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1.
Eur Rev Med Pharmacol Sci ; 24(15): 8226-8231, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767354

RESUMO

OBJECTIVE: To explore whether the climate has played a role in the COVID-19 outbreak, we compared virus lethality in countries closer to the Equator with others. Lethality in European territories and in territories of some nations with a non-temperate climate was also compared. MATERIALS AND METHODS: Lethality was calculated as the rate of deaths in a determinate moment from the outbreak of the pandemic out of the total of identified positives for COVID-19 in a given area/nation, based on the COVID-John Hopkins University website. Lethality of countries located within the 5th parallels North/South on 6 April and 6 May 2020, was compared with that of all the other countries. Lethality in the European areas of The Netherlands, France and the United Kingdom was also compared to the territories of the same nations in areas with a non-temperate climate. RESULTS: A lower lethality rate of COVID-19 was found in Equatorial countries both on April 6 (OR=0.72 CI 95% 0.66-0.80) and on May 6 (OR=0.48, CI 95% 0.47-0.51), with a strengthening over time of the protective effect. A trend of higher risk in European vs. non-temperate areas was found on April 6, but a clear difference was evident one month later: France (OR=0.13, CI 95% 0.10-0.18), The Netherlands (OR=0.5, CI 95% 0.3-0.9) and the UK (OR=0.2, CI 95% 0.01-0.51). This result does not seem to be totally related to the differences in age distribution of different sites. CONCLUSIONS: The study does not seem to exclude that the lethality of COVID-19 may be climate sensitive. Future studies will have to confirm these clues, due to potential confounding factors, such as pollution, population age, and exposure to malaria.


Assuntos
Clima , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Estações do Ano , Tempo (Meteorologia) , Betacoronavirus , Brunei/epidemiologia , Burundi/epidemiologia , Congo/epidemiologia , Infecções por Coronavirus/epidemiologia , Equador/epidemiologia , Guiné Equatorial/epidemiologia , Europa (Continente) , França/epidemiologia , Gabão/epidemiologia , Humanos , Ilhas do Oceano Índico/epidemiologia , Indonésia/epidemiologia , Quênia/epidemiologia , Malásia/epidemiologia , Melanesia/epidemiologia , Micronésia/epidemiologia , Países Baixos/epidemiologia , Pandemias , Papua Nova Guiné/epidemiologia , Pneumonia Viral/epidemiologia , Ruanda/epidemiologia , Samoa/epidemiologia , São Tomé e Príncipe/epidemiologia , Seicheles/epidemiologia , Singapura/epidemiologia , Somália/epidemiologia , Timor-Leste/epidemiologia , Clima Tropical , Uganda/epidemiologia , Reino Unido/epidemiologia
2.
PLoS One ; 15(8): e0236411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745100

RESUMO

BACKGROUND: Access to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of essential medicines have been studied in many developing countries, but no such information has been published about Rwanda yet. This study aimed at providing data on prices, availability and affordability of medicines in different health facilities of Rwanda. METHODS: A survey was carried out on availability, prices and affordability of 18 medicines in Kigali City and five districts of Rwanda. 44 health facilities were surveyed, including public and faith-based hospitals, public and faith-based health centers and private pharmacies. The standardized methodology developed by WHO and Health Action International (HAI) was used to collect and analyze the data. FINDINGS: Prices for generic medicines in public and faith-based health facilities were remarkably low, with median price ratios (MPRs) of 1.0 in comparison to the international procurement prices published by Management Sciences for Health. In private pharmacies, prices were twice as high (MPR = 1.99 for generics). Availability of medicines fell short of the of 80% target set by WHO, but was better than reported from many other developing countries. Availability of medicines was highest in the private sector (71.3%) and slightly lower in the faith-based (62.8%) and public (59.6%) sectors. The government procurement agency was found to work efficiently, achieving prices 30% below the international procurement price given in the International Medical Product Price Guide. Affordability of medicines was better in the public and faith-based sectors than in the private sector. CONCLUSION: In Rwanda, medicines are affordable but poorly available in both the public and the faith-based sectors. Further improvements of the availability of medicines in the public and the faith-based health facilities represent the most important key to increase accessibility and affordability of medicines in Rwanda.


