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Ruhara, Charles Mulindabigwi, and Josue Mbonigaba. "The Role of Economic Factors in the Choice of Medical Providers in Rwanda." Journal of Economics and Behavioral Studies 8, no. 2(J) (May 11, 2016): 65–78. http://dx.doi.org/10.22610/jebs.v8i2(j).1255.
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The purpose of this paper is to investigate the role of economic factors in choosing alternative service providers and to recommend suitable measures that could be taken to improve the use of health services in Rwanda. The study uses a multinomial logit framework and employs the Integrated Household Living Conditions Survey (EICV2) conducted in 2005 by the National Institute of Statistics of Rwanda (NISR). To handle the problem of endogeneity, we estimate a structural model. The results indicate that health insurance is an important factor in the choice of health facilities. User fees are major financial barriers to health care access in Rwanda. The results suggest that as household income increases, patients shift from public to private health facilities where quality is assumed to be high. A number of policy recommendations emerge from these findings. First, as insurance is an important factor in choosing a health care facility, policies that reduce health care costs to patients would substantially increase the use of health services. Second, since an increase in income allows the patient to shift to private facilities, the government should consider subsidizing private health facilities to enable access to care in private sector facilities by low-income households. Finally, since distance affects access to health care in Rwanda, there is a need to improve geographical accessibility to health facilities across regions by upgrading and expanding transportation and health infrastructures.
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Dusengimana, J. M. V., T. Mpunga, C. Shyirambere, L. N. Shulman, E. Mpanumusingo, N. L. Keating, C. Rusangwa, and L. E. Pace. "Integrating Breast Cancer Early Detection Services Into the Rwandan Health Care System." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 147s. http://dx.doi.org/10.1200/jgo.18.70600.
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Background and context: Promoting earlier detection of breast cancer is critical in low-income countries like Rwanda where symptomatic women face long diagnostic delays and most patients present with advanced disease. In these settings, promoting earlier clinical diagnosis should be the initial priority before screening of asymptomatic women. However, there are few data to guide such early detection policies. Aim: Develop a pilot breast cancer early detection program in a rural Rwandan district to evaluate its clinical and health system impact, identify the most effective and feasible roles for staff from each health care system level, and inform national policy. Strategy/Tactics: From 2015-2017 we implemented a training program for 12 randomly selected health centers (HCs) in Burera District, where Butaro Cancer Center of Excellence is located. We trained 1076 community health workers in breast awareness and 127 HC nurses in clinical breast exam (CBE) and management of breast concerns. We trained 9 hospital-level nurses and doctors in diagnostic breast ultrasound to facilitate evaluation of palpable masses. We used pre- and posttests, focus groups, patient surveys, HC registries, and hospital medical records to determine the impact of the training on trainees' knowledge and skills, the volume of patients presenting to health facilities and services provided, cancer detection rate, and clinical stage at diagnosis. Program/Policy process: We met regularly with cancer policy leaders in the Ministry of Health (MOH) and Rwanda Biomedical Centre (RBC) to share findings, identify successes and challenges and build support. Clinicians trained through the project have been invited to serve as national trainers in CBE and contribute to national cancer strategy discussions. Outcomes: Trainings significantly improved knowledge and skills among trainees and increased the number of patients with breast concerns at HCs and the hospital. There was an increase in the proportion of patients with benign disease and the number of needed ultrasounds and biopsies. HCs and the hospital were able to accommodate the increased volume without compromising other services. We had limited power to assess the impact on cancer stage, but noted a nonsignificant increase in incidence of early stage disease among patients referred by intervention HCs. We are now working with MOH/RBC in planning scale-up of the program to other districts and identify a strategy of diagnostic breast ultrasound at the DH level to facilitate evaluation of patients referred from HCs. What was learned: A strategy to promote earlier detection of symptomatic breast cancer was feasible in a rural Rwandan district, effectively strengthened health system capacity to care for patients with breast concerns, and suggests promising impact on patient outcomes. Engagement of key stakeholders in implementation science can help foster evidence-based national cancer control policy.
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Ernestine, Bayisenge. "Psychosocial Wellbeing of Genocide Widows in Rwanda through Their Associations: A Case Study of Avega in Rwimbogo Sector." International Journal of Social Work 3, no. 2 (June 27, 2016): 1. http://dx.doi.org/10.5296/ijsw.v3i2.9666.
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<p>The research conducted on the role of associations of genocide widows was undertaken with the purpose of determining the contribution of Association of Widows of Genocide in Rwanda (AVEGA) in addressing the problems of widows of genocide in Rwanda and improving their wellbeing. The results of investigation carried out on 72 genocide widows through a questionnaire revealed that AVEGA improves the wellbeing of widows with the promotion of good health by providing medical services to them, the economic development by introducing activities which generate income in order to eradicate poverty, establishment of good relationship by encouraging the national policy of unity and reconciliation among Rwandans and supporting children in their studies.</p>
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Rosenberg, Ashley, Rob Rickard, Fraterne Zephyrin Uwinshuti, Gabin Mbanjumucyo, Menelas Nkeshimana, Jean Marie Uwitonze, Ignace Kabagema, Theophile Dushime, and Sudha Jayaraman. "Collaboration for preliminary design of a mobile health solution for ambulance dispatch in Rwanda." Global Health Innovation 3, no. 2 (November 27, 2020): 1–5. http://dx.doi.org/10.15641/ghi.v3i2.986.
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The first 60 minutes after a trauma are described as “the golden hour.” For each minute of prehospital time, the risk of dying increases by 5% (Sampalis et al., 1999). Since 90% of the global burden of injuries occur in low- and middle-income countries and lead to 5.8 million deaths annually, addressing rapid access to emergency services is critical in these settings (Nielsen et al., 2012). In most low- and middle-income countries (LMICs), there are no formal trauma systems, and many lack organized prehospital care (Nielsen et al., 2012). Emergency medical dispatch and communication systems are a foundational component of emergency medical services (World Health Organization, 2005). Yet there are no established recommendations of creating these systems inLMICs.Rwanda, a country of over 12 million people, is a rapidly developing leader in East Africa. The Ministry of Health of Rwanda established the Service d’Aide Medicale Urgente (SAMU) in 2007, recognizing the need for public emergency medical services. SAMU’s national dispatch center receives roughly 3,000 calls per month through a national 912 hotline. It organizes regional transportation with 260 total ambulances located at hospitals throughout the country and provides prehospital emergency services in the capital city of Kigali with a fleet of 12 ambulances. In the city, each ambulance has a driver, nurse and anesthetist dispatched for every call. Emergency department nursing and anesthetist staff are dispatched from hospitals around the country to respond to regional emergencies. No formal prehospital cadre of the workforce exists although the SAMU staffhave extensive field experience in prehospital care. SAMU has several challenges to rapid prehospital emergency care including lack of addresses beyond the capital city, unclear location data in densely populated areas, complex communication processes with little information about health facility capacity, and no established electronic dispatch system. The average response time for SAMU ambulances was 59 minutes in 2018, but 39% of calls were not completed within the golden hour.
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Adeyemi, Olukemi, Mary Lyons, Tsi Njim, Joseph Okebe, Josephine Birungi, Kevin Nana, Jean Claude Mbanya, et al. "Integration of non-communicable disease and HIV/AIDS management: a review of healthcare policies and plans in East Africa." BMJ Global Health 6, no. 5 (May 2021): e004669. http://dx.doi.org/10.1136/bmjgh-2020-004669.
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BackgroundLow-income and middle-income countries are struggling to manage growing numbers of patients with chronic non-communicable diseases (NCDs), while services for patients with HIV infection are well established. There have been calls for integration of HIV and NCD services to increase efficiency and improve coverage of NCD care, although evidence of effectiveness remains unclear. In this review, we assess the extent to which National HIV and NCD policies in East Africa reflect the calls for HIV-NCD service integration.MethodsBetween April 2018 and December 2020, we searched for policies, strategies and guidelines associated with HIV and NCDs programmes in Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. Documents were searched manually for plans for integration of HIV and NCD services. Data were analysed qualitatively using document analysis.ResultsThirty-one documents were screened, and 13 contained action plans for HIV and NCDs service integration. Integrated delivery of HIV and NCD care is recommended in high level health policies and treatment guidelines in four countries in the East African region; Kenya, Rwanda, Tanzania and Uganda, mostly relating to integrating NCD care into HIV programmes. The increasing burden of NCDs, as well as a move towards person-centred differentiated delivery of services for people living with HIV, is a factor in the recent adoption of integrated HIV and NCD service delivery plans. Both South Sudan and Burundi report a focus on building their healthcare infrastructure and improving coverage and quality of healthcare provision, with no reported plans for HIV and NCD care integration.ConclusionDespite the limited evidence of effectiveness, some East African countries have already taken steps towards HIV and NCD service integration. Close monitoring and evaluation of the integrated HIV and NCD programmes is necessary to provide insight into the associated benefits and risks, and to inform future service developments.
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Rubagumya, Fidel, Ainhoa Costas-Chavarri, Achille Manirakiza, Gad Murenzi, Francois Uwinkindi, Christian Ntizimira, Ivan Rukundo, et al. "State of Cancer Control in Rwanda: Past, Present, and Future Opportunities." JCO Global Oncology, no. 6 (September 2020): 1171–77. http://dx.doi.org/10.1200/go.20.00281.
