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Robson, Julia, James Bao, Alissa Wang, Heather McAlister, Jean-Paul Uwizihiwe, Felix Sayinzoga, Hassan Sibomana, Kirstyn Koswin, Joseph Wong, and Stanley Zlotkin. "Making sense of Rwanda’s remarkable vaccine coverage success." International Journal of Healthcare 6, no. 1 (February 26, 2020): 56. http://dx.doi.org/10.5430/ijh.v6n1p56.
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After the Rwandan genocide in 1994, vaccine coverage was close to zero. Several factors, including extreme poverty, rural populations and mountainous geography affect Rwandans’ access to immunizations. Post-conflict, various other factors were identified, including the lack of immunization program infrastructure, and lack of population-level knowledge and demand. In recent years, Rwanda is one of few countries that has demonstrated a sustained increase to near universal vaccination coverage, with a current rate of 98%. Our aim was to ask why and how Rwanda achieved this success so that it could potentially be replicated in other countries.Literature searches of scientific and grey literature, as well as other background research, was conducted from September 2016 through August 2017, including primary fieldwork in Rwanda. We determined that four factors have had a major influence on the Rwandan vaccine program, including strong central government leadership (political will), a culture of accountability, local ownership and a strong health value chain. Rwanda’s national immunization program is rooted in a political landscape shaped by unique aspects of Rwandan history and culture. Rwanda has a strong central government and a hierarchical chain of command supported by decentralized implementation bodies. A culture of accountability transcends the entire health system and there is local-level ownership of the immunization program, including the role of engaged community health workers and a strong health information system. Together, these four factors likely account for Rwanda’s vaccination coverage success.
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Thomson, Dana R., Cheryl Amoroso, Sidney Atwood, Matthew H. Bonds, Felix Cyamatare Rwabukwisi, Peter Drobac, Karen E. Finnegan, et al. "Impact of a health system strengthening intervention on maternal and child health outputs and outcomes in rural Rwanda 2005–2010." BMJ Global Health 3, no. 2 (April 2018): e000674. http://dx.doi.org/10.1136/bmjgh-2017-000674.
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IntroductionAlthough Rwanda’s health system underwent major reforms and improvements after the 1994 Genocide, the health system and population health in the southeast lagged behind other areas. In 2005, Partners In Health and the Rwandan Ministry of Health began a health system strengthening intervention in this region. We evaluate potential impacts of the intervention on maternal and child health indicators.MethodsCombining results from the 2005 and 2010 Demographic and Health Surveys with those from a supplemental 2010 survey, we compared changes in health system output indicators and population health outcomes between 2005 and 2010 as reported by women living in the intervention area with those reported by the pooled population of women from all other rural areas of the country, controlling for potential confounding by economic and demographic variables.ResultsOverall health system coverage improved similarly in the comparison groups between 2005 and 2010, with an indicator of composite coverage of child health interventions increasing from 57.9% to 75.0% in the intervention area and from 58.7% to 73.8% in the other rural areas. Under-five mortality declined by an annual rate of 12.8% in the intervention area, from 229.8 to 83.2 deaths per 1000 live births, and by 8.9% in other rural areas, from 157.7 to 75.8 deaths per 1000 live births. Improvements were most marked among the poorest households.ConclusionWe observed dramatic improvements in population health outcomes including under-five mortality between 2005 and 2010 in rural Rwanda generally and in the intervention area specifically.
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Nishimwe, Grace, Didier Milindi Rugema, Claudine Uwera, Cor Graveland, Jesper Stage, Swaib Munyawera, and Gabriel Ngabirame. "Natural Capital Accounting for Land in Rwanda." Sustainability 12, no. 12 (June 22, 2020): 5070. http://dx.doi.org/10.3390/su12125070.
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Land, as a valuable natural resource, is an important pillar of Rwanda’s sustainable development. The majority of Rwanda’s 80% rural population rely on agriculture for their livelihood, and land is crucial for agriculture. However, since a high population density has made land a scarce commodity, growth in the agricultural sector and plans for rapid urbanisation are being constrained, and cross-sectoral trade-offs are becoming increasingly important, with a risk that long-term sustainability may be threatened if these trade-offs are not considered. To help track land value trends and assess trade-offs, and to help assess the sustainability of trends in land use and land cover, Rwanda has begun developing natural capital accounts for land in keeping with the United Nations’ System of Environmental-Economic Accounting. This paper reports on Rwanda’s progress with these accounts. The accounting approach adopted in our study measures changes in land use and land cover and quantifies stocks for the period under study (2014–2015). Rwanda is one of the first developing countries to develop natural capital accounts for land, but the wide range of possible uses in policy analysis suggests that such accounts could be useful for other countries as well.
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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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Musafiri, Ildephonse, and Pär Sjölander. "The importance of off-farm employment for smallholder farmers in Rwanda." Journal of Economic Studies 45, no. 1 (January 8, 2018): 14–26. http://dx.doi.org/10.1108/jes-07-2016-0129.
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Purpose Based on unique data the authors analyze the Rwandan non-farm employment expansion in rural areas and its relation to agricultural productivity. The purpose of this paper is to analyze the factors that determine off-farm work hours in Rwanda, and how farmers’ off-farm employment affects agricultural output. Since production efficiency may depend on off-farm work and off-farm work depend on production efficiency (Lien et al., 2010), both production and off-farm work are endogenous. While controlling for endogeneity, the authors investigate the relationship between off-farm work and agricultural production. Design/methodology/approach In this paper the authors use a unique panel data set spanning over 26 years originating from household surveys conducted in the northwest and densely populated districts of Rwanda. Econometric estimations are based on a random effects two-stage Tobit model to control for endogeneity. Findings The study confirms theoretical and empirical findings from other developing countries that off-farm employment is one of the essential conditions for having an economically viable agricultural business and vice versa. Research limitations/implications The study is carried out in only one district of Rwanda. Even though most rural areas in Rwanda have similar features the findings cannot necessarily be generalized for the entire country of Rwanda. As in any study, the raw data set suffer from a number of shortcomings which cannot be fully eliminated by the econometric estimation, but this is a new data set which has the best data available for this research question in Rwanda. Practical implications The authors can conclude that there are synergy effects of investing government resources into both on-farm and off-farm employment expansions. Thus, in Rwanda on-farm investments can actually partly contribute to a future natural smooth transformation to more off-farm total output and productivity and vice versa. Though there are still limited off-farm employment opportunities in the studied area, there are considerable potentials to generate income and increase agricultural production through the purchase of additional inputs. Social implications The findings imply that a favorable business climate for off-farm businesses creates spill-over effects which enhance the smallholder farmers’ opportunities to survive, generate wealth, create employment and in effect reduce poverty. Originality/value From the best of the authors’ knowledge, similar studies have not been conducted in Rwanda, nor elsewhere with this type of data set. The findings provide original insights regarding off-farm and agricultural relationships in rural areas under dense population pressure. The results provide some indications that off-farm employment in developing countries (such as Rwanda) is one of the essential conditions for having an economically viable agricultural business and vice versa. The second wave of data was collected by the authors and was used solely for the purpose of this paper.