Assuntos
Medicamentos Essenciais/economia , Saúde Global , Instalações de Saúde/economia , Acesso aos Serviços de Saúde/economia , Custos e Análise de Custo , Medicamentos Essenciais/uso terapêutico , Medicamentos Genéricos/economia , Humanos , Farmácias/economia , Setor Privado , Setor Público/tendências , Ruanda/epidemiologia , Inquéritos e Questionários
6.
Am J Trop Med Hyg ; 103(1): 315-324, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32431276

RESUMO

The field standard for the detection of Schistosoma mansoni infection is Kato-Katz (KK), although it misses many active infections, especially light infections. In 2014, a reassessment of S. mansoni prevalence was conducted in Rwanda using the more sensitive point-of-care circulating cathodic antigen (POC-CCA) rapid assay. A total of 19,371 children from 399 schools were selected for testing for single urine CCA. Of these, 8,697 children from 175 schools were also tested with single stool double-slide KK. Samples from eight of these 175 schools were tested again with CCA and additionally with the highly specific and sensitive up-converting phosphor-lateral flow circulating anodic antigen (UCP-LF CAA) assay. Latent class analysis was applied to all four test results to assess sensitivity and specificity of POC-CCA and estimate the proportion of trace results from Rwanda likely to be true infections. The overall prevalence of S. mansoni infection in Rwanda when CCA trace results were considered negative was 7.4% (school interquartile range [IQR] 0-8%) and 36.1% (school IQR 20-47%) when trace was considered positive. Prevalence by KK was 2.0% with a mean intensity of infection of 1.66 eggs per gram. The proportion of active infections among children diagnosed with CCA trace was estimated by statistical analysis at 61% (Bayesian credibility interval: 50-72%). These results indicate that S. mansoni infection is still widespread in Rwanda and prevalence is much underestimated by KK testing. Circulating cathodic antigen is an affordable alternative to KK and more suitable for measuring S. mansoni prevalence in low-intensity regions.


Assuntos
Antígenos de Helmintos/urina , Glicoproteínas/urina , Proteínas de Helminto/urina , Esquistossomose mansoni/epidemiologia , Adolescente , Anti-Helmínticos/uso terapêutico , Criança , Erradicação de Doenças , Ovos , Fezes/parasitologia , Feminino , Mapeamento Geográfico , Humanos , Masculino , Testes Imediatos , Praziquantel/uso terapêutico , Prevalência , Ruanda/epidemiologia , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/prevenção & controle , Esquistossomose mansoni/urina , Instituições Acadêmicas
7.
BMC Public Health ; 20(1): 621, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375840

RESUMO

BACKGROUND: Sugira Muryango is a father-engaged early child development and violence-prevention home-visiting programme delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty (Ubudehe 1, the poorest category in the Government of Rwanda's wealth ranking) who receive Sugira Muryango in combination with a government-provided social protection programme demonstrate greater responsive, positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC). METHODS: Using detailed maps, we grouped closely spaced villages into 284 geographic clusters stratified by the type of social protection programmes operating in the village clusters; 198 clusters met all enrolment criteria. Sugira Muryango was delivered to n = 541 families in 100 treatment clusters with children aged 6-36 months living in extreme poverty. We assessed changes in outcomes in intervention and n = 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate clustering. RESULTS: Families receiving Sugira Muryango improved on core outcomes of parent-child relationships assessed using the Home Observation for Measurement of the Environment (Cohen's d = 0.87, 95% CI: 0.74, 0.99) and the Observation of Mother-Child Interaction (Cohen's d = 0.29, 95% CI: 0.17, 0.41). We also saw reductions in harsh discipline on items from the UNICEF MICS (OR = 0.30: 95% CI: 0.19, 0.47) and in violent victimisation of female caregivers by their partners (OR = 0.49, 95% CI: 0.24, 1.00) compared with UC. Moreover, children in families receiving SM had a 0.45 higher increase in food groups consumed in the past 24 h (Cohen's d = 0.35, 95% CI: 0.22, 0.47), increased care seeking for diarrhoea (OR = 4.43, 95% CI: 1.95, 10.10) and fever (OR = 3.28, 95% CI: 1.82, 5.89), and improved hygiene behaviours such as proper treatment of water (OR = 3.39, 95% CI: 2.16, 5.30) compared with UC. Finally, Sugira Muryango was associated with decreased caregiver depression and anxiety (OR = 0.58, 95% CI: 0.38, 0.88). CONCLUSIONS: Sugira Muryango led to improvements in caregiver behaviours linked to child development and health as well as reductions in violence. TRIAL REGISTRATION: ClinicalTrials.gov number NCT02510313.


