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Journal articles on the topic 'Primary health care – Rwanda'

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Published: 4 June 2021
Last updated: 1 February 2022

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1

Francois, U., J. P. Balinda, M. Hagenimana, R. Samuel, E. Arielle, and M. A. Muhimpundu. "Scaling Up of Cervical Cancer Screening at Primary Health Care Level in Rwanda." Journal of Global Oncology 4, Supplement 2 (2018): 54s. http://dx.doi.org/10.1200/jgo.18.78700.

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Background: Rwanda is a high cervical cancer-burden country, with an age standardized rate (ASR) of cervical cancer incidence of 41.8 cases per 100,000 people in 2012. In the same year, cervical cancer mortality lay at 26.2 deaths per 100,000 people. Aim: To address this burden, Rwanda initiated the vision inspection with acetic acid (VIA) screening-based strategy in 2013 in line with WHO recommendations for low- and middle-income countries. The target audience of the program was set for women between the ages of 30 and 49 and remains today. Here, we describe the implementation status of the program at the primary health care level; health centers and district hospitals in Rwanda. Methods: Integrating into Rwanda's existing health system, the program was purposefully rooted in health centers, with a pathway designed for women who screen positive to be referred to the district hospital for cryotherapy or LEEP, according to the lesions' size. Nurses, midwives and medical officers from health centers and district hospitals are trained through a 10-day curriculum (5 days for theory and 5 days for practice) before initiating the provision of services to clients in routine care. Monitoring of the program is conducted through both quarterly, on-site mentorship and screening indicators that are integrated into Rwanda's Health Management Information System (HMIS), through which facilities report on monthly basis. Results: Since its initiation in August 2013, Rwanda's cervical cancer screening program has been established in 21 of 38 (55%) district hospitals and 256 health centers in their catchment area. Training has been an integral component as well, with at least two nurses/midwives trained at implementing health centers and a medical officer with two nurses/midwives trained on cervical cancer screening and the treatment of precancerous lesions at district hospital. In addition, district hospitals have been equipped with cryotherapy, LEEP, and colposcopy machines. Over this program's implementation three-and-a-half-year course, 38,000 women have been screened for cervical cancer. Conclusion: Using a simple VIA-based strategy, Rwanda has been able to swiftly and effectively increase the number of health facilities implementing cervical cancer screening program. Though additional innovative implementation strategies are still needed to proportionally increase women's screening coverage, these initial steps hold great promise in Rwanda's ability to effectively implement a sustainable cervical cancer screening program.
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Lygidakis, Charilaos, Jean Paul Uwizihiwe, Per Kallestrup, Michela Bia, Jeanine Condo, and Claus Vögele. "Community- and mHealth-based integrated management of diabetes in primary healthcare in Rwanda (D²Rwanda): the protocol of a mixed-methods study including a cluster randomised controlled trial." BMJ Open 9, no. 7 (2019): e028427. http://dx.doi.org/10.1136/bmjopen-2018-028427.

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IntroductionIn Rwanda, diabetes mellitus prevalence is estimated between 3.1% and 4.3%. To address non-communicable diseases and the shortage of health workforce, the Rwandan Ministry of Health has introduced the home-based care practitioners (HBCPs) programme: laypeople provide longitudinal care to chronic patients after receiving a six-month training. Leveraging technological mobile solutions may also help improve health and healthcare. The D²Rwanda study aims at: (a) determining the efficacy of an integrated programme for the management of diabetes in Rwanda, which will provide monthly patient assessments by HBCPs, and an educational and self-management mHealth patient tool, and; (b) exploring qualitatively the ways the interventions will have been enacted, their challenges and effects, and changes in the patients’ health behaviours and HBCPs’ work satisfaction.Methods and analysisThis is a mixed-methods sequential explanatory study. First, there will be a one-year cluster randomised controlled trial including two interventions ((1) HBCPs’ programme; (2) HBCPs’ programme + mobile health application) and usual care (control). Currently, nine hospitals run the HBCPs’ programme. Under each hospital, administrative areas implementing the HBCPs’ programme will be randomised to receive intervention 1 or 2. Eligible patients from each area will receive the same intervention. Areas without the HBCPs’ programme will be assigned to the control group. The primary outcome will be changes in glycated haemoglobin. Secondary outcomes include medication adherence, mortality, complications, health-related quality of life, diabetes-related distress and health literacy. Second, at the end of the trial, focus group discussions will be conducted with patients and HBCPs. Financial support was received from the Karen Elise Jensens Fond, and the Universities of Aarhus and Luxembourg.Ethics and disseminationEthics approval was obtained from the Rwanda National Ethics Committee and the Ethics Review Panel of the University of Luxembourg. Findings will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberNCT03376607; Pre-results.
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Zraly, Maggie, Julia Rubin-Smith, and Theresa Betancourt. "Primary mental health care for survivors of collective sexual violence in Rwanda." Global Public Health 6, no. 3 (2011): 257–70. http://dx.doi.org/10.1080/17441692.2010.493165.

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4

Kamanzi, Moses. "Community Health Workers and The Promotion of Health Care Services in Gasabo District, Rwanda." Matters of Behaviour 9, no. 10 (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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5

Nyirandagijimana, B., J. K. Edwards, E. Venables, et al. "Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda." Public Health Action 7, no. 3 (2017): 231–36. http://dx.doi.org/10.5588/pha.16.0130.

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6

Price, Jessica E., Jennifer Asuka Leslie, Michael Welsh, and Agnès Binagwaho. "Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects." AIDS Care 21, no. 5 (2009): 608–14. http://dx.doi.org/10.1080/09540120802310957.

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7

Dhillon, Ranu S., Matthew H. Bonds, Max Fraden, Donald Ndahiro, and Josh Ruxin. "The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda." Global Public Health 7, no. 1 (2012): 71–86. http://dx.doi.org/10.1080/17441692.2011.593536.

