Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda: findings from a population based study

This is the published version of a paper published in BMC Psychiatry. Citation for the original published paper (version of record): Umubyeyi, A., Mogren, I., Ntaganira, J., R E S E A R C H A R T I C L E Open Access Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda: findings from a population based study The prevalence of mental disorders was investigated using of a diagnostic tool, the "MINI: Mini International Neuropsychiatric Interview". Risk factor patterns were analysed with bi-and multivariate logistic regression. To find the proportion of mental disorders attributed to IPV, the population attributable fraction was computed

The role of community health workers in COVID-19 home-based care: lessons learned from Rwanda

Investment in the health system is essential for effective pandemic response: Despite Rwanda’s rapid implementation of control measures to manage the COVID-19 pandemic, the country faced several challenges in the early stages, due to inadequate infrastructure and a shortage of trained staff. A home-based care approach alleviated the facility-based care burden during the pandemic: Implemented in September 2020, this key strategy engaged community health workers (CHWs) to provide health education and monitor patients with mild COVID-19 symptoms. The integration of medical doctors (MDs) into home-based care teams strengthened the COVID-19 response in Rwanda: Operation Save the Neighbour, launched in 2021, integrated MDs into home-based care teams. This improved the quality of care provided to COVID-19 patients, enhanced patient monitoring, and offered additional support to CHWs at household level. The provision of continuous support to CHWs contributed to overcoming challenges in implementing home-based care models: CHWs played a critical role in community mobilization and surveillance. However, they faced significant challenges, including fear, anxiety, and overwhelming workloads. To support these frontline workers, ongoing training and an adequate supply of resources, including personal protective equipment (PPE), are required

Evolution of entrepreneurs state support system in the national aspect

The network scale-up method is a promising technique that uses sampled social network data to estimate the sizes of epidemiologically important hidden populations, such as sex workers and people who inject illicit drugs. Although previous scale-up research has focused exclusively on networks of acquaintances, we show that the type of personal network about which survey respondents are asked to report is a potentially crucial parameter that researchers are free to vary. This generalization leads to a method that is more flexible and potentially more accurate. In 2011, we conducted a large, nationally representative survey experiment in Rwanda that randomized respondents to report about one of 2 different personal networks. Our results showed that asking respondents for less information can, somewhat surprisingly, produce more accurate size estimates. We also estimated the sizes of 4 key populations at risk for human immunodeficiency virus infection in Rwanda. Our estimates were higher than earlier estimates from Rwanda but lower than international benchmarks. Finally, in this article we develop a new sensitivity analysis framework and use it to assess the possible biases in our estimates. Our design can be customized and extended for other settings, enabling researchers to continue to improve the network scale-up method

Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda

BACKGROUND: In 2010, Rwanda adopted ART for prevention of mother to child transmission of HIV from pregnant women living with HIV during pregnancy and breasfeeding period. This study examines rates of mother-to-childtransmission of HIV at 6–10 weeks postpartum and risk factors for mother-to-child transmission of HIV (MTCT) among HIV infected women on ART during pregnancy and breastfeeding. METHODS: A cross-sectional survey study was conducted between July 2011–June 2012 among HIV-exposed infants aged 6–10 weeks and their mothers/caregivers. Stratified multi-stage, probability proportional to size and systematic sampling to select a national representative sample of clients. Consenting mothers/caregivers were interviewed on demographic and program interventions. Dry blood spots from HIV-exposed infants were collected for HIV testing using DNA PCR technique. Results are weighted for sample realization. Univariable analysis of socio-demographic and programmatic determinants of early mother-to-child transmission of HIV was conducted. Variables were retained for final multivariable models if they were either at least of marginal significance (p-value < 0.10) or played a confounding role (the variable had a noticeable impact > 10% change on the effect estimate). RESULTS: The study sample was 1639 infants with HIV test results. Twenty-six infants were diagnosed HIV-positive translating to a weighted MTCT estimate of 1.58% (95% CI 1.05–2.37%). Coverage of most elimination of MTCT (EMTCT) program interventions, was above 80, and 90.4% of mother-infant pairs received antiretroviral treatment or prophylaxis. Maternal ART and infant antiretroviral prophylaxis (OR 0.01; 95%CI 0.001–0.17) and maternal age older than 25 years were significantly protective (OR 0.33; 95%CI 0.14–0.78). No disclosure of HIV status, not testing for syphilis during pregnancy and preterm birth were significant risk factors for MTCT. Factors suggesting higher sociodemographic status (flush toilet, mother self-employed) were borderline risk factors for MTCT. CONCLUSION: ART for all women during pregnancy and breastfeeding was associated with the estimated low MTCT rate of 1.58%. Mothers who did not receive a full package of anti-retroviral therapy according to the Rwanda EMTCT protocol, and young and single mothers were at higher risk of MTCT and should be targeted for support in preventing HIV infection