Assuntos
Pai/psicologia , Visita Domiciliar , Relações Pais-Filho , Pobreza/psicologia , Política Pública , Violência/prevenção & controle , Adulto , Agressão/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Cuidadores/psicologia , Desenvolvimento Infantil , Pré-Escolar , Análise por Conglomerados , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Lactente , Masculino , Avaliação de Programas e Projetos de Saúde , Ruanda/epidemiologia , Inquéritos e Questionários , Violência/psicologia
8.
PLoS One ; 15(4): e0231372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32324750

RESUMO

BACKGROUND: Rwanda conducted a national tuberculosis (TB) prevalence survey to determine the magnitude of TB in the country and determine to what extent the national surveillance system captures all TB cases. In addition we measured the patient diagnostic rate, comparing the measured TB burden data with the routine surveillance data to gain insight into how well key population groups are being detected. METHODS: A national representative nationwide cross-sectional survey was conducted in 73 clusters in 2012 whereby all enrolled participants (residents aged 15 years and above) were systematically screened for TB by symptoms and chest X-ray (CXR). Those with either clinical symptoms (cough of any duration) and/or CXR abnormalities suggestive of TB disease were requested to provide two sputum samples (one spot and one morning) for smear examination and solid culture. RESULTS: Of the 45,058 eligible participants, 43,779 were enrolled in the survey. Participation rate was high at 95.7% with 99.8% of participants undergoing both screening procedures and 99.0% of those eligible for sputum examination submitting at least one sputum sample. Forty cases of prevalent mycobacterium tuberculosis (MTB) and 16 mycobacteria other than tuberculosis (MOTT) cases were detected during the survey. Chest x-ray as screening tool had 3 and 5 times greater predictive odds for smear positive and bacteriological confirmed TB than symptom screening alone respectively. A TB prevalence of 74.1 (95% CI 48.3-99.3) per 100,000 adult population for smear positive TB and 119.3 (95% CI 78.8-159.9) per 100,000 adult population for bacteriological confirmed MTB was estimated for Rwanda. CONCLUSIONS: The survey findings indicated a lower TB prevalence than previously estimated by WHO providing key lessons for national TB control, calling for more sensitive screening and diagnostic tools and a focus on key populations. Use of chest x-ray as screening tool was introduced to improve the diagnostic yield of TB.


Assuntos
Tuberculose/diagnóstico , Adolescente , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium/isolamento & purificação , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Ruanda/epidemiologia , Escarro/microbiologia , Tuberculose/diagnóstico por imagem , Tuberculose/epidemiologia , Adulto Jovem
9.
Am J Trop Med Hyg ; 103(1): 183-189, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32314686

RESUMO

In 2018, a large outbreak of Rift Valley fever (RVF)-like illness in cattle in Rwanda and surrounding countries was reported. From this outbreak, sera samples from 157 cows and 28 goats suspected to be cases of RVF were tested to confirm or determine the etiology of the disease. Specifically, the hypothesis that orthobunyaviruses-Bunyamwera virus (BUNV), Batai virus (BATV), and Ngari virus (NRIV)-were co-circulating and contributed to RVF-like disease was tested. Using reverse transcriptase-polymerase chain reaction (RT-PCR), RVFV RNA was detected in approximately 30% of acutely ill animals, but in all cases of hemorrhagic disease. Seven cows with experienced abortion had positive amplification and visualization by gel electrophoresis of all three segments of either BUNV or BATV, and three of these were suggested to be coinfected with BUNV and BATV. On sequencing, five of these seven cows were conclusively positive for BUNV. However, in several other animals, sequencing was successful for some but not all segments of targeted viruses BUNV and BATV. In addition, there was evidence of RVFV-orthobunyavirus coinfection, through RT-PCR/gel electrophoresis and subsequent Sanger sequencing. In no cases were we able to definitely identify the specific coinfecting viral species. This is the first time evidence for orthobunyavirus circulation has been molecularly confirmed in Rwanda. Furthermore, RT-PCR results suggest that BUNV and BATV may coinfect cattle and that RVFV-infected animals may be coinfected with other orthobunyaviruses. Finally, we confirm that BUNV and, perhaps, other orthobunyaviruses were co-circulating with RVFV and contributed to the burden of disease attributed to RVFV in Rwanda.