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8

Ndayisaba, Aphrodis, Emmanuel Harerimana, Ryan Borg, et al. "A Clinical Mentorship and Quality Improvement Program to Support Health Center Nurses Manage Type 2 Diabetes in Rural Rwanda." Journal of Diabetes Research 2017 (December 3, 2017): 1–10. http://dx.doi.org/10.1155/2017/2657820.

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Introduction. The prevalence of diabetes mellitus is rapidly rising in SSA. Interventions are needed to support the decentralization of services to improve and expand access to care. We describe a clinical mentorship and quality improvement program that connected nurse mentors with nurse mentees to support the decentralization of type 2 diabetes care in rural Rwanda. Methods. This is a descriptive study. Routinely collected data from patients with type 2 diabetes cared for at rural health center NCD clinics between January 1, 2013 and December 31, 2015, were extracted from EMR system. Data collected as part of the clinical mentorship program were extracted from an electronic database. Summary statistics are reported. Results. The patient population reflects the rural settings, with low rates of traditional NCD risk factors: 5.6% of patients were current smokers, 11.0% were current consumers of alcohol, and 11.9% were obese. Of 263 observed nurse mentee-patient encounters, mentor and mentee agreed on diagnosis 94.4% of the time. Similarly, agreement levels were high for medication, laboratory exam, and follow-up plans, at 86.3%, 87.1%, and 92.4%, respectively. Conclusion. Nurses that receive mentorship can adhere to a type 2 diabetes treatment protocol in rural Rwanda primary health care settings.
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Ross, Jonathan, Gad Murenzi, Sarah Hill, 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 (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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Huerta Munoz, Ulises, and Carina Källestål. "Geographical accessibility and spatial coverage modeling of the primary health care network in the Western Province of Rwanda." International Journal of Health Geographics 11, no. 1 (2012): 40. http://dx.doi.org/10.1186/1476-072x-11-40.

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11

Smith, Stephanie L., Molly F. Franke, Christian Rusangwa, et al. "Outcomes of a primary care mental health implementation program in rural Rwanda: A quasi-experimental implementation-effectiveness study." PLOS ONE 15, no. 2 (2020): e0228854. http://dx.doi.org/10.1371/journal.pone.0228854.

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Basinga, Paulin, Paul J. Gertler, Agnes Binagwaho, Agnes LB Soucat, Jennifer Sturdy, and Christel MJ Vermeersch. "Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation." Lancet 377, no. 9775 (2011): 1421–28. http://dx.doi.org/10.1016/s0140-6736(11)60177-3.

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13

Müller, Andreas, Janvier Murenzi, Wanjiku Mathenge, Joseph Munana, and Paul Courtright. "Primary eye care in Rwanda: gender of service providers and other factors associated with effective service delivery." Tropical Medicine & International Health 15, no. 5 (2010): 529–33. http://dx.doi.org/10.1111/j.1365-3156.2010.02498.x.

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14

Eberly, Lauren Anne, Christian Rusangwa, Loise Ng'ang'a, et al. "Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda." BMJ Global Health 4, no. 3 (2019): e001449. http://dx.doi.org/10.1136/bmjgh-2019-001449.

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BackgroundIntegrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease.MethodsA retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined.ResultsA total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing.ConclusionsThis is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems.
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Martin, Allison N., Kelly-Mariella Kaneza, Amol Kulkarni, et al. "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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Ng'ang'a, Loise, Gedeon Ngoga, Symaque Dusabeyezu, et al. "Implementation of blood glucose self-monitoring among insulin-dependent patients with type 2 diabetes in three rural districts in Rwanda: 6 months open randomised controlled trial." BMJ Open 10, no. 7 (2020): e036202. http://dx.doi.org/10.1136/bmjopen-2019-036202.

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IntroductionMost patients diagnosed with diabetes in sub-Saharan Africa (SSA) present with poorly controlled blood glucose, which is associated with increased risks of complications and greater financial burden on both the patients and health systems. Insulin-dependent patients with diabetes in SSA lack appropriate home-based monitoring technology to inform themselves and clinicians of the daily fluctuations in blood glucose. Without sufficient home-based data, insulin adjustments are not data driven and adopting individual behavioural change for glucose control in SSA does not have a systematic path towards improvement.Methods and analysisThis study explores the feasibility and impact of implementing self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes in rural Rwandan districts. This is an open randomised controlled trial comprising of two arms: (1) Intervention group—participants will receive a glucose metre, blood test strips, logbook, waste management box and training on how to conduct SMBG in additional to usual care and (2) Control group—participants will receive usual care, comprising of clinical consultations and routine monthly follow-up. We will conduct qualitative interviews at enrolment and at the end of the study to assess knowledge of diabetes. At the end of the study period, we will interview clinicians and participants to assess the perceived usefulness, facilitators and barriers of SMBG. The primary outcomes are change in haemoglobin A1c, fidelity to SMBG protocol by patients, appropriateness and adverse effects resulting from SMBG. Secondary outcomes include reliability and acceptability of SMBG and change in the quality of life of the participants.Ethics and disseminationThis study has been approved by the Rwanda National Ethics Committee (Kigali, Rwanda No.102/RNEC/2018). We will disseminate the findings of this study through presentations within our study settings, scientific conferences and publication in a peer-reviewed journal.Trial registration numberPACTR201905538846394; pre-results.
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Baumann, Ana A., Cole Hooley, Charles W. Goss, et al. "Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda: a cross-sectional study using the COACH questionnaire." BMJ Open 11, no. 9 (2021): e048425. http://dx.doi.org/10.1136/bmjopen-2020-048425.

