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1.
BMC Psychol ; 9(1): 135, 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481518

RESUMO

BACKGROUND: Offspring of the parents with mental disorders are at higher risk to have the mental diseases throughout the world. This study examined the association between psychopathology of parents and the mental health of their offspring in Neuropsychiatric Hospital of Rwanda, Butare Branch. METHODS: A cross-sectional study made up of case and control offspring was conducted on the case group made up of 80 offspring born to parents with mental diseases and a control group of 80 offspring from parents without mental disease. Hamilton Rating Scale for Depression (HRSD, α = 0.82), Posttraumatic stress disorders scale (PTSD, α = 0.73) and the Test of Psychological Problems (TPP, α = 0.93) were used. STATISTICA version 8 was used for statistical analysis. RESULTS: Results indicated a significance difference between the two groups on depressive symptoms, psychological problems and PTSD symptomatology. The case group seemed to experience high level symptoms than the control group. Results indicated that, among the offspring born to parents with mental disease, there was a significant correlation between anxiety and depression symptoms (r = 0.71, p < .001), PTSD and eating disorder (r = 0.75, p < .001), domestic violence and PTSD (r = 0.78, p < .001), aggressive behavior and PTSD (r = 0.79, p < .001), somatoform disorders and PTSD (r = 0.98, p < .001). No significant association between the low self-esteem, depression, anxiety, mental disorders induced drug abuse and PTSD was found. CONCLUSION: Offspring of the parents with mental disorders had higher risk to develop mental diseases than the offspring born to the parents without mental diseases. Taking into account the assessment of parents' mental illness when taking care of the offspring's psychological disorders is needed in the neuropsychiatric hospital.


Assuntos
Saúde Mental , Transtornos de Estresse Pós-Traumáticos , Estudos Transversais , Hospitais , Humanos , Pais , Ruanda/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia
2.
Nat Commun ; 12(1): 5705, 2021 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-34588460

RESUMO

COVID-19 transmission rates are often linked to locally circulating strains of SARS-CoV-2. Here we describe 203 SARS-CoV-2 whole genome sequences analyzed from strains circulating in Rwanda from May 2020 to February 2021. In particular, we report a shift in variant distribution towards the emerging sub-lineage A.23.1 that is currently dominating. Furthermore, we report the detection of the first Rwandan cases of the B.1.1.7 and B.1.351 variants of concern among incoming travelers tested at Kigali International Airport. To assess the importance of viral introductions from neighboring countries and local transmission, we exploit available individual travel history metadata to inform spatio-temporal phylogeographic inference, enabling us to take into account infections from unsampled locations. We uncover an important role of neighboring countries in seeding introductions into Rwanda, including those from which no genomic sequences were available. Our results highlight the importance of systematic genomic surveillance and regional collaborations for a durable response towards combating COVID-19.


Assuntos
COVID-19/virologia , Genoma Viral/genética , SARS-CoV-2/genética , Doença Relacionada a Viagens , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Monitoramento Epidemiológico , Feminino , Humanos , Masculino , Filogenia , Filogeografia , RNA Viral/genética , RNA Viral/isolamento & purificação , Ruanda/epidemiologia , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/patogenicidade , Sequenciamento Completo do Genoma
3.
Biomed Res Int ; 2021: 9957160, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34395630

