Rwanda Journal of Medicine and Health Sciences

Assessment of Patient Waiting Time in Primary Health Care Settings in Rwanda: A Mixed-Method Study

2024-04-22T08:03:11+00:00

Background
Patient waiting time as an important indicator of quality of services has been a
long-standing concern in health care.
Objective
The aim of this study was to assess patient waiting time in primary health care
settings in Rwanda.
Methods
This was a mixed-method study design. In quantitative phase, Patient Flow Time
Log was used to track the time patients spent waiting for the service. On exit,
a structured questionnaire was administered. Observations were conducted to
capture information regarding the flow and processes. In qualitative part, six focus
group discussions with patients were conducted. Semi-structured interviews with
healthcare providers were held.
Results
Among 410 participants, the majority were females (77.1%). The overall health
centre level waiting time was 211 minutes (3.5 hours). To receive a service, patients
waited an average of 81.5 minutes (1.4 hours). Three conceptual themes were
identified: a) reported sections to have long wait time; b) causes of long waiting
time; and c) needs for activities to spend time on as patients wait.
Conclusion
Most patients experienced prolonged waiting times during their visit to the primary
health care settings , and the major factors were the huge number of patients, few
healthcare providers, and lack of medical equipment. To effectively address these
challenges, more resources and personnel must be allocated to primary healthcare
settings to help foster a higher level of client satisfaction with minimal primary
healthcare waiting time.
Rwanda J Med Health Sci 2024;7(1):6-21

Knowledge and Practice of Health Care Professionals Regarding the Prevention of Surgical Site Infections at Tertiary Hospitals in Rwanda

2024-04-22T08:19:26+00:00

Background
The prevention of surgical site infections heavily relies on healthcare professionals
who adhere to appropriate use of guidelines. However, there is limited evidence on
their knowledge and practices regarding surgical site infections prevention in Rwanda.
Therefore, this study aimed to evaluate the knowledge and practice of health care
professionals regarding the prevention of surgical site infections at tertiary hospitals
in Rwanda.
Methodology
A cross-sectional study involving 213 healthcare professionals was conducted to
assess the practice and knowledge of surgical site infection preventions. Univariate
and multivariable logistic regression analyses were performed using SPSS version 25.
Results
This study indicated that 53.1% of healthcare professionals had good knowledge
regarding surgical site infections prevention, while 57% reported good practices.
Nurses were significantly more likely to have good practices, with a 4.7 times higher
likelihood (AOR=4.66, 95% CI=1.23-17.77) than other healthcare professionals.
Healthcare professionals who received in-service training on infection prevention
were more likely to demonstrate good practices compared to those who are not trained
(AOR=2.99, 95% CI=1.29-6.92).
Conclusion
The current study revealed that 43% of study participants reported poor surgical
site infections prevention practices. Therefore, healthcare professionals' knowledge
on surgical site infections prevention needs upgrading, and in-service training on
infection prevention necessary.
Rwanda J Med Health Sci. 2024; 7(1):22-35

Factors Influencing Company Bus Drivers’ Awareness and Attitudes towards Basic Life Support in Kigali

2024-04-22T09:12:05+00:00

Background
Basic life support (BLS) refers to a package of care that first responders provide to
anyone experiencing a life-threatening condition to increase the victim’s chance
of survival. Globally, 92% of people who had out-of-hospital cardiac arrest died
due to limited provision of BLS, therefore, there is a need to assess the awareness
and attitude of the general public towards BLS, such as taxi drivers.
Methods
A quantitative, analytical study that involved 327 drivers recruited from three
different bus stations in Kigali city was undertaken and binary logistic regression
was used for statistical analysis.
Results
The current study found that 19.5% of company bus drivers were aware of basic
life support, and 29% had a positive attitude. However, none of the participants
had a basic emergency kit in their buses. Having basic life support training,
(AOR=7.853:95%CI: 1.326-10.413) and previous involvement in accidents
(AOR=4.321:95% CI 1.163-4.628) were significantly associated with basic life
support awareness.
Conclusion
Kigali city in collaboration with Rwanda Utilities Regulatory Authority need to
devise ways bus drivers can be trained in basic life support. In addition, there is
a need for every bus permitted to work in transportation sectors to get a basic
life support kit.
Rwanda J Med Health Sci. 2024;7(1):36-45

Exploration of Metaperceptions Held by Men Enrolled in Rwanda Men’s Resource Centre Programme, Correlates Behaviours and Coping Strategies