Assuntos
Vírus Bunyamwera/genética , Infecções por Bunyaviridae/veterinária , Doenças dos Bovinos/epidemiologia , Surtos de Doenças , Orthobunyavirus/genética , Febre do Vale de Rift/epidemiologia , Vírus da Febre do Vale do Rift/genética , Animais , Vírus Bunyamwera/classificação , Vírus Bunyamwera/isolamento & purificação , Infecções por Bunyaviridae/epidemiologia , Infecções por Bunyaviridae/transmissão , Infecções por Bunyaviridae/virologia , Bovinos , Doenças dos Bovinos/transmissão , Doenças dos Bovinos/virologia , Coinfecção , Feminino , Cabras/virologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Epidemiologia Molecular , Orthobunyavirus/classificação , Orthobunyavirus/isolamento & purificação , RNA Viral/genética , Febre do Vale de Rift/transmissão , Febre do Vale de Rift/virologia , Vírus da Febre do Vale do Rift/classificação , Vírus da Febre do Vale do Rift/isolamento & purificação , Ruanda/epidemiologia
10.
Anesth Analg ; 131(2): 605-612, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32304459

RESUMO

BACKGROUND: Health care professional migration continues to challenge countries where the lack of surgical and anesthesia specialists results in being unable to address the global burden of surgical disease in their populations. Medical migration is particularly damaging to health care systems that are just beginning to scale up capacity building of human resources for health. Anesthesiologists are scarce in low-resource settings. Defining reasons why anesthesiologists leave their country of training through in-depth interviews may provide guidance to policy makers and academic organizations on how to retain valuable health professionals. METHODS: There were 24 anesthesiologists eligible to participate in this qualitative interview study, 15 of whom are currently practicing in Rwanda and 9 had left the country. From the eligible group, interviews were conducted with 13 currently practicing in Rwanda and 2 who had left to practice elsewhere. In-depth interviews of approximately 60 minutes were used to define themes influencing retention and migration among anesthesiologists in Rwanda. Interviews were conducted using a semistructured guide and continued until theoretical sufficiency was reached. Thematic analysis was done by 4 members of the research team using open coding to inductively identify themes. RESULTS: Interpretation of results used the framework categorizing themes into push, pull, stick, and stay to describe factors that influence migration, or the potential for migration, of anesthesiologists in Rwanda. While adequate salary is essential to retention of anesthesiologists in Rwanda, other factors such as lack of equipment and medication for safe anesthesia, isolation, and demoralization are strong push factors. Conversely, a rich academic life and optimism for the future encourage anesthesiologists to stay. CONCLUSIONS: Our study suggests that better clinical resources and equipment, a more supportive community of practice, and advocacy by mentors and academic partners could encourage more staff anesthesiologists to stay and work in Rwanda.


Assuntos
Anestesiologistas/tendências , Mobilidade Ocupacional , Pesquisa Qualitativa , Inquéritos e Questionários , Recursos Humanos/tendências , Anestesiologistas/economia , Países em Desenvolvimento/economia , Feminino , Humanos , Masculino , Ruanda/epidemiologia , Recursos Humanos/economia
11.
BMC Infect Dis ; 20(1): 239, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32197582

