Rwanda Journal of Medicine and Health Sciences

Effect of Differentiated Service Delivery Model on Retention to Care among People Living with HIV in Rwanda: A Retrospective Cohort Analysis

Mon, 31 Mar 2025 00:00:00 +0000

Introduction
The differentiated service delivery (DSD) model, characterized by early antiretroviral therapy (ART) initiation, is supported by peer educators to enhance treatment adherence to improve retention in care among People Living with HIV (PLHIV). The study assessed effect of the DSD model on retention among PLHIV in Kigali City, Rwanda.
Methods
A retrospective cohort study design was used to evaluate the effect of the DSD model on retention by comparing pre- and post-DSD cohorts of 976 ART-naïve PLHIV aged ≥ 17 years who initiated ART between 2014 and 2019. To assess the effect of the DSD model on retention, we used multivariable logistic regression models to estimate the adjusted odds ratio (aOR) and the corresponding 95% confidence intervals (CI). Covariates, namely demographics, body weight, immunological status, and adherence, were included in the multivariable model.
Results
Of 976 participants evaluated, 903 participants (92.5%) were retained in care. While the DSD model did not significantly affect retention in care [aOR = 1.11, (95% CI: 0.67 – 1.85), p = 0.675)], adherence ≥ 90% was strongly associated with higher retention [aOR = 2.20, (95% CI: 1.31–3.68), p = 0.003).
Conclusion
These findings align with the latest literature, showing comparable retention patterns before and after introducing the DSD.
Rwanda J Med Health Sci 2025;8(1):6-16

Cardiometabolic Risk Marker Changes in Centrally Obese Women Using Depot Medroxyprogesterone Acetate (DMPA) in Kigali, Rwanda

Evelyne Kantarama, Dieudonne Uwizeye, Annette Uwineza — Mon, 31 Mar 2025 00:00:00 +0000

Background
Hormonal contraceptives, such as depot medroxyprogesterone acetate (DMPA), are known to increase the risk of cardiometabolic disease, especially in obese users who are already at high risk.
Objectives
This study aimed to evaluate changes in lipid profile, glycated hemoglobin (HbA1C), blood pressure (BP), and inflammatory markers over a 12-month follow-up in centrally obese women using DMPA in Rwanda.
Methods
A prospective study involving 65 abdominally obese women (aged 15-49 years) was conducted at two family planning centres in Kigali. Measurements were taken at baseline, six months, and twelve months, including a lipid profile, HbA1c, BP, and high-sensitivity C-reactive protein (hs-CRP). Changes were analyzed using the Wilcoxon signed-rank test, with a significance level of 5%.
Results
The study demonstrated significant changes in the median of cardiometabolic parameters over 12 months of DMPA use. WC increased from 96(41) to 99.5(44) cm, TG from 1.15(2.40) to 1.53(3.63) mmol/L, while HDL-c decreased from 1.09(1.55) to 0.90(0.99) mmol/L (all P=0.001). Lipid ratios also increased significantly, where the TC/HDL-c increased from 3.54(5.92) to 5.99(8.58), and LDL-c/HDL-c from 2.63(4.8) to 4.68(7.38) (P=0.001).
Conclusion
Given these findings, assessing central obesity before initiating DMPA and performing cardiovascular risk evaluations every six months is recommended to mitigate adverse effects.
Rwanda J Med Health Sci 2025;8(1):17-29

Adolescent-Parent Communication on Sexual and Reproductive Health Issues in Nyarugenge and Kamonyi Districts, Rwanda: A Qualitative Exploration of Adolescent Insights