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ImportanceHypertension is the largest contributor to the Global Burden of Disease. In Rwanda, as in most low-income and middle-income countries, an increasing prevalence of hypertension and its associated morbidity and mortality is causing major healthcare and economic impact. Understanding healthcare systems context in hypertension care is necessary.ObjectiveTo study the hypertension healthcare context as perceived by healthcare providers using the Context Assessment for Community Health (COACH) tool.DesignA cross-sectional cohort responded to the COACH questionnaire and a survey about hypertension training.SettingThree tertiary care hospitals in Rwanda.ParticipantsHealthcare professionals (n=223).Primary outcome(s) and measure(s)The COACH tool consists of 49 items with eight subscales: resources, community engagement, commitment to work, informal payment, leadership, work culture, monitoring services for action (5-point Likert Scale) and sources of knowledge (on a 0–1 scale). Four questions surveyed training on hypertension.ResultsResponders (n=223, 75% women; 56% aged 20–35 years) included nurses (n=142, 64%, midwives (n=42, 19%), primary care physicians (n=28, 13%) and physician specialists (n=11, 5%)). The subscales commitment to work, leadership, work culture and informal payment scored between 4.7 and 4.1 and the community engagement, monitoring services for action and organizational resources scored between 3.1 and 3.5. Sources of knowledge had a mean score of 0.6±0.3. While 73% reported having attended a didactic hypertension seminar in the past year, only 28% had received long-term training and 51% had <3-year experience working with hypertension care delivery. The majority (99%) indicated a need for additional training in hypertension care.ConclusionsThere is a need for increased and continuous training in Rwanda. Healthcare responders stated a commitment to work and reported supportive leadership, while acknowledging limited resources and no monitoring systems. The COACH tool provides contextual guidance to develop training strategies prior to the implementation of a sustainable hypertension care programme.
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Smith, Stephanie L., Claire Nancy Misago, Robyn A. Osrow, et al. "Evaluating process and clinical outcomes of a primary care mental health integration project in rural Rwanda: a prospective mixed-methods protocol." BMJ Open 7, no. 2 (2017): e014067. http://dx.doi.org/10.1136/bmjopen-2016-014067.

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Murekatete, Fatuma, Claudine Muteteli, Françoise Mujawamariya, and Geldine Chironda. "Low Birth Weight Newborns and Associated Factors at Selected Referral Hospital in Rwanda." Rwanda Journal of Medicine and Health Sciences 3, no. 2 (2020): 214–24. http://dx.doi.org/10.4314/rjmhs.v3i2.11.

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Background
 Low birth weight (LBW) is a major public health problem worldwide that is linked to childhood morbidity and mortality. Newborns considered ‘Very LBW’ have a high risk of disease and death during infancy. Maternal socioeconomic status, medical factors, and lifestyle are linked to LBW, but these factors remain unknown in Rwanda is unknown.
 Objective
 To describe the factors associated with LBW among newborns at a selected referral hospital in Rwanda.
 Methods
 A prospective, cross-sectional design study was used to assess 108 mothers who delivered a low birth weight newborn.
 Results
 Mothers had a mean age of 30.6 years, 79.6% married, 23.1% primary educated, 50.6% unemployed, and 61.9% lived in a rural area. The majority of LBW (63%) were in the first category of LBW (2500-1500g), and over a quarter (25.9%) with Very LBW (VLBW). Mothers were 89.7% multigravida, and 88.8% had a previous unsuccessful pregnancy, 81.3% premature birth, 97.9% LBW. Over half, 59.8% had hypertension during pregnancy. Lifestyle included 45.5% doing strenuous work, and 50.9% heavy lifting during pregnancy. The level of education (p=0.009), spouse employment (p=0.017), having previous premature baby (p=0.025), previous history of miscarriage (p=0.028), presence of hypertension (p=0.020) and antenatal care visits (p=0.025) the trimester of miscarriage were significantly associated to type of low birth weight.
 Conclusion
 Demographic, pregnancy history and lifestyle factors remain a concern to mothers and neonates born with low birth weight. Educational awareness campaigns among mothers with the factors above are crucial to reduce morbidity and mortality related to low birth weight.
 Rwanda J Med Health Sci 2020;3(2):214-224
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20

Musange, Sabine Furere, Elizabeth Butrick, Tiffany Lundeen, et al. "Group antenatal care versus standard antenatal care and effect on mean gestational age at birth in Rwanda: protocol for a cluster randomized controlled trial." Gates Open Research 3 (September 27, 2019): 1548. http://dx.doi.org/10.12688/gatesopenres.13053.1.

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Background: Group antenatal care has demonstrated promise as a service delivery model that may result in improved outcomes compared to standard antenatal care in socio-demographic populations at disparately high risk for poor perinatal outcomes. Intrigued by results from the United States showing lower preterm birth rates among high-risk women who participate in group antenatal care, partners working together as the Preterm Birth Initiative - Rwanda designed a trial to assess the impact of group antenatal care on gestational age at birth. Methods: This study is a pair-matched cluster randomized controlled trial with four arms. Pairs randomized to group or standard care were further matched with other pairs into quadruples, within which one pair was assigned to implement basic obstetric ultrasound at the health center and early pregnancy testing at the community. At facilities randomized to group care, this will follow the opt-out model of service delivery and individual visits will always be available for those who need or prefer them. The primary outcome of interest is mean gestational age at birth among women who presented for antenatal care before 24 completed weeks of pregnancy and attended more than one antenatal care visit. Secondary outcomes of interest include attendance at antenatal and postnatal care, preterm birth rates, satisfaction of mothers and providers, and feasibility. A convenience sample of women will be recruited to participate in a longitudinal survey in which they will report such indicators as self-reported health-related behaviors and depressive symptoms. Providers will be surveyed about satisfaction and stress. Discussion: This is the largest cluster randomized controlled trial of group antenatal and postnatal care ever conducted, and the first in a low- or middle-income country to examine the effect of this model on gestational age at birth. Trial registration: This study is registered on ClinicalTrials.gov as NCT03154177 May 16, 2017.
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Schmidt, Christina N., Elizabeth Butrick, Sabine Musange, Nathalie Mulindahabi, and Dilys Walker. "Towards stronger antenatal care: Understanding predictors of late presentation to antenatal services and implications for obstetric risk management in Rwanda." PLOS ONE 16, no. 8 (2021): e0256415. http://dx.doi.org/10.1371/journal.pone.0256415.