RESUMO

BACKGROUND: Peritoneal tuberculosis is the most common cause of low albumin gradient ascites in developing countries, but it can be easily confused with other causes of ascites. Peritoneal tuberculosis requires early recognition of symptoms and signs in order to make a quick diagnosis for appropriate treatment. Measurement of adenosine deaminase (ADA) level > 39 in ascites fluid is an established test to diagnose peritoneal tuberculosis. Many low-income countries do not currently test for adenosine deaminase in ascites fluid, including Rwanda. METHOD: Cross-sectional, descriptive study conducted through the Internal Medicine Department of three university teaching hospitals in Rwanda. Participants were patients older than 16 years presenting to tertiary referral hospitals with ascites of unknown cause. RESULTS: Of 103 ascites fluid samples collected, 52 of them (50.5%) had an elevated ADA, consistent with a presumptive diagnosis of peritoneal TB. Among those 52 subjects diagnosed with peritoneal TB, 39 out of 52 (75%) did not receive anti-TB medications. Among the 17 subjects who were treated with anti-TB medications, 4 of 17 (23.6%) did not have peritoneal TB based on ADA level. Samples with low-albumin gradient ascites were more likely to have high ADA ≥39 IU/L (p = 0.039). CONCLUSION: Our findings suggest that 3out of 4 patients with PTB in Rwanda are not getting TB treatment and 1 in 4 patients who are taking TB medications do not need it. Even if the true number of Rwandans who are being undertreated and overtreated is less than our study suggests, these results should prompt a larger study of peritoneal tuberculosis. Adding adenosine deaminase (ADA) to the diagnostic tools available to clinicians could help achieve the goal of correctly putting every Rwandan with tuberculosis on treatment, while avoiding unnecessary tuberculosis medications in those who do not have the disease.


Assuntos
Adenosina Desaminase/análise , Ascite/diagnóstico , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/epidemiologia , Adulto , Líquido Ascítico/enzimologia , Ensaios Enzimáticos Clínicos , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/imunologia , Peritônio/microbiologia , Peritonite Tuberculosa/microbiologia , Prevalência , Ruanda/epidemiologia
12.
PLoS One ; 15(2): e0228966, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084167

RESUMO

OBJECTIVE: To assess the value of the inability to walk unassisted to predict hospital mortality in patients with suspected infection in a resource-limited setting. METHODS: This is a post hoc study of a prospective trial performed in rural Rwanda. Patients hospitalized because of a suspected acute infection and who were able to walk unassisted before this disease episode were included. At hospital presentation, the walking status was graded into: 1) can walk unassisted, 2) can walk assisted only, 3) cannot walk. Receiver operating characteristic (ROC) analyses and two-by-two tables were used to determine the sensitivity, specificity, negative and positive predictive values of the inability to walk unassisted to predict in-hospital death. RESULTS: One-thousand-sixty-nine patients were included. Two-hundred-one (18.8%), 315 (29.5%), and 553 (51.7%) subjects could walk unassisted, walk assisted or not walk, respectively. Their hospital mortality was 0%, 3.8% and 6.3%, respectively. The inability to walk unassisted had a low specificity (20%) but was 100% sensitive (CI95%, 90-100%) to predict in-hospital death (p = 0.00007). The value of the inability to walk unassisted to predict in-hospital mortality (AUC ROC, 0.636; CI95%, 0.564-0.707) was comparable to that of the qSOFA score (AUC ROC, 0.622; CI95% 0.524-0.728). Fifteen (7.5%), 34 (10.8%) and 167 (30.2%) patients who could walk unassisted, walk assisted or not walk presented with a qSOFA score count ≥2 points, respectively (p<0.001). The inability to walk unassisted correlated with the presence of risk factors for death and danger signs, vital parameters, laboratory values, length of hospital stay, and costs of care. CONCLUSIONS: Our results suggest that the inability to walk unassisted at hospital admission is a highly sensitive predictor of in-hospital mortality in Rwandese patients with a suspected acute infection. The walking status at hospital admission appears to be a crude indicator of disease severity.


Assuntos
Testes Diagnósticos de Rotina/métodos , Índice de Gravidade de Doença , Triagem/métodos , Adolescente , Adulto , Área Sob a Curva , Criança , Feminino , Mortalidade Hospitalar/tendências , Hospitalização , Humanos , Infecções , Unidades de Terapia Intensiva/tendências , Tempo de Internação , Masculino , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Ruanda/epidemiologia , Sensibilidade e Especificidade , Sepse/mortalidade , Caminhada/fisiologia
13.
Emerg Med J ; 37(3): 146-150, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32001607

