Rwanda Public Health Bulletin

Marburg virus disease outbreak in Rwanda, 2024: Current efforts and calls to action to mitigate the outbreak in Rwanda

2024-12-31T16:36:37+00:00

The recent outbreak of Marburg virus disease (MVD) in Rwanda, first reported in September 2024, marks the country’s initial encounter with this highly lethal hemorrhagic fever caused by the Marburg virus.

With primary transmission from fruit bats and subsequent human-to-human spread through direct contact, MVD presents significant public health challenges due to its rapid progression from flu-like symptoms to severe hemorrhagic fever and high mortality rates.

Rwanda’s Ministry of Health responded swiftly, implementing critical containment measures, such as intensive contact tracing, targeted vaccination for suspected cases and healthcare providers, restricting caregiver access, limiting traditional gatherings, and enforcing strict hygiene and infection control protocols.

In the last three and a half years, Rwanda has been dealing with COVID-19, Mpox (formerly monkeypox), and now the Marburg outbreak. Drawing on lessons from past public health crises, Rwanda’s Ministry of Health is implementing swift action to manage the situation. Here we discussed Rwanda's strategies in managing the MVD outbreak, emphasizing the importance of a One Health approach that integrates human, animal, and environmental health to mitigate zoonotic threats.

Vaccination efforts targeting healthcare providers and high-risk contacts have become a vital component of Rwanda's response, aiming to protect those on the front lines and prevent further spread. The response is further strengthened by partnerships with global health organizations, including the World Health Organization (WHO), underscoring the need for coordinated international support and cross-border containment measures.

This MVD outbreak highlights the urgency of ongoing research into effective treatments and licensed vaccines to bolster Rwanda’s preparedness and resilience against future outbreaks.

Mental health impacts of Marburg virus disease in Rwanda

2024-12-31T16:46:30+00:00

The Marburg Virus Disease (MVD) outbreak in Rwanda marks a significant public health challenge, with 64 reported cases and a 23.4% case fatality rate as of October 2024. While the immediate focus remains on containment and clinical management, the mental health implications of the outbreak present an equally critical concern. This paper discusses the psychological toll of MVD in Rwanda, considering the country's historical trauma and existing mental health landscape. Rwanda's experience with the 1994 Genocide against the Tutsi and the COVID-19 pandemic underscores the vulnerability of populations with pre-existing mental health conditions and those exposed to compounding stressors during health crises.

Key high-risk groups identified include healthcare providers, individuals with prior pandemic exposure, those with underlying mental illnesses, and grieving families. The disruption of traditional mourning practices, widespread stigma, and the psychological demands placed on healthcare workers amplify the outbreak's impact on mental well-being. Drawing on lessons from COVID-19, Rwanda leveraged community health workers, telemedicine, and public awareness campaigns to address psychosocial needs. However, the outbreak highlights gaps in mental health resources and the need for tailored interventions.

Recommendations include strengthening mental health support for high-risk groups, integrating psychological services into epidemic responses, and enhancing community resilience through targeted education and support systems. We also emphasize the importance of a holistic response to MVD, addressing both physical and mental health needs to mitigate the long-term impacts of the outbreak.

Surveillance of conjunctivitis at a school in Kamonyi District, Rwanda, 2024

2024-12-31T16:52:59+00:00

INTRODUCTION: Conjunctivitis, a highly contagious eye condition, can significantly impact public health, especially in close-contact settings like schools. This study investigated a conjunctivitis attack at ECOSE Saint Kizito Musambira Boarding School in Rwanda.

METHODS: This surveillance study examined 577 students and 26 staff members through clinical examinations, health records, and demographic data collection from March 12-20, 2024.

RESULTS: The conjunctivitis primarily affected female students (77%), with symptoms including itchy eyes (80.9%) and foreign body sensation (96.7%). The high attack rate suggested a highly contagious agent. Treatment included ciprofloxacin, ibuprofen, and tetracycline pomade. Close living conditions and bed-sharing were more common behaviors among the students.

CONCLUSION: This conjunctivitis attack highlights the importance of rapid detection and response to infectious diseases in schools. While antibiotic therapy was the main management approach, the specific etiology remains uncertain without diagnostic tests. Future prevention strategies should focus on hygiene measures, early case identification, isolation, and enhanced laboratory testing to manage school outbreaks effectively.

The persistent challenge of cholera in Africa: a complex interplay of factors

2024-12-31T16:59:48+00:00

Cholera remains a formidable public health challenge across Africa, disproportionately impacting marginalized and vulnerable populations [1]. The disease's persistence underscores its multifaceted nature, rooted in more than just the biological characteristics of Vibrio cholerae. Instead, it reflects a complex interplay of environmental, social, economic, and systemic factors, each compounding the difficulty of effective prevention and control [1,2].

Africa continues to bear the highest burden of cholera globally, with recurring outbreaks that cause significant morbidity and mortality, often overwhelming already fragile healthcare systems [3]. The disease frequently strikes regions plagued by inadequate access to clean water, sanitation, and hygiene (WASH) infrastructure [3,4]. These deficiencies create fertile ground for the bacterium's proliferation, particularly in densely populated urban slums and rural areas with limited public health outreach. Climate change further exacerbates the problem, with extreme weather events such as floods and droughts creating conditions conducive to cholera outbreaks [5].