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Rwanda is a densely populated low-income country in East Africa. Previously considered a failed state after the genocide against the Tutsi in 1994, Rwanda has seen remarkable growth over the past 2 decades. Health care in Rwanda is predominantly delivered through public hospitals and is emerging in the private sector. More than 80% of patients are covered by community-based health insurance (Mutuelle de Santé). The cancer unit at the Rwanda Biomedical Center (a branch of the Ministry of Health) is responsible for setting and implementing cancer care policy. Rwanda has made progress with human papillomavirus (HPV) and hepatitis B vaccination. Recently, the cancer unit at the Rwanda Biomedical Center launched the country’s 5-year National Cancer Control Plan. Over the past decade, patients with cancer have been able to receive chemotherapy at Butaro Cancer Center, and recently, the Rwanda Cancer Center was launched with 2 linear accelerator radiotherapy machines, which greatly reduced the number of referrals for treatment abroad. Palliative care services are increasing in Rwanda. A cancer registry has now been strengthened, and more clinicians are becoming active in cancer research. Despite these advances, there is still substantial work to be done and there are many outstanding challenges, including the need to build capacity in cancer awareness among the general population (and shift toward earlier diagnosis), cancer care workforce (more in-country training programs are needed), and research.
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VanEnk, Lauren, Ronald Kasyaba, Prince Bosco Kanani, Tonny Tumwesigye, and Jeannette Cachan. "Closing the gap: the potential of Christian Health Associations in expanding access to family planning." Christian Journal for Global Health 4, no. 2 (June 30, 2017): 53–65. http://dx.doi.org/10.15566/cjgh.v4i2.164.
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Recognizing the health impact of timing and spacing of pregnancies, the Sustainable Development Goals call for increased access to family planning globally. While faith-based organizations in Africa provide a significant proportion of health services, family planning service delivery has been limited. This evaluation sought to assess the effectiveness of implementing a systems approach in strengthening the capacity of Christian Health Associations to provide family planning and increase uptake in their communities. From January 2014 to September 2015, the capacity of three Christian Health Associations in East Africa—Caritas Rwanda, Uganda Catholic Medical Bureau, and Uganda Protestant Medical Bureau—was strengthened in key components of a systems approach to family planning—training, supervision, commodity availability, family planning promotion, data collection, and creating a supportive environment—with the aim of improving access to women with unmet need and harmonizing faith-based service delivery contributions with the national family planning program. Community-based provision of family planning, including fertility awareness methods, was introduced across intervention sites for the first time. 547 facility- and community-based providers were trained in family planning, and 393,964 people were reached with family planning information. 32,176 clients took up a method, and 43% of clients received this service at the community level. According to a provider competency checklist, facility- and community-based providers were able to adequately counsel clients on new fertility awareness methods. Integration of Christian Health Associations into the national family planning strategy improved through participation in routine technical working group meetings, and the Ministries of Health in Rwanda and Uganda recognized them as credible family planning partners. Findings suggest that by strengthening capacity using a systems approach, Christian Health Associations can meaningfully contribute to national and international family planning goals. Increased attention to mainstreaming family planning service delivery across Christian Health Associations is recommended.
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Guzman, Andrea. "Case study: Reducing preventable maternal mortality in Rwandan healthcare facilities through improvements in WASH protocols." Journal of Patient Safety and Risk Management 23, no. 3 (June 2018): 129–34. http://dx.doi.org/10.1177/2516043518778117.
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Problem A lack of proper water, sanitation, and hygiene (WASH) infrastructure and poor hygiene practices reduce the preparedness and response of health care facilities (HCFs) in low-income countries to infection and disease outbreaks. According to a World Bank Service Provision Assessment conducted in 2007, only 28% of HCFs in Rwanda had water access throughout the year supplied by tap and 58% of HCFs provided functioning latrines. 1 This evaluation of services and infrastructure in HCFs in Rwanda indicates that targets for WASH in-country need to be enhanced. Objectives To present a case study of the causes and management of sepsis during delivery that led to the death of a 27-year-old woman, and propose a WASH protocol to be implemented in HCFs in Rwanda. Methods The state of WASH services used by staff, caregivers, and patients in HCFs was assessed in 2009 in national evaluations conducted by the Ministry of Infrastructure of Rwanda. Site selection was purposive, based on the presence of both water and power supply. Direct observation was used to assess water treatment, presence and condition of sanitation facilities and sterile equipment in the delivery room, provision of soap and water, gloves, alcohol-based hand rub, and WASH-related record keeping. Results All healthcare facilities met Ministry policies for water access, but WHO guidelines for environmental standards, including for water quality, were not fully satisfied. Conclusions The promotion and provision of low-cost technologies that enable improved WASH practices could help to reduce high rates of morbidity and mortality due to infection in low-income countries.
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Dzinamarira, Tafadzwa, Collins Kamanzi, and Tivani Phosa Mashamba-Thompson. "Key Stakeholders’ Perspectives on Implementation and Scale up of HIV Self-Testing in Rwanda." Diagnostics 10, no. 4 (April 1, 2020): 194. http://dx.doi.org/10.3390/diagnostics10040194.
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Introduction: The World Health Organisation recommends HIV self-testing as an alternative testing method to help reach underserved populations, such as men in sub-Saharan Africa. Successful implementation and scale-up of HIV self-testing (HIVST) in Rwanda relies heavily on relevant stakeholders’ involvement. We sought to explore HIVST key stakeholders’ perceptions of the implementation and scale-up of HIVST in Rwanda. Method: We conducted in-depth interviews with personnel involved in HIV response projects in Rwanda between September and November 2019. We purposively sampled and interviewed 13 national-level key stakeholders from the Ministry of Health, Rwanda Biomedical Center, non-governmental organizations and HIV clinics at tertiary health facilities in Kigali. We used a thematic approach to analysis with a coding framework guided by Consolidated Framework for Implementation Research (intervention characteristics, inner setting, outer setting, characteristics of individuals involved in the implementation and the implementation process). Results: Key stakeholders perceived HIVST as a potentially effective initiative, which can be used in order to ensure that there is an improvement in uptake of testing services, especially for underserved populations in Rwanda. The following challenges for implementation and scale-up of HIVST were revealed: lack of awareness of the kits, high cost of the self-test kits, and concerns on results interpretation. Key stakeholders identified the following as prerequisites to the successful implementation and scale-up of HIVST in Rwanda; creation of awareness, training those involved in the implementation process, regulation of the selling of the self-test kits, reduction of the costs of acquiring the self-test kits through the provision of subsidies, and ensuring consistent availability of the self-test kits. Conclusions: Key stakeholders expressed confidence in HIVST’s ability to improve the uptake of HIV testing services. However, they reported challenges, which need to be addressed to ensure successful implementation and scale-up of the HIVST. There is a need for further research incorporating lower level stakeholders to fully understand HIVST implementation and scale-up challenges and strategies to inform policy.
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Semrau, Maya, Gail Davey, Ursin Bayisenge, and Kebede Deribe. "High levels of depressive symptoms among people with lower limb lymphoedema in Rwanda: a cross-sectional study." Transactions of The Royal Society of Tropical Medicine and Hygiene 114, no. 12 (November 21, 2020): 974–82. http://dx.doi.org/10.1093/trstmh/traa139.
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Abstract Background There is a growing body of evidence that mental distress and disorder are common among people with lower limb lymphoedema, although no research has been conducted on this subject in Rwanda. Methods This research was embedded within a mapping study to determine the national prevalence and geographical distribution of podoconiosis in Rwanda. Using a cluster sampling design, adult members of households within 80 randomly selected sectors in all 30 districts of Rwanda were first screened and 1143 patients were diagnosed with either podoconiosis (n=914) or lower limb lymphoedema of another cause (n=229). These 1143 participants completed the Patient Health Questionnaire (PHQ)-9 to establish the prevalence of depressive symptoms. Results Overall, 68.5% of participants reported depressive symptoms- 34.3% had mild depressive symptoms, 24.2% had moderate, 8.8% moderately severe and 1.2% severe depressive symptoms. The mean PHQ-9 score was 7.39 (SD=5.29) out of a possible 0 (no depression) to 27 (severe depression). Linear regression showed unemployment to be a consistently strong predictor of depressive symptoms; the other predictors were region (province), type of lymphoedema and, for those with podoconiosis, female gender, marital status and disease stage. Conclusions Levels of depressive symptoms were very high among people with lower limb lymphoedema in Rwanda, which should be addressed through holistic morbidity management and disability prevention services that integrate mental health, psychosocial and economic interventions alongside physical care.
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Muhayimana, Alice, Donatilla Mukamana, Jean Pierre Ndayisenga, Olive Tengera, Josephine Murekezi, Josette Uwacu, Eugenie Mbabazi, and Joyce Musabe. "Implications of COVID-19 Lockdown on Child Preparedness among Rwandan Families." Research Journal of Health Sciences 8, no. 3 (October 9, 2020): 214–20. http://dx.doi.org/10.4314/rejhs.v8i3.8.