RESUMO

INTRODUCTION: Paediatric injuries are a major cause of mortality and disability worldwide, yet little information exists regarding its epidemiology or prehospital management in low-income and middle-income countries. We aimed to describe the paediatric injuries seen and managed by the prehospital ambulance service, Service d'Aide Medicale d'Urgence (SAMU), in Kigali, Rwanda over more than 3 years. METHODS: A retrospective, descriptive analysis was conducted of all injured children managed by SAMU in the prehospital setting between December 2012 and April 2016. RESULTS: SAMU responded to a total of 636 injured children, 10% of all patients seen. The incidence of paediatric injury in Kigali, Rwanda was 140 injuries per 100 000 children. 65% were male and the average age 13.5 (±5.3). Most patients were between 15 and 19 years old (56%). The most common causes of injuries were road traffic incidents (RTIs) (447, 72%), falls (70, 11%) and assaults (50, 8%). Most RTIs involved pedestrians (251, 56%), while 15% (65) involved a bicycle. Anatomical injuries included trauma to the head (330, 52%), lower limb (280, 44%) and upper limb (179, 28%). Common interventions included provision of pain medications (445, 70%), intravenous fluids (217, 34%) and stabilisation with cervical collar (190, 30%). CONCLUSION: In Kigali, RTIs were the most frequent cause of injuries to children requiring prehospital response with most RTIs involving pedestrians. Rwanda has recently instituted several programmes to reduce the impact of paediatric injuries especially with regard to RTIs. These include changes in traffic laws and increased road safety initiatives.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Ferimentos e Lesões/diagnóstico , Adolescente , Criança , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Ruanda/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/fisiopatologia
14.
MMWR Morb Mortal Wkly Rep ; 69(1): 10-13, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917781

RESUMO

Tailoring communicable disease preparedness and response strategies to unique population movement patterns between an outbreak area and neighboring countries can help limit the international spread of disease. Global recognition of the value of addressing community connectivity in preparedness and response, through field work and visualizing the identified movement patterns, is reflected in the World Health Organization's declaration on July 17, 2019, that the 10th Ebola virus disease (Ebola) outbreak in the Democratic Republic of the Congo (DRC) was a Public Health Emergency of International Concern (1). In March 2019, the Infectious Diseases Institute (IDI), Uganda, in collaboration with the Ministry of Health (MOH) Uganda and CDC, had previously identified areas at increased risk for Ebola importation by facilitating community engagement with participatory mapping to characterize cross-border population connectivity patterns. Multisectoral participants identified 31 locations and associated movement pathways with high levels of connectivity to the Ebola outbreak areas. They described a major shift in the movement pattern between Goma (DRC) and Kisoro (Uganda), mainly through Rwanda, when Rwanda closed the Cyanika ground crossing with Uganda. This closure led some travelers to use a potentially less secure route within DRC. District and national leadership used these results to bolster preparedness at identified points of entry and health care facilities and prioritized locations at high risk further into Uganda, especially markets and transportation hubs, for enhanced preparedness. Strategies to forecast, identify, and rapidly respond to the international spread of disease require adapting to complex, dynamic, multisectoral cross-border population movement, which can be influenced by border control and public health measures of neighboring countries.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/epidemiologia , Migração Humana/estatística & dados numéricos , Participação da Comunidade , República Democrática do Congo/epidemiologia , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Ruanda/epidemiologia , Uganda/epidemiologia
15.
MMWR Morb Mortal Wkly Rep ; 69(1): 14-19, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917783

RESUMO

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Vigilância em Saúde Pública/métodos , República Democrática do Congo/epidemiologia , Humanos , Ruanda/epidemiologia , Sudão do Sul/epidemiologia , Fatores de Tempo , Uganda/epidemiologia
16.
BMC Public Health ; 20(1): 83, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959142

RESUMO

BACKGROUND: Rwanda has made substantial economic progress over the past two decades. However, evidence suggests that malnutrition among children remains high in spite of this progress. This study aims to examine trends and potential risk factors associated with childhood stunting from 2000 to 2015 in Rwanda. METHODS: Data for this study come from the 2000 to 2015 Rwanda's Demographic and Health Surveys (DHS), a cross-sectional, population-based survey that is conducted every 5 years. Following prior work, we define stunting based on age and weight as reported in the DHS. We assess the overall prevalence of stunting among children under the age of 5 in Rwanda and then conduct bivariate analyses across a range of policy-relevant demographic, socioeconomic, and health variables. We then incorporate key variables in a multivariable analysis to identify those factors that are independently associated with stunting. RESULTS: The prevalence of stunting among children under the age of 5 in Rwanda declined from 2000 (47.4%) to 2015 (38.3%), though rates were relatively stagnant between 2000 and 2010. Factors associated with higher rates of stunting included living in the lowest wealth quintile, having a mother with limited education, having a mother that smoked, being of the male sex, and being of low-birth weight. CONCLUSIONS: Though overall stunting rates have improved nationally, these gains have been uneven. Furthering ongoing national policies to address these disparities while also working to reduce the overall risk of malnutrition will be necessary for Rwanda to reach its overall economic and health equity goals.


Assuntos
Transtornos do Crescimento/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Demografia , Feminino , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Masculino , Políticas , Prevalência , Fatores de Risco , Ruanda/epidemiologia , Fatores Socioeconômicos
17.
Malar J ; 19(1): 36, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964371

RESUMO

BACKGROUND: Malaria has a considerable impact on the health of the populations of developing countries; indeed, the entire population of Rwanda is at risk of contracting the disease. Although various interventions to control malaria have been implemented in Rwanda, the incidence of malaria has increased since 2012. There is an interest in understanding factors driving its persistence in Rwanda. This study aims at evaluating the effect of socio-economic and environmental factors, seasonality and the use of insecticide-treated mosquito nets (ITNs) on malaria persistence in Rwanda. METHODS: This study analysed data from the 2014-2015 Rwanda Demographic and Health Survey of 11,202 household's members composed of children under the age of 5 and women aged between 15 and 49. Bivariate analysis was performed between the outcome and each covariate including wealth, altitude, education level, place of residence, and use of ITNs generating percentages. Chi square test was performed to compare malaria negatives and positives on each covariate. Significant variables were subjected to logistic regression analysis to evaluate factors that are significantly associated with malaria at P < 0.05. The analysis was performed in R x64 3.6 and QGIS3.6 was used to map geographical distribution of malaria cases. RESULTS: The lowest wealth category was associated with the incidence of malaria [AOR] = 1.54, 95% CI (1.78-2.03). Having a place of residence < 1700 m above sea level (asl) and non-use of ITNs were significantly associated with the incidence of malaria (adjusted odds ratio [AOR] = 2.93, 95% confidence interval [95% CI] 1.94-4.42 and [AOR] = 1.29, 95% C.I (1.03-1.60), respectively). Season and type of residence were not significantly associated with malaria prevalence while women had lower risk of contracting malaria than children. CONCLUSION: Increased malaria prevalence was associated with lower income, non-compliance with bed-net usage and living below 1700 m of altitude. In addition to current malaria control strategies, potential interventions in individuals with lower income and areas at low altitudes should be taken into consideration when formulating malaria-control strategies, Also use of ITNs to control the spread of malaria should be emphasized.


Assuntos
Malária/epidemiologia , Adolescente , Adulto , Pré-Escolar , Países em Desenvolvimento , Exposição Ambiental , Feminino , Humanos , Incidência , Lactente , Mosquiteiros Tratados com Inseticida , Pessoa de Meia-Idade , Ruanda/epidemiologia , Estações do Ano , Fatores Socioeconômicos , Adulto Jovem
18.
Int J Cancer ; 146(6): 1514-1522, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31173641

RESUMO

The study aim was to describe human papillomavirus (HPV)-attributable cancer burden in Rwanda, according to anogenital cancer site, HPV type, age and HIV status. Tissue specimens of cervical, vulvar, vaginal, penile and anal cancer diagnosed in 2012-2018 were retrieved from three cancer referral hospitals and tested for high-risk (HR) HPV DNA. Cervical cancer represented the majority of cases (598 of 738), of which 96.0% were HR-HPV positive. HPV-attributable fractions in other cancer sites varied from 53.1% in 81 penile, through 76.7% in 30 vulvar, 83.3% in 24 vaginal, up to 100% in 5 anal cases. HPV16 was the predominant HR-HPV type in cervical cancer (55.0%), followed by HPV18 (16.6%) and HPV45 (13.4%). HPV16 also predominated in other cancer sites (60-80% of HR-HPV-attributable fraction). For cervical cancer, type-specific prevalence varied significantly by histology (higher alpha-9 type prevalence in 509 squamous cell carcinoma vs. higher alpha-7 type prevalence in 80 adenocarcinoma), but not between 501 HIV-negative and 97 HIV-positive cases. With respect to types targeted, and/or cross-protected, by HPV vaccines, HPV16/18 accounted for 73%, HPV31/33/45/52/58 for an additional 22% and other HR-HPV types for 5%, of HPV-attributable cancer burden, with no significant difference by HIV status nor age. These data highlight the preventive potential of the ongoing national HPV vaccination program in Rwanda, and in sub-Saharan Africa as a whole. Importantly for this region, the impact of HIV on the distribution of causal HPV types was relatively minor, confirming type-specific relevance of HPV vaccines, irrespective of HIV status.