RESUMO

Background: The Ghana Demographic and Health Survey 2014 report indicates that anemia among women in their reproductive age in the country stood at 42 percent, making it a severe public health problem according to the World Health Organization (WHO) classification. WHO Global Observatory data indicates that some sub-Saharan African countries have been able to reduce the prevalence of anemia among women of reproductive age compared to Ghana in 2016. To inform policy decisions, data from the Demographic and Health Surveys 2014-2018 were analyzed to determine the disparities in the prevalence of anemia and related factors among women of reproductive age in Ghana, Ethiopia, Uganda, Tanzania, and Rwanda. Methods: This research utilized data from the Demographic and Health Surveys 2014, 2016, 2014-2015, 2015-2016, and 2016 from Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively. Respondents were women aged between 15 and 49 years. Hemoglobin levels were measured by HemoCue hemoglobin meter. 45,299 women data were extracted from the five countries with 4,644, 14,923, 6,680, 13,064, and 5,988 from Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively. Association between anemia and selected predictive variables was assessed using Pearson's chi-square test statistic. Poisson regression with robust standard errors was used to estimate the prevalence rate ratios of developing anemia. The deviance goodness of fit test was employed to test the fit of the Poisson model to the data set. Results: There was a statistically significant difference in prevalence of 1,962 (42.3%), 3,527 (23.6%), 1,284 (19.3%), 5,857 (44.8%), and 1,898 (31.7%) for Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively, χ 2 = 2,181.86 and p value < 0.001. Parity, pregnancy status, and contraceptives significantly increased the prevalence rate ratio of a woman developing anemia. Women in Ethiopia with a parity of six or more were 58% more likely to develop anemia than those with parity of zero. Tanzanian women who were pregnant had a 14% increased rate ratio of developing anemia. Factors that significantly decreased anemia in this study were wealth index, women's age, and women's highest level of education. Women who were in the higher education category in Ethiopia were 57% less likely to develop anemia. Ugandan women in the richest category of the wealth index were 28% less likely to develop anemia. Rwandan women in the middle category of the wealth index were 20% less likely to develop anemia. Women who were within the 45-49 age category in Ethiopia were 48% less likely to develop anemia. Conclusion: The individual country governments should encourage the implementation of increasing female enrollment in higher education. Women in their reproductive age should be encouraged to use modern contraceptives to reduce their anemia prevalence.


Assuntos
Anemia/epidemiologia , Anticoncepção/efeitos adversos , Adolescente , Adulto , Anemia/etiologia , Etiópia , Feminino , Gana/epidemiologia , Humanos , Pessoa de Meia-Idade , Paridade , Distribuição de Poisson , Gravidez , Prevalência , Ruanda/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia , Saúde da Mulher , Adulto Jovem
4.
Ann Glob Health ; 87(1): 77, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34430227

RESUMO

Background: As the volume of surgical cases in low- and middle-income countries (LMICs) increases, surgical-site infections (SSIs) are becoming more prevalent with anecdotal evidence of antimicrobial resistance (AMR), despite a paucity of data on resistance patterns. Objectives: As a primary objective, this prospective study aimed to describe the epidemiology of SSIs and the associated AMR among women who delivered by cesarean at a rural Rwandan hospital. As secondary objectives, this study also assessed patient demographics, pre- and post-operative antibiotic use, and SSI treatment. Methods: Women who underwent cesarean deliveries at Kirehe District Hospital between September 23rd, 2019, and March 16th, 2020, were enrolled prospectively. On postoperative day (POD) 11 (+/- 3 days), their wounds were examined. When an SSI was diagnosed, a wound swab was collected and sent to the Rwandan National Reference Laboratory for culturing and antibiotic susceptibility testing. Findings: Nine hundred thirty women were enrolled, of whom 795 (85.5%) returned for the POD 11 clinic visit. 45 (5.7%) of the 795 were diagnosed with SSI and swabs were collected from 44 of these 45 women. From these 44 swabs, 57 potential pathogens were isolated. The most prevalent bacteria were coagulase-negative staphylococci (n = 12/57, 20.3% of all isolates), and Acinetobacter baumannii complex (n = 9/57, 15.2%). 68.4% (n = 39) of isolates were gram negative; 86.7% if excluding coagulase-negative staphylococci. No gram-negative pathogens isolated were susceptible to ampicillin, and the vast majority demonstrated intermediate susceptibility or resistance to ceftriaxone (92.1%) and cefepime (84.6%). Conclusions: Bacterial isolates from SSI swab cultures in rural Rwanda predominantly consisted of gram-negative pathogens and were largely resistant to commonly used antibiotics. This raises concerns about the effectiveness of antibiotics currently used for surgical prophylaxis and treatment and may guide the appropriate selection of treatment of SSIs in rural Rwanda and comparable settings.