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The world is currently facing the fatal viral pandemic called coronavirus disease 2019 (COVID-19), earlier named 2019-novel coronavirus (2019- nCoV). Every country of the world keeps responding to the challenges posed by covid-19 in all aspects of human endeavour with high demand and burden on health care. The report of the first case in Rwanda on 14th March 2020 was accompanied by actions to drive control measures by the government of Rwanda importantly to prevent the spread of COVID-19. Those measures included education on personal preventive behaviours, social distancing and restricting the movement of people locally, nationally and internationally resulting to lockdown that allowed only essential services. Lockdown has particularly affected Rwandan families with pregnant mothers in the context of childbirth preparation in different aspects. This review paper articulates the possible various dimensions of influence of the COVID-19 lockdown on birth preparedness by families and the possible maternal and neonatal health adverse outcomes that may be associated. This is with the intention of helping health care providers and other stakeholders anticipate, track and prepare for appropriate mitigation to reduce maternal-neonatal morbidity and mortality.
French title: Implications du verrouillage de COVID-19 sur la préparation des enfants dans les familles RwandaisesLe monde est actuellement confronté à la pandémie virale mortelle appelée maladie à coronavirus 2019 (COVID-19), précédemment appelée 2019-nouveau coronavirus (2019-nCoV). Chaque pays du monde continue de répondre aux défis posés par le Covid-19 dans tous les aspects de l'activité humaine avec une forte demande et un fardeau sur les soins de santé. Le rapport du premier cas au Rwanda le 14e mars 2020 a été accompagné d'actions à conduire des mesures de contrôle par le gouvernement du Rwanda important pour prévenir la propagation de Covid-19. Ces mesures comprenaient une éducation sur les comportements personnels de prévention, la distanciation sociale et la restriction de la circulation des personnes aux niveaux local, national et international, entraînant un verrouillage qui n'autorisait que les services essentiels. Le verrouillage a particulièrement affecté les familles Rwandaises de mères enceintes dans le cadre de la préparation à l'accouchement sous différents aspects. Cet article de synthèse articule les différentes dimensions possibles de l'influence du verrouillage du COVID-19 sur la préparation à la naissance des familles et les éventuels effets indésirables sur la santé maternelle et néonatale qui peuvent être associés. Ceci dans le but d'aider les prestataires de soins de santé et les autres parties prenantes à anticiper, suivre et préparer des mesures d'atténuation appropriées pour réduire la morbidité et la mortalité materné-néonatales.
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Turmusani, Majid. "L’évaluation du programme «réadaptation à base communautaire» au Rwanda." Canadian Journal of Disability Studies 6, no. 2 (June 28, 2017): 213. http://dx.doi.org/10.15353/cjds.v6i2.356.
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Cet article est basé sur une recherche évaluative du projet « réadaptation à base communautaire, RBC », réalisée au Rwanda en 2012 et en 2013. Il concerne un partenariat entre le ministère de la Santé (Minisanté) et Handicap International (HI), où le Minisanté a demandé l’assistance technique de HI dans la mise en œuvre d’un projet pilote de RBC impliquant l’élaboration de politiques, le renforcement des capacités des professionnels de la santé et la prestation de services au niveau communautaire. Le projet est cofinancé par l’Union européenne et Handicap International pour une durée de 4 ans. Une approche émancipatrice de la recherche avec un accent sur le rôle de la société civile (personnes handicapées et leurs organisations) comme protagoniste a été employée au cours de cette évaluation. Des données, majoritairement qualitatives, ont été recueillies à l’aide de plusieurs outils, comme des SSI (semi-structure interviews) avec les planificateurs et des fournisseurs de services, des groupes de discussion avec les usagers du service, des sondages, des études du cas et de l’observation. Les méthodes d’analyse synthétique ont été employées, comme l’analyse FFOM (force, faiblesse, opportunités et menaces), la validation communautaire et l’interprétation synthétique, incluant aussi des statistiques de base comme des tableaux et des pourcentages.Étant donné le succès du projet pilote, des recommandations ont favorisé la mise en œuvre de la RBC à grande échelle dans le pays, avec un accent particulier mis sur le renforcement de la capacité institutionnelle des acteurs locaux en matière de plaidoyer. Cela correspond bien à une meilleure protection des droits des PH selon la convention relative aux droits des personnes handicapées (CDPH).This account is based on an evaluation research to the Community Based Rehabilitation programme in Rwanda which is carried out in 2012-2013. It’s a partnership between Ministry of Health (Minisanté) and Handicap International (HI) where Minisanté requested the technical assistance of HI in implementing a pilot CBR project involving policy development, capacity building of health professionals and the provision of rehabilitation services at community level. The project is financed by the European Union and Handicap International for 4 years. An emancipatory research approach was used in this evaluation where persons with disabilities and their civil society organisations have actively participated in research process. Several tools were used for data collections such as semi-structure interviews with planners and service providers, questionnaires, case study, observations and focus group discussion with service users. Equally, qualitative methods for analysis were used including SWOT (Strength, Weakness, Opportunity and Threat) as well as community validation of research outcomes. Results showed that the objectives of project were adequately fulfilled according to criteria of pertinence, effectiveness, impact, sustainability and gender participation. Given the success of the pilot stage, recommendations were in favor of expanding CBR at the national level with focus on capacity building of local actors on advocacy issues. This may provide higher levels of rights protection and goes in line with the Convention on the Rights of Persons with Disabilities (CRPD).
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Park, Paul H., Cyprien Shyirambere, Fred Kateera, Neil Gupta, Christian Rusangwa, Joia Mukherjee, Alex Coutinho, et al. "Implementing Cancer Care in Rwanda: Capacity Building for Treatment and Scale-Up." Sustainability 13, no. 13 (June 28, 2021): 7216. http://dx.doi.org/10.3390/su13137216.
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Background: The majority of countries in sub-Saharan Africa are ill-prepared to address the rising burden of cancer. While some have been able to establish a single cancer referral center, few have been able to scale-up services nationally towards universal health coverage. The literature lacks a step-wise implementation approach for resource-limited countries to move beyond a single-facility implementation strategy and implement a national cancer strategy to expand effective coverage. Methods: We applied an implementation science framework, which describes a four-phase approach: Exploration, Preparation, Implementation, and Sustainment (EPIS). Through this framework, we describe Rwanda’s approach to establish not just a single cancer center, but a national cancer program. Results: By applying EPIS to Rwanda’s implementation approach, we analyzed and identified the implementation strategies and factors, which informed processes of each phase to establish foundational cancer delivery components, including trained staff, diagnostic technology, essential medicines, and medical informatics. These cancer delivery components allowed for the implementation of Rwanda’s first cancer center, while simultaneously serving as the nidus for capacity building of foundational components for future cancer centers. Conclusion: This “progressive scaling” approach ensured that initial investments in the country’s first cancer center was a step toward establishing future cancer centers in the country.
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Niyonsenga, Simon Pierre, Paul H. Park, Gedeon Ngoga, Evariste Ntaganda, Fredrick Kateera, Neil Gupta, Edson Rwagasore, et al. "Implementation outcomes of national decentralization of integrated outpatient services for severe non‐communicable diseases to district hospitals in Rwanda." Tropical Medicine & International Health 26, no. 8 (May 16, 2021): 953–61. http://dx.doi.org/10.1111/tmi.13593.
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Pace, Lydia E., Jean Marie Vianney Dusengimana, Jean Paul Balinda, Origene Benewe, Vestine Rugema, Cyprien Shyirambere, Jean Bosco Bigirimana, et al. "Integrating breast cancer screening into a cervical cancer screening program in three rural districts in Rwanda." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 2025. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.2025.
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2025 Background: In low-income countries where mammography is not widely available, optimal strategies to facilitate earlier breast cancer detection are not known. We previously conducted a cluster randomized clinical trial of clinician trainings in Burera District in rural Rwanda to facilitate earlier diagnosis among symptomatic women; 1.3% of women evaluated at intervention health centers (HCs) were diagnosed with cancer. Early stage breast cancer incidence was higher in intervention areas. Subsequently, Rwanda Biomedical Centre, Rwanda’s national health implementation agency, adapted the program in 3 other districts, offering screening clinical breast exams (CBE) to all women aged 30-50 years receiving cervical cancer screening and any other woman requesting CBE. A navigator facilitated patient tracking. We sought to examine patient volume, service provision and cancer detection rate in the adapted program. Methods: We abstracted data from weekly HC reports, facility registries, and the referral hospital’s electronic medical record to determine numbers of patients seen, referrals made, biopsies, and cancer diagnoses from July 2018-December 2019. Results: CBE was performed at 17,239 visits in Rwamagana, Rubavu and Kirehe Districts (total population 1.34 million) over 18, 17 and 7 months of program implementation respectively. At 722 visits (4.2%), CBE was abnormal. 571 patients were referred to district hospitals (DH); their average age was 35 years. Of those referred, 388 (68.0%) were seen at DH; 32% were not. Of those seen, 142 (36.6%) were referred to a referral facility; 121 of those referred (85.2%) actually went to the referral facility. Eighty-eight were recommended to have biopsies, 83 (94.3%) had biopsies, and 29 (34.9% of those biopsied; 0.17% of HC visits) were diagnosed with breast cancer. Conclusions: Integrating CBE screening into organized cervical cancer screening in rural Rwandan HCs led to a large number of patients receiving CBE. As expected, patients were young and the cancer detection rate was much lower than in a trial focused on symptomatic women. Even with navigation efforts, loss-to-follow-up was high. Analyses of stage, outcomes, patient and provider experience and cost are planned to characterize CBE screening’s benefits and harms in Rwanda. However, these findings suggest building health system capacity to facilitate referrals and retain patients in care are needed prior to further screening scaleup. In the interim, early diagnosis programs targeting symptomatic women may be more efficient and feasible.
