RESUMO
BACKGROUND: Adolescents in low-middle-income countries often face limited access to health information and services due to several different factors. Ineffective communication between healthcare providers and adolescents is among them. This study aims to assess adolescents' perspectives regarding their communication with reproductive health service providers in Rwanda. METHODS: A phenomenological exploratory qualitative study was used. Eleven focus group discussions were conducted among adolescents aged 10 to 19 years between December 2020 and January 2021. All participants were identified through their respective health care providers in youth-friendly centres available in the Kigali district representing the urban area and Kamonyi district representing the rural area. All interviews were transcribed and translated into English and analysed by using thematic content analysis. RESULTS: Poor communication between healthcare providers and adolescents was identified and attributed to the judgmental attitudes of some healthcare providers, while good communication was cited by many adolescents as an important key of access to services. All adolescents were eager to access reproductive health services and be educated about reproductive health issues. CONCLUSION: Effective communication is essential when it comes to providing reproductive health services, as this establishes a strong relationship between a service provider and an adolescent who wants to talk about their concerns, while poor communication prevents adolescents from asking questions about unknown topics.
Assuntos
Serviços de Saúde Reprodutiva , Comportamento Sexual , Humanos , Adolescente , Ruanda , Grupos Focais , Pesquisa Qualitativa , Comunicação , Saúde ReprodutivaRESUMO
BACKGROUND: Promoting family planning (FP) is a key strategy for health, economic and population growth, and achieving sustainable development goals (SDGs) especially SDG 3, which promotes health and well-being for all. The quality of FP services depends on the training of competent nursing and midwifery graduates before entering the workforce. In order to ensure graduates are well-trained and capable of meeting the needs of the population, their teachers need to demonstrate high self-efficacy and willingness to teach FP. However, there is a lack of research on the capacity and willingness of nursing and midwifery faculty to teach FP at higher learning institutions (HLIs) in Rwanda. The objective is to investigate and articulate the perceived self-efficacy and willingness of the nursing and midwifery faculty to instruct HLIs students on FP. RESEARCH DESIGN/METHODOLOGY: We conducted a mixed methods study using a sequential explanatory design among almost all the HLIs (n = 6, 1 institution declined) that train nurses and midwives in Rwanda. One hundred thirty-six nursing and midwifery faculty who were actively teaching FP either in class, simulation lab, or clinical practice were invited to participate in a self-administered questionnaire and four qualitative focused group discussions. Participants answered questions ranking their self-efficacy in four domains from 0 - not confident to 3 - completely confident. Scores were calculated for each domain. A semi-structured interview guide was developed based on quantitative survey findings to gain a deep understanding of the ability and willingness to teach FP. Data were analyzed using thematic analysis. Ethical approval was obtained from the University of Rwanda, College of Medicine and Health Sciences Institutional Review Board. RESULTS: A total number of 89 nursing and midwifery faculty participated in the study and only 85 completed the questionnaires fully, yielding a response rate of 95.5%. The mean age was 40.39 and there were more females (62.4%) compared to their male counterparts (37.6%). Respondents scored highest for perceived self-efficacy in course preparation (mean = 2.37), evaluation and examination (mean = 2.12) and instructor behavior and delivery (mean = 2.35). However, the score was low for clinical practices (mean = 1.79). There was a significant correlation among the four items of self-efficacy (p < 0.05). Being a female, a midwife, and having more years of experience in nursing education were each significantly associated with perceived self-efficacy to teach FP (p < 0.05). In the qualitative phase, 32 study participants participated in four focus group discussions. Four themes were identified: (a) educational background as a determinant of confidence to teach FP; (b) willingness to teach FP; (c) enabling factors of teaching FP; and (d) structural challenges. CONCLUSION: Nursing and midwifery faculty reported inadequate self-confidence in teaching FP in clinical practice. Addressing personal and structural challenges in teaching FP should be a top priority. This requires a collective effort between nursing and midwifery faculty and HLIs to dismantle individual and systemic barriers that hinder self-efficacy and willingness to teach FP. There is a need for HLIs and different stakeholders to invest in training the nursing and midwifery faculty on FP practical skills to have a nursing and midwifery workforce providing up-to-date clinical FP services that will help Rwanda reach the SDGs.