Assuntos
Antibacterianos/uso terapêutico , Cesárea , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Farmacorresistência Bacteriana , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Bactérias Gram-Positivas/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Gravidez , Estudos Prospectivos , Ruanda/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
5.
BMC Med ; 19(1): 160, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34238298

RESUMO

BACKGROUND: East Africa is home to 170 million people and prone to frequent outbreaks of viral haemorrhagic fevers and various bacterial diseases. A major challenge is that epidemics mostly happen in remote areas, where infrastructure for Biosecurity Level (BSL) 3/4 laboratory capacity is not available. As samples have to be transported from the outbreak area to the National Public Health Laboratories (NPHL) in the capitals or even flown to international reference centres, diagnosis is significantly delayed and epidemics emerge. MAIN TEXT: The East African Community (EAC), an intergovernmental body of Burundi, Rwanda, Tanzania, Kenya, Uganda, and South Sudan, received 10 million € funding from the German Development Bank (KfW) to establish BSL3/4 capacity in the region. Between 2017 and 2020, the EAC in collaboration with the Bernhard-Nocht-Institute for Tropical Medicine (Germany) and the Partner Countries' Ministries of Health and their respective NPHLs, established a regional network of nine mobile BSL3/4 laboratories. These rapidly deployable laboratories allowed the region to reduce sample turn-around-time (from days to an average of 8h) at the centre of the outbreak and rapidly respond to epidemics. In the present article, the approach for implementing such a regional project is outlined and five major aspects (including recommendations) are described: (i) the overall project coordination activities through the EAC Secretariat and the Partner States, (ii) procurement of equipment, (iii) the established laboratory setup and diagnostic panels, (iv) regional training activities and capacity building of various stakeholders and (v) completed and ongoing field missions. The latter includes an EAC/WHO field simulation exercise that was conducted on the border between Tanzania and Kenya in June 2019, the support in molecular diagnosis during the Tanzanian Dengue outbreak in 2019, the participation in the Ugandan National Ebola response activities in Kisoro district along the Uganda/DRC border in Oct/Nov 2019 and the deployments of the laboratories to assist in SARS-CoV-2 diagnostics throughout the region since early 2020. CONCLUSIONS: The established EAC mobile laboratory network allows accurate and timely diagnosis of BSL3/4 pathogens in all East African countries, important for individual patient management and to effectively contain the spread of epidemic-prone diseases.


Assuntos
COVID-19/prevenção & controle , Redes Comunitárias , Dengue/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Laboratórios , Unidades Móveis de Saúde , Burundi/epidemiologia , COVID-19/terapia , Dengue/prevenção & controle , Epidemias , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/terapia , Humanos , Quênia/epidemiologia , Unidades Móveis de Saúde/economia , Saúde Pública , Ruanda/epidemiologia , SARS-CoV-2 , Sudão do Sul/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-34209123

RESUMO

We reported the findings of the first Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) four clusters identified in Rwanda. Case-investigations included contact elicitation, testing, and isolation/quarantine of confirmed cases. Socio-demographic and clinical data on cases and contacts were collected. A confirmed case was a person with laboratory confirmation of SARS-CoV-2 infection (PCR) while a contact was any person who had contact with a SARS-CoV-2 confirmed case within 72 h prior, to 14 days after symptom onset; or 14 days before collection of the laboratory-positive sample for asymptomatic cases. High risk contacts were those who had come into unprotected face-to-face contact or had been in a closed environment with a SARS-CoV-2 case for >15 min. Forty cases were reported from four clusters by 22 April 2020, accounting for 61% of locally transmitted cases within six weeks. Clusters A, B, C and D were associated with two nightclubs, one house party, and different families or households living in the same compound (multi-family dwelling). Thirty-six of the 1035 contacts tested were positive (secondary attack rate: 3.5%). Positivity rates were highest among the high-risk contacts compared to low-risk contacts (10% vs. 2.2%). Index cases in three of the clusters were imported through international travelling. Fifteen of the 40 cases (38%) were asymptomatic while 13/25 (52%) and 8/25 (32%) of symptomatic cases had a cough and fever respectively. Gatherings in closed spaces were the main early drivers of transmission. Systematic case-investigations contact tracing and testing likely contributed to the early containment of SARS-CoV-2 in Rwanda.