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Hagumimana, Noel, Jishi Zheng, Godwin Norense Osarumwense Asemota, Jean De Dieu Niyonteze, Walter Nsengiyumva, Aphrodis Nduwamungu, and Samuel Bimenyimana. "Concentrated Solar Power and Photovoltaic Systems: A New Approach to Boost Sustainable Energy for All (Se4all) in Rwanda." International Journal of Photoenergy 2021 (June 16, 2021): 1–32. http://dx.doi.org/10.1155/2021/5515513.
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The energy sector of today’s Rwanda has made a remarkable growth to some extent in recent years. Although Rwanda has natural energy resources (e.g., hydro, solar, and methane gas, etc.), the country currently has an installed electricity generation capacity of only 226.7 MW from its 45 power plants for a population of about 13 million in 2021. The current national rate of electrification in Rwanda is estimated to 54.5% (i.e.; 39.7% grid-connected and 14.8% off-grid connected systems). This clearly demonstrates that having access to electricity is still a challenge to numerous people not to mention some blackout-related problems. With the ambition of having electricity for all, concentrated solar power (CSP) and photovoltaic (PV) systems are regarded as solutions to the lack of electricity. The production of CSP has still not been seriously considered in Rwanda, even though the technology has attracted significant global attention. Heavy usage of conventional power has led to the depletion of fossil fuels. At the same time, it has highlighted its unfriendly relationship with the environment because of carbon dioxide (CO2) emission, which is a major cause of global warming. Solar power is another source of electricity that has the potential to generate electricity in Rwanda. Firstly, this paper summarizes the present status of CSP and PV systems in Rwanda. Secondly, we conducted a technoeconomic analysis for CSP and PV systems by considering their strengths, weaknesses, opportunities, and threats (SWOT). The input data of the SWOT analysis were obtained from relevant shareholders from the government, power producers, minigrid, off-grid, and private companies in Rwanda. Lastly, the technical and economical feasibilities of CSP and PV microgrid systems in off-grid areas of Rwanda were conducted using the system advisor model (SAM). The simulation results indicate that the off-grid PV microgrid system for the rural community is the most cost-effective because of its low net present cost (NPC). According to the past literature, the outcomes of this paper through the SWOT analyses and the results obtained from the SAM model, both the CSP and PV systems could undoubtedly play a vital role in Rwanda’s rural electrification. In fact, PV systems are strongly recommended in Rwanda because they are rapid and cost-effective ways to provide utility-scale electricity for off-grid modern energy services to the millions of people who lack electricity access.
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Pace, Lydia E., Jean Marie Vianney Dusengimana, Lawrence N. Shulman, Lauren E. Schleimer, Cyprien Shyirambere, Christian Rusangwa, Gaspard Muvugabigwi, et al. "Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda." Journal of Global Oncology, no. 5 (December 2019): 1–13. http://dx.doi.org/10.1200/jgo.19.00209.
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PURPOSE Feasible and effective strategies are needed to facilitate earlier diagnosis of breast cancer in low-income countries. The goal of this study was to examine the impact of health worker breast health training on health care utilization, patient diagnoses, and cancer stage in a rural Rwandan district. METHODS We conducted a cluster randomized trial of a training intervention at 12 of the 19 health centers (HCs) in Burera District, Rwanda, in 2 phases. We evaluated the trainings’ impact on the volume of patient visits for breast concerns using difference-in-difference models. We used generalized estimating equations to evaluate incidence of HC and hospital visits for breast concerns, biopsies, benign breast diagnoses, breast cancer, and early-stage disease in catchment areas served by intervention versus control HCs. RESULTS From April 2015 to April 2017, 1,484 patients visited intervention HCs, and 308 visited control HCs for breast concerns. The intervention led to an increase of 4.7 visits/month for phase 1 HCs ( P = .001) and 7.9 visits/month for phase 2 HCs ( P = .007) compared with control HCs. The population served by intervention HCs had more hospital visits (115.1 v 20.5/100,000 person-years, P < .001) and biopsies (36.6 v 8.9/100,000 person-years, P < .001) and higher breast cancer incidence (6.9 v 3.3/100,000 person-years; P = .28). The incidence of early-stage breast cancer was 3.3 per 100,000 in intervention areas and 0.7 per 100,000 in control areas ( P = .048). CONCLUSION In this cluster randomized trial in rural Rwanda, the training of health workers and establishment of regular breast clinics were associated with increased numbers of patients who presented with breast concerns at health facilities, more breast biopsies, and a higher incidence of benign breast diagnoses and early-stage breast cancers.
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Weatherspoon, Dave D., Steven R. Miller, Fidele Niyitanga, Lorraine J. Weatherspoon, and James F. Oehmke. "Rwanda’s Commercialization of Smallholder Agriculture: Implications for Rural Food Production and Household Food Choices." Journal of Agricultural & Food Industrial Organization 19, no. 1 (March 1, 2021): 51–62. http://dx.doi.org/10.1515/jafio-2021-0011.
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Abstract Rwanda has experienced exceptional economic growth since 2000 despite more than 60% of the predominately-agrarian population living on less than $1.25 a day. Approximately 76% of the country’s working population are engaged in agricultural production, which makes up about one-third of the national economy. Agriculture is also an important source of foreign exchange, making up about 63% of the value of Rwanda’s exports. An important component of household diets – food produced on subsistence agriculture parcels averaging 0.6 ha – faces the challenge by government and private sector development to replace subsistence farming with a value-creating market-oriented food sector. A complex set of relationships across public incentives and programs encourages participation in markets. Designed to promote wealth, the Crop Intensification Program (CIP) has increased access to land, inputs, extension services, markets, supply chains, etc. Wealth and access to land are the dominant predictors of the ability to participate in markets and the extent of participation. For example, smallholders producing a diversity of crops are more likely to sell in markets. Within the confluence of competing policy objectives and market forces, further research is necessary to understand the household-level tradeoffs of both producers and consumers along the food value chain.
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Muggli, Franco, Gianfranco Parati, Paolo Suter, Mario Bianchetti, Dragana Radovanovic, Alice Umulise, Bienvenu Muvunyi, and Evariste Ntaganda. "BLOOD PRESSURE IN A POPULATION OF A RURAL AREA OF RWANDA: PRELIMINARY DATA." Journal of Hypertension 39, Supplement 1 (April 2021): e400. http://dx.doi.org/10.1097/01.hjh.0000749228.89530.93.
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Ndayisaba, Aphrodis, Emmanuel Harerimana, Ryan Borg, Ann C. Miller, Catherine M. Kirk, Katrina Hann, Lisa R. Hirschhorn, 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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Rwigema, Anastase. "Biogas Source of Energy and Solution to the Environment Problems in Rwanda." Applied Mechanics and Materials 705 (December 2014): 268–72. http://dx.doi.org/10.4028/www.scientific.net/amm.705.268.
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In Africa especially in Rwanda, the development of Biogas technology is imperative for development to occur in sustainable manner. Using large centralized power generation facilities to provide electricity to rural population and communities is very expensive and non-viable in Rwanda due to lack of a well dispersed electric grid. In Addition, use of non-renewable fossil fuels is resulting in increased greenhouse gas (GHG) emissions and attendant increased drivers for climate change. Development of Biogas systems serves the purposes of solving sanitation, energy and environmental problems by improving good health conditions and providing a source of energy for cooking and lighting to the communities and households contributing also to the decrease of GHG emissions. In Rwanda, there are 14 prisons, after genocide of 1994, the inmates increased up to 60,000. Number of prisoners was from 2,000 up to 7,500 prisoners in one prison [6]. This high number of inmates caused serious sanitation and environmental problems. Indeed the septic tanks became full and human excreta started to overflow and pollute the environment. In addition, a very big quantity of fuel wood was used for cooking inmates’ food; the consequence was the degradation of the environment. Similar problems were observed in schools. Solution to the mentioned problems was construction of Biogas systems. In Rwanda only about 16% of the population have access to electricity. In order to reduce that deficit of energy, Rwanda Government is developing other sources of energy particularly Biogas for rural areas which so far do not have connection to the national electricity grid. Big size (100 m3) and small size (4, 6, 8 and 10 m3) bio-digesters are installed in several institutions and households and they provide enough Biogas for cooking and lighting in steady of using firewood which is becoming scarce in many areas of the country and their usage as source of energy causes pollution through production of Carbon dioxide (CO2) released in the atmosphere. A study made by SNV (Netherlands Cooperation Development Agency) shows that a domestic bio-digester reduces 4.6 tons of (CO2) per year. Hence, calculation made indicates that the 3,000 domestic bio-digesters currently operational in Rwanda allow to reduce 13,800 tons of Carbon dioxide (CO2) emissions per year. As organic wastes particularly human excreta and other digestible biomass are available everywhere, biogas technology can be developed in all the countries worldwide.
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Maniraguha, Faustin. "Does Formalization of Informal Enterprises Matter? Evidence from Rwanda." Randwick International of Social Science Journal 1, no. 3 (October 23, 2020): 419–32. http://dx.doi.org/10.47175/rissj.v1i3.96.
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In this decade, the formalization of informal sector is challenging as it provides jobs to the big number of the population and on the other hand, this group of active population work in conditions, which do not allow them to benefit some advantages from the government and these lead to not providing enough contribution to the economic growth. The main objective of the study was to find out the factors underlying for formalization of informal enterprises in Rwanda. In order to respond to the main objective, we used a desk research approach and we found that there is a necessity of enterprise formalization in Rwanda and the identified key factors are the enterprise motives/long term objectives, cash less economy/innovation in payment system and government policy for enterprise registration. The study also illustrated the factors or ways for private informal-rural enterprise formalization process may consider and some of them are affordable cost of taxation, accessibility to finance, accessibility to the markets as well as the time taken for getting legal documents. From the findings, the study recommend that the consistency capacity building so that to help managers to understand the necessity of informal sector formalization, government to continue working on the minimization of the costs related to the enterprise registration that include time, distance and other procedures and government also to continue enhancing infrastructures in rural zones. The study used secondary data both qualitative and quantitative from existing reports and data from National Institute of statistics of Rwanda.
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Moss, Charles B., Alexandre Lyambabaje, and James F. Oehmke. "An economic evaluation of SPREAD on Rwanda’s rural population." Applied Economics 49, no. 36 (December 15, 2016): 3634–44. http://dx.doi.org/10.1080/00036846.2016.1265076.
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Ndayishimiye, Costase. "Women’s Perceptions and Attitudes Related to Family Planning Use among Poor Population in Rural Rwanda." Advances in Reproductive Sciences 09, no. 01 (2021): 1–12. http://dx.doi.org/10.4236/arsci.2021.91001.
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Ndayishimiye, Costase. "Women’s Perceptions and Attitudes Related to Family Planning Use among Poor Population in Rural Rwanda." Advances in Reproductive Sciences 09, no. 01 (2021): 1–12. http://dx.doi.org/10.4236/arsci.2021.91020.
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Iyer, Hari S., John Flanigan, Nicholas G. Wolf, Lee Frederick Schroeder, Susan Horton, Marcia C. Castro, and Timothy R. Rebbeck. "Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency." BMJ Global Health 5, no. 10 (October 2020): e003493. http://dx.doi.org/10.1136/bmjgh-2020-003493.
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IntroductionDecisions regarding the geographical placement of healthcare services require consideration of trade-offs between equity and efficiency, but few empirical assessments are available. We applied a novel geospatial framework to study these trade-offs in four African countries.MethodsGeolocation data on population density (a surrogate for efficiency), health centres and cancer referral centres in Kenya, Malawi, Tanzania and Rwanda were obtained from online databases. Travel time to the closest facility (a surrogate for equity) was estimated with 1 km resolution using the Access Mod 5 least cost distance algorithm. We studied associations between district-level average population density and travel time to closest facility for each country using Pearson’s correlation, and spatial autocorrelation using the Global Moran’s I statistic. Geographical clusters of districts with inefficient resource allocation were identified using the bivariate local indicator of spatial autocorrelation.ResultsPopulation density was inversely associated with travel time for all countries and levels of the health system (Pearson’s correlation range, health centres: −0.89 to −0.71; cancer referral centres: −0.92 to −0.43), favouring efficiency. For health centres, negative spatial autocorrelation (geographical clustering of dissimilar values of population density and travel time) was weaker in Rwanda (−0.310) and Tanzania (−0.292), countries with explicit policies supporting equitable access to rural healthcare, relative to Kenya (−0.579) and Malawi (−0.543). Stronger spatial autocorrelation was observed for cancer referral centres (Rwanda: −0.341; Tanzania: −0.259; Kenya: −0.595; Malawi: −0.666). Significant geographical clusters of sparsely populated districts with long travel times to care were identified across countries.ConclusionNegative spatial correlations suggested that the geographical distribution of health services favoured efficiency over equity, but spatial autocorrelation measures revealed more equitable geographical distribution of facilities in certain countries. These findings suggest that even when prioritising efficiency, thoughtful decisions regarding geographical allocation could increase equitable physical access to services.
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Ndayambaje, Benjamin, Hellen Amuguni, Jeanne Coffin-Schmitt, Nancy Sibo, Martin Ntawubizi, and Elizabeth VanWormer. "Pesticide Application Practices and Knowledge among Small-Scale Local Rice Growers and Communities in Rwanda: A Cross-Sectional Study." International Journal of Environmental Research and Public Health 16, no. 23 (November 28, 2019): 4770. http://dx.doi.org/10.3390/ijerph16234770.
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Background: Agriculture contributes a third of Rwanda’s GDP and is the main source of income for rural households, with 80% of the total population involved in crop and/or livestock production. The Government of Rwanda established the Muvumba rice project in 2011 amidst a policy shift towards rice as a national staple crop. However, the indiscriminate use of pesticides by local, low-income rice growers has raised concerns about potential human, animal and ecosystem health impacts as pesticide distribution and application are not strictly regulated. Although pesticide use can directly influence farmer health and ecosystems, little is known about small-scale farmers’ pesticide application practices and knowledge. We aimed to assess local application practices and understanding of pesticides to identify gaps in farmers’ knowledge on safe pesticide use and deviations from established standards and recommended practices. Methods: We conducted a cross-sectional study consisting of observations of pesticide practices and interviews with 206 small-scale rice growers in Nyagatare District, Rwanda, in March 2017. Descriptive statistical analyses (sample means, standard deviation and range) were performed, and we evaluated the association between farmers’ personal protective equipment (PPE) use and their education level and literacy status. Results: Over 95% of observed farmers did not comply with minimum standards for safe pesticide use, and 80% of respondents reported that they stored pesticides in their homes without personal protection measures. Education and literacy level were not significantly associated with PPE use. Additionally, 90% of respondents had experienced adverse health effects after using pesticides including intense headache, dizziness, stomach cramps, skin pain and itching, and respiratory distress. All respondents also reported animals in and around the rice scheme (cattle, birds, and fish) behaving abnormally or with signs consistent with pesticide exposure in the six months preceding the study, which may be linked to pesticide-contaminated water. Conclusions: Our study demonstrates potential for high exposure to pesticides for farmers, their families, and animals sharing rice-growing or downstream environments and points to the need for training on safe and effective pesticide use.
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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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Eberly, Lauren Anne, Christian Rusangwa, Loise Ng'ang'a, Claire C. Neal, Jean Paul Mukundiyukuri, Egide Mpanusingo, Jean Claude Mungunga, et al. "Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda." BMJ Global Health 4, no. 3 (June 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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Muvugabigwi, Gaspard, Irenee Nshimiyimana, Lauren Greenberg, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, Kiran Bhai, et al. "Decreasing Histology Turnaround Time Through Stepwise Innovation and Capacity Building in Rwanda." Journal of Global Oncology, no. 4 (December 2018): 1–6. http://dx.doi.org/10.1200/jgo.17.00081.
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Purpose Minimal turnaround time for pathology results is crucial for highest-quality patient care in all settings, especially in low- and middle-income countries, where rural populations may have limited access to health care. Methods We retrospectively determined the turnaround times (TATs) for anatomic pathology specimens, comparing three different modes of operation that occurred throughout the development and implementation of our pathology laboratory at the Butaro Cancer Center of Excellence in Rwanda. Before opening this laboratory, TAT was measured in months because of inconsistent laboratory operations and a paucity of in-country pathologists. Results We analyzed 2,514 individual patient samples across the three modes of study. Diagnostic mode 1 (samples sent out of the country for analysis) had the highest median TAT, with an overall time of 30 days (interquartile range [IQR], 22 to 43 days). For diagnostic mode 2 (static image telepathology), the median TAT was 14 days (IQR, 7 to 27 days), and for diagnostic mode 3 (onsite expert diagnosis), it was 5 days (IQR, 2 to 9 days). Conclusion Our results demonstrate that telepathology is a significant improvement over external expert review and can greatly assist sites in improving their TATs until pathologists are on site.
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Misako, Fraternel Amuri. "Milices Maï-Maï, Dénonciation De L’impérialisme Et Politisation Des Masses Rurales Au Maniema (RDC)." European Scientific Journal, ESJ 13, no. 17 (June 30, 2017): 65. http://dx.doi.org/10.19044/esj.2017.v13n17p65.
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Based on a documentary inquiry aimed at reconstructing the processes of denunciation of imperialism associated with the Congolese Rally for Democracy (RCD)’s war in the Democratic Republic of Congo (DRC), by the maï-maï militia of Maniema, the article examines under the lens of historical criticism (heuristic and hermeneutic) the politicoideological contents of the essential documents whose impact on the rural masses remains crucial: their over-politicization of the latter. The study shows how a political mobilization that initially targeted awareness-raising for the recruitment of new combatants among rural Congolese youths has reactivated the protesting reflex of the rural populations both towards the rebels and their Rwandan allies, and maï-maï combatants. The repeated abuses of the maï-maï militias have thus brought down the nationalist mask which their ideological propaganda maintained until then. The pervasive activism of youths and especially the emergence of radicalized groups confirm the thesis of political violence as an indicator of democratic deficiencies of a weakened state through processes of globalization badly assumed in the African Great Lakes area.
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Samuel, Kyei, Tagoh Selassie, Kwarteng Michael, and Aboagye Evans. "Ophthalmic Anthropometry among Rural Dwellers in Mashonaland Central Province, Zimbabwe." Rwanda Journal of Medicine and Health Sciences 4, no. 1 (April 8, 2021): 99–111. http://dx.doi.org/10.4314/rjmhs.v4i1.8.
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Introduction
The measures of ophthalmic anthropometric parameters may vary among races and ethnic groups but are of immense importance in clinical diagnosis and management of oculo-visual defects. There is paucity of data on these measures among the Zimbabwean population.
Purpose
The aim was to determine ophthalmic anthropometric parameters among rural dwellers in Zimbabwe.
Methods
Six ophthalmic anthropometric parameters including interpupillary distance (IPD), head width (HW), temple width (TW), length to bend (LTB), and apical radius were measured using a pupillometer, PD rule, Head width calipers, Fairbank facial gauge, and ABDO frame rule.
Results
A total of 471 participants aged 18 to 100 years (mean age = 55.13; SD± 17.33 years). Of the 471 participants, 206 (43.7%) were males and 265 (56.3%) were females. A mean interpupillary distance at far was 65.57 ± 4.80 mm, mean temple width of 12.49 ± 1.53 cm, mean head width of 13.61 ± 1.39 cm and a side length to bend of 10.24 ± 1.20 cm and the apical radius was 9.94 ± 1.37. There was a significant (P < 0.05) difference between the ophthalmic anthropometric parameters of males and females except for temple width and apical radius.
Conclusion
A narrower interpupillary distance but a wider temple width was observed among adult Zimbabweans. A significant difference in ophthalmic anthropometric parameters between males and females were observed except for temple width and apical radius. This should inform eyewear manufacturers and importers of frames on the facial and ocular parameters of Zimbabweans to improve the aesthetics and ensure a comfortable vision for wearers of already-made near vision spectacles for presbyopes.
Rwanda J Med Health Sci 2021;4(1):99-111
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Minani, Bonaventure, Déo-Guide Rurema, and Philippe Lebailly. "Rural resilience and the role of social capital among farmers in Kirundo province, Northern Burundi." Applied Studies in Agribusiness and Commerce 7, no. 2-3 (September 30, 2013): 121–25. http://dx.doi.org/10.19041/apstract/2013/2-3/20.
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In Burundi, more than 90% of the active population is engaged in family agriculture, which plays a vital role in food production and constitutes more than 50% of the GDP. Before the civil war of 1993, Kirundo was deemed the “breadbasket of the country”, as the region fed many parts of Burundi through growing particular foods such as legumes and cereals. Family farming was market-oriented. Kirundo alone includes 8 lakes which offer opportunities for field irrigation. Today, this region is the first province in Burundi which shows a high rate of malnutrition, as poverty has increased and a sharp 53.9 % decline in agricultural production has been witnessed between 1996 and 2009. The aim of this article is to analyse the role of social capital through the local association network in improving family agriculture and the resilience to climate change and conflict crisis. In this study, 73 farmers were surveyed in Kirundo province through means of a questionnaire, and the study was completed by collecting secondary data. Analysis of the data reveals that, despite recurrent droughts in that region which caused deaths due to famines and displacement of people to neighbouring countries such as Rwanda and Tanzania, 44% of the farmers who were surveyed were shown to have resilience to climate change. The analysis of data shows that these farmers were members of well organised local associations, and had learned about specific topics such as financial management, processing and storage of agricultural products and livestock. The social capital network positively influences their income and their resilience to climate change and conflict crisis.
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Petry, Nicolai, James Wirth, Valerie Friesen, Fabian Rohner, Arcade Nkundineza, Elli Chanzu, Kidist G. Tadesse, et al. "Assessing the Coverage of Biofortified Foods: Development and Testing of Methods and Indicators in Musanze, Rwanda." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1833. http://dx.doi.org/10.1093/cdn/nzaa067_060.
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Abstract Objectives Biofortification is a promising approach to increase micronutrient intakes, especially among populations that are hard to reach with other interventions. Information on the coverage of biofortified foods is needed to ascertain potential for impact, understand program performance, and identify bottlenecks. In this study, we aimed to develop and test methods and indicators for assessing household coverage of biofortified foods. Methods We developed five recall-based indicators of household coverage to assess biofortification programs building on approaches previously used to assess targeted and large-scale food fortification programs. These were: 1) consumption of the food; 2) awareness of the biofortified food; 3) availability of the biofortified food; 4) consumption of the biofortified food (ever); and 5) consumption of the biofortified food (current). We tested these indicators in a cross-sectional, cluster, household survey in 20 rural and five peri-urban areas in Musanze, Rwanda where two biofortification programs, i.e., biofortified beans and orange fleshed sweet potatoes (OFSP), were implemented. Results Among the 242 households surveyed, consumption of beans and sweet potatoes was high (99% and 96%, respectively) while awareness of biofortified beans or OFSP was 66% and 49%, respectively, and availability was 24% and 11%, respectively. Overall, 15% and 11% of households had ever consumed biofortified beans and OFSP, respectively, and 10% and 2% of households were currently consuming them, respectively. The major bottlenecks to coverage were awareness and availability of the biofortified foods. Conclusions The proposed methods and indicators fill a gap in the availability of tools to assess biofortification program coverage and the results of the survey highlight their utility for assessing program performance and identifying bottlenecks. Further testing is warranted to confirm the generalizability of the coverage indicators and inform their operationalization when deployed in different contexts. Funding Sources Bill & Melinda Gates Foundation.
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Ndoli, Alain, Athanase Mukuralinda, Antonius G. T. Schut, Miyuki Iiyama, Jean Damascene Ndayambaje, Jeremias G. Mowo, Ken E. Giller, and Frédéric Baudron. "On-farm trees are a safety net for the poorest households rather than a major contributor to food security in Rwanda." Food Security 13, no. 3 (January 29, 2021): 685–99. http://dx.doi.org/10.1007/s12571-020-01138-4.
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AbstractThe world is challenged to meet the food demand of a growing population, especially in developing countries. Given the ambitious plans to scale up agroforestry in Africa, an improved understanding of the effect of agroforestry practices on the already challenged food security of rural households is crucial. The present study was undertaken to assess how on-farm trees impacted food security in addition to other household income sources in Rwanda. In each of the six agroecologies of Rwanda, a stratified sampling procedure was used where two administrative cells (4th formal administrative level) were selected in which households were randomly selected for interviews. A survey including 399 farmers was conducted and farmers were grouped in three types of agroforestry practice (i) low practitioners (LAP) represented by the first tertile, (ii) medium practitioners (MAP) represented by the second tertile and (iii) high practitioners (HAP) represented by the third tertile of households in terms of tree number. Asset values, household income sources, crop production, farm size, crop yield, and food security (food energy needs) were quantified among the types of agroforestry practice. A larger proportion of HAP households had access to adequate quantity and diversity of food when compared with MAP and LAP households. Food security probability was higher for households with more resources, including land, trees and livestock, coinciding with an increased crop and livestock income. We found no difference in asset endowment among types of agroforestry practices, while farmers in agroecologies with smaller farms (0.42 ha to 0.66 ha) had more on-farm trees (212 to 358 trees per household) than farms in agroecologies with larger farms (0.96 ha to 1.23 ha) which had 49 to 129 trees per household, probably due to differences in biophysical conditions. A positive association between tree density and food security was found in two out of six agroecologies. The proportion of income that came from tree products was high (> 20%) for a small fraction of farmers (12%), with the more food insecure households relying more on income from tree products than households with better food security status. Thus, tree income can be percieved as a “safety net” for the poorest households.
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Singer, T., J. Rugengande, B. Barikumana, P. Zhu, I. Holmen, P. Hakizimana, Z. Rukemba, and O. Urayeneza. "Human-centered Strategic Planning at a Rural Rwandan Medical School: A Case Study for Navigating Institutional Challenges and Strengthening Community and National Population Health in Low and Middle Income Countries." Annals of Global Health 83, no. 1 (April 7, 2017): 139. http://dx.doi.org/10.1016/j.aogh.2017.03.311.
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Adu-Gyamfi, Samuel, Razak Mohammed Gyasi, and Benjamin Dompreh Darkwa. "Historicizing medical drones in Africa: a focus on Ghana." History of science and technology 11, no. 1 (June 26, 2021): 103–25. http://dx.doi.org/10.32703/2415-7422-2021-11-1-103-125.
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While the genesis of the drone technology is not clear, one thing is ideal: it emerged as a military apparatus and gained much attention during major wars, including the two world wars. Aside being used in combats and to deliver humanitarian services, drones have also been used extensively to kill both troops and civilians. Revolutionized in the 19th century, the drone technology was improved to be controlled as an unmanned aerial devices to mainly target troops. A new emerging field that has seen the application of the drone technology is the healthcare sector. Over the years, the health sector has increasingly relied on the device for timely transportation of essential articles across the globe. Since its introduction in health, scholars have attempted to address the impact of drones on healthcare across Africa and the world at large. Among other things, it has been reported by scholars that the device has the ability to overcome the menace of weather constraints, inadequate personnel and inaccessible roads within the healthcare sector. This notwithstanding, data on drones and drone application in Ghana and her healthcare sector in particular appears to be little within the drone literature. Also, few attempts have been made by scholars to highlight the use of drones in African countries. By using a narrative review approach, the current study attempts to address the gap above. Using this approach, a thorough literature search was performed to locate and assess scientific materials that focus on the application of drones in the military field and in the medical systems of Africa and Ghana in particular. With its sole responsibility to deliver items, stakeholders of health across several parts of the world have relied on drones to transport vital articles to health centers. Countries like Senegal, Madagascar, Rwanda and Malawi encouraged Ghana to consider the application of drones in her mainstream healthcare delivery. Findings from the study have revealed that Ghana’s adoption of the drone policy has enhanced the timely delivery of products such as test samples, blood and Personal Protective Equipment to various health centres and rural areas in particular. Drones have contributed to the delivery of equity in healthcare delivery in Ghana. We conclude that with the drone policy, the continent has the potential to record additional successes concerning the over-widened gap in healthcare between rural and urban populations.
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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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Tyrer, Peter. "From the Editor's desk." British Journal of Psychiatry 195, no. 2 (August 2009): 188. http://dx.doi.org/10.1192/bjp.195.2.188.
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The merits of a global perspectiveIt has almost become a pointless mantra to repeat ‘we are now international’ but there is important substance to the wish for a more global perspective in psychiatry. For those involved in developing community services it is amazing to follow the time change zones round the world. In the Czech Republic services are at the stage we were in the UK in 1977, in Slovakia it is 1972, in the Ukraine it is 1965, in Rwanda 1964, in Tibet 1960 and in Belarus 1953. So why not take advantage of this time warp and help Belarus now to develop the best possible services from the 50 extra years of accumulated knowledge? The reverse is also true. We can test hypotheses now that we might have considered many years ago by looking at the experiences of other countries. Schizophrenia remains difficult to treat and much concern has been expressed about its excess mortality, particularly the suspicion that this is a consequence of antipsychotic drug treatment.1These drugs may lead to obesity, a growing problem with increasing age (Kivimäkiet al, pp. 149–155), and its associated metabolic syndrome.2,3In low- and middle-income countries our view of outcome has been influenced greatly by data from Chandigarh in North India, where better results may be related to different family structures with low expressed emotion, conferring protection.4But long-term outcome is poor in such countries also5and Ranet al(pp. 126–131) suggest that those never treated for schizophrenia, even though they may have received traditional remedies,6have the same mortality as those treated with Western evidence-based interventions. When we get consistency across very different countries we can have much more confidence in our conclusions, and the association of urbanicity and schizophrenia first identified by Faris & Dunham 70 years ago,7and repeatedly identified in all population groups,8now seems to have its final badge of approval from Lundberget al(pp. 156–162) in their study from Uganda. I cannot help noticing from their paper that grandiosity as a psychotic experience is a marked distinguishing feature between urban and rural rearing; perhaps being surrounded by all those tall city buildings unduly raises expectations. We need to be reminded that increased mortality is also common in other psychiatric disorders. This is illustrated in depression by Mykletunet al(pp. 118–125), who also intriguingly find that greater trait anxiety increases your lifespan, so perhaps there is some gain from constant worry and increased help-seeking behaviour.
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Olieba, Anne Nipher, and Ronald Kikechi. "UNRAVELING THE POWER OF TEACHERS’ COMPETENCY AND TEACHING STYLES IN CURRICULUM IMPLEMENTATION: A PERSPECTIVE OF ENGLISH LANGUAGE AS A MEDIUM OF INSTRUCTION." European Journal of Education Studies 8, no. 8 (August 5, 2021). http://dx.doi.org/10.46827/ejes.v8i8.3876.
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<p>The language policy in Rwanda states that English is the medium of Instruction (MOI) to be used in the Education system following the 2008 Language shift. However, this change in the MOI brought about extreme challenges to both Rwandan teachers and learners. Moreover, the extensive day to day usage of Kinyarwanda, the local dialect, has greatly inhibited the use of English. This has adversely obstructed the use of the English language as a MOI and the curriculum implementation for over 20 years hence adversely affecting the teaching and learning process. The proficiency of the teachers who are meant to teach in the MOI is quite questionable; many realize the need to learn English while teaching or risk unemployment. As such, this study purposed to examine the teacher competency and teaching styles in use of English as a MOI in facilitating curriculum implementation in rural primary schools in Rwanda. Guided by the inter language theory and the Discrepancy theory, the study applied a descriptive survey research design. With a target population of 3,269, the study entailed a sample of 1470 randomly selected learners from Primary 4 to Primary 6, teachers and head teachers from 21 schools. The study used questionnaires, interviews, and observation to collect primary data. The study found that the teachers’ competency in using English language as MOI had significant influence on curriculum implementation in rural primary schools in Muhanga district and in the entire republic of Rwanda. The teaching styles factors positively and significantly influence the use of MOI in curriculum implementation when other factors are held constant.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0807/a.php" alt="Hit counter" /></p>
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Bavuma, Charlotte M., Sanctus Musafiri, Pierre-Claver Rutayisire, Loise M. Ng’ang’a, Ruth McQuillan, and Sarah H. Wild. "Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: time to contextualize the interventions? A cross-sectional study." BMC Endocrine Disorders 20, no. 1 (December 2020). http://dx.doi.org/10.1186/s12902-020-00660-y.