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Ross, Jonathan, Gad Murenzi, Sarah Hill, Eric Remera, Charles Ingabire, Francine Umwiza, Athanase Munyaneza, et al. "Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study." BMJ Open 11, no. 4 (April 2021): e047443. http://dx.doi.org/10.1136/bmjopen-2020-047443.
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IntroductionCurrent HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one.Methods and analysesThe present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome).Ethics and disseminationThis clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders.Trial registration numberNCT04567693.
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Martin, Allison N., Kelly-Mariella Kaneza, Amol Kulkarni, Pacifique Mugenzi, Rahel Ghebre, David Ntirushwa, André M. Ilbawi, Lydia E. Pace, and Ainhoa Costas-Chavarri. "Cancer Control at the District Hospital Level in Sub-Saharan Africa: An Educational and Resource Needs Assessment of General Practitioners." Journal of Global Oncology, no. 5 (December 2019): 1–8. http://dx.doi.org/10.1200/jgo.18.00126.
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PURPOSE The WHO framework for early cancer diagnosis highlights the need to improve health care capacity among primary care providers. In Rwanda, general practitioners (GPs) at district hospitals (DHs) play key roles in diagnosing, initiating management, and referring suspected patients with cancer. We sought to ascertain educational and resource needs of GPs to provide a blueprint that can inform future early cancer diagnosis capacity–building efforts. METHODS We administered a cross-sectional survey study to GPs practicing in 42 Rwandan DHs to assess gaps in cancer-focused knowledge, skills, and resources, as well as delays in the referral process. Responses were aggregated and descriptive analysis was performed to identify trends. RESULTS Survey response rate was 76% (73 of 96 GPs). Most responders were 25 to 29 years of age (n = 64 [88%]) and 100% had been practicing between 3 and 12 months. Significant gaps in cancer knowledge and physical exam skills were identified—88% of respondents were comfortable performing breast exams, but less than 10 (15%) GPs reported confidence in performing pelvic exams. The main educational resource requested by responders (n = 59 [81%]) was algorithms to guide clinical decision-making. Gaps in resource availability were identified, with only 39% of responders reporting breast ultrasound availability and 5.8% reporting core needle biopsy availability in DHs. Radiology and pathology resources were limited, with 52 (71%) reporting no availability of pathology services at the DH level. CONCLUSION The current study reveals significant basic oncologic educational and resource gaps in Rwanda, such as physical examination skills and diagnostic tools. Capacity building for GPs in low- and middle-income countries should be a core component of national cancer control plans to improve accurate and timely diagnosis of cancer. Continuing professional development activities should address and focus on context-specific educational gaps, resource availability, and referral practice guidelines.
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d'Ardenne, Patricia, Hanspeter Dorner, James Walugembe, Allen Nakibuuka, James Nsereko, Tom Onen, and Cerdic Hall. "Training in the management of post-traumatic stress disorder in Uganda." International Psychiatry 6, no. 3 (July 2009): 67–68. http://dx.doi.org/10.1192/s174936760000062x.
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The aims of this study were to establish the feasibility and effectiveness of training Ugandan mental health workers in the management of post-traumatic stress disorder (PTSD) based on guidelines from the UK National Institute of Health and Clinical Excellence (NICE). The Butabika Link is a mental health partnership between the East London Foundation NHS Trust (ELFT) and Butabika National Psychiatric Referral Hospital, Kampala, Uganda, supported by the Tropical Health Education Trust (THET), and based on the recommendations of the Crisp report (Crisp, 2007). The Link has worked on the principle that the most effective partnership between high-income and low- or middle-income countries is through organisations already delivering healthcare, that is, through the support of existing services. Butabika Hospital is a centre of excellence, serving an entire nation of 30 million people, many of them recovering from 20 years of armed conflict that took place mainly in the north of Uganda. In addition, Uganda has received refugees from conflicts in neighbouring states, including Congo, Rwanda, Kenya, Sudan and Burundi. The Ugandan Ministry of Health's Strategic Plan (2000) has prioritised post-conflict mental disorders and domestic violence, which is reflected in the vision of the Link's work.
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Adewuyi, Emmanuel O., and Asa Auta. "Medical injection and access to sterile injection equipment in low- and middle-income countries: a meta-analysis of Demographic and Health Surveys (2010–2017)." International Health 12, no. 5 (December 18, 2019): 388–94. http://dx.doi.org/10.1093/inthealth/ihz113.
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Abstract Background Unsafe injection practices contribute to increased risks of blood-borne infections, including human immunodeficiency virus, hepatitis B and hepatitis C viruses. The aim of this study was to estimate the prevalence of medical injections as well as assess the level of access to sterile injection equipment by demographic factors in low- and middle-income countries (LMICs). Methods We carried out a meta-analysis of nationally representative Demographic and Health Surveys (DHSs) conducted between 2010 and 2017 in 39 LMICs. Random effects meta-analysis was used in estimating pooled and disaggregated prevalence. All analyses were conducted using Stata version 14 and Microsoft Excel 2016. Results The pooled 12-month prevalence estimate of medical injection was 32.4% (95% confidence interval 29.3–35.6). Pakistan, Rwanda and Myanmar had the highest prevalence of medical injection: 59.1%, 56.4% and 53.0%, respectively. Regionally, the prevalence of medical injection ranged from 13.5% in west Asia to 42.7% in south and southeast Asia. The pooled prevalence of access to sterile injection equipment was 96.5%, with Pakistan, Comoros and Afghanistan having comparatively less prevalence: 86.0%, 90.3% and 90.9%, respectively. Conclusions Overuse of medical injection and potentially unsafe injection practices remain a considerable challenge in LMICs. To stem the tides of these challenges, national governments of LMICs need to initiate appropriate interventions, including education of stakeholders, and equity in access to quality healthcare services.
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Perehudoff, S. Katrina, Nikita V. Alexandrov, and Hans V. Hogerzeil. "Legislating for universal access to medicines: a rights-based cross-national comparison of UHC laws in 16 countries." Health Policy and Planning 34, Supplement_3 (December 1, 2019): iii48—iii57. http://dx.doi.org/10.1093/heapol/czy101.
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Abstract Universal health coverage (UHC) aims to ensure that all people have access to health services including essential medicines without risking financial hardship. Yet, in many low- and middle-income countries (LMICs) inadequate UHC fails to ensure universal access to medicines and protect the poor and vulnerable against catastrophic spending in the event of illness. A human rights approach to essential medicines in national UHC legislation could remedy these inequities. This study identifies and compares legal texts from national UHC legislation that promote universal access to medicines in the legislation of 16 mostly LMICs: Algeria, Chile, Colombia, Ghana, Indonesia, Jordan, Mexico, Morocco, Nigeria, Philippines, Rwanda, South Africa, Tanzania, Turkey, Tunisia and Uruguay. The assessment tool was developed based on WHO’s policy guidelines for essential medicines and international human rights law; it consists of 12 principles in three domains: legal rights and obligations, good governance, and technical implementation. Relevant legislation was identified, mapped, collected and independently assessed by multi-disciplinary, multi-lingual teams. Legal rights and State obligations toward medicines are frequently codified in UHC law, while most good governance principles are less common. Some technical implementation principles are frequently embedded in national UHC law (i.e. pooled user contributions and financial coverage for the vulnerable), while others are infrequent (i.e. sufficient government financing) to almost absent (i.e. seeking international assistance and cooperation). Generally, upper-middle and high-income countries tended to embed explicit rights and obligations with clear boundaries, and universal mechanisms for accountability and redress in domestic law while less affluent countries took different approaches. This research presents national law makers with both a checklist and a wish list for legal reform for access to medicines, as well as examples of legal texts. It may support goal 7 of the WHO Medicines & Health Products Strategic Programme 2016–30 to develop model legislation for medicines reimbursement.
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Atijosan, Oluwarantimi, Victoria Simms, Hannah Kuper, Dorothea Rischewski, and Chris Lavy. "The Orthopaedic Needs of Children in Rwanda: Results From a National Survey and Orthopaedic Service Implications." Journal of Pediatric Orthopaedics 29, no. 8 (December 2009): 948–51. http://dx.doi.org/10.1097/bpo.0b013e3181c18962.
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Gamba, Freddy Jirabi. "SME development policies of Tanzania and Rwanda: comparability of policy presentation on focus, significance, challenges and participation." Journal of Development and Communication Studies 6, no. 1 (February 15, 2019): 1–17. http://dx.doi.org/10.4314/jdcs.v6i1.1.
