Evaluation of oral health services and challenges faced by oral health practitioners working in Nyarugenge, Rwanda.

OBJECTIVE: Oral healthcare professionals encounter considerable challenges while providing services to curb the oral disease burden. The aim of this study was to explore the challenges faced by oral health practitioners providing oral health services in Nyarugenge, Rwanda and to appraise the availability and adequacy of oral hygiene equipment, instruments, and materials. METHODS: This was a cross-sectional concurrent mixed methods study. The quantitative and qualitative parts were independent during data collection and analyses and merged during the interpretation phase. All seven public health facilities and 14 dental professionals working in Nyarugenge were included in the study. Data were collected using an audit checklist and an in-depth interview guide. Descriptive statistics were used to analyze the quantitative data. The interviews were analyzed using thematic content analysis. RESULTS: Most of the dental health professionals were dental therapists (n = 11), women (n = 9), aged 31-40 years (n = 7), and with 11-20 years' experience as oral health practitioners (n = 6). There were five health centers and two hospitals that were audited for equipment, instruments, and materials. The audit of the facilities revealed that most facilities have dental equipment and instruments, but none have adequate preventive dental instruments and materials. Four broad themes emerged from the interviews with the oral health practitioners, namely human resources, supply chain management, patients' oral health awareness and service rendering, and strategic management and administration. The most significant challenges oral health practitioners faced included high dental practitioner/patient ratios, lack of adequate and appropriate equipment and materials, patients' lack of oral health awareness, and a lack of administrative support. CONCLUSIONS: Well-established community preventive interventions, such as a mobile oral health App, could reduce the patient/provider ratio by increasing population awareness of oral health and encouraging healthy behaviours. The management of the health facilities should address the human resource challenges and equipment supply chain issues.

Oral health knowledge, attitude and oral hygiene practices among adults in Rwanda

Introduction: oral diseases (OD), commonly dental caries and periodontitis are a major public health problem. Poor oral hygiene has been associated with OD, causing tooth loss, which leads to disability and compromised patients' oral health. In Rwanda, OD is among the leading causes of morbidity at the health center level. Therefore, the purpose of this study was to assess the knowledge, attitude, and oral health practices among adult participants in Rwanda Methods: a descriptive cross-sectional study was done among participants attending public health facilities in Nyarugenge District, Rwanda. Participants were interviewed using a structured questionnaire. The data were analyzed using frequency distribution, percentage distribution, and bivariate and multivariate logistic regression at a 5% significant level. Results: among 426 participants who were interviewed, 39.44% (n=168) were 18-27 years old and the majority, 61.5% (n=262) were female. Poor oral health knowledge was found in 42% (n=179) of the participants, whilst 12.44% (n=53) showed poor oral health attitudes, and 67.37% (n=287) were found to have poor oral health practice. Participants with a high school level of education were more likely to have better oral health knowledge and the results were statistically significant aOR: 1.79, 95% CI 1.14; 2.82; p = 0.011 Conclusion: the findings of our study showed that almost half of the participants had poor oral health knowledge. Oral health attitude and oral hygiene practices were also lacking. There is a need to enhance oral health education in this community to improve their oral health knowledge, attitudes, and practices.

Use of an online medical database for clinical decision-making processes: assessment of knowledge, attitude, and practice of oral health care providers.

Purpose: This study was conducted to determine the level of knowledge, attitude, and practice of oral health care providers toward the use of online medical databases for clinical decision-making processes. Subjects and methods: The study population included all the licensed oral health care providers living in Rwanda, registered either with the Rwanda Allied Health Professional Council (RAHPC) or Rwanda Medical and Dental Council (RMDC). A self-administered questionnaire was used to collect demographic data as well as data regarding knowledge, attitude, and practice of oral health care providers regarding the use of online medical databases for making clinical decisions. A pilot study with 12 oral health care providers was done before the main study to pretest the questionnaire. Results: The study results show that among the 201 respondents, 80% (N=160) reported using internet-based resources to support their clinical decisions, while 20% (N=41) of oral health care providers do not use online resources when making their clinical decisions. In general, there was a positive attitude towards internet-based resources among the participants, as 92% (N=184) respondents believe that internet-based resources are helpful in clinical decision-making processes. Of clinical importance, 68% respondents (N=136) believe that by using current internet-based information, better clinical care can be offered to their patients. Conclusion: Educating oral health care providers on the useful and appropriate online resources available for supporting clinical decision-making processes might increase the efficiency of patient care.

The impact of an mHealth monitoring system on health care utilization by mothers and children: an evaluation using routine health information in Rwanda.

Maternal and child mortality rates remain unacceptably high globally, particularly in sub-Saharan Africa. A popular approach to counter these high rates is interventions delivered using mobile phones (mHealth). However, few mHealth interventions have been implemented nationwide and there has been little evaluation of their effectiveness, particularly at scale. Therefore, we evaluated the Rwanda RapidSMS programme-one of the few mHealth programmes in Africa that is currently operating nationwide. Using interrupted time series analysis and monthly data routinely reported by public health centres (n = 461) between 2012 and 2016, we studied the impact of RapidSMS on four indicators: completion of four antenatal care visits, deliveries in a health facility, postnatal care visits and malnutrition screening. We stratified all analyses based on whether the district received concurrent additional supports, including staff and equipment (10 out of 30 Districts). We found that community health workers in Rwanda sent more than 9.3 million messages using RapidSMS, suggesting the programme was successfully implemented. We found that the implementation of the RapidSMS system combined with additional support including training, supervision and equipment provision increased the use of maternal and child health services. In contrast, implementing the RapidSMS system alone was ineffective. This suggests that mHealth programmes alone may be insufficient to improve the use of health services. Instead, they should be considered as a part of more comprehensive interventions that provide the necessary equipment and health system capacity to support them.

Assessing the perspectives of users and beneficiaries of a community health worker mHealth tracking system for mothers and children in Rwanda.

INTRODUCTION: Mobile Health (mHealth) programs have increasingly been used to tackle maternal and child health problems in low and middle income countries. However, few studies have evaluated how these programs have been perceived by intended users and beneficiaries. Therefore, we explored perceptions of healthcare officials and beneficiaries regarding RapidSMS Rwanda, an mHealth system used by Community Health Workers (CHWs) that was scaled up nationwide in 2013. METHODS: We conducted key informant interviews and focus group discussions with key stakeholders, providers, and beneficiaries of maternal and child health services at both the national and community levels. Semi-structured interviews were used to assess perceptions about the impact of and challenges facing the RapidSMS system. Interviews and focus group discussions were recorded (with the exception of one), transcribed verbatim, and analyzed. RESULTS: We conducted a total of 28 in-depth interviews and 10 focus group discussions (93 total participants). A majority of respondents believed that RapidSMS contributed to reducing maternal and child mortality rates. RapidSMS was generally accepted by both CHWs and parents. Participants identified insufficient training, a lack of equipment, and low CHW motivation as the main challenges facing RapidSMS. CONCLUSION: Our findings suggest that an mHealth program can be well accepted by both policymakers, health providers, and the community. We also found significant technical challenges that have likely reduced its impact. Addressing these challenges will serve to strengthen future mHealth programs.