Factors associated with anaemia among pregnant women in Rwanda: an analysis of the Rwanda demographic and health survey of 2020.

BACKGROUND: Anaemia in pregnancy is associated with several adverse outcomes for mothers and newborns, as well as their families. In this study, we assessed the prevalence of anaemia and the associated factors among pregnant women in Rwanda. METHODS: Secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS) was used. Multistage stratified sampling was used to select 435 pregnant women included in the study. Anaemia among pregnant women was defined as a haemoglobin value < 11 g/dL. Multivariable logistic regression was used to assess the associated factors with anaemia in pregnancy, using SPSS (version 26). RESULTS: Of the 435 pregnant women, 24.6% (95%CI: 21.1-29.3) were anaemic (1 in 4 pregnant women). Not working (AOR = 2.45; 95%CI: 1.14-5.26), being unmarried (AOR = 1.23; 95%CI: 1.24-3.57), low wealth index (AOR = 9.19; 95%CI: 1.64-51.56), having difficulty accessing a nearby health facility (AOR = 5.40; 95%CI: 2.21-13.23), and normal body mass index (AOR = 3.33; 95%CI: 1.46-7.59) were associated with higher odds of being anaemic. However, not taking iron supplements (AOR = 0.16; 95% CI: 0.04-0.67), having no exposure to television (AOR = 0.35; 95%CI: 0.14-0.91), being from the southern region (AOR = 0.14; 95% CI: 0.03-0.66), and low husband/partner's education (AOR = 0.08; 95% CI: 0.01-0.59) were associated with lower odds of being anaemic. CONCLUSIONS: The study findings indicate a high prevalence of anaemia in pregnancy, which was associated with several socio-demographics. There is a need for setting up mobile clinics and health facilities in hard-to-reach areas for easy accessibility to early anaemia screening services. Conducting mass screening for anaemia targeting pregnant women who are not working, the unmarried, and those with a low wealth index would also be beneficial. The intake of locally available iron rich foods and/ or bio-fortified foods is also recommended.

Understanding and barriers to formation Professional Identity among current and recent graduates of nurses and midwifery in two universities in a low resource setting: A qualitative study.

Introduction: Professional identity (PI) in nursing is a sense of oneself and one's relationship with others that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting, and feeling like a nurse. Therefore, transformative educational approaches that include professional judgement, reasoning, critical self-evaluation and a sense of accountability are required to foster professional identity. We explored the understanding and barriers to professional identity formation among recent graduates and nursing students in Uganda. Methods: A qualitative research design was used to collect data from student Nurses and Midwives from Makerere University, Mbarara University and recent graduates attending their internship training at Mulago National and Mbarara Regional Referral hospitals. Thematic analysis was used to analyse the data. Results: The participants who reported understanding of PI in nursing and midwifery mentioned that these are principles, characteristics and values, competencies, ethics and code of conduct, sense of belonging and professionalism that define the nursing profession and practice. Barriers to the formation of PI were provided under two themes education and health service delivery. Regarding education (nursing educators not working in clinical settings and inadequate clinical mentoring). Under health service delivery:(high workload, lack of interprofessional collaboration, many different professional groups, no clear scope of practice for the different professional careers, Low esteem among nurses and midwives, media and lack of policy implementation). Conclusion and recommendation: Participants were knowledgeable about professional identity in nursing/midwifery. They faced several challenges and barriers in professional identity formation during their training and internship. We recommend a need to streamline the scope of practice and enhance clinical mentorship and engagement of Leadership in Nursing in developing PI among students.

Knowledge and preparedness for home-based, family-centered management of COVID-19 patients and dead bodies among residents in a COVID-19 high-risk setting.

Background: The overwhelming coronavirus disease- 2019 (COVID-19) cases have called for inevitable home-based care for some cases and direct involvement in COVID-19 dead body burials by many families worldwide. However, data on the knowledge and readiness by families for these practices is still scarce, hence this study among residents of Wakiso district, Uganda. Methods: We conducted a cross-sectional study between 6th March and 4th April 2021. Household heads aged 15years and above in 5 sub counties of Wakiso district were interviewed using a pre-tested questionnaire. Multivariable logistic regression analysis was used to assess the association between COVID-19 related knowledge on home-based care and burials with demographics characteristics. Results: We enrolled 205 participants, with a median age of 28 (range: 25-35) years. Majority (n = 157, 76.6%) were female and had achieved at least secondary level of education (n = 117, 57.1%). The mean knowledge score on home-based care for COVID-19 patient was 49.5 %, while that on COVID-19 dead body management was 36.5%. Seven (3.4%) respondents were ready to undertake home-based care and dead body management. For the remainder 198 (96.6%) unready respondents reported inadequate knowledge (n = 166, 84%) and lack of personal protective equipment (PPE) (n = 17, 8.6%) as major barriers for their readiness. There was no statistically significant difference in both the knowledge on home-based COVID-19 patient care and dead body management stratified by demographics characteristics. Conclusion: The knowledge and preparedness for home-based Covid-19 patient care and dead body management are suboptimal among Wakiso district residents. More public education programmes and PPE provision are recommended.

Nutrition Challenges of Patients with Alzheimer's Disease and Related Dementias: A Qualitative Study from the Perspective of Caretakers in a Mental National Referral Hospital.

PURPOSE: The burden of Alzheimer's dementia greatly impacts patients and their immediate families. Studies on the perspective of caretakers regarding nutrition in patients with Alzheimer's disease (AD) dementia are lacking. Yet this information is needed to guide clinical care for patients with dementia. The study explored caretakers' perspective on nutritional challenges faced by patients with Alzheimer's disease and related Dementias at Butabika National Referral Hospital. METHODS: We conducted 20 in-depth interviews and 2 focus group discussions with 20 health workers and 16 caregivers, respectively. The focus group discussions and in-depth interviews were audio-recorded and transcribed. Analysis was conducted using a thematic, constant comparative approach with an emphasis on dominant themes. RESULTS: Participants had a mean age of 37 in the range (27-44) years. Seventeen (47%) of them were males. Their duration of Care for Dementia to patients was in the range (2-7) years. The highest level of education was a bachelor's degree and the primary level was the lowest. Thirteen (35%) were married and twenty-three (65%) were not, and they either survived on salaries or wages as a source of income. The key emerging issues were 1) hindrances to nutritional care in dementia, 2). Factors leading to inadequate nutrition among people with dementia and 3). Recommendations to improve nutrition needs. CONCLUSION: Caretakers experience challenges ranging from psychotic manifestations of a patient to hindrances in the provision of nutritional care. A better understanding of their experience is essential for the development of interventions to help the family members, health workers and other care takers promote good nutrition in patients with Alzheimer's dementia. A clear referral system should be established to prevent overcrowding of patients at a mental national referral hospital to ensure adequate timely nutritional support to those admitted. Capacity building programs should continue to address the knowledge gap in nutritional requirements of patients with Alzheimer's dementia.