Mon, 31 Mar 2025 00:00:00 +0000

Background
The quality of communication between adolescents and parents regarding sexual and reproductive health is a crucial area that needs improvement. Although existing studies emphasize the significance of parent-adolescent communication from parental views, there is a gap in investigating adolescents' perspectives. Understanding their experiences can help develop effective communication strategies that address their developmental needs and promote healthier behaviours.
Objective
This study aims to collect detailed information about how adolescents view their communication with their parents, the difficulties they face in these exchanges, and solutions for enhancing adolescent health.
Methods
A phenomenological exploratory study design was conducted using eleven focus group discussions among adolescents between December 2020 and January 2021.
Findings
The study revealed three key themes, including communication patterns, challenges that make open dialogue difficult, and various solutions to enhance discussions about sexual and reproductive health between parents and adolescents.
Conclusion
Improving communication between parents and adolescents about reproductive health is crucial for encouraging healthier behaviours. By addressing challenges such as cultural taboos, limited knowledge, and fear of family and social stigma that leads to poor communication, parents and adolescents will navigate the complexities of sexual and reproductive health issues effectively.
Rwanda J Med Health Sci 2025;8(1):30-48

Determinants of Micronutrient Powder Coverage among Children Aged 6–23 Months in Nyarugenge District, Rwanda

Adeline Ufitinema, Clemence Nishimwe, Monica Mochama, Theogene Kubahoniyesu — Mon, 31 Mar 2025 00:00:00 +0000

Background
Micronutrient deficiencies continue to affect millions globally, particularly pregnant women and children. This study aims to identify the determinants of Micronutrient Powder (MNP) coverage among children aged 6–23 months in Nyarugenge District, Rwanda.
Methods
A cross-sectional study was conducted on 380 children aged 6–23 months. Data were analyzed using SPSS version 21. Logistic regression was employed to assess the determinants of MNP coverage.
Results
The study found that 71.1% of children received MNP. Children aged 12–17 months (AOR = 1.63, 95% CI: 1.005–2.483, p = 0.046); 18–23 months (AOR = 2.14, 95% CI: 1.061–4.335, p = 0.034); Attendance at postnatal care (PNC) (AOR = 2.62, 95% CI: 1.346–5.097, p = 0.004), participation in supplementary feeding programs (AOR = 2.94, 95% CI: 1.214–7.109, p = 0.017), and having married mothers (AOR = 1.85, 95% CI: 1.033–3.306, p = 0.037) were positively associated with MNP coverage. Conversely, mothers aged 30–40 years (AOR = 0.14, 95% CI: 0.026–0.771, p = 0.024), UBUDEHE-2 (AOR = 0.40, 95% CI: 0.162–0.906, p = 0.031) were negatively associated with MNP coverage.
Conclusion
Integrating MNP distribution with maternal and child health services could enhance MNP coverage and adherence.
Rwanda J Med Health Sci 2025;8(1):49-60

Time to Death and Its Predictors among Children with Bacterial Meningitis in Southwest Ethiopia, 2022. A Retrospective follow-up study

Asaye Worku Agegn, Girum Sebsbie Teshome, Tewodros Tesfaye Kebede — Mon, 31 Mar 2025 00:00:00 +0000

Background
Bacterial Meningitis (BM) is an infectious disease characterized by infection and inflammation of the meninges covering the brain and spinal cord. Globally, it is a major cause of morbidity and mortality, affecting 2.81 million children each year.
Objective
The aim of the study was to assess the time to death and its predictors among children with bacterial meningitis in Southwest, Ethiopia.
Methods
Institutional-based retrospective follow-up study design was conducted among 372 paediatric patients with bacterial meningitis. Systematic random sampling was used to select eligible medical records from February 15 to March 15, 2022. Kaplan-Meier survival curve and log-rank were computed to estimate and compare failure time. Bivariate and multivariable Cox-regression models were fitted to identify predictors of time to death. A hazard ratio (HR) and adjusted hazard ratio (AHR) with a p-value < 0.05 were considered statistically significant.
Result
The overall median time of death was 16 (95% CI, 11.4-17.5) days. Impaired consciousness (AHR=3.88; 95%CI 1.9- 7.9), seizure (AHR=2.2; 95%CI 1.06- 4.45), and steroid drug use (AHR=4.8; 95%CI 2.03-11.3) were predictors significantly associated with time to death.
Conclusion
The proportion of deaths was high compared to those of the previous studies. Impaired consciousness, seizure and use of steroid were associated with time to death.
Rwanda J Med Health Sci 2025;8(1):61-74

Satisfaction with Prosthesis and Walking Ability among Trans-Tibial Prosthesis Users from Two Selected Rehabilitation Hospitals in Rwanda