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Background Early antenatal care (ANC) reduces maternal and neonatal morbidity and mortality through identification of pregnancy-related complications, yet 44% of Rwandan women present to ANC after 16 weeks gestational age (GA). The objective of this study was to identify factors associated with delayed initiation of ANC and describe differences in the obstetric risks identified at the first ANC visit (ANC-1) between women presenting early and late to care. Methods This secondary data analysis included 10,231 women presenting for ANC-1 across 18 health centers in Rwanda (May 2017-December 2018). Multivariable logistic regression models were constructed using backwards elimination to identify predictors of presentation to ANC at ≥16 and ≥24 weeks GA. Logistic regression was used to examine differences in obstetric risk factors identified at ANC-1 between women presenting before and after 16- and 24-weeks GA. Results Sixty-one percent of women presented to ANC at ≥16 weeks and 24.7% at ≥24 weeks GA, with a mean (SD) GA at presentation of 18.9 (6.9) weeks. Younger age (16 weeks: OR = 1.36, 95% CI: 1.06, 1.75; 24 weeks: OR = 1.33, 95% CI: 0.95, 1.85), higher parity (16 weeks: 1–4 births, OR = 1.55, 95% CI: 1.39, 1.72; five or more births, OR = 2.57, 95% CI: 2.17, 3.04; 24 weeks: 1–4 births, OR = 1.93, 95% CI: 1.78, 2.09; five or more births, OR = 3.20, 95% CI: 2.66, 3.85), lower educational attainment (16 weeks: primary, OR = 0.75, 95% CI: 0.65, 0.86; secondary, OR = 0.60, 95% CI: 0.47,0.76; university, OR = 0.48, 95% CI: 0.33, 0.70; 24 weeks: primary, OR = 0.64, 95% CI: 0.53, 0.77; secondary, OR = 0.43, 95% CI: 0.29, 0.63; university, OR = 0.12, 95% CI: 0.04, 0.32) and contributing to household income (16 weeks: OR = 1.78, 95% CI: 1.40, 2.25; 24 weeks: OR = 1.91, 95% CI: 1.42, 2.55) were associated with delayed ANC-1 (≥16 and ≥24 weeks GA). History of a spontaneous abortion (16 weeks: OR = 0.74, 95% CI: 0.66, 0.84; 24 weeks: OR = 0.70, 95% CI: 0.58, 0.84), pregnancy testing (16 weeks: OR = 0.48, 95% CI: 0.33, 0.71; 24 weeks: OR = 0.41, 95% CI: 0.27, 0.61; 24 weeks) and residing in the same district (16 weeks: OR = 1.55, 95% CI: 1.08, 2.22; 24 weeks: OR = 1.73, 95% CI: 1.04, 2.87) or catchment area (16 weeks: OR = 1.53, 95% CI: 1.05, 2.23; 24 weeks: OR = 1.84, 95% CI: 1.28, 2.66; 24 weeks) as the health facility were protective against delayed ANC-1. Women with a prior preterm (OR, 0.71, 95% CI, 0.53, 0.95) or low birthweight delivery (OR, 0.72, 95% CI, 0.55, 0.95) were less likely to initiate ANC after 16 weeks. Women with no obstetric history were more likely to present after 16 weeks GA (OR, 1.18, 95% CI, 1.06, 1.32). Conclusion This study identified multiple predictors of delayed ANC-1. Focusing existing Community Health Worker outreach efforts on the populations at greatest risk of delaying care and expanding access to home pregnancy testing may improve early care attendance. While women presenting late to care were less likely to present without an identified obstetric risk factor, lower than expected rates were identified in the study population overall. Health centers may benefit from provider training and standardized screening protocols to improve identification of obstetric risk factors at ANC-1.
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Ntacyabukura, B. "Childhood Cancer Early Detection Training Program for Primary Healthcare Providers." Journal of Global Oncology 4, Supplement 2 (2018): 135s. http://dx.doi.org/10.1200/jgo.18.12500.

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Background and context: Over 250,000 new pediatric cancer cases are diagnosed yearly worldwide. Health care providers (mainly nurses) at health centers (HC) level are the children´s first opportunity for correctly recognizing and responding to early signs and symptoms of childhood cancers by appropriately referring them to district hospitals but studies show that 83% of nurses did not receive training on pediatric cancers. Insufficient knowledge about the warning signs and symptoms of pediatric cancer usually leads to improper diagnosis or delay to diagnosis and hence loss of many lives of these children. After realizing that majority in our community lack information on childhood cancers, our efforts since 2017 has been concentrated on training primary healthcare providers to recognize early signs and symptoms of childhood cancers. Aim: Improve survival of children with cancer by early detection of symptoms and signs and prompt referral by nurses at health centers. Strategy/Tactics: The program is consisted of trainings in selected regions of Rwanda. The first step is a “train the trainer workshop” where volunteering medical students and doctors are trained to train the nurses and community health workers. A two days workshop is organized subsequently in each province bringing together at least with one nurse from each selected health center. These trained nurses go back with materials to train their colleagues. They are followed up every three months with a survey to assess how much they retain the learned knowledge and the impact made. Prior to trainings, RCCR and pediatric oncologists develop training materials that include training curriculum for both the trainers and for the trainees (nurses), educational and awareness material (posters, fliers, brochures). Trained nurses are kept in RCCR database for their follow-up and track any case of a childhood cancer at their health facilities. Program/Policy process: The program is run in 4 phases, Phase 1: Develop training materials materials Phase 2: Recruitment and train the trainer phase Phase 3: Selection of health center and recruitment of healthcare providers Phase 4: The execution phase. Trainings are carried out in selected health centers. Phase 5: Post training follow-up. Outcomes: In 2017, the program was conducted in 4 health centers and around 90 health care providers were trained with more than 800 posters, 950 brochures and 300 flyers distributed. According to reports, after the training, the number of referrals from health centers increased and the posttraining showed how accurate nurses were in stating their differential diagnoses. What was learned: Childhood cancers are curable when detected and treated early, there is a need to build strong partnerships with private and public sectors to address the challenge of early detection and late presentation at the hospital because the program of training primary healthcare providers showed a good impact.
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Majyambere, Onesphore, Andrew K. Nyerere, Louis S. Nkaka, Nadine Rujeni, and Raphael L. Wekessa. "Prevalence and Genetic Diversity of Hepatitis B and C Viruses Among Couples Attending Antenatal Care in a Rural Community in Rwanda." East Africa Science 1, no. 1 (2019): 23–29. http://dx.doi.org/10.24248/easci.v1.iss1.15.