Assuntos
COVID-19 , SARS-CoV-2 , Busca de Comunicante , Humanos , Quarentena , Ruanda/epidemiologia
7.
Ann Glob Health ; 87(1): 57, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34249619

RESUMO

Globally, 10-20% of children and adolescents experience mental health conditions, but most of them do not receive the appropriate care when it is needed. The COVID-19 deaths and prevention measures, such as the lockdowns, economic downturns, and school closures, have affected many communities physically, mentally, and economically and significantly impacted the already-neglected children and adolescents' mental health. As a result, evidence has shown that many children and adolescents are experiencing psychological effects such as depression and anxiety without adequate support. The consequences of not addressing the mental health conditions in children and adolescents extend through adulthood and restrict them from reaching their full potential. The effects of COVID-19 on children and adolescents' mental health highlight the urgent need for multisectoral home-grown solutions to provide early diagnosis and treatment and educate caregivers on home-based interventions and community outreach initiatives to address children and adolescents' mental health challenges during this pandemic and beyond.


Assuntos
COVID-19 , Serviços Comunitários de Saúde Mental , Intervenção Médica Precoce/organização & administração , Transtornos Mentais , Quarentena/psicologia , Adolescente , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Controle de Doenças Transmissíveis/métodos , Serviços Comunitários de Saúde Mental/métodos , Serviços Comunitários de Saúde Mental/tendências , Educação à Distância , Saúde Global , Necessidades e Demandas de Serviços de Saúde , Humanos , Colaboração Intersetorial , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental/tendências , Carência Psicossocial , Ruanda/epidemiologia , SARS-CoV-2
8.
Sci Rep ; 11(1): 14107, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238978

RESUMO

The number of secondary cases, i.e. the number of new infections generated by an infectious individual, is an important parameter for the control of infectious diseases. When individual variation in disease transmission is present, like for COVID-19, the distribution of the number of secondary cases is skewed and often modeled using a negative binomial distribution. However, this may not always be the best distribution to describe the underlying transmission process. We propose the use of three other offspring distributions to quantify heterogeneity in transmission, and we assess the possible bias in estimates of the mean and variance of this distribution when the data generating distribution is different from the one used for inference. We also analyze COVID-19 data from Hong Kong, India, and Rwanda, and quantify the proportion of cases responsible for 80% of transmission, [Formula: see text], while acknowledging the variation arising from the assumed offspring distribution. In a simulation study, we find that variance estimates may be biased when there is a substantial amount of heterogeneity, and that selection of the most accurate distribution from a set of distributions is important. In addition we find that the number of secondary cases for two of the three COVID-19 datasets is better described by a Poisson-lognormal distribution.


Assuntos
COVID-19/transmissão , COVID-19/virologia , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , SARS-CoV-2 , COVID-19/epidemiologia , Simulação por Computador , Hong Kong/epidemiologia , Humanos , Índia/epidemiologia , Distribuição de Poisson , Ruanda/epidemiologia
9.
JCO Glob Oncol ; 7: 1116-1128, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34264750

RESUMO

PURPOSE: In East Africa, cervical cancer is a leading cause of morbidity and mortality among women diagnosed with cancer. In this study, we describe the burden of risk factors for cervical cancer among women of reproductive age in five East African countries. METHODS: For each country, using STATA13 software and sampling weights, we analyzed the latest Demographic and Health Survey data sets conducted between 2014 and 2017 in Burundi, Kenya, Rwanda, Tanzania, and Uganda. We included women age 15-49 years and considered six risk factors (tobacco use, body mass index, age at first sexual intercourse, age at first birth, number of children, and hormonal contraceptive use). RESULTS: Of the 93,616 women from the five countries, each country had more than half of the women younger than 30 years and lived in rural areas. Pooled proportion of women with at least one risk factor was 89% (95% CI, 87 to 91). Living in a rural area in Burundi (adjusted incidence rate ration 0.94; 95% CI, 0.9 to 0.99; P = .019) and Rwanda (adjusted incidence rate Ration 0.92; 95% CI, 0.88 to 0.96; P < .001) was associated with a lower number of risk factors compared with living in an urban area. In all the countries, women with complete secondary education were associated with a lower number of risk factors compared with those with no education. CONCLUSION: This study reveals a high burden of risk factors for cervical cancer in East Africa, with a high proportion of women exposed to at least one risk factor. There is a need for interventions to reduce the exposure of women to these risk factors.