Mon, 31 Mar 2025 00:00:00 +0000

Background
Satisfaction with the prosthesis is the key element to using the prosthesis for better walking and performing daily activities among transtibial prosthesis users. Different factors affect satisfaction and walking ability.
Objective
To evaluate satisfaction and assess walking ability among transtibial prosthesis users from two rehabilitation hospitals in Rwanda.
Methods
A quantitative cross-sectional study was conducted on 45 transtibial prosthesis users who received their prostheses from the University Teaching Hospital of Kigali and Gatagara Orthopedics and Rehabilitation Hospital, Nyanza. The research was done from February 1, 2024, to April 30, 2024. The Trinity Amputation and Prosthesis Experience-Revised (TAPES-R) was utilized to evaluate satisfaction whereas the Timed Up and Go (TUG) and the 2 minutes’ walk test (2MWT) were used for walking ability assessment.
Results
Out of 45 participants, 71.1% (n=32) were males and the remaining were females. On satisfaction with prosthesis, 62.2% were satisfied while 37.8% were unsatisfied. The satisfaction was statistically significantly associated with shape (p≤0.001), appearance (p≤0.003), weight (p≤0.001), usefulness (p≤0.027), reliability (p≤0.035), fit (p≤0.001), and comfort (p≤0.038) of their prosthesis, their health status (p≤0.011) and physical status (p≤0.001). For walking ability, 60% of the participants demonstrated moderate walking ability.
Conclusion
Some transtibial prosthesis users were unsatisfied with their prosthesis. Moderate walking ability was observed generally. More rehabilitation including gait training, physiotherapy, early prosthetic fitting, rehabilitation team follow-ups and use of advanced prosthetic technology are recommended.
Rwanda J Med Health Sci 2025;8(1):75-88

Effectiveness of Physiotherapy-Based Ergonomics and Postural Correction on Management of Work-related Musculoskeletal Disorders among Dental Practitioners in Tamil Nadu, India: A Randomized Controlled Trial

Mon, 31 Mar 2025 00:00:00 +0000

Background
Work-related musculoskeletal disorders among dentists have greatly increased since the Industrial Revolution. Self-management interventions, including exercises, have been proven to be effective. The of the study was to determine the effectiveness of physiotherapy-based ergonomic and postural correction on disability and performance among dental practitioners.
Methods
A Randomized Controlled Trial study design was conducted among 30 dental practitioners and students from Sri-Ramaswami Memorial (SRM) Dental College, who reported Work-Related Musculoskeletal Disorders. The Experimental group followed the Posturite protocol and University of California, Los Angeles (UCLA) exercise protocols. The control group was exposed to routine regular exercises of their choice for at least 30 minutes, three times per week. The Neck Disability Index (NDI), Upper Extremity Function Index (UEFI), and Rolland Morris Disability Questionnaire (RMDQ) were administered as outcome measures.
Results
The experimental group improved the symptoms of the neck, upper limb, and lower back than their control counterparts in paired t-tests where there was a high statistical improvement in both experimental and control groups with t=7, p≤0.001 and t=6, p≤0.01 respectively. On other outcomes UEFI and RMDQ the experimental group had a high statistical significance with UEFI -5, p≤0.001; RMDQ 13, p≤0.001. For the same outcomes, the control group was the least favored as it had t=-3, p≤0.05 and t=4, p≤0.05 on UEFI and RMDQ respectively.
Conclusion
Ergonomics and postural correction education interventions can be effective in the management of work-related musculoskeletal disorders.
Rwanda J Med Health Sci 2025;8(1):89-99

Knowledge, Attitude and Practice Regarding Malnutrition among Parents of Under-Five Children with Disabilities in Rwanda

Placide Hakizuwera, Mojeed Gbadamosi — Thu, 03 Apr 2025 00:00:00 +0000

Background
Growth-related problems and malnutrition are common in children with disabilities. Malnutrition increases childhood morbidity and mortality, impairs intellectual development, and raises the risk of developing diseases later in life. However, information is limited for children with disabilities.
Objectives
To assess the knowledge, attitudes and practices towards malnutrition among parents of under-five children with disabilities in HVP Gatagara Hospital.
Methods
Using a non-probability census sampling, 130 parents of disabled children under five years of age participated in the cross-sectional study. Information was gathered using a structured questionnaire, and it was analysed descriptively and by binomial logistic regression.
Results
According to the results, 61.54% of parents had moderate knowledge, while 7.69% and 69.2% had poor knowledge and positive attitude, respectively. In addition, 16.9% had insufficient practice, but most parents (70.3%) had moderate practice. Those with high knowledge (>70%) had 3.6-fold higher odds of good practices [OR=3.61; 95% CI=1.22 - 5.99; p=0.003]. Furthermore, being female was associated with increased odds of having adequate nutritional practice [OR=1.77; 95% CI=2.22 -3.24; p=0.019].
Conclusion
High knowledge of malnutrition led to adequate nutritional practice. Therefore, to improve best practices regarding malnutrition, it is necessary to focus on health education interventions that will raise parents' knowledge and positive attitudes about the condition of their children with disabilities.
Rwanda J Med Health Sci 2025;8(1):100-110

Determinants of Stunting in Children Under Five Years: A Case Study of Nyagatare District, Rwanda

Thu, 03 Apr 2025 00:00:00 +0000

Background
Stunting is an indicator of chronic malnutrition. It is highly prevalent in Rwanda and negatively impacts children's survival and overall growth development.
Objective
This study aimed to investigate the determinants of stunting among children under five years in Nyagatare District, Rwanda.
Methods
A quantitative cross-sectional study was conducted in December 2021 involving 253 households with mothers of children under five years of age. The data were collected using structured questionnaires, and anthropometric measurements were taken for both children and mothers. The analyses were performed using WHO Anthro Survey Analyser and SPSS version 21. Findings were reported through frequency tables, bivariate analysis, and logistic regression.
Results
The study found that 19.1% of the children were stunted, and 7.2% severely stunted. Bivariate analysis revealed that, lower level of the mother’s education was associated with stunting (p=0.025). Logistic regression analysis indicated that children whose mothers had no education had higher odds of being stunted (OR=3.6, 95%CI: 1.3–9.9, p=0.012) compared to the mothers attained secondary education. Likewise, those whose mothers had primary education had higher odds of stunting (OR=1.7, 95% CI: 0.9–3.3) than those with secondary education.
Conclusion
The prevalence of stunting in Nyagatare District remains a concern. Preventing childhood stunting in this rural area, efforts should focus on improving mothers' education.
Rwanda J Med Health Sci 2025;8(1):111-124

Lost Life at an Early Age: Life-threatening Consequences Faced by Children of Female Sex Workers in Rwanda

Pacifique Mukangabire, Madeleine Mukeshimana, Rumagihwa Liberatha, Noel Korukire — Tue, 08 Apr 2025 00:00:00 +0000

Background
Various studies have focused on female sex workers aiming to reduce the risk of HIV infection and other sexually transmitted diseases and educate them on behaviour change. However, limited research has been on how mothers' profession affects their children. To address this gap, this study aimed to explore the life-threatening consequences faced by children of female sex workers in Rwanda and provide recommendations for supporting these vulnerable individuals.
Methodology
This cross-sectional study used a qualitative approach with a phenomenological design. We interviewed 40 children born to sex workers and 19 mothers who are sex workers from 2 provinces and City of Kigali .We used an interview guide to conduct individual in-depth interviews.
Results
The interviewed children reported most five problems encountered by children born to female sex workers in Rwanda including (1) stigma and rejection (2) humiliation and shame (3) Being forced to have early sex by their mother's clients and or forced/sold by mothers (4) poverty and hunger (5) early sex, pregnancy, and birth. The five problems most reported by mothers as being faced by children born to female sex workers are the same as those reported by the children.
Conclusion
This study found that the children born to female sex workers in Rwanda face enormous life challenges/problems that put their health at risk and their future in jeopardy. We recommend that government and non-government organizations that have the mandate of child protection take appropriate measures to safeguards these vulnerable children.
Rwanda J Med Health Sci 2025;8(1):125-138

Marburg Virus Disease in Rwanda: The Role of Infection Prevention and Control in Reducing Transmission of Infectious Disease Outbreaks among Healthcare Professionals

David Ryamukuru, Joselyne Mukantwari, Fauste Uwingabire, Gerard Nyiringango — Tue, 08 Apr 2025 00:00:00 +0000

Rwanda’s first Marburg Virus Disease (MVD) outbreak resulted in 58 infections and 13 deaths within the first two weeks. Over 70% of cases occurred among healthcare professionals, highlighting the vulnerability of frontline workers and exposing critical gaps in the country’s healthcare system, particularly in infection prevention and control (IPC) practices. Healthcare workers are essential to sustaining functional healthcare systems. However, they face a higher risk of infection and death at the onset of outbreaks, potentially due to lapses in IPC practices, thereby weakening the healthcare system. Routine and strict adherence to IPC measures would have protected healthcare workers and prevented the transmission of both known and emerging diseases. Thus far, Rwanda has successfully implemented containment strategies such as early detection, contact tracing, and isolation. However, this article argues that long-term investment in IPC protocols is essential to safeguard healthcare workers and ensure system resilience. Strengthening IPC measures and fostering a culture of safety are vital steps toward building a healthcare system capable of effectively managing future infectious disease outbreaks. This perspective article aims to raise awareness about the role of infection prevention and control in reducing the transmission of infectious disease outbreaks among healthcare professionals, motivated by the devastating consequences of the MVD outbreak on the health workforce in Rwanda.
Rwanda J Med Health Sci 2025;8(1):139-143

Anatomical Variation of the Origin and Course of the Right Renal Artery

Gabriel Jackob Mchonde — Tue, 08 Apr 2025 00:00:00 +0000

The anatomy of renal vascular variants plays an important role during planning of major procedures involving retroperitoneal spaces. The present observation revealed the co-existence of arterial and venous variants on the right kidney. A single right renal artery originates from the abdominal aorta at the level of fourth lumbar vertebrae and ascends superolaterally towards the hilum of the right kidney, arching above the inferior vena cava, leading to compression of the largest retroperitoneal vein. Accompanying this, a variant anastomosing vein connecting the right renal vein and the inferior vena cava was also observed. Understanding the existence of these variants is of important to clinicians, surgeons, urologists, radiologists, and cardiologists during their routine procedures such as nephrectomy, kidney transplant, and management of inferior vena cava syndrome and deep venous thrombosis.
Rwanda J Med Health Sci 2025;8(1):144-147

ePOCT+ Rwanda: A Clinical Decision Support Algorithm For Managing Sick Children Below 15 Years of Age in Primary Healthcare Settings

Tue, 08 Apr 2025 00:00:00 +0000

Primary health systems in resource-constrained settings suffer from human resource shortages, low quality care, and diagnostic uncertainty, resulting in over-reliance on antibiotics, increasing risks of antimicrobial resistance. Digital clinical decision support algorithms (CDSAs) help healthcare workers adhere to clinical guidelines and improve prescribing practices. In this manuscript, we present the scope and content of ‘ePOCT+ Rwanda’ (electronic Point-Of-Care Tests +), a CDSA trialed in primary health centers of Rusizi and Nyamasheke districts during the DYNAMIC project. The algorithm is based on the WHO IMCI guidelines, expanded to include a broader range of ages (between 1 day and 14 years, inclusive) and acute medical conditions encountered in primary care (57 diagnoses for young infants < 2 months and 144 diagnoses for children 2 months to 14 years). The digital application used to deploy ePOCT+ prompts users to enter the results of medical history, physical examinations and laboratory tests to propose diagnoses, treatments and managements. In addition to routine point-of-care tests, ePOCT+ utilizes haemoglobin and C-reactive protein tests, as well as pulse oximetry, targeted to specific clinical conditions. We discuss the rationale behind the content of the algorithm and the process of aligning it with the Rwandan paediatric guidelines and tailoring it to the primary care setting.
Rwanda J Med Health Sci 2025;8(1):148-162
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