Assessment of common perinatal mental disorders in a selected district hospital of the Eastern Province in Rwanda

BACKGROUND: Common perinatal mental disorders (CPMDs) in women (depression & anxiety) are recognized as a significant public health concern. In African countries, CPMDs are most prevalent. However, there is limited evidence inliterature about CPMDs in Rwanda. PURPOSE: To determine CPMDs in a selected district hospital of the Eastern Province of /Rwanda. Methods Descriptive quantitative cross-sectional survey was conducted with a sample of 165 mothers in perinatal period selected systematically. Ethical approval was obtained from University of the Western Cape of South Africa and the former Kigali Health Institute of Rwanda. The Zungu Self-rating Anxiety Scale (SAS) and Edinburgh Postnatal Depression Scale (EPDS) were used to collect data. SPSS version 21 was used for analysis. RESULTS: Most of the respondents (38.2%) were aged 25-29 years; married (44.8%); and unemployed (77%). Thirty-seven percent of the respondents had perinatal anxiety (PNA) while 50.3% had perinatal depression (PND). Statistically significant relationships were found between PNA (≥45scores) and factors such as relationship with husband/partner (c2 (2)=12.045, p=.002), husband/partner’s behaviour (c2 (8) = 16.401, p= .037), number of children (c2 (8)=16.017, p=.042), planned pregnancy (c2 (2)=8.244, p=.016), stressful events (c2 (14)=55.035, p=.000). Relationship with husband/partner was the only predictor of PNA (Odd ratio= 0.437). With regard to PND (≥10 scores), statistically significant relationships were found between factors such as marital status (c2 (3) = 17.559, p= .001), level of education (c2 (3) =16.857, p= .001), husband/partner relationship (c2 (1) = 38.207, p= .000), husbands’ behaviour (c2 (4) =43.242, p= .000), number of children (c2 (4) = 18.554, p= .001), planned pregnancy (c2 (1) = 17.773, p=.000), personal stressful events (c2 (7) = 30.232, p=.000). Age was the strongest determinants of PND (Odd ratio: 131.973). CONCLUSION: CPMDs are prevalent. Poor relationship with husband and young age were found to be the strongest determinants of CPMDs

Nurses’ knowledge in the early detection and management of acute kidney injury in selected referral hospitals in Rwanda

INTRODUCTION: Acute kidney injury (AKI) is a global health issue, and its prevalence is higher in low- and middle-income countries (LMICs). The knowledge of nurses in the early detection and management of AKI has rarely been explored in the current literature; thus, this study aims to assess the knowledge of nurses in the early detection and management of patients with AKI in Rwanda. METHODS: A cross-sectional research design was implemented for this study. The study setting included selected referral hospitals in Kigali. A convenience sample of 165 nurses was obtained and data was collected using a self-administered questionnaire. Analyses were made using descriptive and inferential statistics in SPSS version 21. RESULTS: Nurses' knowledge in the early detection and management of AKI was low. Receiving in-service training on AKI positively influenced their knowledge in the early detection (p-value= 0.049), whereas studying AKI in nursing school p-value = 0.035) and receiving in-service training on AKI (p-value= 0.008) were associated with knowledge of the management of AKI. CONCLUSION: AKI is a common and potentially life-threatening condition that prolongs hospital stay, increases resource utilization, and mortality risks. Nurses need to be more involved in the early identification and management of AKI as they mostly serve as frontline health care providers and their role of continuous patient monitoring

Phenotyping and genotyping of CYP2C19 using comparative metabolism of proguanil in sickle‐cell disease patients and healthy controls in Nigeria

Polymorphic expression of metabolic enzymes have been identified as one of the key factors responsible for the interindividual/ethnic/racial variability in drug metabolism and effect. In Nigeria, there is a disproportionately high incidence of sickle‐cell disease (SCD), a condition characterized by painful crisis frequently triggered by malaria. Proguanil, a substrate of the polymorphic CYP2C19, is a chemoprophylactic antimalarial drug widely used among SCD patients in Nigeria. This study aimed to conduct a comparative CYP2C19 phenotyping among SCD patients and healthy controls and to compare the results with those previously reported. One hundred seventy‐seven unrelated subjects comprising 131 SCD patients and 46 non‐SCD volunteers were phenotyped. This was carried out by collecting pooled urine samples over 8 h following PG administration. Proguanil and its major CYP2C19‐dependent metabolites were measured by high‐performance liquid chromatography. Metabolic ratios (MRs) were computed and employed in classifying subjects into poor or extensive metabolizers. Among SCD group, 130 (99.2%) were extensive metabolizers (EMs) and 1 (0.8%) was poor metabolizer (PM) of PG, while 95.7 and 4.3% non‐SCDs were EMs and PMs, respectively. MRs ranged from 0.02 to 8.70 for SCD EMs and from 0.22 to 8.33 for non‐SCD EMs. Two non‐SCDs with MRs of 18.18 and 25.76 and the SCD with MR of 16.77 regarded as PMs had earlier been genotyped as CYP2C19*2/*2. Poor metabolizers of proguanil in SCD patients are reported for the first time. Regardless of clinical significance, a difference in metabolic disposition of proguanil and CYP2C19 by SCDs and non‐SCDs was established

Synthesis, Characterization, Catalytic Activity, and DFT Calculations of Zn(II) Hydrazone Complexes