Assuntos
Tocologia , Gravidez , Masculino , Humanos , Feminino , Adulto , Serviços de Planejamento Familiar , Autoeficácia , Ruanda , DocentesRESUMO
AIMS AND OBJECTIVES: To explore the level of knowledge and perceptions of T2DM among people in the Rwamagana district. BACKGROUND: Diabetes is one of the leading causes of death in the world. Knowledge of type 2 diabetes mellitus (T2DM) can assist in early detection of the disease and reduce the incidence of complications. Therefore, a descriptive study was conducted to determine the level of knowledge and perceptions of T2DM among people in the Rwamagana district, Rwanda. DESIGN: The study used a cluster multistage sampling technique to obtain a representative sample. The clusters were provinces, districts, sectors, household clusters and sample units selection. The Kigabiro sector was studied, and a sample size of 355 respondents was calculated using Raosoft Sample Size Calculator (Raosoft, Inc 2004, http://www.raosoft.com/samplesize.html). METHODS: A descriptive method, using questionnaires, was used for data collection. Data were analysed using descriptive statistics, contingency tables and chi-square test. The target population comprised 4556 people (women and men aged between 15-65 years) living in a sampled sector of Kigabiro. RESULTS: The level of knowledge of respondents was inadequate. Few respondents got a high score on questions intended to explore the knowledge of definition, signs, causes and risk factors of diabetes. CONCLUSION: The perceptions were also poor and inadequate. The recommendations focused on education campaigns by the Kigabiro sector authorities. RELEVANCE TO CLINICAL PRACTICE: If people are knowledgeable on managing long-term conditions such as diabetes, there will be less expenditure on curative care. The healthcare services will have fewer burdens, and the focus will be on specific and relevant ailments.
Assuntos
Diabetes Mellitus Tipo 2/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Conhecimento , Masculino , Pessoa de Meia-Idade , Ruanda , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION: Comprehensive abortion care is an emerging intervention being integrated into nursing and midwifery curricula. Yet, no studies have been conducted in Rwanda to determine whether faculty perceive themselves as capable of teaching comprehensive abortion care. This study aims to evaluate the perceived self-efficacy to teach comprehensive abortion care among nursing and midwifery faculty in higher learning institutions in Rwanda. MATERIALS AND METHODS: The University of Rwanda College of Medicine and Health Sciences Institutional Review Board approved this study (UR-CMHS-IRB No 335/CMHSIRB/2022). In quantitative, a self-administered questionnaire was administered to 98 study participants. Data were entered into Statistical Package for the Social Sciences (SPSS) version 26 and analyzed using Chi-square test with a p-value of 0.05 set as the significance level. In the qualitative part, an interview guide was developed based on quantitative data to understand comprehensive abortion care teaching fully. Data were collected from four focus group discussions with eight participants in each group, entered in Dedoose, and analyzed thematically. RESULTS: Among the 98 study participants who were invited to participate in this study, only 85 filled out the questionnaires. This translates into 86.7% of the response rate. More than half 58.8% had adequate self-efficacy in teaching comprehensive abortion care. A Chi-square test has revealed that being a male, being a midwife, and having more years of working experience in nursing education were significantly associated with self-efficacy in teaching comprehensive abortion care (p value <0.05). In the qualitative phase, 32 study participants participated in four focus group discussions and four themes were identified: a) variability in confidence levels to teach comprehensive abortion care; b) readiness about teaching comprehensive abortion care; c) facilitators of teaching comprehensive abortion care; and d) contextual challenges to teach comprehensive abortion care. CONCLUSIONS: The findings revealed that faculty's self-efficacy in teaching comprehensive abortion care was not adequate. Personal and religious beliefs and institutional barriers were also reported to hinder self-efficacy in teaching comprehensive abortion care. Therefore, intensive comprehensive abortion care training for nursing and midwifery faculty in higher learning institutions should be provided, including values clarification and attitude transformation training for attitudes and beliefs. It is also critical for higher learning institutions to develop strategies for overcoming the challenges faculty face when teaching comprehensive abortion care.