Perceptions of stroke patients attending King Faisal Hospital-Rwanda regarding the effectiveness of the rehabilitation services

2024-12-31T17:11:19+00:00

INTRODUCTION: Stroke rehabilitation involves a multidisciplinary approach to restore functional abilities and improve quality of life. This study aimed to explore stroke patients' perceptions of the effectiveness of rehabilitation interventions provided at King Faisal Hospital, Rwanda.

METHODS: A qualitative study using in-depth face-to-face interviews was conducted with ten stroke survivors aged 30 to 80 years. Participants shared their experiences of physiotherapy, occupational therapy, and speech and language therapy interventions. The data was analyzed using a qualitative inductive thematic approach with Atlas ti software.

RESULTS: Participants reported significant improvements in physical function and mobility due to physiotherapy services, including increased balance, enhanced muscle strength, and the ability to perform activities such as walking on uneven surfaces and climbing stairs. However, two participants noted limited progress in their affected limbs. Occupational Therapy was reported to lead to improvements in functional performance, self-care activities, and job-related skills. Participants regained abilities such as transferring independently, holding objects, bathing, and dressing. Occupational therapy also enabled some participants to return to work. A minority expressed the need for increased therapy frequency for better outcomes. Speech and Language Therapy improved participants’ communication and interaction skills. Some regained their ability to talk, express themselves, and engage in conversations, although challenges with pronunciation and fluency persisted for a few.

CONCLUSION: Rehabilitation interventions at King Faisal Hospital- Rwanda, are perceived as effective in enhancing physical function, independence in daily activities, and communication skills among stroke survivors. The findings underscore the importance of a multidisciplinary approach and suggest potential benefits of increasing therapy frequency for improved outcomes.

Factors, beliefs, and barriers associated with adherence to secondary prophylaxis amongst children and adolescents with rheumatic heart disease at public tertiary hospitals in Rwanda: A cross-sectional observational study

2024-12-31T17:16:15+00:00

INTRODUCTION: Rheumatic heart disease (RHD) is the most prevalent cardiovascular disease among young people under 25 years. This study aimed to explore the factors, beliefs, and barriers associated with adherence to penicillin among children and adolescents with RHD undergoing secondary prophylaxis at public tertiary hospitals in Rwanda.

METHODS: This cross-sectional observational study included children aged 5 to 18 years diagnosed with RHD and on secondary prophylaxis for at least six months, from two public tertiary hospitals in Rwanda. Regression analyses were performed to identify factors associated with adherence.

RESULTS: Employment status was significantly associated with adherence to prophylaxis (OR [95% CI]: 12.17 [1.42-103.9], p=0.022). Living in an urban area also increased the likelihood of adherence compared to rural areas (OR [95% CI]: 9.05 [2.28-35.91], p=0.001). A long distance to the clinic was strongly associated with poor adherence (OR [95% CI]: 5.55 [1.94-15.89], p=0.001). Additionally, long waiting times at the clinic are also significantly associated with poor adherence (OR [95% CI]: 4.77 [1.69-13.43], p=0.003). Patients with good adherence have significantly higher belief scores than those with poor adherence (M ± SE: 1.56 ± 0.54, t=2.878, p=0.005), and patients with higher barrier scores are significantly less adherent than those with lower barrier scores (M ± SE: 4.6 ± 0.85, t=5.531, p<0.001).

CONCLUSION: Factors negatively affecting adherence included parental unemployment and rural residence. Long travel distances and extended waiting times at clinics were the most common barriers to adherence. To improve adherence, educational efforts targeting RHD patients and their caregivers should be strengthened, and RHD prevention activities should be decentralized to health centers.

Employee absenteeism at the University Teaching Hospital of Kigali in Rwanda, 2020

2024-12-31T17:20:09+00:00

INTRODUCTION: Background: Absenteeism among health workers has become a problematic issue all over the world. This study aimed to determine the rate, cost, types, and factors of employee absenteeism at the University Teaching Hospital of Kigali (CHUK)

METHODS: A descriptive cross-sectional study was carried out at CHUK, using prospective and retrospective approaches/aspects, and a self-administered semi-structured questionnaire from July 2019 to June 2020. A comprehensive analysis was conducted to assess individual, institutional, and workplace factors associated with absenteeism among CHUK staff (clinical and administrative)

RESULTS: One hundred and fifty-nine staff (159) completed the study, which gave a response rate of 88.3%. The findings revealed that 337 (38.3%) staff were had absenteeism from 2019 to 2020. The absenteeism rate at CHUK was 3.3%, with the highest absenteeism observed among clinical staff, 82% (278 staff), and the lowest among administrative staff, 17.5 % (59 staff). The average cost per absentee was observed to be 173.4 USD, and the estimated total cost for absenteeism at CHUK was 58 465 USD per year. Key contributing factors included inadequate equipment (72%), high workload (54%), and long commuting distances, with 83% of participants traveling more than 10 km to work. The average cost per absentee was $173.40, translating to an estimated annual financial burden of $58,465. The study also highlighted the role of workplace-related challenges, such as insufficient resources and limited flexibility in work schedules.

CONCLUSION: The study found that CHUK employees' absenteeism rate was 3.3%, with clinical staff being the most affected. Addressing identified factors through improved management practices, employee welfare, and strategic Human Resource Management (HRM) interventions could reduce absenteeism and its financial impact.