Two new Zn(II) complexes with tridentate hydrazone-based ligands (condensation products of 2-acetylthiazole) were synthesized and characterized by infrared (IR) and nuclear magnetic resonance (NMR) spectroscopy and single crystal X-ray diffraction methods. The complexes 1, 2 and recently synthesized [ZnL3(NCS)2] (L3 = (E)-N,N,N-trimethyl-2-oxo-2-(2-(1-(pyridin-2-yl)ethylidene)hydrazinyl)ethan-1-aminium) complex 3 were tested as potential catalysts for the ketone-amine-alkyne (KA2) coupling reaction. The gas-phase geometry optimization of newly synthesized and characterized Zn(II) complexes has been computed at the density functional theory (DFT)/B3LYP/6–31G level of theory, while the highest occupied molecular orbital and lowest unoccupied molecular orbital (HOMO and LUMO) energies were calculated within the time-dependent density functional theory (TD-DFT) at B3LYP/6-31G and B3LYP/6-311G(d,p) levels of theory. From the energies of frontier molecular orbitals (HOMO–LUMO), the reactivity descriptors, such as chemical potential (μ), hardness (η), softness (S), electronegativity (χ) and electrophilicity index (ω) have been calculated. The energetic behavior of the investigated compounds (1 and 2) has been examined in gas phase and solvent media using the polarizable continuum model. For comparison reasons, the same calculations have been performed for recently synthesized [ZnL3(NCS)2] complex 3. DFT results show that compound 1 has the smaller frontier orbital gap so, it is more polarizable and is associated with a higher chemical reactivity, low kinetic stability and is termed as soft molecule

Correlating Structure and KA2 Catalytic Activity of Zn(II) Hydrazone Complexes

Two new Zn(II) complexes bearing tridentate hydrazone-based ligands with NNO or NNS donor atoms were synthesised and characterised by elemental analysis, infrared (IR) and nuclear magnetic resonance (NMR) spectroscopies, and single crystal X-ray diffraction methods. These complexes, together with four previously synthesised analogues, having hydrazone ligands with a NNO donor set of atoms, were successfully employed as catalysts in the ketone-amine-alkyne (KA2) coupling reaction, furnishing tetrasubstituted propargylamines, compounds with unique applications in organic chemistry. DFT calculations at the CAM-B3LYP/TZP level of theory were performed to elucidate the electronic structure of the investigated Zn(II) complexes, excellently correlating the structure of the complexes to their catalytic reactivity

Perceptions of the Impact of Positive Action in EU and non-EU Countries

yesAbstract: Around the world, inequalities exist around boundaries of race, social class, gender, disability, religious beliefs and sexual orientation, often resulting from past and current discriminatory practices. Governments have taken certain measures, including enacting policies such as positive action, to remedy such discrimination. This paper provides a comparative analysis of perceptions of the impact of positive action in seven EU and three non-EU countries. The study adopted participatory methods including consensus workshops, interviews and policy analysis to obtain data from designers of positive action. Findings are discussed, conclusions drawn and wide-ranging recommendations are made at the EC, individual countries and organisational levels

Chloroquine and Hydroxychloroquine for the Prevention or Treatment of Novel Coronavirus Disease (COVID-19) in Africa: Caution for Inappropriate Off-Label Use in Healthcare Settings

The novel severe acute respiratory syndrome-coronavirus-2 pandemic has spread to Africa, where nearly all countries have reported laboratory-confirmed cases of novel coronavirus disease (COVID-19). Although there are ongoing clinical trials of repurposed and investigational antiviral and immune-based therapies, there are as yet no scientifically proven, clinically effective pharmacological treatments for COVID-19. Among the repurposed drugs, the commonly used antimalarials chloroquine (CQ) and hydroxychloroquine (HCQ) have become the focus of global scientific, media, and political attention despite a lack of randomized clinical trials supporting their efficacy. Chloroquine has been used worldwide for about 75 years and is listed by the WHO as an essential medicine to treat malaria. Hydroxychloroquine is mainly used as a therapy for autoimmune diseases. However, the efficacy and safety of CQ/HCQ for the treatment of COVID-19 remains to be defined. Indiscriminate promotion and widespread use of CQ/HCQ have led to extensive shortages, self-treatment, and fatal overdoses. Shortages and increased market prices leave all countries vulnerable to substandard and falsified medical products, and safety issues are especially concerning for Africa because of its healthcare system limitations. Much needed in Africa is a cross-continental collaborative network for coordinated production, distribution, and post-marketing surveillance aligned to low-cost distribution of any approved COVID-19 drug; this would ideally be piggybacked on existing global aid efforts. Meanwhile, African countries should strongly consider implementing prescription monitoring schemes to ensure that any off-label CQ/HCQ use is appropriate and beneficial during this pandemic

Methodological Challenges of Researching Positive Action Measures

This paper highlights some ofthe methodological challenges which have arisen in collecting data for an international study on positive action measures. It will describe strategies employed to encourage participation in the study from as wide a range of organisations and individuals using a mixed method approach. The paper will also discuss the methodological and sensitive issues related to this type of research in organisations and strategies adopted by the research team to ameliorate any problems that have arisen whilst maintaining trustworthiness and rigour in the study

Positive Action Measures Across Different Equality Grounds, Organisations and Sectors in European and Non-european Countries

yesAbstract: This article is based on a large-scale European Commission project on international perspectives on positive action measures. The paper presents an analysis of the perceptions of positive action held by respondents from all the countries participating in an international survey, focussing specifically upon differences across equality grounds, sector and organisation type. This paper will also provide examples of positive action being applied in European and non-European countries that participated in the study. The study adopted extensive literate and online survey to obtain data from designers of positive action. Findings are discussed, conclusions drawn and wide-ranging recommendations are made at the European Commission, individual countries and organisational levels

Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda.

Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload