Rwanda Journal of Medicine and Health Sciences

Barriers to Community Pharmacists’ Prescribing Role in Limpopo Province, South Africa: A Qualitative Study

Noko Brilliant Moloto — 2024-07-31

Background
The healthcare system had rapidly advanced with greater focus on improving the quality of healthcare and safety of patients. Parallel with the transforming healthcare systems, new policies have emerged to allow pharmacists to prescribe. Little is known about the barriers to community pharmacists’ prescribing role in Limpopo province.
Purpose
The purpose of this study was to explore the barriers to community pharmacists’ prescribing role in Limpopo province and give recommendations to enhance pharmacists’ prescribing role at community pharmacies.
Methodology
This was a qualitative study in which community pharmacists in Polokwane were interviewed. Due to data saturation, 14 pharmacists participated. Data collection was through semi-structured face-to-face interviews. The interviews were audio-recorded, transcribed verbatim and analysed using Tesch’s open coding method.
Results
Most participants reported their readiness to prescribe and viewed it as a positive initiative. Results revealed barriers associated with the prescribing role such as lack of knowledge and awareness of the supplementary program, lack of dedicated time for prescribing, lack of recognition from employer, lack of support from medical doctors, and limited scope of practice.
Conclusion
Pharmacists’ prescribing role is a great initiative that will strengthen the healthcare system however the identified barriers need to be addressed to ensure that pharmacists offer safe and effective patient-centred healthcare. A coordinated effort is therefore necessary for the formulation of clear policy frameworks, including more training facilities, increasing stakeholder awareness to support pharmacist prescribing role, and identifying financial, infrastructure, and other resource demands to support the smooth integration of pharmacist prescribing.
Rwanda J Med Health Sci 2024;7(2):106-119

Radiographic Spectrums of Adults with Traumatic Femoral Shaft Fracture in the South-West, Nigeria

Omotayo Oluseyi Osinaike — 2024-07-31

Background
Femoral shaft fracture injuries are common in our environment. The weight-bearing function of the femur makes its damage important in the young and adult population, as it leads to prolonged immobilization and hospitalization, which may result in pulmonary embolism and even death.
Objectives
To determine the relationship between the mechanism of injury and the patterns of fractures on the plain radiographs of adults with femoral shaft fractures.
Methods
A cross-sectional study of 390 adults with 402 femoral shaft fractures at three tertiary hospitals’ Surgical Emergency and Orthopedics units was carried out over one year using plain radiographs. The demographics, fracture etiology, fracture site, and associated injuries were evaluated. Data were analyzed using the IBM SPSS Statistics for Windows version 23.0 (IBM Corp, Armonk, NY, USA)
Results
The mean age was 40.93 (SD=16.3) years. Road traffic accidents (82.8%) were the commonest etiology, while mid-shaft fracture (52.2%) and comminuted fractures (36.3%) were the most common fracture sites and fracture patterns, respectively. Soft tissue injuries were commonly associated.
Conclusion
Road traffic accident was the most common cause of femoral shaft fracture. The pattern of femoral fractures varied with age and the etiology of injury. Reducing road traffic accidents is key to decreasing femoral shaft fractures worldwide. The prompt assessment of femoral shaft fracture will enhance its effective management, reducing mortality and morbidity in affected individuals.
Rwanda J Med Health Sci 2024;7(2):120-130

Prevalence and Factors Associated with Low-Birth-Weight in Kicukiro District, Rwanda

Jeanne Mumporeze — 2024-07-31

Background
Low birth weight (LBW) and neonatal deaths have continued to be a major global challenge. The global prevalence of LBW is 15.5 per cent, which amounts to about 30 million LBW infants born each year, 96.5 per cent of them are found in developing countries according to the World Health Organization. This study aimed to assess the prevalence and factors associated with LBW amongst children aged 0 to 15 months at immunization clinics brought by mothers at health centers in Kicukiro district, Kigali city, Rwanda.
Methods
A cross-sectional design, quantitative approach was used. Three hundred forty nine participants were chosen by a systematic sampling technique. A questionnaire using Open Data Kit (ODK) and SPSS version 21 were used for data collection and analysis respectively. Multivariable analysis was utilized to identify the factors associated with LBW for p-value <0.05.
Results
The LBW prevalence in Kicukiro District, Kigali was 23.8%. Adolescent mothers under 18 years (AOR=32.49, p=002), pre-delivery weight loss (AOR=2.18, p=018) and multiple babies (AOR=6.16, p=004) were significantly associated with LBW.
Conclusion
In conclusion, low birth weight is an important problem that needs to be addressed in Kicukiro district. Interventions would mainly focus on the key determinants of low birth weight relating to adolescent mothers under 18 years, pre-delivery weight loss and mothers with multiple babies.
Rwanda J Med Health Sci 2024;7(2):131-139

Factors Associated with Adherence to Medication among Hypertensive Patients in a District Hospital, Northern Province, Rwanda

Denys Abazimana — 2024-07-31

Background
Globally, half of cardiovascular deaths are related to hypertension. Unfortunately, sub-Saharan Africa is burdened with lower adherence to anti-hypertensive medications. Hence, to successful-ly control and prevent the now-increasing hypertension crisis and its complications is to ensure good adherence to anti-hypertensive medications.
Aim
The aim of this study was to assess factors associated with adherence to hypertensive medica-tions among hypertensive patients in a district hospital of Northern Province in Rwanda.
Methods
A cross-sectional analytical study was conducted on 272 hypertensive patients. Data were ana-lyzed using SPSS version 21.0 in which bivariate and multivariable analyses were performed. The significance level was set at p < 0.05; and odds ratio and adjusted odds ratios with 95% confidence intervals (CI) were calculated.
Results
Self-reported adherence was 64.3%. Factors associated with adherence to hypertension medi-cations were being a female (AOR= 4.188, 95% CI [1.555-11.281], p=0.005); having been diag-nosed and on treatment for five years or more (AOR=33.35, 95% CI [5.016-221.2851], p<0.001), good belief of medication (AOR=16.867 95% CI [5.438-52.321], p<0.001), taking medication even when there are no symptoms (AOR: 24, 95% CI [4.831-119.281], p<0.001); in the past hav-ing been a smoker but stopped (AOR: 9.348, 95%CI [2.594-33.686], p=0.001).
Conclusion
Adherence was low, and multiple factors were associated. As a result, there is a need to develop and strengthen strategies aiming at improving medication adherence among hypertensive pa-tients by addressing the factors associated.
Rwanda J Med Health Sci 2024;7(2):140-150

Kidney Impairment in HIV/AIDS Patients Attending Kabutare Level II Teaching Hospital, Southern Province of Rwanda

Augustin Nzitakera — 2024-07-31

Background
HIV infection itself and antiretroviral therapy (ART) can lead to the impaired kidney function that in turn can significantly impact the quality of life and clinical outcomes in people living with HIV. In this study, we evaluated kidney function status in Rwandan people using serum creatinine levels which were lacking in the existing reports.
Objective
To determine the prevalence and associated risk factors of kidney impairment in patients infected with HIV attending Kabutare level II teaching hospital in southern Rwanda.
Methods
An analytical cross-sectional study was carried out on 179 HIV infected and 179 uninfected patients. Weight and height were measured and a blood sample was drawn from each participant for measurement of serum creatinine. Statistical tools were used to determine the association between kidney impairment and participants characteristics.
Results
Among the 358 participants, 19% HIV positive and 1.7% HIV uninfected participants had GFR impairment. Gender (χ² = 4.566; p = 0.033) and advancing age (χ² = 24.991; p < 0.001) were identified as independent predictors for kidney impairment.
Conclusion
Patients infected with HIV are at higher risk of developing kidney impairment compared to the HIV uninfected. Routine surveillance of kidney function in patients infected with HIV is paramount.
Rwanda J Med Health Sci 2024;7(2):151-164

A Comparative Study of Mental Health Challenges in Parents of Children with Genetic versus Non-Genetic Conditions in Rwanda

Benjamin Tuyishimire — 2024-08-08

Background
This study addresses a critical gap in research by examining the psychosocial impact on parents of children with genetic diseases compared to those with non-genetic conditions. While existing literature mainly focuses on medical aspects, it overlooks the emotional and mental health challenges faced by these parents.
Objectives
The main objective was to investigate and compare levels of depression, anxiety, perceived stress, parenting stress, self-esteem, and intimate partner violence between parents of children with genetic diseases and parents of children with non-genetic conditions.
Method
A cross-sectional comparative study was conducted with 100 caretakers of children with genetic diseases and 109 caretakers of patients with non-genetic diseases. Data were collected using standardized measures of self-esteem, intimate partner violence, perceived stress, and the Parenting Stress. Independent sample t-tests were performed to compare the means between the two groups.
Results
Parents of children with genetic diseases exhibited significantly higher levels of depression (t(207) = 5.683, p < 0.001), anxiety (t(207)= 6.107, p<0.001), perceived stress (t(207)=11.680, p<0.001), parenting stress (t(207)= 12.893, p<0.001), and intimate partner violence (t(207)= 10.617, p < 0.001) compared to parents of children with non-genetic conditions. Low self-esteem was also more prevalent in the case group (t(207)= -14.565, p<0.001).
Conclusion
These findings underscore the urgent need for comprehensive support systems to address the psychosocial challenges faced by parents and caregivers of children with genetic diseases. Recognition and targeted interventions for these issues can significantly enhance healthcare services, benefiting both patients and their parents.
Rwanda J Med Health Sci 2024;7(2):165-177

Knowledge, Attitude, and Practice towards Prevention of Hypertension among Pregnant Women Attending Antenatal Care Clinic at a District Hospital in Kigali City

Dieudonne Muhire Havugimana — 2024-08-08

Background
Hypertensive disorders during pregnancy (HDP) pose significant risks globally. Adequate knowledge of HDP aids in prevention. This study aimed to assess knowledge, attitude, and practice towards preventing hypertension among pregnant women attending antenatal care at Muhima District Hospital in Kigali city.
Methodology
Altogether, 384 pregnant women receiving antenatal care at Muhima Hospital were surveyed to obtain their knowledge, attitudes, and practices regarding hypertension prevention. A descriptive cross-section study was used; a bivariate and multivariate analysis with odds ratios (OR) and 95% confidence intervals were calculated to investigate associations with preventive practices.
Results
The participants’ ages ranged from 18 to 45 with a mean of 32.4(SD±.838). Majority were in the age range of 32-38 years. 291 (75.8%) had low knowledge about preventing hypertension, and 226 (58.9%) had negative attitudes toward hypertension prevention among pregnant women. Additionally, 226(58.9%) exhibited low preventive practices. Multivariate logistic regression revealed that higher education (AOR=6.79; 95%CI: 2.02 – 22.93), third wealth category (AOR=3.34: 95%CI: 1.72 – 6.49), and higher knowledge (AOR=2.18: 95 %CI: 1.25 – 3.80) were associated with hypertension prevention practices.
Conclusion
These findings highlight the need for targeted education on hypertension prevention for pregnant women. Prioritizing educational programs can improve knowledge and proactive healthcare practices.
Rwanda J Med Health Sci 2024;7(2):178-191

Survival Status and Associated Factors among Under-Five Children Managed with Congenital Heart Diseases in Addis Ababa Ethiopia: A Retrospective Follow-up Study

Daba Suyum Jaleta — 2024-08-08

Background
Congenital heart disease is the most prevalent congenital abnormality with a prevalence of 9 per 1000 live births. Despite the advancements in medical and surgical care, congenital heart disease is high in developing countries including Ethiopia. The aim of this study is to assess Survival status and associated factors of under-five children managed with congenital heart diseases in Addis Ababa, Ethiopia.
Methods
An Institution-based retrospective follow-up study design was used among under-five children managed with congenital heart disease. Data was collected by pretested checklist from 235 randomly selected patient charts. Kaplan-Meier survival analysis; log-rank test and cox proportional hazard were employed. SPSS version 26 was used for data analysis.
Result
A total of 224 charts were reviewed. Thirty four of them died whereas 190 of them were censored. The survival status of CHD was 84.8% to five years. Cox regression identified the following factors to be significantly associated with mortality: weight at admission (AHR=19.023; P=0.004), types of interventions (AHR=73.016; P=0.007), pre-operative condition (AHR=65.097; P=0.0001), family history of heart disease (AHR=10.81; P=0.003), maternal history of substance use (AHR=46.67; P=0.001) and maternal history of viral infection (AHR=52.034; P<0.0001).
Conclusion
This study showed that the survival status of all infants born with CHD was 84.8%. Mortality risk was decrease by 98.7% in surgically managed patients.
Rwanda J Med Health Sci 2024;7(2):192-203

Prevalence, Knowledge, Attitude, and Factors Associated With Practices of High Blood Pressure Prevention among Employees of an Authority in Kigali City

Joyce Icyimpaye — 2024-08-13

Background
Hypertension is becoming a burden globally with a significant shift in developing countries resulting from rapid urbanization with associated changes in lifestyles. In Rwanda, there is limited knowledge about high blood pressure and its prevention measures practices among office workers.
Objective
This study assessed the prevalence, knowledge, attitude, and factors associated with practices to prevent high blood pressure among employees of an authority in Kigali City.
Methods
A cross-sectional study was undertaken with 166 employees of Rwanda FDA to collect data on blood pressure levels, knowledge, attitude and practice toward prevention of High Blood Pressure. Bivariate and multivariate logistic regression analysis were carried out using SPSS version 21.
Results
The study surveyed 166 participants, mostly male (61.4%). High blood pressure prevalence was 4.8%, 81.3% had good knowledge, 69.3% had positive attitude, and 7.2% had good practice. This study discovered that the respondents with poor knowledge were less likely to have good practice.
Conclusion
The study revealed lower blood pressure prevalence and high knowledge among participants, however, some knowledge questions on hypertension symptoms and complications were not answered correctly. Moreover, a quarter of participants with High blood pressure were unaware of their condition. These findings highlighted the need for public health education and awareness programs.
Rwanda J Med Health Sci 2024;7(2):204-216

International Internship Collaborations: Rwandan Nephrology Graduate Nurses Describe Their Experiences Abroad

Gerard Nyiringango — 2024-08-13

Background
International internships provide many benefits to graduate nurses, including bridging the gap between theory and practice. Yet, these internships in culturally diverse regions also present various challenges.
Objective
This study explored the experiences gained by nephrology graduate master’s nurses from the University of Rwanda who attended clinical training in more advanced settings in Asia and Africa.
Methods
A qualitative design and semi-structured interview guide was employed to solicit individual opinions of nine nephrology graduate nurses who had attended international internships in India and Kenya. Content analysis was used to analyse and interpret the meaning of the textual data.
Results
Four themes emerged from the analysis, namely Inter-professional collegiality,
Cross-cultural adaptation, Challenges of the internships, and becoming a Change
agent upon return to work in Rwanda.
Conclusion
Participants reported many positive learning experiences and some challenges. These
challenges could be rectified in future internships abroad. The training bridged the
theory-practice gap and increased the graduate nurses’ experiences as global citizens.
Rwanda J Med Health Sci 2024;7(2):217-228

Factors Associated with Knowledge and Attitudes of HIV Patients towards HIV-Based Services at Kibagabaga District Hospital

Axell Karamage — 2024-08-22

Background
HIV is still a significant global public health issue. World health organization (WHO) recommends that people infected with HIV should initiate HIV-based services as early as possible. The aim of this study was to assess the knowledge and attitude levels of HIV patients towards HIV-based services and associated factors.
Methods
A cross-sectional study was conducted on 274 HIV patients obtaining HIV-based services at Kibagabaga Hospital. Descriptive analysis, bivariate and logistic regression analysis were performed using SPSS version 21. P-value <0.05 was declared as significant.
Results
The majority of respondents were female 158 (57.7%) and 107 (39.1%) were aged 50 years old and more. Analysis revealed that 86.1% had good knowledge on HIV-based services and 81% exhibited positive attitudes. Respondents aged 40-49 years (AOR: 11.59; 95% CI: 1.560 - 86.063), aged 50 years (AOR: 16.44; 95% CI: 2.150 - 125.653), Urban (AOR: 7.05; 95% CI: 1.999 - 24.88) and engaged for more than 5 years (AOR: 13.29; 95% CI: 1.694 - 104.182) were more likely to exhibit good knowledge towards HIV-based services.
Conclusion
The study revealed favorable knowledge and attitudes towards HIV-based services, However, improved awareness is needed to improve uptake in rural communities.
Rwanda J Med Health Sci 2024;7(2):229-238

Prevalence of Anemia and Associated Factors among Pregnant Women in Kigeme Refugee Camp, Rwanda

Jean Jacques Safari Musirakumva — 2024-08-22

Background
The most prevalent nutritional deficiency experienced by pregnant women is anemia, which is defined as a hemoglobin level below 11 g/dl in a pregnant woman. This study aimed at determining the prevalence of anemia and identifying its associated factors among pregnant women in Kigeme Camp, Rwanda.
Methods
A cross-sectional, quantitative approach was used. Two hundred twenty one participants were chosen by a systematic sampling technique. A questionnaire was used to collect data and SPSS version 21 was used for data analysis. A p-value of 5% or less was set for significance. Multivariable analysis was utilized to identify the factors associated to anemia.
Results
The anemia prevalence among pregnant women in Kigeme Refugee Camp was 20.8%. Not eating variety of food (AOR= 4.72, 95%CI: 1.77–12.57, p=0.002), sleeping hungry (AOR=0.45, 95%CI: 0.27–0.73, p=0.001), iron/folic acid supplementation (AOR=5.83, 95%CI: 2.04–16.68, p=0.001), use of modern contraceptives (AOR=2.12, 95%CI: 1.09–4.10, p=0.025), bleeding during pregnancy (AOR=0.26, 95%CI: 0.17–0.64, p=0.001) and not eating food from animals were significantly associated to the occurrence of anemia among study participants.
Conclusion
The current study’s findings will be critical for policymakers in designing strategic interventions; it will provide information necessary for different concerned stakeholders, especially clinicians and policy makers who involve in designing anemia curative and preventive measures.
Rwanda J Med Health Sci 2024;7(2):239-247

Male Involvement in Family Planning Services Utilization and Associated Factors in Musanze District, Northern Rwanda

Emmanuel Ndahiro Manirafasha — 2024-08-22

Background
Male involvement in family planning (FP) is crucial for reducing unplanned pregnancies, unsafe abortions, and maternal and child mortality. As primary decision-makers in many African households, men significantly influence women’s use of contraceptive methods. However, male participation in FP services remains limited for various reasons. This study aims to assess male involvement in FP services and associated factors in Musanze district, Northern Rwanda.
Methods
A cross-sectional study was conducted on 397 married men in Musanze district. Participants were selected using simple random sampling. Data were collected through pre-tested, interview-administered questionnaires. Multivariable logistic regression analysis identified factors associated with male involvement in FP services.
Results
The overall level of male involvement in FP services was 36.7%. Male involvement was influenced by age (OR=6.199, 95% CI: 1.727-22.251), employment status (OR=2, 95% CI: 1.24-3.224) and distance to the FP facilities (OR=0.071, 95% CI: 0.009-0.579).
Conclusion
Male involvement in FP services in Musanze district is low. Factors such as age, employment, and distance to FP facilities influence male involvement in FP. Integrating men into existing FP services could enhance utilization and sustainability.
Rwanda J Med Health Sci 2024;7(2):248-259

Prevalence and Risk Factors for Surgical Site Infections among Patients in Referral Hospitals in Rwanda

Aloys Niyomugabo — 2024-08-22

Background
Post-operative surgical site infections (SSIs) are a global public health problem, disproportionately affecting developing countries. The purpose of this study was to identify the prevalence and risk factors for SSIs among patients admitted to tertiary hospitals in Rwanda.
Methods
A retrospective cross-sectional involving 396 medical files for surgical patients discharged between July 2020, and December 2021 to assess the prevalence and risk factors associated with surgical site infections. Univariate and multivariable logistic regression analyses were performed using SPSS version 25.
Results
Of 396 participants,121(30.6%) developed SSIs. SSIs was significantly associated with spending more than 120 minutes (COR = 2.87, 95% CI: 1.58-5.23) in operation and undergoing emergency admission (COR = 1.66, 95% CI: 1.08-2.57) were associated with higher odds of developing surgical site infections. In multivariable analysis, after controlling for covariates, spending more than 120 minutes in operation (AOR = 2.52, 95% CI: 1.29-4.93) and undergoing emergency admission (AOR = 1.68, 95% CI: 1.03-2.73) remained significantly associated with surgical site infections.
Conclusion
The 30.6% of surgical patients developed post-operative SSIs despite receiving prophylactic antibiotic. Therefore, regular infection surveillance and adherence to preoperative, intraoperative, and postoperative infection prevention measures are crucial to reduce the burden of SSIs.
Rwanda J Med Health Sci 2024;7(2):260-272

Profile of Perinatal Deaths at Masaka District Hospital in Kigali City, Rwanda: A Retrospective Cross Sectional Study

Alain Nshimirimana — 2024-08-22

Background
The global perinatal deaths and stillbirths in 2018 was alarming, with around 5 million perinatal deaths and 2 million stillbirths, predominantly concentrated in sub-Saharan Africa and South Asia (95%).
Objective
To assess the profile and factors associated with perinatal deaths among deliveries conducted in a public district hospital in Kigali City, Rwanda .
Methods
A retrospective cross-sectional study design was conducted using data from hospital files of neonates and mothers who delivered at Masaka District Hospital from January to December 2022. All 303 perinatal deaths were considered. Chi-square was performed for categorical variables to check the association between the outcome variable and predictor variable at significance level of 5%.
Results
The perinatal mortality rate was 35.8 deaths per 1000 live births. The leading cause of perinatal death were maternal sepsis 67(22%), followed by prematurity 62(20.5%), birth asphyxia 30(9.9%) and congenital anomalies 17(5.6%).However,88(29%) were with unknown causes. Perinatal deaths were statistically associated with maternal anemia (AOR:29.904,P-value:0.001),maternalSTIs(AOR:10.036,P-value:0.036),delivery complications(AOR:0.308,P-value:0.003),and neonatal factors such as birth weight (AOR:6.361,P-value :0.015) and prematurity (AOR:0.038,P-value:0.001).
Conclusion
The perinatal deaths at Masaka district hospital were relatively high. Management of following factors like prematurity, birth asphyxia, and maternal infection with high-quality care could significantly reduce perinatal deaths at district level.
Rwanda J Med Health Sci 2024;7(2):273-285

User Satisfaction with Technology-Enhanced Health Insurance among Community-Based Health Insurance Users: A Survey at one Selected Referral Hospital, Rwanda

Ferdinand Maniriho Maombi — 2024-08-22

Background
Expanding health insurance coverage is crucial for improving access to healthcare services in Africa. While Rwanda has successfully implemented a community-based health insurance scheme (Mutuelle de Santé), the transition from traditional paper-based systems to Technology-based platforms presents a new challenge. Understanding user satisfaction with these new platforms is critical for their long-term success.
Objective
This study seeks to investigate the satisfaction level of community health insurance users attending the Outpatient Department at One selected Referral Hospital in Rwanda.
Methods
The mixed-methods study used an explanatory sequential design among 384 Community Based Health Insurance (CBHI) users. A structured questionnaire used for data collection; Analysis was done using Statistical Package for Social Sciences Version 21.
Results
The majority of participants (81.3%) expressed satisfaction. Young participants aged <20 years (AOR:1.96, 95% CI:1.037-2.718, p=0.003) Young participants are very satisfied. Limited medication availability and internet reliance hindered user experience. Healthcare providers faced increased workload from managing patient files and the CBHI system. Improved payment processes and patient verification streamlined billing, saving time and reducing errors.
Conclusion
The findings indicate a generally positive satisfaction and factors such as age, education, marital status, occupation, health insurance, and presence of under 5 children were found to be associated with satisfaction levels.
Rwanda J Med Health Sci 2024;7(2):286-301

“How can I seek a consultation if I don’t have a high fever ?”: Barriers to Mental Healthcare Access for Women in the Perinatal Period in Rwanda

Providence M. Umuziga — 2024-08-29

Background
Literature highlights barriers to mental healthcare access in the perinatal period, but none specific to Rwanda. The unique historical context of the genocide against the Tutsi may present distinct challenges. This study aimed to identify these barriers in Rwanda.
Methods
This study employed a qualitative interpretive descriptive approach as part of a multi-method investigation. Four focus group discussions were conducted with 31 perinatal women, and 32 individual interviews were conducted with healthcare providers, including community health workers. Data were analysed thematically.
Results
Barriers were identified at multiple levels. At the individual level, barriers included low literacy about perinatal mental health symptoms, minimizing negative experiences, fear of being stigmatized, ignorance about the availability of mental health services in the perinatal period, and economic challenges. Family and social-cultural barriers included stigmatization of people with mental health problems, minimization of what happened by friends and family, and lack of support from partners and friends. Institutional and structural barriers included limited services, misdiagnosis, heavy workloads, staff unawareness, and lack of training and guidelines for screening and reporting.
Conclusion
This study identified barriers to perinatal mental healthcare at individual, family and social-cultural, institutional and structural levels. Addressing these barriers requires targeted strategies to improve perinatal mental healthcare access across all identified levels.
Rwanda J Med Health Sci 2024;7(2):302-318

Exploring Key Stakeholders’ Perceptions of Air Quality and its Effects on Children in School Environments in Kigali, Rwanda: A qualitative study

Noel Korukire — 2024-08-29

Bacground
There is limited knowledge about educational stakeholders’ perceptions of air quality in school environments and its effects on schoolchildren. This study explored various perspectives of educational stakeholders, including their perceptions of air quality in school settings, the perceived effects, and the current strategies employed to enhance air quality in schools.
Methods
This study was conducted with a qualitative approach. The researchers conducted a total of 16 in-depth interviews with schools and staff of the city of Kigali. The collected data were analyzed using thematic analysis.
Results
Participants perceive the morning and evening as the most polluted period of the day. Overcrowding, poor quality of chalk, and inadequate ventilation are perceived as the primary contributors to poor air quality within school premises. The perceived adverse effects include respiratory problems, increased absenteeism, poor school performance and school dropout. Additionally, the unavailability of well-defined air quality standards was highlighted as a barrier to achieving optimal air quality in school environments.
Conclusion
This study has revealed that most educational stakeholders perceive air pollution as a significant environmental problem that adversely affects the health and comfort of schoolchildren. The study advocates for the promotion of collaborative efforts across various disciplines to formulate and implement strategies aiming at improving air quality in schools.
Rwanda J Med Health Sci 2024;7(2):319-337

Strategies to Sustain Interprofessional Collaboration in Emergency Obstetric and Neonatal Care in Rwanda: Perspectives of Healthcare Professionals and Hospital Managers

Assumpta Yamuragiye — 2024-08-29

Introduction
Interprofessional collaboration (IPC) is beneficial in delivering quality healthcare. Lack of IPC increases healthcare errors and work under stress. Despite its importance, achieving a desired IPC continue to be a challenge worldwide. In Rwanda, different maternal death audits identified poor IPC as one of the contributing factors. However, there is no study conducted to identify strategies to improve IPC in obstetric and neonatal care. Accordingly, this study explored the perspectives of healthcare professionals and hospital managers on strategies to sustain inter professional collaboration in EmONC
Methodology
A qualitative descriptive study was conducted to explore suggestions and strategies to improve IPC in five hospitals in the northern province of Rwanda. Thirty interviews were conducted among general nurses, midwives, nurse anesthetists and medical doctors. To delve deeper into this study, additional interviews were conducted among hospital managers. Thematic analysis was used to analyze data.
Results
The findings revealed that strategies to improve IPC practice were: Trainings on IPC; availability of resources; interprofessional conflict resolution; recognition and rewarding; open and constant communication and research.
Conclusion
Based on perspectives from different healthcare professionals working in obstetrics and neonatal units, and their managers, all staff need IPC training focusing on communication as one of important aspect in IPC practice. Regular audits should be conducted to ensure protocols are followed and IPC challenges are constantly identified and addressed.
Rwanda J Med Health Sci 2024;7(2):338-349

Prevalence and Factors Associated with Postpartum Hemorrhage among Women who Delivered at Rwinkwavu District Hospital in the Eastern Province of Rwanda

Aphrodis Nyirijuru — 2024-08-29

Background
More than 25% of maternal deaths in low and middle-income countries were due to post-partum hemorrhage (PPH). The PPH is considered as the maternal mortality leading cause worldwide. The aim of this study was to determine the prevalence of postpartum hemorrhage and to identify its associated factors among women who delivered at Rwinkwavu District Hospital in the Eastern Province of Rwanda.
Methods
A facility based cross-sectional study design, was used. Four hundred ten (410) participants were selected systematically. The SPSS version 21 was used for data analysis. Descriptive statistics were used to determine the prevalence of PPH at Rwinkwavu District Hospital. Chi-square test and multivariable logistic regression were used to generate adjusted odds ratios with 95%CI to identify the PPH associated factors. The findings were considered significant for p-value <0.05.
Results
The PPH prevalence was 15.1%. The odds of bleeding in postpartum were 2.411 times [AOR=2.411, 95%CI: 1.027-5.661, p-value=0.043] higher among married women than single ones. Women who delivered by Cesarean section were 3.092 times more likely to bleed in postpartum [AOR=3.092, 95%CI: 1.176-8.128, p<0.001] compared to those who delivered normally. Women whose delivery labors were induced were 25.689 times more likely to suffer from PPH [AOR=25.689, 95%CI: 3.864-45.759, p<0.001] compared to those whose labor was not induced. Women with prolonged labor were 11.391 times more likely to bleed in postpartum [AOR=11.391, 95%CI: 5.011-25.893, p<0.001] compared to those with normal length of delivery labor.
Conclusion
The prevalence of PPH was high, and this is a great public health concern; therefore, the Ministry of Health and health facilities need to strengthen strategies to prevent PPH. Marital status, mode of delivery, labor induction and prolonged labor were significantly associated with PPH.
Rwanda J Med Health Sci 2024;7(2): 350-358

Knowledge and Attitudes of Circumcision among Adult Male Clients Receiving Care in a Teaching Hospital in Kigali City, Rwanda