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The world’s new ideologies of regionalisationism and globalizationism anchor on the role of Small and Medium Enterprises (SMEs) for promotion of a healthy business climate for upgrading the private sector and engineering for economic efficiency and development. SMEs have been a mechanism of inclusion and equity for economic empowerment and deepening of economic and business services especially in developing countries. The SMEs‘cultural and socio-economic importance has driven the initiation of national SME development in many countries. SMEs have gained elevating importance in developed and developing economies, have the capability of quick adaptation, low cost of management, less capital and sometimes labor intensive for enabling cheap production. Despite their size related weaknesses, SMEs are less affected by economic crises due to their inherent flexibility and adaptability characteristics. SMEs are vital actors for enhancing entrepreneurial innovation and innovation system as well as competitiveness in economies. National SME development policies, being high level political intent, directives and guidelines are critical for development, coordination and deployment of potential and available resources and capabilities. The paper, therefore, aims at analyzing and comparing the presentations of SME development policies of Tanzania and Rwanda based on policy framework options namely, focus, significance, challenges and participation. The findings show elevating differences in various spheres of the policy processes including the SME definition, vision, mission and objectives in terms of activeness in presentation, political flavour, sharpness of intent and sense of anticipated commitment. This implies a continued gap of SME development between countries under review and other East African Community (EAC) member countries until policies affecting SMEs are harmonized.Keywords: SMEs, Policy Presentation, Policy Framework, Entrepreneurship, BDS, Tanzania, Rwanda
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Kawooya, Michael G. "Training for Rural Radiology and Imaging in Sub-Saharan Africa: Addressing the Mismatch Between Services and Population." Journal of Clinical Imaging Science 2 (June 29, 2012): 37. http://dx.doi.org/10.4103/2156-7514.97747.
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The objectives of this review are to outline the needs, challenges, and training interventions for rural radiology (RR) training in Sub-Saharan Africa (SSA). Rural radiology may be defined as imaging requirements of the rural communities. In SSA, over 80% of the population is rural. The literature was reviewed to determine the need for imaging in rural Africa, the challenges, and training interventions. Up to 50% of the patients in the rural health facilities in Uganda may require imaging, largely ultrasound and plain radiography. In Uganda, imaging is performed, on an average, in 50% of the deserving patients in the urban areas, compared to 10–13 % in the rural areas. Imaging has been shown to increase the utilization of facility-based rural health services and to impact management decisions. The challenges in the rural areas are different from those in the urban areas. These are related to disease spectrum, human resource, and socio-economic, socio-cultural, infrastructural, and academic disparities. Countries in Sub-Saharan Africa, for which information on training intervention was available, included: Uganda, Kenya, Tanzania, Rwanda, Zambia, Ghana, Malawi, and Sudan. Favorable national policies had been instrumental in implementing these interventions. The interventions had been made by public, private-for-profit (PFP), private-not-for profit (PNFP), local, and international academic institutions, personal initiatives, and professional societies. Ultrasound and plain radiography were the main focus. Despite these efforts, there were still gross disparities in the RR services for SSA. In conclusion, there have been training interventions targeted toward RR in Africa. However, gross disparities in RR provision persist, requiring an effective policy, plus a more organized, focused, and sustainable approach, by the stakeholders.
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Birungi, Francine Mwayuma, Stephen Graham, Jeannine Uwimana, and Brian van Wyk. "Assessment of the Isoniazid Preventive Therapy Uptake and Associated Characteristics: A Cross-Sectional Study." Tuberculosis Research and Treatment 2018 (2018): 1–9. http://dx.doi.org/10.1155/2018/8690714.
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Objective. To assess the uptake of isoniazid preventive therapy (IPT) by eligible children in Kigali, Rwanda, and associated individual, households, and healthcare systems characteristics. Methods. A cross-sectional study was conducted among child contacts of index cases having sputum smear-positive pulmonary tuberculosis. Data were collected from 13 selected primary health centres. Descriptive statistics were used to generate frequency tables and figures. Logistic regression models were performed to determine characteristics associated with IPT uptake. Results. Of 270 children (under 15 years), who were household contacts of 136 index cases, 94 (35%) children were less than 5 years old and eligible for IPT; and 84 (89%, 95% CI 81–94) were initiated on IPT. The reasons for not initiating IPT in the remaining 10 children were parents/caregivers’ lack of information on the need for IPT, refusal to give IPT to their children, and poor quality services offered at health centres. Factors associated with no uptake of IPT included children older than 3 years, unfriendly healthcare providers, HIV infected index cases, and the index case not being the child’s parent. Conclusion. The National Tuberculosis Program’s policy on IPT delivery was effectively implemented. Future interventions should find strategies to manage factors associated with IPT uptake.
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Orem, J., H. Ddungu, F. Karsan, S. Nafuna, F. Okuku, D. Kanyike, A. Kavuma, I. Luutu, and S. Bolouki. "Challenges of Building and Sustaining Radiation Therapy Capacity in Low-Resource Settings: A Case of the Breakdown of Cobalt 60 Teletherapy in Uganda and Lessons Learned." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 168s. http://dx.doi.org/10.1200/jgo.18.23500.
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Background and context: The use of radiotherapy in developing countries is slowly gaining momentum but the gains are accompanied by some pitfalls. The breakdown of a teletherapy (cobalt 60) machine in Uganda is an example of the challenges to be considered while expanding access to treatment. It was a major test for the country and the Uganda Cancer Institute the agency of government responsible for provision of cancer services. It attracted a national and international outcry. This unprecedented response was based on the importance a seemingly old equipment in Kampala was playing in the entire region (Kenya, Tanzania, Rwanda, Burundi, Democratic Republic of Congo and southern Sudan). However, the manner in which the crisis was handled demonstrated clearly how to turn a misfortune into an opportunity given the many lessons learnt. Aim: In this paper we aim to highlight how the breakdown of the equipment triggered a major crisis and the response to the crisis resulting in the restoration of services within a reasonable time frame. We also want to show the long-term service modernization and expansion drive this has triggered within Uganda and the entire region. Strategy/Tactics: The restoration process comprised planning, decommissioning, renovation, security and safety systems, procurement of new machine, installation and commissioning. As this was ongoing there was the need for care provision for patient in need. Concurrently undertaken was public reassurance through building confidence and trust in the capacity for speedy restoration of services. Program/Policy process: All these steps were taken collaboratively within country, region and internationally. In the region there was support from the Aga Khan University Hospital Nairobi and internationally, technical support from the IAEA. Outcomes: Service has been fully restored, a new teletherapy cobalt machines installed and commissioned. The machine has modern capabilities compared with the previous. So far more than 200 patients have been treated. The numbers of patients are steadily increasing hence the government has embarked on modernization and expansion of the radiotherapy services in the country. What was learned: The breakdown of Uganda's radiotherapy machines has provided lessons that are important for handling health system operational crisis which may occur as we try to build complex delivery systems. It provided lessons that are important in the drive for expansion of radiotherapy services in developing countries. In particular that benefit of investments in modern equipment transcends national boundaries. Secondly how to limit potential impact of major crisis through regional and international collaboration. Further that the needs of patients is central in crisis management. Finally need to consider pooling infrastructure investments in tackling NCD's such as the East Africa's centre of excellence for skills and tertiary education project of the East African community.
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Wall, Kristin M., Julien Nyombayire, Rachel Parker, Rosine Ingabire, Jean Bizimana, Jeannine Mukamuyango, Amelia Mazzei, et al. "Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services." PLOS ONE 16, no. 4 (April 20, 2021): e0250044. http://dx.doi.org/10.1371/journal.pone.0250044.
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Introduction The longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms. Methods Radio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men. Results Among 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts. Conclusions Syndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.
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Yohana, Emmanuel, Shiferaw Mitiku, P. Claver Kayumba, and Omary Swalehe. "Electronic Immunization Registry in Improving Vaccine Supply Chain Availability in Tanga City Council, Tanzania." Rwanda Journal of Medicine and Health Sciences 4, no. 2 (September 10, 2021): 223–36. http://dx.doi.org/10.4314/rjmhs.v4i2.3.
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BackgroundDespite the advantages of the electronic registry which has been explained in other areas of health and other parts of the world, there has been no empirical research conducted with the aim of assessing the impact of the electronic immunization registry practices on the availability of immunization commodities.ObjectivesTo assess the effect of electronic immunization registry practices on the availability of immunization commodities.MethodsA cross-sectional study was carried out to health facilities providing vaccination services in Tanga City Council. A total of 27 health care workers in 27 health facilities were interviewed for availability of vaccines and their experience in using electronic immunization system in supply chain system functioning using structured questionnaires. The data from the vaccines manual ledger and electronic TImR system were also collected administered in April-June, 2019 specifically for Bacillus-Calmette Guerin (BCG), Diphtheria-Pertussis-Tetanus-Hepatis B-Haemophilus influenza type b (DPT-HepB-Hib), bi-oral polio vaccine (bOPV), Measles-Rubella and Human Papilloma Virus Vaccine (HPV). These data were analyzed by statistical software SPSS using one sample T test and 95% confidence interval.ResultsThe study affirmed that the mean numbers of children registered at the health facilities using electronic immunization registry was 1.5-3 times higher than the target population for the three months preceding the study given by the National Bureau of Statistics (NBS). The number of doses for the studied vaccines (DPT-HepB-Hib, measles rubella, HPV, BCG and bOPV) were found to be different in the manual and electronic TImR systems. Also, the number of doses available at the health facilities increased significantly with the number of the electronic system registered children.ConclusionThis study found that the adoption of Electronic immunization registry has improved the health supply chain in terms of improving the vaccines availability. Rwanda J Med Health Sci 2021;4(2): 223-236
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Jordi, Emma, Caitlin Pley, Matthew Jowett, Gerard Joseph Abou Jaoude, and Hassan Haghparast-Bidgoli. "Assessing the efficiency of countries in making progress towards universal health coverage: a data envelopment analysis of 172 countries." BMJ Global Health 5, no. 10 (October 2020): e002992. http://dx.doi.org/10.1136/bmjgh-2020-002992.