2024-04-22T09:19:20+00:00

Background
Men participating in the Rwanda Men’s Resource Centre (RWAMREC) programme,
designed to challenge negative masculinity, have exhibited positive shifts in
household responsibilities and collaborative decision-making with their wives.
However, little was known about how these men believe non-enrolled men perceive
them.
Aim
The study aimed to explore the metaperceptions of enrolled men regarding how
they are perceived by other men in their community and it investigated strategies
employed to overcome these metaperceptions.
Method
Using a qualitative approach, 15 men involved in the RWAMREC programme,
selected based on their completion of a couples' curriculum on domestic violence
using a gender transformation approach, were interviewed.
Results
The findings indicated that men engaging in traditionally feminine tasks faced
societal stigma, being viewed as bewitched or not real men. Despite these
challenges, many expressed gratitude for the positive impact on family dynamics.
The majority of enrolled males were criticized and regarded as not embodying true
masculinity; nonetheless, some concealed their involvement in certain tasks, and
a few discontinued providing care after the being aggressed by the men who tried
to protect their threatened masculinity.
Conclusion
The study concludes that the metaperceptions and defensive reactions of men
protecting their threatened manhood may hinder the programme's goal of
fostering positive masculinity adoption. To sustain the intervention across diverse
organizations, positive masculinity promotion has to be included in the package
provided to friends of family volunteers.
Rwanda J Med Health Sci. 2024;7(1):46-62

Lived Experiences of Adolescents with HIV in Rwanda: A Phenomenology Study

2024-04-22T09:32:41+00:00

Background
HIV is a chronic disease with a potentially negative impact on quality of life.
Globally, adolescents with HIV (AWH) face incredible challenges related to their
growth, social interactions, and well-being. The experiences and choices of AWH
in Rwanda are poorly known.
Objective
The current study explored the lived experiences of AWH in Rwanda using an
interpretive phenomenological approach.
Methods
A purposive and snowball sampling was used to recruit twenty AWH from five
health centers. A semi-structured interview guide was used to conduct in-depth
interviews from April to August 2022. All interviews were recorded, and field notes
were taken. The recorded interviews were transcribed verbatim, translated in
English, and analyzed using Interpretative phenomenological analysis (IPA).
Results
Three main themes and nine subthemes emerged from data: burden of HIV
(existential crisis, experiences with stigma, keep it a secret), owning my story
(awareness of having HIV, making decisions) and successful living with HIV
(features of successful living, continuum of self-acceptance, behavioural impact,
social interaction).
Conclusion
The AWH face challenges related to HIV condition and develop strategies to
overcome challenges that hinder their well-being. Results provide valuable insights
that inform targeted interventions and support programs, ultimately promoting
the well-being of AWH.
Rwanda J Med Health Sci. 2024;7(1):63-78

Effectiveness of Smartphone Application “Gororokapp” for Type 2 Diabetes Patients’ Self-Management in Rwanda: A Randomized Controlled Trial

2024-04-22T10:39:53+00:00

Background
Type 2 diabetes has become a public health concern, representing more than 90%
of all types of diabetes and affecting 536.6 million people worldwide in 2021. It is
a disabling condition and is considered a major risk factor for developing chronic
complication such as cardiovascular diseases if not well controlled. Studies have
shown that individuals with diabetes can make a positive impact on the outcomes
of their disease by participating to their healthcare. Contextualized innovative and
effective applications are needed to facilitate individuals with diabetes to participate
to their care.
Aim
To assess the effectiveness of Smartphone Application “GororokApp” in monitoring
of glucose control among type 2 diabetes individuals.
Materials & Methods
A Randomized Controlled Trial (RCT) was used to assess the effectiveness of smartphone
application (GororokApp) in monitoring of glucose control for self-management by
the patients with type 2 diabetes in Rwanda. Participants in intervention group used
the GororokApp and recorded their blood glucose measurements and received health
care advice remotely while the control group continued routine care. The participants
were followed up over a period of 12 weeks. The primary outcomes were glycated
haemoglobin, and daily blood glucose measurements.
Results
After 12 weeks of follow up, the intervention and control, groups demonstrated
difference of changes in glycated haemoglobin; whereby in the intervention group
the glycated haemoglobin reduced from 8.45±2.93 to 6.89±1.86 (p ≤ 0.001),
whereas in the control group the glycated haemoglobin increased from 7.12±2.52 to 8.14±2.17 (p ≤0.001).
Conclusion
The smartphone application “GororokApp” is effective in self-monitoring and
management of the daily blood glucose levels in intervention group to achieve
treatment targets of blood glucose and glycated haemoglobin among individuals
with type 2 diabetes.
Rwanda J Med Health Sci. 2024;7(1):79-88