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Background: Globally, over 325 and 170 million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), respectively. If untreated, these infections can progress to cirrhosis or hepatocellular carcinoma. The primary aim of this study was to determine the prevalence, genetic diversity, and factors associated with HBV and HCV among couples attending antenatal care in rural Rwanda. Methods: This was a cross-sectional survey of HBV and HCV seroprevalence. Study participants were administered a brief structured questionnaire to obtain information on sociodemographic and behavioural risk factors for HBV and HCV. Participant blood samples were screened for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies (anti-HCV) using rapid diagnostic kits; confirmatory testing was done by enzyme immunoassay and nucleic acid tests. HBV genotypes were determined using nested polymerase chain reaction; HCV genotypes were determined by reverse transcriptase PCR followed by hybridisation with sequence-specific oligonucleotides. Statistical associations between risk factors and infection status were determined using Chi-square tests and bivariate logistic regression. Results: In total, 220 individuals participated in the study. This includes 110 pregnant women and 110 male partners who were attending antenatal care at Gitare and Cyanika health centres. Two participants (0.9%) had serological evidence of HBV infection, and 4 participants (1.8%) were infected with HCV. HBV genotype A accounted for all HBV infections; HCV genotype 4 accounted for all HCV infections. None of the assessed factors were associated with HBV infection while occupation type and scarification were significantly associated with HCV infection (P values were .03 and <.01 respectively). All cases of infection were discordant with their respective partners. Conclusion: Prevalence rates of HBsAg and anti-HCV are low in couples attending antenatal clinics in rural Rwanda. Consideration should be given to interventions aimed at reducing the risk of transmission in discordant couples and infants of infected mothers.
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Majyambere, Onesphore, Andrew K. Nyerere, Louis S. Nkaka, Nadine Rujeni, and Raphael L. Wekessa. "Prevalence and Genetic Diversity of Hepatitis B and C Viruses Among Couples Attending Antenatal Care in a Rural Community in Rwanda." East Africa Science 1, no. 1 (2019): 23–29. http://dx.doi.org/10.24248/easci.v1.iss1.6.

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Background: Globally, over 325 and 170 million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), respectively. If untreated, these infections can progress to cirrhosis or hepatocellular carcinoma. The primary aim of this study was to determine the prevalence, genetic diversity, and factors associated with HBV and HCV among couples attending antenatal care in rural Rwanda. Methods: This was a cross-sectional survey of HBV and HCV seroprevalence. Study participants were administered a brief structured questionnaire to obtain information on sociodemographic and behavioural risk factors for HBV and HCV. Participant blood samples were screened for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies (anti-HCV) using rapid diagnostic kits; confirmatory testing was done by enzyme immunoassay and nucleic acid tests. HBV genotypes were determined using nested polymerase chain reaction; HCV genotypes were determined by reverse transcriptase PCR followed by hybridisation with sequence-specific oligonucleotides. Statistical associations between risk factors and infection status were determined using Chi-square tests and bivariate logistic regression. Results: In total, 220 individuals participated in the study. This includes 110 pregnant women and 110 male partners who were attending antenatal care at Gitare and Cyanika health centres. Two participants (0.9%) had serological evidence of HBV infection, and 4 participants (1.8%) were infected with HCV. HBV genotype A accounted for all HBV infections; HCV genotype 4 accounted for all HCV infections. None of the assessed factors were associated with HBV infection while occupation type and scarification were significantly associated with HCV infection (P values were .03 and <.01 respectively). All cases of infection were discordant with their respective partners. Conclusion: Prevalence rates of HBsAg and anti-HCV are low in couples attending antenatal clinics in rural Rwanda. Consideration should be given to interventions aimed at reducing the risk of transmission in discordant couples and infants of infected mothers.
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Majyambere, Onesphore, Andrew K. Nyerere, Louis S. Nkaka, Nadine Rujeni, and Raphael L. Wekessa. "Prevalence and Genetic Diversity of Hepatitis B and C Viruses Among Couples Attending Antenatal Care in a Rural Community in Rwanda." East Africa Science 1, no. 1 (2019): 23–29. http://dx.doi.org/10.24248/easci.v1i1.6.

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Background: Globally, over 325 and 170 million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), respectively. If untreated, these infections can progress to cirrhosis or hepatocellular carcinoma. The primary aim of this study was to determine the prevalence, genetic diversity, and factors associated with HBV and HCV among couples attending antenatal care in rural Rwanda. Methods: This was a cross-sectional survey of HBV and HCV seroprevalence. Study participants were administered a brief structured questionnaire to obtain information on sociodemographic and behavioural risk factors for HBV and HCV. Participant blood samples were screened for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies (anti-HCV) using rapid diagnostic kits; confirmatory testing was done by enzyme immunoassay and nucleic acid tests. HBV genotypes were determined using nested polymerase chain reaction; HCV genotypes were determined by reverse transcriptase PCR followed by hybridisation with sequence-specific oligonucleotides. Statistical associations between risk factors and infection status were determined using Chi-square tests and bivariate logistic regression. Results: In total, 220 individuals participated in the study. This includes 110 pregnant women and 110 male partners who were attending antenatal care at Gitare and Cyanika health centres. Two participants (0.9%) had serological evidence of HBV infection, and 4 participants (1.8%) were infected with HCV. HBV genotype A accounted for all HBV infections; HCV genotype 4 accounted for all HCV infections. None of the assessed factors were associated with HBV infection while occupation type and scarification were significantly associated with HCV infection (P values were .03 and <.01 respectively). All cases of infection were discordant with their respective partners. Conclusion: Prevalence rates of HBsAg and anti-HCV are low in couples attending antenatal clinics in rural Rwanda. Consideration should be given to interventions aimed at reducing the risk of transmission in discordant couples and infants of infected mothers.
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Arinitwe, Richard, Alice Willson, Sean Batenhorst, and Peter T. Cartledge. "Using a Global Health Media Project Video to Increase Knowledge and Confidence in the Mothers of Admitted Neonates in Rwanda: A Prospective Interventional Study." Journal of Tropical Pediatrics 66, no. 2 (2019): 136–43. http://dx.doi.org/10.1093/tropej/fmz042.

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Abstract Introduction In resource-limited settings, the ratio of trained health care professionals to admitted neonates is low. Parents therefore, frequently need to provide primary neonatal care. In order to do so safely, they require effective education and confidence. The evolution and availability of technology mean that video education is becoming more readily available in this setting. Aim This study aimed to investigate whether showing a short video on a specific neonatal topic could change the knowledge and confidence of mothers of admitted neonates. Methods A prospective interventional study was conducted in two hospitals in Kigali, Rwanda. Mothers of admitted neonates at a teaching hospital and a district hospital were invited to participate. Fifty-nine mothers met the inclusion criteria. Participants were shown ‘Increasing Your Milk Supply, for mothers’ a seven-minute Global Health Media Project video in the local language (Kinyarwanda). Before and after watching the video, mothers completed a Likert-based questionnaire which assessed confidence and knowledge on the subject. Results Composite Likert scores showed a statistically significant increase in knowledge (pre = 27.2, post = 33.2, p < 0.001) and confidence (pre = 5.9, post = 14.2, p < 0.001). Satisfaction levels were high regarding the video content, language and quality. However, only 10% of mothers owned a smartphone. Discussion We have shown that maternal confidence and knowledge on a specific neonatal topic can be increased through the use of a short video and these videos have the potential to improve the quality of care provided to admitted neonates by their parents in low-resource settings.
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Pace, Lydia E., Jean-Marie Vianney Dusengimana, Nancy L. Keating, et al. "Impact of Breast Cancer Early Detection Training on Rwandan Health Workers’ Knowledge and Skills." Journal of Global Oncology, no. 4 (December 2018): 1–10. http://dx.doi.org/10.1200/jgo.17.00098.

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Purpose In April 2015, we initiated a training program to facilitate earlier diagnosis of breast cancer among women with breast symptoms in rural Rwanda. The goal of this study was to assess the impact of the training intervention in breast cancer detection on knowledge and skills among health center nurses and community health workers (CHWs). Methods We assessed nurses’ and CHWs’ knowledge about breast cancer risk factors, signs and symptoms, and treatability through a written test administered immediately before, immediately after, and 3 months after trainings. We assessed nurses’ skills in clinical breast examination immediately before and after trainings and then during ongoing mentorship by a nurse midwife. We also examined the appropriateness of referrals made to the hospital by health center nurses. Results Nurses’ and CHWs’ written test scores improved substantially after the trainings (overall percentage correct increased from 73.9% to 91.3% among nurses and from 75.0% to 93.8% among CHWs ( P < .001 for both), and this improvement was sustained 3 months after the trainings. On checklists that assessed skills, nurses’ median percentage of actions performed correctly was 24% before the training. Nurses’ skills improved significantly after the training and were maintained during the mentorship period (the median score was 88% after training and during mentorship; P < .001). In total, 96.1% of patients seen for breast concerns at the project’s hospital-based clinic were deemed to have been appropriately referred. Conclusion Nurses and CHWs demonstrated substantially improved knowledge about breast cancer and skills in evaluating and managing breast concerns after brief trainings. With adequate training, mentorship, and established care delivery and referral systems, primary health care providers in sub-Saharan Africa can play a critical role in earlier detection of breast cancer.
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Gatabazi, P., S. F. Melesse, and S. Ramroop. "Multiple Events Model for the Infant Mortality at Kigali University Teaching Hospital." Open Public Health Journal 11, no. 1 (2018): 464–73. http://dx.doi.org/10.2174/1874944501811010464.

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Introduction: The present study applies multiple events survival analysis to infant mortality at the Kigali University Teaching Hospital (KUTH) in Rwanda. Materials and Methods: The primary dataset consists of newborns from KUTH recorded in the year 2016 and in the current paper, a complete case analysis was used. Two events per subject were modeled namely death and the occurrence of at least one of the following conditions that may also cause long-term death to infants such as severe oliguria, severe prematurity, very low birth weight, macrosomia, severe respiratory distress, gastroparesis, hemolytic, trisomy, asphyxia and laparoschisis. Covariates of interest include demographic covariates namely the age and the place of residence for parents; clinical covariates for parents include obstetric antecedents, type of childbirth and previous abortion. Clinical covariates for babies include APGAR, gender, number of births at a time, weight, circumference of the head, and height. Results/Conclusion: The results revealed that Wei, Lin and Weissfeld Model (WLWM) fit the data well. The covariates age, abortion, gender, number, APGAR, weight and head were found to have a significant effect.
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van Griensven, Johan, Rony Zachariah, Jules Mugabo, and Tony Reid. "Weight loss after the first year of stavudine-containing antiretroviral therapy and its association with lipoatrophy, virological failure, adherence and CD4 counts at primary health care level in Kigali, Rwanda." Transactions of the Royal Society of Tropical Medicine and Hygiene 104, no. 12 (2010): 751–57. http://dx.doi.org/10.1016/j.trstmh.2010.08.016.

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Manyuat, Adut Jervase, Kashi Carasso, and Mulatedzi Makhado. "Assessment of Storage and Inventory Practices to Improve Medicine Supply Chain in Jubek State South Sudan." Rwanda Journal of Medicine and Health Sciences 4, no. 2 (2021): 310–20. http://dx.doi.org/10.4314/rjmhs.v4i2.9.