Assuntos
Neoplasias do Colo do Útero , Adolescente , Adulto , Burundi , Criança , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Quênia , Pessoa de Meia-Idade , Fatores de Risco , Ruanda/epidemiologia , Fatores Socioeconômicos , Tanzânia , Uganda , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
10.
Int J Cardiol ; 338: 154-160, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34146584

RESUMO

BACKGROUND: Acute Rheumatic Fever and Rheumatic Heart Disease are the leading cause of acquired heart disease in Low-Income Countries, and a common cause in High-Income Countries. We compared rheumatic carditis, its echocardiographic presentation at diagnosis and its progression in Italy and Rwanda. METHODS: Retrospective study including all consecutive patients diagnosed with rheumatic carditis in an Italian (IT) and two Rwandan Hospitals (RW). Echocardiography was performed at diagnosis and three follow-up visits. Baseline characteristics, history of primary and secondary prophylaxis and cardiovascular complications data were collected. RESULTS: Seventy-nine and 135 patients were enrolled in IT and RW, respectively. Mitral regurgitation was the most common lesion (IT: 70%, RW: 96%) in both cohorts; mixed valve lesions and severe lesions were more prevalent in RW. Age at diagnosis (IT: 8.4 ± 2.9 yrs.; RW: 11.1 ± 2.7 yrs.; P < 0.001), adherence to secondary prophylaxis (IT: 99%; RW: 48%; P < 0.001) and history of primary prophylaxis (IT: 65%; RW: 6%; P < 0.001) were different. During the follow-up, native valve lesions completely resolved in 38% of IT and in 2% of RW patients (P < 0.001). By contrast, cardiac surgery was performed in 31% of RW and 5% of IT patients (P < 0.001). Cardiovascular complications and death were only observed in RW. CONCLUSIONS: The more severe cardiac involvement, the higher rate of valve surgery, CV complications and deaths in RW, could be due to delayed diagnosis and treatment, scarce adherence to secondary prophylaxis and differences in social determinants of health.


Assuntos
Insuficiência da Valva Mitral , Miocardite , Febre Reumática , Cardiopatia Reumática , Doença Aguda , Criança , Humanos , Itália/epidemiologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/cirurgia , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/epidemiologia , Ruanda/epidemiologia , Fatores Socioeconômicos
12.
BMJ Glob Health ; 6(6)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34103325

RESUMO

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.


Assuntos
COVID-19/transmissão , Busca de Comunicante , Teorema de Bayes , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Humanos , Masculino , Ruanda/epidemiologia , SARS-CoV-2
14.
Ann Glob Health ; 87(1): 40, 2021 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-33977083

RESUMO

Background: Neonatal mortality continues to be a global challenge, particularly in low- and middle-income countries. There is growing work to reduce mortality through improving quality of systems and care, but less is known about sustainability of improvements in the setting post initial implementation. We conducted a 12-month sustainability assessment of All Babies Count (ABC), a district-wide quality improvement project including mentoring and improvement collaborative designed to improve quality and reduce neonatal mortality in two districts in rural Rwanda. Methods: We measured changes in key neonatal process, coverage, and outcome indicators between the completion of ABC implementation and 12 months after the completion. In addition, we conducted 4 focus group discussions and 15 individual in-depth interviews with health providers and facility and district leaders to understand factors that influenced sustainability of improvements. We used an inductive, content analytic approach to derive six themes related to the ABC sustainability to explain quantitative results. Findings: Twelve months after the completion of ABC implementation, we found continued improvements in core quality, coverage, and neonatal outcomes. During ABC, the percentage of women with 4 antenatal visits increased from 12% to 30% and remained stable 12 months post-ABC (30%, p = 0.7) with an increase in facility-based delivery from 92.6% at the end of ABC to 95.8% (p = 0.01) at 12-month post-ABC. During ABC intervention, the 2 districts decreased neonatal mortality from 30.1 to 19.4 deaths per 1,000 live births with maintenance of the lower mortality 12 months post-ABC (19.4 deaths per 1,000 live births, p = 0.7). Leadership buy-in and development of self-reliance encouraging internally generated solutions emerged as key factors to sustain improvements while staff turnover, famine, influx of refugees, and unintended consequences of new national newborn care policies threatened sustainability. Interpretation: Despite discontinuity of key ABC support, health facilities kept the momentum of good practices and were able to maintain or increase the level of prenatal, neonatal quality of care and outcomes over a period of 12 months following the end of initial ABC implementation. Additional studies are needed to determine the longer-term sustainability beyond one year.