Knowledge about Vitamin D among General Population in Baghdad City

2024-04-22T11:26:08+00:00

Background
Globally and in Iraq, vitamin D insufficiency is becoming more of a problem. Knowledge is crucial in preventing deficiency and future consequences. The current study intends to investigate the general population's knowledge about vitamin D in Baghdad, Iraq.
Methods
A cross-sectional online study including 1,011 residents of Baghdad, Iraq, was carried out. To choose participants, a non-probability convenience sampling method was applied. Knowledge questionnaires with 17 items were taken from earlier research. Fisher exact and Chi-Square were utilized to identify associations between the variables.
Results
The overall prevalence of good knowledge among participants was 74.3%. About 48.8% did blood tests before to check vitamin D levels. Around half of respondents (47.1%) did take vitamin D supplements before. The level of good knowledge among respondents was 74.3%. Multivariable logistic regression model showed that respondents taking vitamin d supplements had better knowledge (AOR; 2.241, 95 CI: 1.701-3.444).
Conclusion
People living in Baghdad have a good knowledge level about Vitamin D but more health education and promotion are needed to address specific issues like dietary sources and, the best season to get vitamin D as the majority did not know it.
Rwanda J Med Health Sci. 2024;7(1):89-100

Exploring Perceptions about Enablers of Women’s Attendance and Adherence to the Recommended Antenatal Care Visits in Rwanda: A Qualitative Study

2024-04-22T11:37:10+00:00

Background
Antenatal care (ANC) helps ensure the best health conditions of the mother and foetus during pregnancy. However, achieving optimal ANC attendance and adherence to the World Health Organization (WHO) recommendations remains a global challenge, with significant disparities in attendance rates. A qualitative study was conducted exploring pregnant women's perspectives of various enablers to their attendance and adherence to recommended ANC visits in Rwanda.
Methods
This exploratory qualitative study involved 22 pregnant women attending ANC in four public health centres in the Eastern province, of Rwanda. An interview guide with semi-structured questions was used to gather information about the moderators of ANC attendance and adherence among pregnant women. Data were audio-recorded and transcribed verbatim, and thematic analysis was used to categorize themes under the five-level Social Ecological Model (SEM).
Results
Early recognition of pregnancy, financial stability, and female participation in decision-making were identified as intrapersonal enabling factors of ANC attendance and adherence; spousal support was identified as an interpersonal enabling factor; community health workers, and community relationships as community enabling factors; availability and cost of ANC services as institutional enabling factors; and media campaign, community outreach as public policy enabling factors contributing to the pregnant women's attendance and adherence to ANC visits.
Conclusion
Enablers at multiple levels affect women’s attendance and adherence to ANC visits. It is essential to consider each level when implementing effective strategies to maximize ANC attendance and adherence to the WHO recommendations in order to improve maternal- foetal well-being in Rwanda.
Rwanda J Med Health Sci. 2024;7(1):101-115

Psychology of Abortion: A Qualitative Exploration of Women’s Quality of Life after Termination of Pregnancy Service Provision

2024-04-22T11:55:30+00:00

Background
Although safe abortion is a human right, some research indicates that abortion can be considered a life event that could trigger an adverse psychological reaction, including mental ill health, particularly in vulnerable women. Unplanned pregnancies and abortions affect women’s mental and physical health while increasing psychological risk; hence, measures are needed to improve the quality of life (QoL) of women post termination of pregnancy (ToP). The purpose of this study was to explore the psychological effects of abortion on women provided with this service in Rwanda, and factors surrounding QoL after service provision.
Methods
An interpretive description design was used. Focus group discussions were used to hear the voices of 30 women and girls who had sought ToP services. The six steps of interpretive description together with framework analysis guided the analysis.
Results
From responses provided by the participants with experience of ToP services five themes and six sub-themes were generated, (1) Ambivalence with mixed feelings and uncertainty, anger, wonder, and frustration; (2) Insecurity and abortion stigma, with judgement and inadequacy; (3) Personalized care with respectful care and dignity and self-reliance; (4) Lack of connection with relationships, coping, and a sense of belonging; (5) Wellness and preferences for care with hope and positive physical health.
Conclusion
The lack of psychological support post ToP negatively affects QoL and indicates an opportunity to include a psychological support package in the ToP service provision, which is the predictor of positive mental health to improve QoL in Rwanda.
Rwanda J Med Health Sci. 2024;7(1):116-130