: stunting rates among the under-five children are generally high in Rwanda. They are unexpectedly lower than the national average stunting rate in some districts where poverty rates are the highest in the country. This study aimed to ascertain the key factors that protect children from stunting in these poorest areas, where stunting rates are lower than expected. Methods: we analysed cross-sectional data from 2019/2020 Rwanda Demographic and Health Survey (RDHS) for 477 under-five children from Karongi, Rulindo, Nyanza, and Gisagara districts. Univariate and bivariate statistical analyses were used to find out the factors to retain for multivariable analysis. We obtained the key risk factors of child stunting through a multivariable binary logistic regression analysis. Results: the child stunting rate in the study districts was 30 percent, which is three percent lower than the national average rate. Child stunting was negatively associated with a birth weight of at least 2.5 kg (AOR = 0.393, 95% CI: 0.180 - 0.856), a high household economic status (AOR = 0.506, 95%CI: 0.273 - 0.937), urban residence (AOR = 0.467; 95% CI: 0.222 - 0.984), and health insurance coverage (AOR = 0.418; 95% CI: 0.228 -0.767). Children aged one year and above, as well as female-headed households, were associated with at least three times and two times greater odds of child stunting than children aged below 12 months and those from male-headed households respectively. Conclusion: the nutritional performance of children in the study districts is substantially driven by the high uptake of health insurance, which fosters increased access to healthcare services. To address child-stunting gaps in low-income areas in Rwanda, child nutrition programs should improve the utilization of healthcare services, and leverage the potential high effect of nutrition education, especially during pregnancy and lactation.

Perceptions, attitudes and practices regarding canine zoonotic helminthiases among dog owners in Nyagatare district, Rwanda.

BACKGROUND: Despite their importance to society, dogs are susceptible to various helminths. This study aimed to understand perceptions, attitudes and practices (PAP) regarding canine zoonotic helminthiases (CZH) among dog owners in Rwanda. METHODS: A cross-sectional study was carried out in Nyagatare district of Rwanda, where 203 dog owners were randomly selected and interviewed. To analyse this study's data, we used frequency distributions, chi-square test of association and binary logistic regression model. RESULTS: Overall, 75.9% and 30% of the respondents were aware of canine and human helminthiases, respectively. Around 74.4% knew that dogs source helminthiases from eating raw infected meat. Also, 74.4% knew vomiting, diarrhoea and swelling of the belly as clinical signs of the helminthiases. Around 58.6% washed hands with soap and water after handling a dog. Only 17.2% and 15.5% dewormed the dogs and treated them against ectoparasites using conventional anthelmintics and acaricides manufactured for dogs, respectively. Of all respondents, 33% held genuine perceptions, while 78.3% and 25.1% adopted positive attitudes and appropriate practices about CZH, respectively. The respondents' educational level and length of dog ownership correlated with their perceptions and practices about CZH, respectively, while sources of information on CZH influenced their PAP of such infections. The adjusted odds ratio (OR) of having genuine perceptions and positive attitudes were more than 82% lower among those who sourced the information from neighbours & colleagues compared to those who gathered it through reading. Again, the length of dog ownership (OR = 0.37, 95% CI: 0.15-0.90) correlated with the respondent's practices about CZH. CONCLUSIONS: Only 33% and 25.1% of the respondents held genuine perceptions and adopted positive attitudes regarding CZH, respectively. The findings indicate increased zoonotic helminths in dogs, possible spillover in humans and anthelmintic resistance. Therefore, awareness campaigns are needed to upgrade dog owners' knowledge of the zoonotic helminthiases in dogs in Nyagatare district.

Prevalence and factors associated with fertility desire among HIV-positive women in Rwanda in the context of improved life expectancy.

BACKGROUND: The knowledge of the key factors associated with fertility desire among people living with HIV/AIDS is crucial for the efficient planning of maternal and child health care programs. Fertility desire has generally increased among women of reproductive age in Rwanda. However, its level and determinants among women living with HIV/AIDS (WLHA) are currently not well known in the context of Rwanda. The present study aimed to fill in this knowledge gap. METHODS: Data were extracted from the 2015 Rwanda demographic and health survey (RDHS) for 243 HIV-positive women of reproductive age. Univariate and multivariable logistic regression analyses were conducted in order to identify the most influential factors. RESULTS: The prevalence of desire to have another child in HIV-positive women was found to be as high as 40.7%. Multivariable logistic regression analyses showed that the woman's age of 35-49 years (AOR = 0.051, 95% CI: 0.013-0.204), woman's parity of 3 children or above (AOR = 0.177, 95% CI: 0.037-0.837), being employed (AOR = 0.298, 95% CI: 0.113-0.782) and currently using contraceptives (AOR = 0.146; 95% CI: 0.057-0.375) were significantly associated with low odds of fertility desire among HIV- positive women in Rwanda. Women younger than 25 years, with no living child, or who were unemployed or who were not using any contraceptive were significantly associated with greater odds of desire to have another child than did other HIV- positive women. A woman whose partner's desire for children is different  from hers was associated with about four times higher odds (AOR = 3.752; 95% CI: 1.203-11.702) of desire for more children than women who desire the same as their partners. CONCLUSION: Fertility desire in WLHA is currently high in Rwanda. It is significantly influenced by demographic and socioeconomic factors. The Rwanda's health care system should be prepared to intensify the required services for the prevention of the vertical transmission of HIV, the delivery of maternal and child health care services, and the support to WLHA in planning their fertility. Interventions should target low-parity young women, with a particular focus on meeting their contraceptive needs.