Innocent Mwiseneza — 2024-08-29

Background
Surgical male circumcision is one of the oldest and most frequently performed surgical procedures in the world. It reduces the risk of heterosexually acquired HIV infection by around 60%. Knowledge and Attitudes toward male circumcision are still a concern in Rwanda as male circumcision is not traditionally widespread in the country. This study assessed the knowledge and attitudes of male clients attending RMH regarding circumcision.
Methodology
A cross-sectional study design was used. Participants were 355 adult males and data was collected during 10 days. A structured questionnaire was used. Descriptive and analytical statistics were computed and OR, p values were presented in tables.
Results
The participants were sufficiently knowledgeable at 79.4% (n=282) and had positive attitudes at 57.7% (n=205) towards medical male circumcision(MMC). Private sector employees, method used for MMC, positive attitude, and proof of manhood were associated with knowledge with COR=0.291,(CI=0.095–0.891), p-value 0.031; COR=1.872, (CI=1.076–3.258], p-value 0.026; COR=0.492,(CI=0.255–0.767), p-value 0.004; COR=2.336,(CI=1.329–4.107) p-value 0.003 respectively. Community encouragement and knowledge were associated with attitude COR=1.680,(CI=1.025–2.753), p-value 0.040; COR=0.413,(CI=0.245–0.696), p-value 0.001 respectively.
Conclusion
Knowledge of male circumcision was sufficient and attitudes were positive. Generally, participants were highly motivated and knowledgeable about MMS.
Rwanda J Med Health Sci 2024;7(2):359-371

Quality of Post-Cesarean Section Pain Management at Referral Hospital in Kigali Rwanda: A Cross-Sectional Study

Emmanuel Habimana Sibomana — 2024-08-29

Background
Studies in high-income settings have demonstrated that pain management after Cesarean section leads to higher patients’ satisfaction. However, little is known about the quality of pain management and patients’ satisfaction among parturients undergoing cesarean in low resources settings.
Methodology
A cross-sectional study was conducted for 385 parturients from May 2020 to October 2020 at a referral hospital in Kigali Rwanda. The sample size was calculated: S= Z² ×P× (1-P)/M². S= (1.96)2 ×0.5× (1-0.5)/ (0.05)2 =384.16≈385. Parturients aged over 18 years who underwent cesarean were enrolled prior to surgery and followed up within the first 24 hours post cesarean. Data on patients’ characteristics, type of analgesia, type of anesthesia, pain scores, and patients’ satisfaction were collected and analyzed.
Results
Age group 26-33 years 199(51.7%) underwent cesarean section and 201(52, 2%) were elective cesarean section; 361 (93.8%) received spinal anesthesia. Most patients had pain control with low pain scores throughout the first 24 hours 90.1% except immediately after recovery admission 46.8% and 76.1% were satisfied. Morphine was associated with higher patients’ satisfaction.
Conclusion
The quality of post cesarean section pain management within 24 hours at hospital is good leading to satisfaction among most patients. However, the quality of pain management was lower after leaving the theatre compared to other post-operative periods; this requires intrathecal morphine which was not used.
Rwanda J Med Health Sci 2024;7(2):372-378

Kidnapping-Induced Post-Traumatic Stress Disorder in an Elderly Nigerian Woman: Biopsychosocial Insights and Cognitive Processing Therapy Outcomes

Tajudeen Abiola — 2024-08-29

Background
In Nigeria, the rising prevalence of kidnapping incidents has led to significant psychological impacts on victims. This study explores the biopsychosocial consequences of kidnapping-induced post-traumatic stress disorder (PTSD) in an elderly Nigerian woman and assesses the efficacy of Cognitive Processing Therapy (CPT) as a therapeutic intervention.
Objectives
To examine the psychological aftermath of kidnapping through a biopsychosocial lens and evaluate the outcomes of CPT in treating PTSD symptoms in a 65-year-old Nigerian woman.
Methods
An elderly Nigerian woman who experienced a kidnapping event, was assessed for PTSD using the Acute Stress Disorder Scale and PTSD Checklist (PCL). She underwent six sessions of CPT, and her progress was evaluated using the PCL, Brief Resilience Scale and Spirituality Self-Rating Scale.
Results
The patient initially exhibited severe PTSD and acute stress disorder. After the intervention, her PTSD symptoms significantly reduced from severe to moderate levels. Additionally, her resilience and spirituality scores increased, indicating an overall improvement in her psychological state.
Conclusion
The case highlights the significant psychological impact of kidnapping and effectiveness of CPT in reducing PTSD symptoms. The findings underscore the importance of incorporating resilience and spirituality into holistic treatment strategies for managing the psychological effects of traumatic experiences like kidnapping.
Rwanda J Med Health Sci 2024;7(2):380-385