Assuntos
Aborto Espontâneo , Educação em Enfermagem , Tocologia , Feminino , Gravidez , Humanos , Masculino , Autoeficácia , Ruanda , Docentes , Docentes de EnfermagemRESUMO
BACKGROUND: Addressing the gap between research and practice is crucial for enhancing reproductive healthcare outcomes. In Rwanda and other low- and middle-income countries, bolstering health researchers' implementation science (IS) capacity is essential. We present a pre-post-intervention study assessing the influence of an intensive IS training program on Rwandan reproductive health researchers' perceived IS knowledge and self-efficacy in applying IS in their own research. METHODS: To introduce IS principles, we held a one-day training for a diverse cohort of 25 sexual and reproductive health researchers in Rwanda. The training encompassed modules on IS concepts, methodologies, and practical applications. Pre- and post-training assessments gauged changes in participants' perceived IS knowledge and self-efficacy in applying IS in their own work. RESULTS: The study revealed a significant improvement in self-efficacy related to performing IS related tasks. Researchers reported heightened confidence in designing and implementing evidence-based interventions. In terms of perceived knowledge, participants retained what they learned at 4 months. The training fostered a collaborative learning environment, encouraging participants to exchange ideas and experiences. CONCLUSION: Targeted training in IS appears to enhance reproductive health researchers' capacity to translate research into practice, potentially leading to improved healthcare outcomes in Rwanda. Moving forward, we advocate for the Ministry of Health to establish structures for IS research agenda-setting, particularly for sexual and reproductive health and rights. Ideally, universities, health systems, and research institutions will incorporate IS capacity strengthening into their routine activities. Ongoing training is crucial to reinforce and expand IS knowledge. Our findings are expected to inform future interventions and guide policy development.
Assuntos
Atenção à Saúde , Ciência da Implementação , Saúde Reprodutiva , Autoeficácia , Ruanda , Humanos , Saúde Reprodutiva/educação , Feminino , Pesquisadores/educação , Masculino , Adulto , Fortalecimento InstitucionalRESUMO
Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.
Assuntos
Doenças Autoimunes , COVID-19 , Eczema , Hipertensão , Síndrome do Intestino Irritável , Hepatopatias , Infarto do Miocárdio , Estado Pré-Diabético , Doença Pulmonar Obstrutiva Crônica , Distúrbios do Início e da Manutenção do Sono , Adulto , Humanos , Colesterol , Doença Crônica , COVID-19/epidemiologia , Estilo de Vida , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Qualidade de Vida , ÚlceraRESUMO
Background: In this study, we assessed the general population's fears towards various diseases and events, aiming to inform public health strategies that balance health-seeking behaviours. Methods: We surveyed adults from 30 countries across all World Health Organization (WHO) regions between July 2020 and August 2021. Participants rated their fear of 11 factors on an 11-point Likert scale. We stratified the data by age and gender and examined variations across countries and regions through multidimensional preference analysis. Results: Of the 16 512 adult participants, 62.7% (n = 10 351) were women. The most feared factor was the loss of family members, reported by 4232 participants (25.9%), followed by cancer (n = 2248, 13.7%) and stroke (n = 1416, 8.7%). The highest weighted fear scores were for loss of family members (mean (xÌ) = 7.46, standard deviation (SD) = 3.04), cancer (xÌ = 7.00, SD = 3.09), and stroke (xÌ = 6.61, SD = 3.24). The least feared factors included animals/insects (xÌ = 3.72, SD = 2.96), loss of a mobile phone (xÌ = 4.27, SD = 2.98), and social isolation (xÌ = 4.83, SD = 3.13). Coronavirus disease 2019 (COVID-19) was the sixth most feared factor (xÌ = 6.23, SD = 2.92). Multidimensional preference analyses showed distinct fears of COVID-19 and job loss in Australia and Burundi. The other countries primarily feared loss of family members, cancer, stroke, and heart attacks; this ranking was consistent across WHO regions, economic levels, and COVID-19 severity levels. Conclusions: Fear of family loss can improve public health messaging, highlighting the need for bereavement support and the prevention of early death-causing diseases. Addressing cancer fears is crucial to encouraging the use of preventive services. Fear of non-communicable diseases remains high during health emergencies. Top fears require more resources and countries with similar concerns should collaborate internationally for effective fear management.