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Abstract Background Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural Rwanda compared to those of urban dwellers. Methods A cross-sectional, clinic-based study was conducted in which individuals with diabetes mellitus were consecutively recruited from April 2015 to April 2016. Demographic and clinical data were collected from patient interviews, medical files and physical examinations. Chi-square tests and T-tests were used to compare proportions and means between rural and urban residents. Results A total of 472 participants were recruited (mean age 40.2 ± 19.1 years), including 295 women and 315 rural residents. Compared to urban residents, rural residents had lower levels of education, were more likely to be employed in low-income work and to have limited access to running water and electricity. Diabetes was diagnosed at a younger age in rural residents (mean ± SD 32 ± 18 vs 41 ± 17 years; p < 0.001). Physical inactivity, family history of diabetes and obesity were significantly less prevalent in rural than in urban individuals (44% vs 66, 14.9% vs 28.7 and 27.6% vs 54.1%, respectively; p < 0.001). The frequency of fruit and vegetable consumption was lower in rural than in urban participants. High waist circumference was more prevalent in urban than in rural women and men (75.3% vs 45.5 and 30% vs 6%, respectively; p < 0.001). History of childhood under-nutrition was more frequent in rural than in urban individuals (22.5% vs 6.4%; p < 0.001). Conclusions Characteristics of people with diabetes in rural Rwanda appear to differ from those of individuals with diabetes in urban settings, suggesting that sub-types of diabetes exist in Rwanda. Generic guidelines for diabetes prevention and management may not be appropriate in different populations.
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Kateera, Fredrick, Petra F. Mens, Emmanuel Hakizimana, Chantal M. Ingabire, Liberata Muragijemariya, Parfait Karinda, Martin P. Grobusch, Leon Mutesa, and Michèle van Vugt. "Malaria parasite carriage and risk determinants in a rural population: a malariometric survey in Rwanda." Malaria Journal 14, no. 1 (January 21, 2015). http://dx.doi.org/10.1186/s12936-014-0534-x.
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Gad Iradukunda, Patrick, Thierry Habyarimana, Francois Niyongabo Niyonzima, Ange-Yvette Uwitonze, and Tharcisse Mpunga. "Risk factors associated with hepatitis B and C in rural population of Burera district, Rwanda." Pan African Medical Journal 35 (2020). http://dx.doi.org/10.11604/pamj.2020.35.43.16226.
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Uwiringiyimana, Vestine, Antonie Veldkamp, and Sherif Amer. "Stunting spatial pattern in Rwanda: An examination of the demographic, socio-economic and environmental determinants." Geospatial Health 14, no. 2 (November 6, 2019). http://dx.doi.org/10.4081/gh.2019.820.
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Stunting is recognised as a major public health problem in Rwanda. We therefore aimed to study the demographic, socio-economic and environmental factors determining the spatial pattern of stunting. A cross-sectional study using the data from the 2014- 2015 Rwanda Demographic and Health Survey and environmental data from external geospatial datasets were conducted. The study population was children less than two years old with their mothers. A multivariate linear regression model was used to estimate the effects of demographic, socio-economic and biophysical factors and a proxy measure of aflatoxins exposure on height-for-age. Also, a spatial prediction map of height-for-age to examine the stunting pattern was produced. It was found that age of child, height of mother, secondary education and higher, a child being male and birth weight were associated with height-for-age. After adjusting for demographic and socioeconomic factors, elevation and being served by a rural market were also significantly associated with low height-for-age in children. The spatial prediction map revealed the variability of height-for-age at the cluster-level that was lost when the levels are aggregated at the district level. No associations with height-for-age were found for exclusive breastfeeding, use of deworming tablets, improved water source and improved sanitation in the study population. In addition to the child and mother factors known to determine height-for-age, our study confirms the influence of environmental factors in determining the height-of-age of children in Rwanda. A consideration of the environmental drivers of anthropometric status is crucial to have a holistic approach to reduce stunting.
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Petry, Nicolai, James P. Wirth, Valerie M. Friesen, Fabian Rohner, Arcade Nkundineza, Elli Chanzu, Kidist G. Tadesse, et al. "Assessing the Coverage of Biofortified Foods: Development and Testing of Methods and Indicators in Musanze, Rwanda." Current Developments in Nutrition 4, no. 8 (June 18, 2020). http://dx.doi.org/10.1093/cdn/nzaa107.
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ABSTRACT Background Biofortification of staple crops has the potential to increase nutrient intakes and improve health outcomes. Despite program data on the number of farming households reached with and growing biofortified crops, information on the coverage of biofortified foods in the general population is often lacking. Such information is needed to ascertain potential for impact and identify bottlenecks to parts of the impact pathway. Objectives We aimed to develop and test methods and indicators for assessing household coverage of biofortified foods. Methods To assess biofortification programs, 5 indicators of population-wide household coverage were developed, building on approaches previously used to assess large-scale food fortification programs. These were 1) consumption of the food; 2) awareness of the biofortified food; 3) availability of the biofortified food; 4) consumption of the biofortified food (ever); and 5) consumption of the biofortified food (current). To ensure that the indicators are applicable to different settings they were tested in a cross-sectional household-based cluster survey in rural and peri-urban areas in Musanze District, Rwanda where planting materials for iron-biofortified beans (IBs) and orange-fleshed sweet potatoes (OFSPs) were delivered. Results Among the 242 households surveyed, consumption of beans and sweet potatoes was 99.2% and 96.3%, respectively. Awareness of IBs or OFSPs was 65.7% and 48.8%, and availability was 23.6% and 10.7%, respectively. Overall, 15.3% and 10.7% of households reported ever consuming IBs and OFSPs, and 10.4% and 2.1% of households were currently consuming these foods, respectively. The major bottlenecks to coverage of biofortified foods were awareness and availability. Conclusions These methods and indicators fill a gap in the availability of tools to assess coverage of biofortified foods, and the results of the survey highlight their utility for identifying bottlenecks. Further testing is warranted to confirm the generalizability of the coverage indicators and inform their operationalization when deployed in different settings.