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IntroductionMaximising efficiency of resources is critical to progressing towards universal health coverage (UHC) and the sustainable development goal (SDG) for health. This study estimates the technical efficiency of national health spending in progressing towards UHC, and the environmental factors associated with efficient UHC service provision.MethodsA two-stage efficiency analysis using Simar and Wilson’s double bootstrap data envelopment analysis investigates how efficiently countries convert health spending into UHC outputs (measured by service coverage and financial risk protection) for 172 countries. We use World Bank and WHO data from 2015. Thereafter, the environmental factors associated with efficient progress towards UHC goals are identified.ResultsThe mean bias-corrected technical efficiency score across 172 countries is 85.7% (68.9% for low-income and 95.5% for high-income countries). High-achieving middle-income and low-income countries such as El Salvador, Colombia, Rwanda and Malawi demonstrate that peer-relative efficiency can be attained at all incomes. Governance capacity, income and education are significantly associated with efficiency. Sensitivity analysis suggests that results are robust to changes.ConclusionWe provide a 2015 baseline for cross-country UHC technical efficiency scores. If countries wish to improve their UHC outputs within existing budgets, they should identify their current efficiency and try to emulate more efficient peers. Policy-makers should focus on strengthening institutions and implementing known best practices to replicate efficient systems. Using resources more efficiently is likely to positively impact UHC coverage goals and health outcomes, and without addressing gaps in efficiency progress towards achieving the SDGs will be impeded.
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De Schaepdryver, André. "Medische Ontwikkelingssamenwerking in Centraal-Afrika." Afrika Focus 6, no. 1 (January 26, 1990): 5–18. http://dx.doi.org/10.1163/2031356x-00601003.
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Medical Development-Cooperation in Central Africa The author describes the Project of Medical Cooperation between the Medical Faculties of the University of Ghent and the National University of Rwanda in Butare. The objectives of this project, which started in 1966, were the following: (1) to organize and dispense the theoretical education and practical training at the G.P.-level; (2) to structure the postgraduate education of alumni selected for higher education posts; (3) to take care of the postgraduate training of specialists; (4) to organize the continuing education of health personnel; (5) to promote and participate in medical research. The results of the Project were, in 1984: (1) at the level of health personnel: the education and training of 220 physicians, 19 university lecturers and 15 specialists; (2) at the level of the infrastructure: the building of the Medical Faculty facilities, the pediatric and medical policlinics and clinics, the community health service for adults; the adaptation of the gynecological-obstetrical policlinic and clinic and of the community health service for children; the founding of the Faculty library, secretariat and workshop, (3) at the research level: the founding and development of the University Center for Research on Traditional Pharmacopoeia and Medicine, aiming at: a) the valorization and integration of traditional medicine; b) the study of Rwandese medicinal plants; c) the local production of pharmaceutical preparations of plant origin and organic raw materials. The attention is drawn to the importance of the postgraduate education in Belgium, for periods of 5 years, of 25 Rwandese medical alumni, which resulted in 15 Ph.D. -theses and a nearly complete rwandization of the Faculty of Medicine and University Hospital in Butare. A pairing Agreement Butare-Ghent has taken the relief of the Project, insuring its continuity through visiting lecturers, and the coaching of trainees and of research projects in various fields of the local pathology.
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Schleimer, Lauren E., Nancy L. Keating, Lawrence N. Shulman, Ben O. Anderson, Catherine Duggan, Daniel S. O’Neil, and Lydia E. Pace. "Review of Quality Measures for Breast Cancer Care by Country Income Level." Journal of Global Oncology 4, Supplement 3 (October 2018): 41s. http://dx.doi.org/10.1200/jgo.18.10480.
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Purpose Measurement of the quality of cancer care is essential for quality improvement and is widely implemented in oncology programs in high-income countries. Growing efforts are being made to measure care quality in emerging cancer care delivery systems in low- and middle-income countries (LMICs). This will require the development of measures that are clinically important, actionable, relevant to existing resources, and feasible to routinely evaluate. As part of a project to develop resource-adapted quality measures for Rwanda and other LMICs, we conducted a systematic review of the literature to identify published quality measures for the diagnosis and treatment of breast cancer. Methods We performed a literature search in accordance with PRISMA guidelines using the following terms in PubMed: ‘breast cancer’ and ‘quality indicator,’ ‘quality measure,’ or ‘quality metric’; and the following MeSH terms: ‘breast neoplasms’ and ‘healthcare quality indicator.’ We included English-language articles published before August 2017 that described the systematic identification of process measures for breast cancer diagnosis or treatment through literature review, clinical validation, and/or expert panel determination. We directly searched the Web sites of prominent cancer care organizations to identify additional publicly available measures. Income level was classified using World Bank definitions. Results We identified 521 published quality measures, including 419 measures from 27 peer-reviewed journal articles and 102 measures from the Web sites of national and international cancer care organizations. Twenty-five peer-reviewed publications (93%) originated from high-income countries, one from an upper-middle income country (People’s Republic of China), and one from the international Breast Health Global Initiative with process measures to assess the phased implementation of breast cancer services. No resources or articles other than that from the Breast Health Global Initiative provided suggestions for adapting measures to limited resources. Conclusion A large number of quality measures for breast cancer care have been identified and published in high-income countries; however, no breast cancer care quality measures have been systematically developed and validated for use in settings where resource limitations crucially affect care delivery and measurement feasibility. We are collaborating with clinicians in LMICs and global breast cancer experts to develop and validate quality measures that will enable quality improvement initiatives in Rwanda and other emerging cancer care delivery systems. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
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Ngoie, Leonard Banza, Eva Dybvik, Geir Hallan, Jan-Erik Gjertsen, Nyengo Mkandawire, Carlos Varela, and Sven Young. "Prevalence, causes and impact of musculoskeletal impairment in Malawi: A national cluster randomized survey." PLOS ONE 16, no. 1 (January 6, 2021): e0243536. http://dx.doi.org/10.1371/journal.pone.0243536.
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Background There is a lack of accurate information on the prevalence and causes of musculoskeletal impairment (MSI) in low income countries. The WHO prevalence estimate does not help plan services for specific national income levels or countries. The aim of this study was to find the prevalence, impact, causes and factors associated with musculoskeletal impairment in Malawi. We wished to undertake a national cluster randomized survey of musculoskeletal impairment in Malawi, one of the UN Least Developed Countries (LDC), that involved a reliable sampling methodology with a case definition and diagnostic criteria that could clearly be related to the classification system used in the WHO International Classification of Functioning, Disability and Health (ICF) Methods A sample size of 1,481 households was calculated using data from the latest national census and an expected prevalence based on similar surveys conducted in Rwanda and Cameroon. We randomly selected clusters across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the distribution of the population. In the field, randomization of households in a cluster was based on a ground bottle spin. All household members present were screened, and all MSI cases identified were examined in more detail by medical students under supervision, using a standardized interview and examination protocol. Data collection was carried out from 1st July to 30th August 2016. Extrapolation was done based on study size compared to the population of Malawi. MSI severity was classified using the parameters for the percentage of function outlined in the WHO International Classification of Functioning (ICF). A loss of function of 5–24% was mild, 25–49% was moderate and 50–90% was severe. The Malawian version of the EQ-5D-3L questionnaire was used, and EQ-5D index scores were calculated using population values from Zimbabwe, as a population value set for Malawi is not currently available. Chi-square test was used to test categorical variables. Odds ratio (OR) was calculated with a linear regression model adjusted for age, gender, location and education. Results A total of 8,801 individuals were enumerated in 1,481 households. Of the 8,548 participants that were screened and examined (response rate of 97.1%), 810 cases of MSI were diagnosed of which 18% (108) had mild, 54% (329) had moderate and 28% (167) had severe MSI as classified by ICF. There was an overall prevalence of MSI of 9.5% (CI 8.9–10.1). The prevalence of MSI increased with age, and was similar in men (9.3%) and women (9.6%). People without formal education were more likely to have MSI [13.3% (CI 11.8–14.8)] compared to those with formal education levels [8.9% (CI 8.1–9.7), p<0.001] for primary school and [5.9% (4.6–7.2), p<0.001] for secondary school. Overall, 33.2% of MSIs were due to congenital causes, 25.6% were neurological in origin, 19.2% due to acquired non-traumatic non-infective causes, 16.8% due to trauma and 5.2% due to infection. Extrapolation of these findings indicated that there are approximately one million cases of MSI in Malawi that need further treatment. MSI had a profound impact on quality of life. Analysis of disaggregated quality of life measures using EQ-5D showed clear correlation with the ICF class. A large proportion of patients with moderate and severe MSI were confined to bed, unable to wash or undress or unable to perform usual daily activities. Conclusion This study has uncovered a high prevalence of MSI in Malawi and its profound impact on a large proportion of the population. These findings suggest that MSI places a considerable strain on social and financial structures in this low-income country. The Quality of Life of those with severe MSI is considerably affected. The huge burden of musculoskeletal impairment in Malawi is mostly unattended, revealing an urgent need to scale up surgical and rehabilitation services in the country.
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Vickery, C. "Rebuilding health services in Rwanda." BMJ 309, no. 6962 (October 29, 1994): 1160. http://dx.doi.org/10.1136/bmj.309.6962.1160c.
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Wanyana, D., R. Wong, and D. Hakizimana. "Rapid assessment on the utilization of maternal and child health services during COVID-19 in Rwanda." Public Health Action 11, no. 1 (March 21, 2021): 12–21. http://dx.doi.org/10.5588/pha.20.0057.
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SETTING: All public health facilities in Rwanda, East Africa.OBJECTIVE: To assess the change in the utilization of maternal and child health (MCH) services during the COVID-19 outbreak.DESIGN: This was a cross-sectional quantitative study.RESULTS: During the COVID-19 outbreak in Rwanda, the utilization of 15 MCH services in all four categories—antenatal care (ANC), deliveries, postnatal care (PNC) and vaccinations—significantly declined. The Northern and Western Provinces were affected the most, with significant decrease in respectively nine and 12 services. The Eastern Province showed no statistically significant utilization changes. Kigali was the only province with significant increase in the fourth PNC visits for babies and mothers, while the Southern Province showed significant increase in utilization of measles + rubella (MR) 1 vaccination.CONCLUSION: Access and utilization of basic MCH services were considerably affected during the COVID-19 outbreak in Rwanda. This study highlighted the need for pre-emptive measures to avoid disruptions in MCH service delivery and routine health services during outbreaks. In order for the reductions in MCH service utilization to be reversed, targeted resources and active promotion of ANC, institutional deliveries and vaccinations need to be prioritized. Further studies on long-term impact and geographical variations are needed.
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Hackley, Donna M., Shruti Jain, Sarah E. Pagni, Matthew Finkelman, Joseph Ntaganira, and John P. Morgan. "Oral health conditions and correlates: a National Oral Health Survey of Rwanda." Global Health Action 14, no. 1 (January 1, 2021): 1904628. http://dx.doi.org/10.1080/16549716.2021.1904628.
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Kitema, Gatera Fiston, Priya Morjaria, Wanjiku Mathenge, and Jacqueline Ramke. "The Appointment System Influences Uptake of Cataract Surgical Services in Rwanda." International Journal of Environmental Research and Public Health 18, no. 2 (January 16, 2021): 743. http://dx.doi.org/10.3390/ijerph18020743.
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The aim of this study was to investigate barriers and enablers associated with the uptake of cataract surgery in Rwanda, where financial protection is almost universally available. This was a hospital-based cross-sectional study where potential participants were adults aged >18 years who accepted an appointment for cataract surgery during the study period (May–July 2019). Information was collected from hospital records and a semi-structured questionnaire was used for data collection. Of the 297 people with surgery appointments, 221 (74.4%) were recruited into the study, 126 (57.0%) of whom had attended their appointment. People more likely to attend their surgical appointment were literate, had fewer than 8 children, had poorer visual acuity, had access to a telephone in the family, received a specific date to attend their appointment, received a reminder, and reported no difficulties walking (95% significance level, p < 0.05). The most commonly reported barriers were insufficient information about the appointment (n = 40/68, 58.8%) and prohibitive indirect costs (n = 29/68, 42.6%). This study suggests that clear communication of appointment information and a subsequent reminder, together with additional support for people with limited mobility, are strategies that could improve uptake of cataract surgery in Rwanda.
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Ensio, A., M. Laine, P. Nykänen, P. Itkonen, and N. Saranummi. "National Health IT Services in Finland." Methods of Information in Medicine 46, no. 04 (2007): 463–69. http://dx.doi.org/10.1160/me9054.
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Summary Objectives: In 2002 a decision was reached to set up a nation-wide electronic health record system in Finland. The legal framework of actors with the necessary mandate was approved in the parliament in December 2006. A set of standards and norms have been selected that all health care actors need to follow. Functional specifications of the services were completed in 2006. Setting up the centralized health IT services begins in 2007.Centralization of patient record data allows the reorganization of health service providers to take place at local and regional levels according to need. The services allow users to access patient records securely from anywhere with the provision that they have the right to access private patient data. Methods: The functionality of the services and the necessary infrastructure has been agreed to in projects and working groups involving users, experts, key stakeholders and vendors. Results: The legal framework was approved in the parliament in December 2006. The functional specifications of thecentralized health IT services were finalized in 2006. Conclusions: The implementation of the services will start in 2007.
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Maynard, Alan. "Financing the U.K. national health services." Health Policy 6, no. 4 (January 1986): 329–40. http://dx.doi.org/10.1016/0168-8510(86)90048-5.
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Morgan, John P., Moses Isyagi, Joseph Ntaganira, Agnes Gatarayiha, Sarah E. Pagni, Tamar C. Roomian, Matthew Finkelman, et al. "Building oral health research infrastructure: the first national oral health survey of Rwanda." Global Health Action 11, no. 1 (January 2018): 1477249. http://dx.doi.org/10.1080/16549716.2018.1477249.
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Dzinamarira, Tafadzwa, and Tivani Phosa Mashamba-Thompson. "Adaptation of a Health Education Program for Improving the Uptake of HIV Self-Testing by Men in Rwanda: A Study Protocol." Medicina 56, no. 4 (March 26, 2020): 149. http://dx.doi.org/10.3390/medicina56040149.
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Background and objectives: Available evidence shows a low uptake of HIV services among men in Rwanda. HIV self-testing (HIVST), a new intervention, may have the potential to improve the uptake of HIV testing services among men. The current study aims to adapt a health education program (HEP) for improving the uptake of HIVST among men in Rwanda. Materials and Methods: We propose a mixed method study, which will be conducted in four phases. In Phase 1, we will conduct a scoping review to map the available evidence on health education programs for men in low- and middle-income countries (LMICs). In Phase 2, we will conduct interviews with stakeholders in the Rwanda HIV response and healthcare providers to determine their perspectives on implementation of HIVST in Rwanda. In Phase 3, a cross-sectional survey will be used to assess HIVST awareness and acceptability among men in Rwanda. Guided by findings from Phases 1, 2, and 3, we will employ the nominal group technique to develop and optimize the HEP for improving the uptake of HIVST among men in Rwanda. In Phase 4, we will use a pragmatic pilot randomized controlled trial to assess the preliminary impact of the HEP for men in Rwanda and assess the feasibility of a later, larger study. We will employ the Stata version 16 statistical package and NVivo version 12 for the analysis of quantitative and qualitative data, respectively. We anticipate that the findings of this study will inform implementers and policy makers to guide strategies on the implementation of HIVST in Rwanda and ultimately accomplish goals set forth in the Rwanda 2019–2024 Fourth Health Sector Strategic Plan on scaling up the number of men who know their HIV status. Conclusion: It is anticipated that this study will proffer solutions and strategies that are applicable not only in Rwanda but also in similar settings of LMICs.
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Kamanzi, Moses. "Community Health Workers and The Promotion of Health Care Services in Gasabo District, Rwanda." Matters of Behaviour 9, no. 10 (April 25, 2019): 1–5. http://dx.doi.org/10.26455/mob.v9i10.57.
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Health care is a primary need of human being. Life expectancy as an indicator of Human Development is below 40 years in most developing countries due to high Maternal Mortality Rate, HIV prevalence, Infant Mortality rate, Malaria prevalence and many other related diseases. This study examined the importance of Community Health Workers (CHWs) role in promoting Health Care services in Gasabo District of Rwanda. A simple random sampling method with the use of a self-administered questionnaire to get primary data was used as well as a literature review for secondary data. The target population was 1500 CHWs with a sample size of 183 CHWs. 55.6% of CHWs have a role of monitoring Malnutrition & growth for children under the age of 5years, 43.2% monitor women during their pregnancy period and diagnose and treat Malaria, Diarrhoea & Pneumonia for children under 5 years old. Other roles of CHWs include; providing health education (43% of CHWs), providing Family Planning services to women (24%), and sensitizing the community for HIV/AIDS testing (14.3%), psychosocial support (11%) and Vaccination (9.8%). The challenges faced by CHWs to accomplish their roles include; transportation facilitation (39.9%), limited time (32.8%), negative perception by communities (37.7%) and no monthly salary pay (38.8%). Although the work of CHWs in Rwanda is voluntary, however, the Ministry of Health should invest more in their work through the provision of transportation facilitation and motivational incentives CHWs.