Canine Gastrointestinal Nematodiases and Associated Risk Factors in Kigali City, Rwanda.

Canine nematodes pose a public health risk to humans and livestock; however, the prevalence of canine nematodiases in Rwanda is unknown. This study aimed at determining the prevalence of canine nematodiases and identifying the risk factors for such infections in Kigali, the capital city of Rwanda. A cross-sectional study involved 93 dogs selected across Kigali city. Faecal samples were collected from apparently healthy dogs, and nematode eggs were identified and quantified using the McMaster technique. Risk factors for canine nematodiases were analysed by a multivariable binary logistic regression model. The overall prevalence of gastrointestinal (GI) nematodiases in dogs was 33.3% (95% CI: 23.8-42.9). The most prevalent species was Ancylostoma spp with 32.3% (95% CI: 22.8-41.8). Nearly 38.7% and 3.2% of the dogs infected with Ancylostoma spp and Toxocara canis had high egg counts per gram (EPG) of faeces (≥550), respectively. Approximately 96.8% of dogs infected with nematodes had monoinfection. Logistic regression analysis showed that dog's age (1 to 2.5 years old), location (Gasabo and Kicukiro districts), and feeding practices were significantly associated with prevalence of canine nematodiases. In particular, the adjusted odds ratio (AOR) was more than 5 times higher for dogs fed on uncooked animal products and leftovers from households and restaurants compared to those who ate food prepared for them. The AOR was also about 16 times higher for dogs that scavenged and ate leftovers from households compared to those who ate food prepared for them. The findings of this study indicate that the prevalence of GI nematodes in domestic dogs in Kigali city, Rwanda, was 33.3% (95% CI: 23.8-42.9). The identified nematodes, namely, Ancylostoma spp. and Toxocara canis, are zoonotic, and dogs and humans are at risk of contracting these nematodes. The factors associated with canine GI nematodes in Kigali city include feeding practices and the dog's age and location (district). Dog owners need to rethink procedures for deworming and feeding their dogs. Again, the public should be made aware of the role of dogs in transmitting zoonotic nematodes to humans.

The secondary transmission pattern of COVID-19 based on contact tracing in Rwanda.

INTRODUCTION: COVID-19 has shown an exceptionally high spread rate across and within countries worldwide. Understanding the dynamics of such an infectious disease transmission is critical for devising strategies to control its spread. In particular, Rwanda was one of the African countries that started COVID-19 preparedness early in January 2020, and a total lockdown was imposed when the country had only 18 COVID-19 confirmed cases known. Using intensive contact tracing, several infections were identified, with the majority of them being returning travellers and their close contacts. We used the contact tracing data in Rwanda for understanding the geographic patterns of COVID-19 to inform targeted interventions. METHODS: We estimated the attack rates and identified risk factors associated to COVID-19 spread. We used Bayesian disease mapping models to assess the spatial pattern of COVID-19 and to identify areas characterised by unusually high or low relative risk. In addition, we used multiple variable conditional logistic regression to assess the impact of the risk factors. RESULTS: The results showed that COVID-19 cases in Rwanda are localised mainly in the central regions and in the southwest of Rwanda and that some clusters occurred in the northeast of Rwanda. Relationship to the index case, being male and coworkers are the important risk factors for COVID-19 transmission in Rwanda. CONCLUSION: The analysis of contact tracing data using spatial modelling allowed us to identify high-risk areas at subnational level in Rwanda. Estimating risk factors for infection with SARS-CoV-2 is vital in identifying the clusters in low spread of SARS-CoV-2 subnational level. It is imperative to understand the interactions between the index case and contacts to identify superspreaders, risk factors and high-risk places. The findings recommend that self-isolation at home in Rwanda should be reviewed to limit secondary cases from the same households and spatiotemporal analysis should be introduced in routine monitoring of COVID-19 in Rwanda for policy making decision on real time.

Prediction of out-of-pocket health expenditures in Rwanda using machine learning techniques.

INTRODUCTION: in Rwanda, the estimated out-of-pocket health expenditure has been increased from 24.46% in 2000 to 26% in 2015. Despite the existence of guideline in estimation of out-of-pocket health expenditures provided by WHO (2018), the estimation of out-of-pocket health expenditure still have difficulties in many countries including Rwanda. METHODS: the purpose of this paper was to figure out the best model which predicts the out-of-pocket health expenditures in Rwanda during the process of considering various techniques of machine learning by using the Rwanda Integrated Living Conditions Surveys (EICV5) of 14580 households (2018). RESULTS: our findings presented the model which predict the out-of-pocket health expenditures with higher accuracy and was found as treenet model. Furthermore, machine learning techniques were used to judge which predictor variable was important in our prediction process and comparison of the performance of the algorithms through train accuracy and test accuracy metric measures. Finally, the findings show that the tests of accuracy of the models were 50.16% for multivariate adaptive regression splines (MARS) model, 74% decision tree model, 87% for treenet model, 83% for random forest model, gradient boosting 81%, predictor total consumption played a significant role in the model for all tested models. CONCLUSION: finally, we conclude that the total consumption of the household came out to be the most important variable which is consistently true to all the algorithms tested. The findings from our study have policy implications for policy makers in Rwanda and in the world generally. We recommend the government to significantly increase public spending on health. Domestic financial resources are key to moving closer to universal health coverage (UHC) and should be increased on a long-term basis. In addition, these results will be useful for the future to assess the out-of-pocket health expenditures dataset.

Child mortality inequalities across Rwanda districts: a geoadditive continuous-time survival analysis.

Child survival programmes are efficient when they target the most significant and area-specific factors. This study aimed to assess the key determinants and spatial variation of child mortality at the district level in Rwanda. Data from the 2010 Rwanda Demographic and Health Survey were analysed for 8817 live births that occurred during five years preceding the survey. Out of the children born, 433 had died before survey interviews were carried out. A full Bayesian geo-additive continuous-time hazard model enabled us to maximise data utilisation and hence improve the accuracy of our estimates. The results showed substantial district- level spatial variation in childhood mortality in Rwanda. District-specific spatial characteristics were particularly associated with higher death hazards in two districts: Musanze and Nyabihu. The model estimates showed that there were lower death rates among children from households of medium and high economic status compared to those from low-economic status households. Factors, such as four antenatal care visits, delivery at a health facility, prolonged breastfeeding and mothers younger than 31 years were associated with lower child death rates. Long preceding birth intervals were also associated with fewer hazards. For these reasons, programmes aimed at reducing child mortality gaps between districts in Rwanda should target maternal factors and take into consideration district-specific spatial characteristics. Further, child survival gains require strengthening or scaling-up of existing programmes pertaining to access to, and utilisation of maternal and child health care services as well as reduction of the household gap in the economic status.

Bayesian mapping of HIV infection among women of reproductive age in Rwanda.

HIV prevalence is rising and has been consistently higher among women in Rwanda whereas a decreasing national HIV prevalence rate in the adult population has stabilised since 2005. Factors explaining the increased vulnerability of women to HIV infection are not currently well understood. A statistical mapping at smaller geographic units and the identification of key HIV risk factors are crucial for pragmatic and more efficient interventions. The data used in this study were extracted from the 2010 Rwanda Demographic and Health Survey data for 6952 women. A full Bayesian geo-additive logistic regression model was fitted to data in order to assess the effect of key risk factors and map district-level spatial effects on the risk of HIV infection. The results showed that women who had STIs, concurrent sexual partners in the 12 months prior to the survey, a sex debut at earlier age than 19 years, were living in a woman-headed or high-economic status household were significantly associated with a higher risk of HIV infection. There was a protective effect of high HIV knowledge and perception. Women occupied in agriculture, and those residing in rural areas were also associated with lower risk of being infected. This study provides district-level maps of the variation of HIV infection among women of child-bearing age in Rwanda. The maps highlight areas where women are at a higher risk of infection; the aspect that proximate and distal factors alone could not uncover. There are distinctive geographic patterns, although statistically insignificant, of the risk of HIV infection suggesting potential effectiveness of district specific interventions. The results also suggest that changes in sexual behaviour can yield significant results in controlling HIV infection in Rwanda.

Sharing perspectives and experiences of doctoral fellows in the first cohort of Consortium for Advanced Research Training in Africa: 2011-2014.

BACKGROUND: Resolution of public health problems in Africa remains a challenge because of insufficient skilled human resource capacity. The Consortium for Advanced Research Training in Africa (CARTA) was established to enhance capacity in multi-disciplinary health research that will make a positive impact on population health in Africa. OBJECTIVE: The first cohort of the CARTA program describes their perspectives and experiences during the 4 years of fellowship and puts forward suggestions for future progress and direction of research in Africa. CONCLUSIONS: The model of training as shown by the CARTA program is an effective model of research capacity building in African academic institutions. An expansion of the program is therefore warranted to reach out to more African academics in search of advanced research training.