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BackgroundIn order to deliver quality health services, safe, effective, affordable and quality medicines are needed. Inappropriate storage conditions, poor infrastructure and poor medicine management practices may lead to poor medicines quality, stock damage and expiration.ObjectiveAssess storage and inventory practices to improve the medicine supply chain in South Sudan.MethodologyThe study used a descriptive cross-sectional design. The study population comprised 12 Health Centers in Juba where inventory management was practiced. Both questionnaire‐guided interviews for staff self‐assessment, and observer assessment were used by the researcher. With regard to storage and inventory management, the researcher collected data on the condition of storerooms with regards to availability of enough storage space, availability of enough storage equipment, and temperature conditions of the medicines stores, among others.ResultsThe study found that store and inventory management practices varied widely in the different health facilities. Hospitals and central medical stores exhibited good or average inventory and storeroom management practices, respectively. The two hospitals and medical stores scored 100% in the elements in the assessment of storerooms and stock management. Some primary health care centers exhibited good inventory and store room management practice, whilst others were rated as average or poor. Most of the elements assessed scored 37% in storeroom assessment while elements assessed for inventory management scored less than 75%. There was great similarity between the observation assessment and the self-assessment.ConclusionIn conclusion, store and inventory management practices and knowledge of the respondents varied in the different health facilities. Hospitals and central medical stores exhibited good, average and poor inventory and storeroom management practices assessed through self-assessment and observation assessment by the researcher. There was a great similarity between the observation assessment and the self-assessment.
 Rwanda J Med Health Sci 2021;4(2): 310-320
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Meeks, V. I., M. N. Johnson, R. E. Salzman, and S. Yoon. "Developing an oral health care curriculum for Rwandan primary school-aged children using the classroom teachers in a non-traditional manner to promote life-long oral health knowledge and practices." Annals of Global Health 82, no. 3 (2016): 482. http://dx.doi.org/10.1016/j.aogh.2016.04.319.

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Alexander, Lisa Mustone. "Primary Care Workforce Needs in Rwanda." Journal of Physician Assistant Education 21, no. 1 (2010): 45–48. http://dx.doi.org/10.1097/01367895-201021010-00010.

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Alexander, Lisa Mustone. "Primary Care Workforce Needs in Rwanda." Journal of Physician Assistant Education 21, no. 1 (2014): 45–48. http://dx.doi.org/10.1097/01367895-201421010-00010.

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34

Bliznashka, Lilia, Ifeyinwa E. Udo, Christopher R. Sudfeld, Wafaie W. Fawzi, and Aisha K. Yousafzai. "Associations between women’s empowerment and child development, growth, and nurturing care practices in sub-Saharan Africa: A cross-sectional analysis of demographic and health survey data." PLOS Medicine 18, no. 9 (2021): e1003781. http://dx.doi.org/10.1371/journal.pmed.1003781.

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Background Approximately 40% of children 3 to 4 years of age in low- and middle-income countries have suboptimal development and growth. Women’s empowerment may help provide inputs of nurturing care for early development and growth by building caregiver capacity and family support. We examined the associations between women’s empowerment and child development, growth, early learning, and nutrition in sub-Saharan Africa (SSA). Methods and findings We pooled data on married women (15 to 49 years) and their children (36 to 59 months) from Demographic and Health Surveys that collected data on child development (2011 to 2018) in 9 SSA countries (N = 21,434): Benin, Burundi, Cameroon, Chad, Congo, Rwanda, Senegal, Togo, and Uganda. We constructed a women’s empowerment score using factor analysis and assigned women to country-specific quintile categories. The child outcomes included cognitive, socioemotional, literacy–numeracy, and physical development (Early Childhood Development Index), linear growth (height-for-age Z-score (HAZ) and stunting (HAZ <−2). Early learning outcomes were number of parental stimulation activities (range 0 to 6) and learning resources (range 0 to 4). The nutrition outcome was child dietary diversity score (DDS, range 0 to 7). We assessed the relationship between women’s empowerment and child development, growth, early learning, and nutrition using multivariate generalized linear models. On average, households in our sample were large (8.5 ± 5.7 members) and primarily living in rural areas (71%). Women were 31 ± 6.6 years on average, 54% had no education, and 31% had completed primary education. Children were 47 ± 7 months old and 49% were female. About 23% of children had suboptimal cognitive development, 31% had suboptimal socioemotional development, and 90% had suboptimal literacy–numeracy development. Only 9% of children had suboptimal physical development, but 35% were stunted. Approximately 14% of mothers and 3% of fathers provided ≥4 stimulation activities. Relative to the lowest quintile category, children of women in the highest empowerment quintile category were less likely to have suboptimal cognitive development (relative risk (RR) 0.89; 95% confidence interval (CI) 0.80, 0.99), had higher HAZ (mean difference (MD) 0.09; 95% CI 0.02, 0.16), lower risk of stunting (RR 0.93; 95% CI 0.87, 1.00), higher DDS (MD 0.17; 95% CI 0.06, 0.29), had 0.07 (95% CI 0.01, 0.13) additional learning resources, and received 0.16 (95% CI 0.06, 0.25) additional stimulation activities from their mothers and 0.23 (95% CI 0.17 to 0.29) additional activities from their fathers. We found no evidence that women’s empowerment was associated with socioemotional, literacy–numeracy, or physical development. Study limitations include the possibility of reverse causality and suboptimal assessments of the outcomes and exposure. Conclusions Women’s empowerment was positively associated with early child cognitive development, child growth, early learning, and nutrition outcomes in SSA. Efforts to improve child development and growth should consider women’s empowerment as a potential strategy.
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Pettigrew, Luisa M., and Ronald MacVicar. "Overcoming challenges in primary care education: stories from Rwanda." Education for Primary Care 26, no. 5 (2015): 342. http://dx.doi.org/10.1080/14739879.2015.1079968.

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36

Carney, Andrew. "Lack of care in Rwanda." British Journal of Psychiatry 165, no. 4 (1994): 556. http://dx.doi.org/10.1192/bjp.165.4.556a.

