Late and Persistent Symptoms Suggestive of Surgical Site Infections After Cesarean Section: Results from a Prospective Cohort Study in Rural Rwanda.

Background: Women in low-resource settings will likely develop late surgical site infections (SSIs), diagnosed after post-operative day (POD) 10. We measured SSI prevalence and predictors of late and persistent SSIs-suggestive symptoms among women who delivered via cesarean section (c-section). Patients and Methods: Women who underwent c-sections at Kirehe District Hospital (KDH) between September 2019 and February 2020 were prospectively enrolled. Data were collected on POD1, POD11, and POD30. Logistic regression identified factors associated with persistent and late SSI symptoms. Results: In total, 808 women were study enrolled. Of these, 646 women physically attended the POD11 clinic visit follow-up, while 671 received the POD30 telephone-based follow-up review. Thirty-three (5.0%) women were diagnosed with an SSI on POD11, and 39 (5.3%) had an SSI diagnosis during POD11 to POD30, giving a cumulative prevalence of 10.3% late SSI rate. Of 671, 400 (59.9%) reported at least one SSI-associated symptom between POD11 and POD30. The reported symptoms included pain (56.6%), fever (19.4%), or incision drainage (16.6%). Of these, 200 women reported still having at least one of these symptoms on POD30. Of the 400 women with late SSI symptoms, 232 (58.0%) did not seek care, and of these, 80 (48.5%), 59 (35.8%), and 15 (8.9%) could not afford transport fare, did not believe symptoms were severe for a medical visit, and were not able to travel, respectively. Lower odds of late SSI-suggestive symptoms were reported among women with health insurance (adjusted odds ratio [aOR], 0.06; p = 0.013), whereas higher late SSI-suggestive symptoms odds were among women with wealthier socioeconomic status (aOR, 2.88; p = 0.004). Conclusions: Women in rural Rwanda are at risk of late and persistent SSI-suggestive symptoms. Financial barriers and the perception that their symptoms were not serious enough for the medical visit need education on early care seeking and interventions to mitigate financial barriers for optimizing perinatal care.

Predictors and factors associated with stunting among under- five-year children: a cross-sectional population-based study in Rwanda of the 2014-2015 demographic and Health Survey.

Background: Globally, stunting affects 159 million Under-five-years-old (U-5) children. Stunting affects the physical, mental, and cognitive development of children increasing the risk of suffering and death. This paper aimed to determine the predictors and factors associated with stunting among under-five children in Rwanda. Methods: We retrieved data from the Rwanda Demographic and Health Survey (RDHS) 2014-2015 data set. A sample of 3599 U-5 eligible children with complete and valid anthropometric data was taken. Stata software was used to analyze the data extracted using a developed checklist. Descriptive statistics and Logistic regression analysis were performed to test the association between study variables. Results: Of 3599 U-5 children, 37.5% of children were stunted. The demographic characteristics: age (p< 0.001), sex (p<0.001), and place of residence (p< 0.001) and Household wealth index (p <0.001) were associated with stunting. Age, sex, and household wealth index were predictors of stunting. Conclusion: Stunting is still a burden in Rwanda. Age and sex were predictors of stunting among children under 5 years of age. Household wealth index was a predictor and significantly associated with stunting among children U-5 years in Rwanda. Investing in the interventions that target maternal and nutrition health support is imperative.