Assuntos
Cuidado do Lactente , Mortalidade Infantil , Melhoria de Qualidade , Serviços de Saúde Rural , Feminino , Grupos Focais , Seguimentos , Humanos , Lactente , Cuidado do Lactente/organização & administração , Cuidado do Lactente/normas , Mortalidade Infantil/tendências , Recém-Nascido , Gravidez , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Melhoria de Qualidade/organização & administração , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/normas , Ruanda/epidemiologia
15.
Soc Psychiatry Psychiatr Epidemiol ; 56(10): 1761-1769, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34018028

RESUMO

PURPOSE: To examine the association between adherence to childhood religious affiliations and serious suicide intentions in 371 women exposed to the 1994 Genocide against the Tutsi in Rwanda. METHODS: Participants were randomly sampled in 2011 from households in the Southern Province of Rwanda. Trained interviewers gathered information on socio-economic background, genocide-related trauma exposure, Major Depressive Episode (MDE) and suicide intentions (assessed with the Mini International Neuropsychiatric Interview), and Posttraumatic Stress Disorder (PTSD) (assessed with the PTSD Checklist-Civilian version). RESULTS: In this predominantly Christian sample, 62.8% (233/371) had adhered to their childhood religious affiliation. Adherence was associated with lower odds of serious suicide intentions (OR 0.321, 95% CI 0.13-0.78, P < 0.01) independent of socio-economic factors, court-designated victim status, trauma exposure, MDE, and PTSD; that association held following consideration of specific denomination. CONCLUSION: Women who adhere to their childhood religious affiliation may be less likely to have serious suicide intentions following major catastrophes. Whether that association is attributable to stronger connections with lost and remaining family and friends, or greater faith in the church as a facilitator of reconciliation and coping, requires further study.


Assuntos
Transtorno Depressivo Maior , Genocídio , Transtornos de Estresse Pós-Traumáticos , Criança , Feminino , Humanos , Intenção , Ruanda/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Ideação Suicida , Violência
17.
PLoS One ; 16(5): e0251839, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34029321

RESUMO

BACKGROUND: Soccer players incur injuries that typically affect their performance. Injuries are caused by intrinsic and extrinsic factors that call for multifactorial preventive interventions. The study examines the impact of the FIFA 11+ warm up programme on the incidence and severity of injuries in second division soccer players in Rwanda. METHODS: Twelve teams (309 players) were randomised in the intervention group and 12 teams (317 players) in the control group using a cluster randomized controlled trial with teams as the unit of randomization. Intervention group teams implemented the FIFA 11+ soccer specific warm-up programme during training and matches at least three times a week over seven months of the Rwandan soccer season. Control group teams continued with usual warm up exercises. The primary outcome of this study was the overall incidence of training and match injuries. Injuries, training and match exposure as well as severity categories were recorded per the F-MARC guidelines. RESULTS: A lower proportion of players sustained injuries in the intervention group (52%) compared to the control group (63%) (Odd ratio: 0.7; 95%CI: 0.5-0.9). A significantly lower rate ratio was observed in the intervention group for overall (RR = 0.6; 95%CI: 0.5-0.8) and match (RR = 0.6; 95%CI: 0.5-0.8) injuries. Compliance to the injury prevention programme was 77%. In the intervention group, the incidence of injury was similar across all teams and across the medium and highly compliant teams. There was a statistically significant 55% and 71% reduction of the rate of moderate and severe injuries in the intervention group respectively. CONCLUSION: The 11+ warm up injury prevention programme resulted in a significant reduction in the odds of sustaining injuries. In addition, injuries sustained were less severe. The programme should be rolled out to all teams in Rwanda and may well result in a decrease in the incidence and severity of injury in similar contexts. TRIAL REGISTRATION: Pan African Clinical Trial Registry (PACTR201505001045388).