Assuntos
COVID-19 , Medo , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Feminino , Medo/psicologia , Masculino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Acontecimentos que Mudam a Vida , SARS-CoV-2 , Inquéritos e Questionários , Adolescente , Saúde Global , Neoplasias/psicologiaRESUMO
AIM: The aim of this discursive paper was to describe and expound on how paediatric nurses will be able to address the needs of children and adolescents through the lens of selected Sustainable Development Goals (SDGs) in Rwanda. DESIGN: A discursive analysis of SDGs relating to the roles of paediatric nurses in the context of Rwanda. METHODS: A discursive method using SDGs as a guiding framework is used in this paper. We drew on our own experiences and supported them with the available literature. RESULTS: A collection of contextually relevant examples of how paediatric nurses will be able to address the needs of children and adolescents through the lens of selected SDGs in Rwanda was discussed. The selected SDGs expounded on were: no poverty, good health and well-being, quality of education, decent work and economic growth, reduced inequalities, and partnerships for the goals. CONCLUSIONS: There is no doubt that the paediatric nurses in Rwanda play undeniable key roles in attaining SDGs and their targets. Thus, there is a need to train more paediatric nurses with the support of the interdisciplinary partners. Collaboratively, this is possible in the bid to ensure equitable and accessible care to the current and future generations. PUBLIC CONTRIBUTION: This discursive paper is intended to inform the different stakeholders in nursing practice, research, education and policy to support and invest in the advanced education of paediatric nurses for attainment of the SDGs.
Assuntos
Enfermeiros Pediátricos , Desenvolvimento Sustentável , Criança , Humanos , Adolescente , RuandaRESUMO
BACKGROUND: Research efforts in Rwanda to improve sexual and reproductive health and rights (SRHR) are increasing; however, comprehensive literature reviews on SRHR are limited. This scoping review examines individual and contextual factors shaping knowledge, attitudes, and practices in the domains of: 1) family planning, 2) abortion care, and 3) other SRHR in Rwanda. Recognizing that individual, community, and societal factors influence RH, this review is guided by Bronfenbrenner's Ecological Systems Theory. METHODS: Eligible studies were conducted in Rwanda, included males and/or females of any age, and were published within the past 20 years. Studies reporting views of only healthcare or other professionals were excluded. RESULTS: Thirty-six studies were included. The majority addressed individual and contextual considerations. At the individual level, studies explored knowledge about SRHR problems while at the interpersonal level, the support and attitudes of men and community members for adolescent SRHR were investigated. In terms of healthcare organization, maternal health practices, increased access to family planning programs, and the need for sexually transmitted infection programs was explored. At the social and cultural level, researchers investigated beliefs and traditional gender roles. Regarding public health policy, studies mentioned promoting and increasing funding for SRHR and reducing gender inequities. CONCLUSION: Our findings can inform SRHR research programs, public health campaigns, and policy advances in Rwanda.
Assuntos
Serviços de Saúde Reprodutiva , Saúde Reprodutiva , Masculino , Gravidez , Adolescente , Humanos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Ruanda , Comportamento SexualRESUMO
Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.
Assuntos
COVID-19 , Adulto , Feminino , Humanos , COVID-19/epidemiologia , Estilo de Vida , Inquéritos e Questionários , Saúde Mental , EmoçõesRESUMO
Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.