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Abimana, Marie Claire, Egide Karangwa, Ibrahim Hakizimana, Catherine M. Kirk, Kathryn Beck, Ann C. Miller, Silas Havugarurema, et al. "Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24–47 months in rural Rwanda." BMC Pregnancy and Childbirth 20, no. 1 (October 21, 2020). http://dx.doi.org/10.1186/s12884-020-03301-3.
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Abstract Background Global investments in neonatal survival have resulted in a growing number of children with morbidities surviving and requiring ongoing care. Little is known about the caregivers of these children in low- and middle-income countries, including maternal mental health which can further negatively impact child health and development outcomes. We aimed to assess the prevalence and factors associated with poor maternal mental health in mothers of children born preterm, low birthweight (LBW), and with hypoxic ischemic encephalopathy (HIE) at 24–47 months of age in rural Rwanda. Methods Cross-sectional study of children 24–47 months born preterm, LBW, or with HIE, and their mothers discharged from the Neonatal Care Unit (NCU) at Kirehe Hospital between May 2015–April 2016 or discharged and enrolled in a NCU follow-up program from May 2016–November 2017. Households were interviewed between October 2018 and June 2019. Mothers reported on their mental health and their child’s development; children’s anthropometrics were measured directly. Backwards stepwise procedures were used to assess factors associated with poor maternal mental health using logistic regression. Results Of 287 total children, 189 (65.9%) were born preterm/LBW and 34.1% had HIE and 213 (74.2%) screened positive for potential caregiver-reported disability. Half (n = 148, 51.6%) of mothers reported poor mental health. In the final model, poor maternal mental health was significantly associated with use of violent discipline (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.17,4.45) and having a child with caregiver-reported disability (OR 2.96, 95% CI 1.55, 5.67). Greater household food security (OR 0.80, 95% CI 0.70–0.92) and being married (OR = 0.12, 95% CI 0.04–0.36) or living together as if married (OR = 0.13, 95% CI 0.05, 0.37) reduced the odds of poor mental health. Conclusions Half of mothers of children born preterm, LBW and with HIE had poor mental health indicating a need for interventions to identify and address maternal mental health in this population. Mother’s poor mental health was also associated with negative parenting practices. Specific interventions targeting mothers of children with disabilities, single mothers, and food insecure households could be additionally beneficial given their strong association with poor maternal mental health.
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Matsenko, Irina. "Labour Potential in Africa: the State and Development Prospects." Journal of the Institute for African Studies, September 30, 2019, 18–29. http://dx.doi.org/10.31132/2412-5717-2019-48-3-18-29.
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The subject of this study is the state, use and development prospects of the labour potential in the countries of Africa. For the first time in Russian African studies, last information on the current state of the employment problem in Africa, its urgency and complexity of the solution is summarized. The study shows that the impressive economic growth in many African countries over the past two decades has not been accompanied by any evident changes in employment in terms of creating new jobs and reducing unemployment and poverty. The high rates of unemployment, informal employment and working poverty have no analogues anywhere in the world. The author analyzes the causes of this phenomenon ̶ a sharp imbalance between the rapid growth of the working-age population and the creation of jobs, resulting in a huge excess of labour supply over demand, especially skilled labour. Particular attention is paid to youth unemployment, fraught with explosive growth of political instability in the society. With regard to possible ways of solving the employment problem in Africa, the successful experience in this field in a number of African countries (Ghana, Rwanda, Ethiopia) leads the author to the conclusion that at this stage the priority efforts should be aimed at creating decent jobs in the sectors and areas with prevalence of work of the poor, namely agriculture and economic activities in rural areas. In the long term, however, it is necessary to carry out a gradual transition to more productive sectors of the economy (manufacturing and the modern services sector) for creating decent jobs in them. In general, in order to create quality jobs and reduce poverty, African countries need the sustainable and inclusive economic growth, which involves structural transformation on the basis of economic diversification, including industrialization, and increasing agricultural productivity. There is no universal recipe for all countries of the continent, but a comprehensive employment policy covers a wide range of necessary steps ̶ from investing in education and vocational training to targeted measures to increase employment and social protection, including public works projects. Ultimately, the author believes, the rise of the African economy and the reduction of poverty will largely depend on the state of the workforce both in urban and rural areas.
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Gebremichael, Shewayiref Geremew, and Setegn Muche Fenta. "Determinants of institutional delivery in Sub-Saharan Africa: findings from Demographic and Health Survey (2013–2017) from nine countries." Tropical Medicine and Health 49, no. 1 (May 26, 2021). http://dx.doi.org/10.1186/s41182-021-00335-x.
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Abstract Introduction Institutional delivery is a major concern for a country’s long-term growth. Rapid population development, analphabetism, big families, and a wider range of urban-rural health facilities have had a negative impact on institutional services in Sub-Saharan Africa (SSA) countries. The aim of this study was to look into the factors that influence women’s decision to use an institutional delivery service in SSA. Methods The most recent Demographic and Health Survey (DHS), which was conducted in nine countries (Senegal, Ethiopia, Malawi, Rwanda, Tanzania, Zambia, Namibia, Ghana, the Democratic Republic of Congo) was used. The service’s distribution outcome (home delivery or institutional delivery) was used as an outcome predictor. Logistic regression models were used to determine the combination of delivery chances and different covariates. Results The odds ratio of the experience of institutional delivery for women living in rural areas vs urban area was 0.44 (95% confidence interval (CI) 0.41–0.48). Primary educated women were 1.98 (95% CI 1.85–2.12) times more likely to deliver in health institutes than non-educated women, and secondary and higher educated women were 3.17 (95% CI 2.88–3.50) times more likely to deliver in health centers with facilities. Women aged 35–49 years were 1.17 (95% CI 1.05–1.29) times more likely than women aged under 24 years to give birth in health centers. The number of ANC visits: women who visited four or more times were 2.98 (95% CI 2.77–3.22) times, while women who visited three or less times were twice (OR = 2.03; 95% CI 1.88–2.18) more likely to deliver in health institutes. Distance from home to health facility were 1.18 (95% CI 1.11–1.25) times; media exposure had 1.28 (95% CI 1.20–1.36) times more likely than non-media-exposed women to delivery in health institutions. Conclusions Women over 24, primary education at least, urban residents, fewer children, never married (living alone), higher number of prenatal care visits, higher economic level, have a possibility of mass-media exposure and live with educated husbands are more likely to provide health care in institutions. Additionally, the distance from home to a health facility is not observed widely as a problem in the preference of place of child delivery. Therefore, due attention needs to be given to address the challenges related to narrowing the gap of urban-rural health facilities, educational level of women improvement, increasing the number of health facilities, and create awareness on the advantage of visiting and giving birth in health facilities.