Assuntos
Traumatismos em Atletas/prevenção & controle , Futebol/fisiologia , Exercício de Aquecimento/fisiologia , Adolescente , Adulto , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/fisiopatologia , Humanos , Masculino , Ruanda/epidemiologia , Futebol/lesões
18.
BMJ Glob Health ; 6(5)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33975886

RESUMO

INTRODUCTION: Child mortality remains highest in regions of the world most affected by HIV/AIDS. The aim of this study was to assess child mortality rates in relation to maternal HIV status from 2005 to 2015, the period of rapid HIV treatment scale-up in Rwanda. METHODS: We used data from the 2005, 2010 and 2015 Rwanda Demographic Health Surveys to derive under-2 mortality rates by survey year and mother's HIV status and to build a multivariable logistic regression model to establish the association of independent predictors of under-2 mortality stratified by mother's HIV status. RESULTS: In total, 12 010 live births were reported by mothers in the study period. Our findings show a higher mortality among children born to mothers with HIV compared with HIV negative mothers in 2005 (216.9 vs 100.7 per 1000 live births) and a significant reduction in mortality for both groups in 2015 (72.0 and 42.4 per 1000 live births, respectively). In the pooled reduced multivariable model, the odds of child mortality was higher among children born to mothers with HIV, (adjusted OR, AOR 2.09; 95% CI 1.57 to 2.78). The odds of child mortality were reduced in 2010 (AOR 0.69; 95% CI 0.59 to 0.81) and 2015 (AOR 0.35; 95% CI 0.28 to 0.44) compared with 2005. Other independent predictors of under-2 mortality included living in smaller families of 1-2 members (AOR 5.25; 95% CI 3.59 to 7.68), being twin (AOR 4.93; 95% CI 3.51 to 6.92) and being offspring from mothers not using contraceptives at the time of the survey (AOR 1.6; 95% CI 1.38 to 1.99). Higher education of mothers (completed primary school: (AOR 0.74; 95% CI 0.64 to 0.87) and secondary or higher education: (AOR 0.53; 95% CI 0.38 to 0.74)) was also associated with reduced child mortality. CONCLUSIONS: This study shows an important decline in under-2 child mortality among children born to both mothers with and without HIV in Rwanda over a 10-year span.


Assuntos
Mortalidade da Criança , Infecções por HIV , Criança , Humanos , Mortalidade Infantil , Estudos Retrospectivos , Ruanda/epidemiologia
19.
Lancet Infect Dis ; 21(8): 1120-1128, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33864801

RESUMO

BACKGROUND: Partial artemisinin resistance is suspected if delayed parasite clearance (ie, persistence of parasitaemia on day 3 after treatment initiation) is observed. Validated markers of artemisinin partial resistance in southeast Asia, Plasmodium falciparum kelch13 (Pfkelch13) R561H and P574L, have been reported in Rwanda but no association with parasite clearance has been observed. We aimed to establish the efficacy of artemether-lumefantrine and genetic characterisation of Pfkelch13 alleles and their association with treatment outcomes. METHODS: This open-label, single-arm, multicentre, therapeutic efficacy study was done in 2018 in three Rwandan sites: Masaka, Rukara, and Bugarama. Children aged 6-59 months with P falciparum monoinfection and fever were eligible and treated with a 3-day course of artemether-lumefantrine. Treatment response was monitored for 28 days using weekly microscopy screenings of blood samples for P falciparum. Mutations in Pfkelch13 and P falciparum multidrug resistance-1 (Pfmdr1) genes were characterised in parasites collected from enrolled participants. Analysis of flanking microsatellites surrounding Pfkelch13 was done to define the origins of the R561H mutations. The primary endpoint was PCR-corrected parasitological cure on day 28, as per WHO protocol. FINDINGS: 228 participants were enrolled and 224 (98·2%) reached the study endpoint. PCR-corrected efficacies were 97·0% (95% CI 88-100) in Masaka, 93·8% (85-98) in Rukara, and 97·2% (91-100) in Bugarama. Pfkelch13 R561H mutations were present in 28 (13%) of 218 pre-treatment samples and P574L mutations were present in two (1%) pre-treatment samples. 217 (90%) of the 240 Pfmdr1 haplotypes observed in the pretreatment samples, had either the NFD (N86Y, Y184F, D1246Y) or NYD haplotype. Eight (16%) of 51 participants in Masaka and 12 (15%) of 82 participants in Rukara were microscopically positive 3 days after treatment initiation, which was associated with pre-treatment presence of Pfkelch13 R561H in Masaka (p=0·0005). Genetic analysis of Pfkelch13 R561H mutations suggest their common ancestry and local origin in Rwanda. INTERPRETATION: We confirm evidence of emerging artemisinin partial resistance in Rwanda. Although artemether-lumefantrine remains efficacious, vigilance for decreasing efficacy, further characterisation of artemisinin partial resistance, and evaluation of additional antimalarials in Rwanda should be considered. FUNDING: The US President's Malaria Initiative. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.