Assuntos
Neoplasias do Ânus/virologia , Neoplasias dos Genitais Femininos/virologia , Infecções por HIV/virologia , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Neoplasias Penianas/virologia , Adulto , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/patologia , Estudos Transversais , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/patologia , Genótipo , Infecções por HIV/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Neoplasias Penianas/epidemiologia , Neoplasias Penianas/patologia , Prevalência , Ruanda/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Neoplasias Vaginais/epidemiologia , Neoplasias Vaginais/patologia , Neoplasias Vaginais/virologia , Neoplasias Vulvares/epidemiologia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/virologia
19.
Midwifery ; 80: 102568, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31698295

RESUMO

OBJECTIVE: Rwanda amended its abortions law in 2012 to allow for induced abortion under certain circumstances. We explore how Rwandan health care providers (HCP) understand the law and implement it in their clinical practice. DESIGN: Fifty-two HCPs involved in post-abortion care in Kigali were interviewed by qualitative individual in-depth interviews (n =32) and in focus group discussions (n =5) in year 2013, 2014, and 2016. All data were analyzed using thematic analysis. FINDINGS: HCPs express ambiguities on their rights and responsibilities when providing abortion care. A prominent finding was the uncertainties about the legal status of abortion, indicating that HCPs may rely on outdated regulations. A reluctance to be identified as an abortion provider was noticeable due to fear of occupational stigma. The dilemma of liability and litigation was present, and particularly care providers' legal responsibility on whether to report a woman who discloses an illegal abortion. CONCLUSION: The lack of professional consensus is creating barriers to the realization of safe abortion care within the legal framework, and challenge patients right for confidentiality. This bring consequences on girl's and women's reproductive health in the setting. IMPLICATIONS FOR PRACTICE: To implement the amended abortion law and to provide equitable maternal care, the clinical and ethical guidelines for HCPs need to be revisited.


Assuntos
Aborto Induzido/legislação & jurisprudência , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Adulto , Confidencialidade/ética , Confidencialidade/psicologia , Revelação/ética , Revelação/legislação & jurisprudência , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Legislação como Assunto , Responsabilidade Legal , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Ruanda/epidemiologia , Estigma Social , Adulto Jovem
20.
J Surg Res ; 245: 390-395, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425881

RESUMO

BACKGROUND: Cesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda. METHODS: This retrospective cohort study included all women aged ≥ 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported. RESULTS: Of the 621 women included in the study, 45.7% (n = 284) were aged 25-34 y; 42.2% (n = 262) were married; 67.5% (n = 419) had primary education; and 75.7% (n = 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n = 85) of the study population. The most common indication for c-section was having undergone a c-section previously (31.9%, n = 198), followed by acute fetal distress (30.8%, n = 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7% spent less than 4 d at the hospital and 96.1% had no postoperative complications before discharge. Approximately 10% (59/572) of neonates were admitted to the neonatal unit, with the most common reason being neonatal infection (59.6%, n = 31). CONCLUSIONS: Our study found that previous delivery via c-section was the primary indication for c-section and that most of these cases were emergent or urgent on presentation. This study highlights the need for further research to explore the feasibility, safety, and appropriateness of vaginal birth after cesarean in rural district hospitals in sub-Saharan Africa.


Assuntos
Cesárea/estatística & dados numéricos , Assistência Perioperatória , População Rural/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Complicações Pós-Operatórias/epidemiologia , Gravidez , Estudos Retrospectivos , Ruanda/epidemiologia , Adulto Jovem
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