Assuntos
Estilo de Vida , Qualidade de Vida , Masculino , Adulto , Feminino , Humanos , Estudos Transversais , Exercício Físico , Avaliação de Resultados em Cuidados de SaúdeRESUMO
Background: Injuries are a leading cause of mortality among children globally, with children in low- and middle-income countries more likely to die if injured compared to children in high-income countries. Timely and high-quality care are essential to reduce injury-related morbidity and mortality. Objectives: This study describes patterns, management, and outcomes of children 0-15 years presenting with unintentional injuries at three district hospitals in rural Rwanda between January 1 and December 31, 2017. Methods: Using a retrospective cross-sectional study design, we assessed the demographic and clinical characteristics, care provided, and outcomes of the children using data extracted from patient medical charts. We describe the patient population using frequencies and proportions as well as median and interquartile ranges. Findings: Of the 449 injured children who sought care at the three rural district hospitals, 66.2% (n = 297) were boys. The main causes of injury were falls (n = 261, 58.1%), burns (n = 101, 22.5%), and road traffic injuries (n = 67, 14.9%). Burns were the most common injury among children aged 0-5 years while falls were the leading injury type among the 5-15 years age group. Vital signs were inconsistently completed ranging between 23.8-89.1% of vital sign items. Of the injured children, 37.0% (n = 166) received surgery at the district hospital, general practitioners performed 80.9% (n = 114) of surgeries, 87.4% (n = 145) of operated patients received no anesthesia, and 69.3% (n = 311) were admitted to the district hospital, while 2.7% (n = 12) were transferred to tertiary facilities for higher-level care. Conclusions: The presentation of child injuries-namely falls, burns, and road traffic accidents-is similar to what has been reported in other sub-Saharan African countries. However, more needs to be done to improve the completion and documentation of vital signs and increase availability of surgical specialists. Finally, targeted strategies to prevent burns and motorcycle-related injuries are recommended prevention interventions for this rural population.
Assuntos
Hospitais Rurais , Ferimentos e Lesões , Criança , Estudos Transversais , Hospitais de Distrito , Humanos , Lactente , Masculino , Estudos Retrospectivos , Ruanda/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapiaRESUMO
BACKGROUND: Various studies have found a greater prevalence of depression among patients having one or more chronic non communicable disease like diabetes mellitus than in the general population. This co-morbidity is linked with serious health consequences such as high mortality and morbidity, debility, low quality of life and increased health costs. The aim was to determine the prevalence of depression among patients with diabetes attending three selected district hospitals in Rwanda. Sociodemographic factors associated with depression were also explored. METHODS: It was a descriptive cross sectional study. A sample of 385 was selected randomly to participate in the study and 339 complete the questionnaires making a response rate of 88%. The Patient Health Questionnaire-9 (PHQ-9) was used to screen depression. Descriptive and inferential analysis were done. RESULTS: The majority of respondents 83.8% (n=284) had depression. Among them 17.9% (n=61) had moderately severe to severe depression while 81.9% (n=223) had minimal to moderate depression. A statistically significant association was found between age and depression (p=0.01) also between gender and depression (p=0.02). Significance was determined at P<0.05. CONCLUSION: we found a high prevalence of depression among patients with diabetes. The regular screening of depression among these patients is recommended.
Assuntos
Atitude Frente a Saúde , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Pacientes/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Ruanda/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. METHODS: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. RESULTS: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. CONCLUSION: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
Assuntos
Fortalecimento Institucional , Programas Governamentais , Pessoal de Saúde/educação , Mão de Obra em Saúde , Cooperação Internacional , Organizações , Instituições Acadêmicas , Países em Desenvolvimento , Docentes , Administração Financeira , Humanos , Ruanda , Estudantes , Estados UnidosRESUMO
BACKGROUND: Chronic non-communicable diseases (NCDs) are a major global health problem of the 21 stcentury. They are now the world's leading cause of disease burden and high mortality. An even more alarming health problem is when depression coexists with chronic NCDs, as is frequently the case. Management of this co-morbidity with collaborative care has become a global topic of interest, with the World Health Organization (WHO) recommending implementation of collaborative care for this purpose. The study investigated existing protocols and/or interventions for managing this co-morbidity in Rwandan district hospitals. METHODS: The study used an action research design involving a research team of 14 health care professionals to collaboratively identify existing protocols or interventions for managing co-morbidity of depression and NCDs in Rwanda. Focus group discussion using a structured interview guide was used to collect qualitative data, followed by qualitative content analysis using inductive approach. RESULTS: We found no particular protocols or interventions in place to manage the co-morbidity of depression and chronic NCDs. Depression and chronic NCDs were found to be treated separately, in separate health care settings and by different health professionals. CONCLUSION: The findings revealed a gap in management of co-morbid depression and chronic NCDs in Rwanda district hospitals. We recommend that health care providers follow the WHO collaborative care advisory for better quality care and better patient improvement in management of this co-morbidity.