Assuntos
Artemisininas/uso terapêutico , Resistência a Medicamentos/genética , Malária Falciparum/tratamento farmacológico , Malária Falciparum/parasitologia , Plasmodium falciparum/genética , Proteínas de Protozoários/genética , Animais , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Pré-Escolar , Feminino , Genótipo , Humanos , Lactente , Malária Falciparum/epidemiologia , Masculino , Mutação de Sentido Incorreto , Testes de Sensibilidade Parasitária , Plasmodium falciparum/efeitos dos fármacos , Polimorfismo Genético , Ruanda/epidemiologia
20.
West J Emerg Med ; 22(2): 435-444, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33856336

RESUMO

INTRODUCTION: While trauma prognostication and triage scores have been designed for use in lower-resourced healthcare settings specifically, the comparative clinical performance between trauma-specific and general triage scores for risk-stratifying injured patients in such settings is not well understood. This study evaluated the Kampala Trauma Score (KTS), Revised Trauma Score (RTS), and Triage Early Warning Score (TEWS) for accuracy in predicting mortality among injured patients seeking emergency department (ED) care at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda. METHODS: A retrospective, randomly sampled cohort of ED patients presenting with injury was accrued from August 2015-July 2016. Primary outcome was 14-day mortality and secondary outcome was overall facility-based mortality. We evaluated summary statistics of the cohort. Bootstrap regression models were used to compare areas under receiver operating curves (AUC) with associated 95% confidence intervals (CI). RESULTS: Among 617 cases, the median age was 32 years and 73.5% were male. The most frequent mechanism of injury was road traffic incident (56.2%). Predominant anatomical regions of injury were craniofacial (39.3%) and lower extremities (38.7%), and the most common injury types were fracture (46.0%) and contusion (12.0%). Fourteen-day mortality was 2.6% and overall facility-based mortality was 3.4%. For 14-day mortality, TEWS had the highest accuracy (AUC = 0.88, 95% CI, 0.76-1.00), followed by RTS (AUC = 0.73, 95% CI, 0.55-0.92), and then KTS (AUC = 0.65, 95% CI, 0.47-0.84). Similarly, for facility-based mortality, TEWS (AUC = 0.89, 95% CI, 0.79-0.98) had greater accuracy than RTS (AUC = 0.76, 95% CI, 0.61-0.91) and KTS (AUC = 0.68, 95% CI, 0.53-0.83). On pairwise comparisons, RTS had greater prognostic accuracy than KTS for 14-day mortality (P = 0.011) and TEWS had greater accuracy than KTS for overall (P = 0.007) mortality. However, TEWS and RTS accuracy were not significantly different for 14-day mortality (P = 0.864) or facility-based mortality (P = 0.101). CONCLUSION: In this cohort of emergently injured patients in Rwanda, the TEWS demonstrated the greatest accuracy for predicting mortality outcomes, with no significant discriminatory benefit found in the use of the trauma-specific RTS or KTS instruments, suggesting that the TEWS is the most clinically useful approach in the setting studied and likely in other similar ED environments.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Triagem , Ferimentos e Lesões , Adulto , Emergências/epidemiologia , Serviços Médicos de Emergência/normas , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ruanda/epidemiologia , Índices de Gravidade do Trauma , Triagem/métodos , Triagem/organização & administração , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia
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