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Tuyisenge, Germaine, Celestin Hategeka, Yvone Kasine, Isaac Luginaah, David Cechetto, and Stephen Rulisa. "Mothers’ perceptions and experiences of using maternal health-care services in Rwanda." Women & Health 59, no. 1 (July 24, 2018): 68–84. http://dx.doi.org/10.1080/03630242.2018.1434591.
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Simms, Victoria, Oluwarantimi Atijosan, Hannah Kuper, Assuman Nuhu, Dorothea Rischewski, and Christopher Lavy. "Prevalence of epilepsy in Rwanda: a national cross-sectional survey." Tropical Medicine & International Health 13, no. 8 (August 2008): 1047–53. http://dx.doi.org/10.1111/j.1365-3156.2008.02108.x.
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Lal, Pankaj, Bernabas Wolde, Michel Masozera, Pralhad Burli, Janaki Alavalapati, Aditi Ranjan, Jensen Montambault, Onil Banerjee, Thomas Ochuodho, and Rodrigue Mugabo. "Valuing visitor services and access to protected areas: The case of Nyungwe National Park in Rwanda." Tourism Management 61 (August 2017): 141–51. http://dx.doi.org/10.1016/j.tourman.2017.01.019.
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Quentin, Wilm, Hans-Helmut König, Jean-Olivier Schmidt, and Andreas Kalk. "Recurrent costs of HIV/AIDS-related health services in Rwanda: implications for financing." Tropical Medicine & International Health 13, no. 10 (October 2008): 1245–56. http://dx.doi.org/10.1111/j.1365-3156.2008.02142.x.
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Jeong, Hyoung-Sun. "Management of Health Services Uncovered by National Health Insurance." Health Insurance Review & Assessment Service Research 1, no. 1 (May 31, 2021): 16–22. http://dx.doi.org/10.52937/hira.21.1.1.16.
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Whiteford, Harvey, Bill Buckingham, and Ronald Manderscheid. "Australia's National Mental Health Strategy." British Journal of Psychiatry 180, no. 3 (March 2002): 210–15. http://dx.doi.org/10.1192/bjp.180.3.210.
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BackgroundAustralia commenced a 5-year reform of mental health services in 1993.AimsTo report on the changes to mental health services achieved by 1998.MethodAnalysis of data from the Australian National Mental Health Report 2000 and an independent evaluation of the National Mental Health Strategy.ResultsMental health expenditure increased 30% in real terms, with an 87% growth in community expenditures, a 38% increase in general hospitals and a 29% decrease in psychiatric hospitals. The growth in private psychiatry, averaging 6% annually prior to 1992, was reversed. Consumer and carer involvement in services increased.ConclusionsMajor structural reform was achieved but there was limited evidence that these changes had been accompanied by improved service quality. The National Mental Health Strategy was renewed for another 5 years.
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Taylor, Ben. "The National Day Services Modernisation Network." A Life in the Day 13, no. 3 (August 10, 2009): 30–32. http://dx.doi.org/10.1108/13666282200900029.
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Namahoro, Jean Pierre, and Adrien Mugabushaka. "Forecasting Maternal Complications Based on the Impact of Gross National Income Using Various Models for Rwanda." Journal of Environmental and Public Health 2020 (August 19, 2020): 1–8. http://dx.doi.org/10.1155/2020/7692428.
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Introduction. Preferably maternal mortalities are predominant in low- and middle-income countries (LMICs). In some African countries, including Rwanda, programs related to health-care delivery to reduce significantly severe complications including mortalities are established. Unfortunately, historical and forecasted maternal mortality reduction and the influence of gross national income (GNI) were not accessed. This study is aimed to forecast the three years of maternal mortalities (MMs) based on the influence of gross national income (GNI) in Rwanda. Methods. The period involved is from January 2009 to April 2018. Data analyzed were obtained from the Central Hospital of the University of Kigali (CHUK) and mined data from the WHO database. Time series approach (Box-Jenkins and exponential smoothing) and linear regression models were applied. Besides, IBM-SPSS and Eviews were used in the analysis. Results. The results revealed that MMs were not statistically different in several years, and there was a significant correlation between MMs and GNI (-0.610, P value 0.012 < 0.05). A double exponential smoothing model (DESM) was fitted for the best forecast and ARIMA (0,1,0) and linear regression models for a quick forecast. Conclusion. There was a slight effect of GNI in maternal mortality reduction, which leads to the steady decrease of the forecasted maternal mortality up to May 2021. The Government of Rwanda should intensively strengthen the health-care system, save the children programs, and support pregnant women by using GNI for reducing MMs at an advanced level.
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Hategeka, Celestin, Catherine Arsenault, and Margaret E. Kruk. "Temporal trends in coverage, quality and equity of maternal and child health services in Rwanda, 2000–2015." BMJ Global Health 5, no. 11 (November 2020): e002768. http://dx.doi.org/10.1136/bmjgh-2020-002768.
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IntroductionAchieving the maternal and child health (MCH)-related Sustainable Development Goals (SDG) will require equitable and effective (quality-adjusted) coverage of recommended health interventions in low- and middle-income countries. We assessed effective coverage and equity of MCH services in Rwanda in the Millennium Development Goal (MDG) era to help guide policy decisions to improve equitable health gains in the SDG era and beyond.MethodsUsing four rounds of Rwanda demographic and health surveys conducted from 2000 to 2015, we identified coverage and quality indicators for five MCH services: antenatal care (ANC), delivery care, and care for child diarrhoea, suspected pneumonia and fever. We calculated crude coverage and quality in each survey and used these to estimate effective coverage. The effective coverage should be regarded as an upper bound because there were few available quality measures. We also described equity in effective coverage of these five MCH services over time across the wealth index, area of residence and maternal education using equiplots.ResultsA total of 48 910 women aged 15–49 years and 33 429 children under 5 years were included across the four survey rounds. In 2015, average effective coverage was 33.2% (range 19.9%–44.2%) across all five MCH services, 30.1% (range 19.9%–40.2%) for maternal health services (average of ANC and delivery) and 35.3% (range 27.3%–44.2%) for sick child care (diarrhoea, pneumonia and fever). This is in contrast to crude coverage which averaged 56.5% (range 43.6%–90.7%) across all five MCH services, 67.3% (range 43.9%–90.7%) for maternal health services and 49.2% (range 43.6%–53.9%) for sick child care. Between 2010 and 2015 effective coverage increased by 154.2% (range 127.3%–170.0%) for maternal health services and by 27.4% (range 4.2%–79.6%) for sick child care. These increases were associated with widening socioeconomic inequalities in effective coverage for maternal health services, and narrowing inequalities in effective coverage for sick child care.ConclusionWhile effective coverage of common MCH services generally improved in the MDG era, it still lagged substantially behind crude coverage for the same services due to low-quality care. Overall, effective coverage of MCH services remained suboptimal and inequitable. Policies should focus on improving effective coverage of these services and reducing inequities.
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Niyonsenga, Gaudence, Darius Gishoma, Ruth Sego, Marie Goretti Uwayezu, Bellancille Nikuze, Margaret Fitch, and Pierre Céléstin Igiraneza. "Knowledge, utilization and barriers of cervical cancer screening among women attending selected district hospitals in Kigali - Rwanda." Canadian Oncology Nursing Journal 31, no. 3 (July 22, 2021): 266–74. http://dx.doi.org/10.5737/23688076313266274.
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Background: Cervical cancer is the third most common cancer attacking women globally, and the second in Eastern Africa where Rwanda is located. Regular screening is an effective prevention approach for cervical cancer. Despite that, the screening rate for cervical cancer in Africa is estimated between 10% and 70%, with a number of barriers. This is especially the case in sub-Saharan Africa. In Rwanda, there is limited literature on the rate of use of screening services or the barriers to cervical screening. Objective: To assess knowledge, utilization, and barriers of cervical cancer screening among women attending selected district hospitals in Kigali, Rwanda. Methods: A descriptive cross-sectional study with a structured questionnaire was used to collect data. Nominal ‘yes’ or ‘no’ questions were used to gather data on knowledge and utilisation of cervical cancer and its screening. Likert-type scale questions were used to identify different barriers to screening services. Data were analysed using descriptive and inferential statistics. Respondents were selected by systematic random sampling from the database of women attending gynaecology services at three district hospitals in Kigali, Rwanda. Results: Three hundred and twenty-nine women responded to the survey. Half of the respondents (n = 165) had high knowledge level scores on cervical cancer screening. The cervical cancer screening rate was 28.3%. Utilization of screening was associated with knowledge (P = 0.000, r = -0.392) and selected demographic factors (P = 0.000). Individual barriers included poor knowledge on availability of screening services, community barriers included living in a rural area, and health provider and systems barriers included lack of awareness campaigns, negative attitudes of healthcare providers toward clients, and long waiting times; all barriers limit the access to screening services. Conclusion: A low rate of cervical cancer screening was identified for women attending selected district hospitals in Kigali-Rwanda due to various barriers. On-going education on cervical cancer and its screening is highly recommended. It is important that trained health providers encourage their clients to have cervical cancer screening and work to reduce related barriers.