Prevalence and levels of disability post road traffic orthopaedic injuries in Rwanda.

Background: Prolonged disability resulting from road traffic injuries (RTIs) contributes significantly to morbidity and disease burden. A good understanding of the prevalence and the level of disability of orthopaedic injuries in developing countries is crucial for improvement; however, such data are currently lacking in Rwanda. Objectives: To determine the prevalence and levels of disability of 2 years post-road traffic orthopaedic injuries in Rwanda. Method: A multicentre, cross-sectional study from five Rwandan referral hospitals of 368 adult RTI victims' sustained from accidents in 2019. Between 02 June 2022, and 31 August 2022, two years after the injury, participants completed the World Health Organization Disability Assessment Schedule (WHODAS 2.0) Questionnaire for the degree of impairment and the Upper Extremity Functional Scale and Lower-Extremity Functional Scale forms for limb functional evaluation. Descriptive, inferential statistics Chi-square and multinomial regression models were analysed using R Studio. Results: The study's mean age of the RTOI victims was 37.5 (±11.26) years, with a sex ratio M: F:3: 1. The prevalence of disability following road traffic orthopedic injury (RTOI) after 2 years was 36.14%, with victims having WHODAS score > 25.0% and 36.31% were still unable to return to their usual activities. Age group, Severe Kampala Trauma Score and lack of rehabilitation contributed to disability. The most affected WHODAS domains were participation in society (33%) and life activities (28%). Conclusion: The prevalence and levels of disability because of RTOI in Rwanda are high, with mobility and participation in life being more affected than other WHODAS domains. Middle-aged and socio-economically underprivileged persons are the most affected. Contribution: This study showed that a good rehabilitation approach and economic support for the RTI victims would decrease their disabilities in Rwanda.

The status and outcomes of interprofessional health education in sub-Saharan Africa: A systematic review.

The increasing burden of chronic diseases, and shortage of health care workers especially in Low and Middle Income countries (LMICs) requires greater collaborative working between health professions. There is a growing body of evidence that interprofessional education (IPE) and interprofessional continuous education (IPCE) can improve collaborative practice thus strengthening health care delivery in low resource settings. The World Health Organization (WHO) promotes this educational strategy in these regions as part of wider programs to improve health care. The purpose of this systematic review was to summarize IPE and IPCE activities in sub-Saharan Africa (SSA) and its outcomes; including practice, service and patient outcomes. Standard guidelines for conducting and reporting systematic reviews were followed. The online databases searched included MEDLINE, Embase, Education Resources Information Centre (ERIC), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Science Direct. The Kirkpatrick model was used to classify IPE outcomes reported from literature. Following full text screening, 41 articles were selected for data extraction. It was found that IPE/IPCE is still a relatively new concept in SSA with 93% of studies published after 2012. Furthermore, IPE is concentrated predominantly in undergraduate institutions and mainly implemented to improve collaborative practice and address important public health concerns. Positive reaction and outcomes of IPE/IPCE were reported in terms of change of attitude and perception toward collaborative practice as well as knowledge and skills acquisition. Few studies in SSA sought to understand and measure the outcomes of IPE/IPCE relating to health care practice. More work in this important potential outcome of IPE/IPCE is recommended.

Functioning among persons with lower limb amputation with or without prostheses in Rwanda.

Background: Limb loss limits functioning and restricts participation in various environments. Persons with lower limb amputations (PLLA) experience challenges ranging from self-care and independence to psychological disorders that negatively impact their functioning. Objectives: To assess the functioning and the level of disability of PLLA with or without prostheses in Rwanda. Method: A descriptive, cross-sectional study was conducted among PLLAs aged 18 years and above in 10 districts of Rwanda. A total of 247 participants were purposively selected to fill the questionnaires. Descriptive and inferential statistics using t-test and binary logistic regression were performed to analyse data using Statistical Package for Social Sciences (SPSS) (version 21.0). Results: Out of 247 PLLA, 99 (40.1%) had prostheses and remaining 148 (59.9%) did not. Majority of PLLA without prostheses reported having more difficulties in mobility (s.d. 3.98), participation (s.d. 5.18) and life activities (s.d. 3.87). The majority of PLLA reported mild and moderate functioning in the domains of cognitive (odds ratio [OR] 8.842, 5.384 with 95% confidence interval [CI]) mobility (OR 16.154, 2.485 with 95% CI) and participation (OR 13.299, 15.282 with 95% CI). Conclusion: Persons without prostheses demonstrated reduced level of functioning and high levels of disability compared to those with prostheses in all domains. However, the mobility, self-activities and the participation domains were the mainly affected. Contribution: The study helps to understand the needs of the PLLA and emphasises that not only having prostheses can improve functioning but also emphasises the psychosocial aspects to reduce disability.

Interprofessional ArclightTM eye health workshop: impact on students' clinical identification and ophthalmic skills.

Visual impairment and blindness affect an estimated 2.2 billion people worldwide. Accessible low-cost diagnostic tools and interprofessional education and collaborative practice are part of ongoing strategies to improve eye care services. This study evaluated the impact of an interprofessional Arclight workshop on undergraduate healthcare students' clinical identification skills related to eye health, and self-reported confidence in ophthalmic skills. Undergraduate students from clinical medical officer, ophthalmic clinical officer, Bachelors and Diploma nursing, and medical programs at the University of Rwanda participated in a pilot interprofessional eye health workshop. The Arclight device, a low-cost ophthalmoscope and simulation eyes were used to enable students to practice ophthalmic skills and thereafter equip them. Clinical identification skills related to common eye conditions, and self-reported confidence in ophthalmic skills were assessed pre and post workshop. Overall, students' ability to identify common eye conditions, and self-reported confidence in relation to all skills statistically improved post workshop, with some differences between professional groups in relation to eye health skills. This IPE experience used the Arclight package as a vehicle for IPE, enabling healthcare students to share and acquire new skills and confidence in relation to recognizing common eye conditions and assessing eye health.

Factors affecting social integration after road traffic orthopaedic injuries in Rwanda.

Background: Road traffic injuries (RTIs) leading to long-term disability present a significant public health challenge, causing immense personal and societal consequences. Every year, 50 million people are hurt, 1.2 million die, 30% are permanently disabled, and 14% cannot return to work due to road traffic accidents. However, in many developing countries, information on the social integration of patients post-RTI remains limited. This study aimed to identify factors contributing to social integration following road traffic-related orthopedic injuries (RTOI) in Rwanda. Methodology: A multicenter, cross-sectional study included 369 adult Road traffic orthopedic injuries (RTOI) victims from five Rwandan referral hospitals. Participants completed the IMPACT-S Questionnaire between 2 June 2022, and 31 August 2022, two years after the injury. It measured social integration in terms of activities and paricipation. We used logistic regression statistical analysis with a significance level of p < 0.05 to estimate odds ratios (OR) and 95% confidence intervals (CI). The Institutional Review Board for Health Sciences and Medicine at the University of Rwanda College of Medicine ethically authorized this study. Participants signed a written consent form before participating in the study. The data was kept private and was used only for this study. Results: The study's findings indicated that the mean age of RTOI victims was 37.5 ± 11.26 years, with a notable male predominance over females. Of the participants, 5.69% were unable to resume normal life activities. The overall mean score on the IMPACT-S scale was moderate, at 77 ± 17. Specifically, participants achieved an average score of 76 ± 16 for "activities" and a higher average of 84 ± 16 for "participation." Certain factors were associated with poor social integration compared to others, including belonging to the age group above 65 years (OR = 8.25, p = 0.02), female sex (OR = 3.26, p = 0.02), lack of rehabilitation (OR = 3.82, p = 0.01), and length of hospital stay >15 days (OR = 4.44, p = 0.02). Conclusion: The majority of RTOI victims in Rwanda achieved successful reintegration into society; nevertheless, their mobility and community engagement were more significantly impacted compared to other aspects assessed by the IMPACT-S scale. The study emphasized the importance of early management, effective rehabilitation, and prompt patient discharge from the hospital in facilitating a successful return to everyday life after road traffic-related orthopedic injuries.

The status and use of prosthetic devices by persons with lower limb amputation in Rwanda.

Background: Amputation is one of the leading causes of disabilities because of reduced mobility. Without assistive devices specifically prostheses, the quality of life of persons with lower limb amputation (PLLA) further deteriorates. Therefore, prostheses are fundamental to improving their quality of life. Objectives: This study aimed to establish the number of PLLA with or without prosthesis and to determine their socio-economic profile in Rwanda. Method: A descriptive, cross-sectional study was conducted in all sectors of Rwanda. As a result of coronavirus disease 2019 movement restrictions, data collection was carried out through telephone calls with participants to complete the questionnaires. Descriptive, inferential statistics and chi-square test were performed to analyse data using Statistical Package for Social Science (SPSS) 21.0. Results: Of the 3026 participants identified countrywide, 68.8% were males and 60.3% of them did not have any prosthesis (p = 0.003). The majority (62.4%) of those who had prosthetic devices needed repair of their prostheses while 14.8% of participants reported that their prosthetic devices were completely broken and/or damaged (p = 0.604). Among the participants, 63.7% had no source of income and 66.7% had dependents (p ≤ 0.001). Conclusion: The majority of the PLLA in Rwanda did not have prosthetic devices and even those with prostheses did not fully function and thus required repair. Therefore, it adversely affects their livelihood. Contribution: The government should collaborate with stakeholders working with persons with disabilities and implement mechanisms and/or strategies to make prosthetic devices accessible and affordable.

The impact of a training programme incorporating the conceptual framework of the International Classification of Functioning (ICF) on knowledge and attitudes regarding interprofessional practice in Rwandan health professionals: a cluster randomized control trial.

BACKGROUND: The first step in improving interprofessional teamwork entails training health professionals (HP) to acknowledge the role and value the contribution of each member of the team. The International Classification of Functioning, Disability and Health (ICF) has been developed by WHO to provide a common language to facilitate communication between HPs. OBJECTIVE: To determine whether ICF training programme would result in improved knowledge and attitudes regarding interprofessional practice within Rwandan district hospitals. DESIGN, SETTING AND PARTICIPANTS: A cluster randomised, single blinded, control trial design was used to select four district hospitals. Participants included physicians, social workers, physiotherapists, nutritionists, clinical psychologists/mental health nurses. INTERVENTION: Health professionals either received one day's training in interprofessional practice (IPP) based on the ICF (experimental group) as a collaborative framework or a short talk on the topic (control group). OUTCOME MEASURES: Validated questionnaires were used to explore changes in knowledge and attitudes. Ethical approval was obtained from the relevant authorities. RESULTS: There were 103 participants in the experimental and 100 in the control group. There was no significant difference between Knowledge and Attitude scales at baseline. Post-intervention the experimental group (mean = 41.3, SD = 9.5) scored significantly higher on the knowledge scale than the control group (mean = 17.7, SD = 4.7 (t = 22.5; p < .001)). The median scores on the Attitude Scale improved in the Experimental group from 77.8 to 91.1%, whereas the median scores of the control remained approximately 80% (Adjusted Z = 10.72p < .001). CONCLUSION: The ICF proved to be a useful framework for structuring the training of all HPs in IPP and the training resulted in a significant improvement in knowledge and attitudes regarding IPP. As suggested by the HPs, more training and refresher courses were needed for sustainability and the training should be extended to other hospitals in Rwanda. It is thus recommended that the framework can be used in interprofessional education and practice in Rwanda and possibly in other similar countries. TRIAL REGISTRATION: Name of the registry: Pan African Clinical Trial Registry. TRIAL REGISTRATION NUMBER: PACTR201604001185358 . Date of registration: 22/04/2016. URL of trial registry record: www.pactr.org.

Evaluation of a pilot interprofessional Arclight™ workshop for healthcare students in Rwanda: promoting collaborative practice in eye health.

Preventable and treatable visual impairment affects more than 1 billion people worldwide. Rwanda has an estimated visual impairment prevalence of 3.7% amongst the 12 million inhabitants. Around one third of this demand could be addressed through a more integrated and collaborative approach, particularly in primary eye care services. Healthcare students, therefore, need to be prepared for collaborative practice in eye health through interprofessional learning. Interprofessional workshops were piloted with ophthalmic clinical officer, medical clinical officer, nursing and medical students from the University of Rwanda. The aim was to promote collaborative practice by teaching students how to assess and recognize common eye conditions using the Arclight; a low cost, solar powered, portable ophthalmoscope designed for use in low resource settings. Students reported that the workshop content was relevant to all professional groups. They valued the opportunity to learn interprofessionally, share their knowledge and perspectives, and acquire new knowledge and skills together. This pilot helped to identify the most relevant skills and knowledge for future interprofessional eye health training. It enabled the facilitators to reflect on how best to maintain a balance between a quality interprofessional experience and the more specific eye health related learning objectives.

The impact of a training programme incorporating the conceptual framework of the International Classification of Functioning (ICF) on behaviour regarding interprofessional practice in Rwandan health professionals: A cluster randomized control trial.

BACKGROUND: Appropriate collaboration between health professionals (HP) can reduce medical errors, enhance the spread of critical information, and assist in interpretation of health information resulting in improved patient care. The International Classification of Functioning, Disability and Health (ICF) may provide a useful conceptual framework to facilitate better interprofessional practice. PURPOSE: To determine whether a training programme based on the ICF framework resulted in improved interprofessional behaviour among HPs in Rwanda. METHODOLOGY: A cluster randomised control trial was used. Four district hospitals were randomly allocated to receive either a day's training in interprofessional practice based on the ICF framework (experimental) or a short talk and a booklet on the topic (control). A total of 203 participants included medical doctors, nurses, and other HPs took part in this study. Simple random sampling was used to select the hospital records of 200 patients discharged from relevant wards at both the experimental and control hospitals at baseline and at two, four and six months after training (800 patients' records from each group). A self-designed checklist has undergone some validation and was based on the ICF conceptual model was used to audit the quality of information included in the patients' records. Ethical approval was obtained from the relevant authorities. RESULTS: The demographic and medical profile of the patients in the two sets was equivalent. An ANOVA and post-hoc Tukey test indicated the mean number of items correctly filled in was not significant at baseline (p = 0.424) but the difference was significant (p < .001) for the post-intervention scores at two, four and six months. The control group scores did not improve over time. The improved behavior was still evident at six months although it had begun to decay. CONCLUSION: Behaviour change as evidenced by more comprehensive recording of patient management can result from a well-structured training programme. The ICF appeared to provide a common language and facilitate HPs interaction and patient management plans. IMPLICATION: The ICF provided an effective conceptual framework to structure the content of the training and the audit tool. It is recommended that the framework be used to facilitate interprofessional education and practice in Rwanda and that the training approach may be applicable to other health care contexts.