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Maurice, John. "Faith-based organisations bolster health care in Rwanda." Lancet 386, no. 9989 (2015): 123–24. http://dx.doi.org/10.1016/s0140-6736(15)61213-2.

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38

Bright, Tess, Hannah Kuper, David Macleod, David Musendo, Peter Irunga, and Jennifer L. Y. Yip. "Population need for primary eye care in Rwanda: A national survey." PLOS ONE 13, no. 5 (2018): e0193817. http://dx.doi.org/10.1371/journal.pone.0193817.

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39

Wilkin, David. "Primary Health Care." Ageing and Society 6, no. 3 (1986): 359–61. http://dx.doi.org/10.1017/s0144686x00006024.

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Plant, Paul. "Primary Health Care." Ageing and Society 10, no. 1 (1990): 109–12. http://dx.doi.org/10.1017/s0144686x0000790x.

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Wilkin, David. "Primary Health Care." Ageing and Society 5, no. 4 (1985): 470–73. http://dx.doi.org/10.1017/s0144686x00012046.

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42

MCELMURRY, BEVERLY J. "Primary Health Care." Annual Review of Nursing Research 17, no. 1 (1999): 241–68. http://dx.doi.org/10.1891/0739-6686.17.1.241.

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Primary Health Care (PHC) has been promulgated for over two decades as a global strategy for ensuring basic health care for all people. PHC is characterized by equity, accessibility, availability of resources, social participation, intersectoral community action, and cultural sensitivity. While PHC can be discussed as philosophy or a process, it is critical that PHC be understood as a community focus in health care that differs from a primary care focus on individuals. Capturing PHC components in community-based interventions in order to advance the development of a rigorous research base requires a shift in thinking about what constitutes acceptable methods and evidence for evaluating changes in health care. To this end, the authors of this review discuss perspectives and available research that inform practice within multidisciplinary teams, highlight the importance of social discourse, and review participatory evaluation issues for achieving a working relationship with communities. Particular attention is focused on education for nurses’ roles in PHC activities within implementation models fostering community mobilization and development. An action plan is suggested as a means for situating discrete research activity within a PHC framework.
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Kar, S. B. "Primary health care." Academic Medicine 65, no. 5 (1990): 301–6. http://dx.doi.org/10.1097/00001888-199005000-00006.

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Davidson, Patricia, Judith MacIntosh, Dianne McCormack, and Evelyn Morrison. "Primary Health Care." Holistic Nursing Practice 16, no. 4 (2002): 65–74. http://dx.doi.org/10.1097/00004650-200207000-00010.

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Fleetwood, Tony, Vi Wagner, Ben Brazellc, and Bernie Callan. "Primary health care." Nursing Standard 4, no. 23 (1990): 41. http://dx.doi.org/10.7748/ns.4.23.41.s47.

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Leslie, Laurel K., Christopher J. Mehus, J. David Hawkins, et al. "Primary Health Care." American Journal of Preventive Medicine 51, no. 4 (2016): S106—S118. http://dx.doi.org/10.1016/j.amepre.2016.05.014.

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Sharan, Sudhir. "Primary Health Care." Journal of Health Management 7, no. 2 (2005): 295–302. http://dx.doi.org/10.1177/097206340500700209.

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Goodman, Mark. "Primary health care." Veterinary Record 177, no. 1 (2015): 24.3–24. http://dx.doi.org/10.1136/vr.h3571.

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Allan, Ross. "Primary health care." Veterinary Record 177, no. 3 (2015): 80.2–80. http://dx.doi.org/10.1136/vr.h3842.

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Haque, Azizul, Bourèma Kouriba, N’diaye Aïssatou, and Anudeep Pant. "Eliminating Cervical Cancer in Mali and Senegal, Two Sub-Saharan Countries: Insights and Optimizing Solutions." Vaccines 8, no. 2 (2020): 181. http://dx.doi.org/10.3390/vaccines8020181.

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Background: The number of cases with cervical cancer is rapidly increasing in Sub-Saharan Africa driven by inadequate rates of human papilloma virus (HPV) vaccination and screening programs and accompanied by poor health delivery systems. There are other factors to contend with such as lack of awareness, social myths, reluctance to vaccine acceptance and stigma with sexually transmitted diseases. Here, we formulate strategies to implement intervention programs against HPV infections and other risk factors for cervical cancer in these countries. Methods: We searched PubMed, Web of Science, and African Journals Online for this review. The current status of anti-HPV vaccination and precancerous screening programs in Mali and Senegal has been assessed by onsite visits. Collaborators from Mali and Senegal collected data and information concerning HPV vaccination and screening programs in these countries. Findings: We found that anti-HPV vaccination and cervical cancer screening have been conducted sporadically mainly in urban areas of Mali and Senegal. No known population-based programs are in progress in either of the two countries. We highlighted the advantages and drawbacks of currently available screening tests and proposed that screening by visual inspection with acetic acid (VIA) accompanied by self-sampling is the most cost-effective, culturally acceptable and most feasible strategy to implement in primary care settings. In addition, HPV DNA testing would be affordable, if local laboratory facilities could be established. We found that many of the factors that increase HPV acquisition and promote the oncogenic effect of the virus are largely widespread in both Senegal and Mali. These include infections with HIV and other sexually transmitted infections (STIs), immunosuppression, polygamous marriages, high parity, early sexual activities, early pregnancies, and multiple sexual partners. Interpretation: Neither vaccines nor screening tests are within the reach of the population in Mali and Senegal because of the high cost. The effective intervention measure would be to integrate anti-HPV vaccines into the Extended Program for Immunization (EPI), which has saved 3 million young lives per year in Africa with the support of GAVI, to implement cost control mechanisms for HPV vaccinations via price negotiations with manufacturing companies, as has recently been done by Rwanda. The collective efforts by local governments, researchers, private sector, and donors may lead to the introduction of affordable screening tests. A robust awareness campaign coupled with sustained and regular engagement of local communities about the prevention and risk factors is extremely important. The projected solutions may be well applicable to other Sub-Saharan countries that face similar challenges containing cervical cancer.
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