Intimate partner violence and its mental health and help seeking implications for young adults in Rwanda

Aim: This thesis aimed to explore the magnitude of Intimate Partner Violence (IPV), its risk factors and resulting mental health effects. A further aim was to explore the barriers to care for people suffering from mental disorders as well as for people exposed to IPV. Methods: A population-based cross-sectional study was conducted, using the World Health Organization’s questionnaire for violence research. It included 477 women and 440 men aged 20-35 years. For mental disorders, we used the Mini International Neuropsychiatric Interview questionnaire. Simple and multivariable logistic regression was used to identify risk factors associated with IPV, mental disorders and barriers to care. In addition, six focus group discussions were conducted with health care professionals regularly meeting people exposed to partner violence. Results: Women were highly exposed to IPV, with a tremendous impact on women’s mental health. In spite of this, women rarely sought professional help for mental problems due to the many barriers experienced. Instead, they preferred to go to someone they knew, partly due to services not being available, accessible, acceptable and of a good quality. Further, a conflict between what the state wants to achieve in terms of gender equality and the existing culture, heavily influenced by masculinity norms, was identified. This situation exposes women to high levels of abuse and poor access to help and support services. For men, there was a different pattern as they were considerably less exposed to IPV. However, men still suffered from mental problems found to be associated with IPV but mainly due to other factors, such as poverty and exposure to traumatic episodes during the genocide. Further, men sought health care for mental problems to a much lower extent than women, possibly due to gender norms. Health care professionals also confirm that men are not seen in the health care services as victims of IPV. Conclusions: The findings in this thesis revealed that women were more exposed to IPV, with serious mental health effects compared to men, and women also faced more barriers when seeking care. Gender inequality was an important factor behind women’s poor health. Hence, the promotion of gender equality needs to be reinforced at all levels of societal organization. For both men and women, the attainment of higher levels of education, can improve the present situation. Further, interventions to decrease poverty will lower the prevalence of IPV and reduce its mental health effects. Mental health care and IPV support services need to be made available and equipped with health professionals able to handle IPV cases and mental disorders

Effect of pregnancy intention on the timing and sustained use of antenatal care services in Rwanda

We investigated the relationship between intended pregnancy and utilization of antenatal care services in Rwanda. Using Demographic and Health Survey 2014/2015, secondary data was obtained on maternal health services utilization. We performed stepwise logistic regression analysis to examine the effect of independent variables on women’s early and late utilization, as well as their sustained use of antenatal services. Dependent and main independent variables included: first trimester visits, completed antenatal visits and intended pregnancy respectively. Of 5,944 women sampled; 56.6% had made early antenatal visits and 44% had completed 4 visits. Unintended pregnancies were less likely to make early antenatal visits and complete 4 antenatal visits. Religion and being in union had positive association with standard antenatal visits; while age (&gt;24 years), grand multiparty, and poor economic status had negative association. Our results call for deeper sensitization on utilization of antenatal services and more use of contraception to reduce unintended pregnancies. Nous avons étudié la relation entre la grossesse prévue et l'utilisation des services de soins prénatals au Rwanda. À l'aide de l'Enquête démographique et de santé 2014/2015, des données secondaires ont été obtenues sur l'utilisation des services de santé maternelle. Nous avons effectué une analyse de régression logistique par étapes pour examiner l’effet de variables indépendantes sur l’utilisation précoce et tardive des femmes, ainsi que leur utilisation soutenue des services prénatals. Les variables dépendantes et principales indépendantes comprenaient: les visites au premier trimestre, les visites prénatales terminées et la grossesse prévue respectivement. Sur 5 944 femmes échantillonnées; 56,6% avaient effectué des visites prénatales précoces et 44% avaient effectué 4 visites. Les grossesses non désirées étaient moins susceptibles de faire des visites prénatales précoces et d'effectuer 4 visites prénatales. La religion et le fait d'être en union avaient une association positive avec les visites prénatales standard; tandis que l'âge (&gt; 24 ans), le grand multipartisme et la mauvaise situation économique avaient une association négative. Nos résultats appellent à une sensibilisation plus profonde sur l'utilisation des services prénatals et une plus grande utilisation de la contraception pour réduire les grossesses non désirées

Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda : findings from a population based study

Background: In low income countries, mental disorders are a neglected health problem. Mental disorders are influenced by a number of factors in people's everyday life of which intimate partner violence (IPV) commonly form an important part. The aim of this study was to investigate the prevalence of mental disorders in young men and women in Rwanda and their risk factors with main emphasis on IPV and its contribution to mental disorders, taking into account the genocide context. Methods: This population-based study included a representative sample of 917 men and women aged 20-35 years. The prevalence of mental disorders was investigated using of a diagnostic tool, the "MINI: Mini International Neuropsychiatric Interview". Risk factor patterns were analysed with bi- and multivariate logistic regression. To find the proportion of mental disorders attributed to IPV, the population attributable fraction was computed. Results: The prevalence rates of current depression, suicide risk and PTSD were more than two times higher in women than in men while for generalized anxiety disorder, the prevalence was about the same. Physical, sexual and psychological intimate partner violence exposure was highly associated with all forms of mental disorders for women. For physical violence, after adjusting for socio-demographic factors and exposure to traumatic episodes during the Rwandan genocide, the risk of current depression for women was elevated four times. Even though few men reported partner violence exposure, physical violence in the past year was found to be a statistically significant risk factor for current depression and for generalized anxiety disorder. However, having an experience of traumatic episodes during the genocide contributed to the risk of most of mental disorders investigated for men. Conclusion: In Rwanda, IPV contributed considerably to mental disorders investigated. Thus, prevention of IPV should be considered as a public health priority, as its prevention would considerably reduce the prevalence of mental disorders

Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda : findings from a population based study

Background: In low income countries, mental disorders are a neglected health problem. Mental disorders are influenced by a number of factors in people's everyday life of which intimate partner violence (IPV) commonly form an important part. The aim of this study was to investigate the prevalence of mental disorders in young men and women in Rwanda and their risk factors with main emphasis on IPV and its contribution to mental disorders, taking into account the genocide context. Methods: This population-based study included a representative sample of 917 men and women aged 20-35 years. The prevalence of mental disorders was investigated using of a diagnostic tool, the "MINI: Mini International Neuropsychiatric Interview". Risk factor patterns were analysed with bi- and multivariate logistic regression. To find the proportion of mental disorders attributed to IPV, the population attributable fraction was computed. Results: The prevalence rates of current depression, suicide risk and PTSD were more than two times higher in women than in men while for generalized anxiety disorder, the prevalence was about the same. Physical, sexual and psychological intimate partner violence exposure was highly associated with all forms of mental disorders for women. For physical violence, after adjusting for socio-demographic factors and exposure to traumatic episodes during the Rwandan genocide, the risk of current depression for women was elevated four times. Even though few men reported partner violence exposure, physical violence in the past year was found to be a statistically significant risk factor for current depression and for generalized anxiety disorder. However, having an experience of traumatic episodes during the genocide contributed to the risk of most of mental disorders investigated for men. Conclusion: In Rwanda, IPV contributed considerably to mental disorders investigated. Thus, prevention of IPV should be considered as a public health priority, as its prevention would considerably reduce the prevalence of mental disorders

Women are considerably more exposed to intimate partner violence than men in Rwanda : results from a population-based, cross-sectional study

Background: Intimate partner violence (IPV) against women is an important, yet often neglected public health issue. The existence of gender norms imbalance expressed by men's and women's attitudes in relation to power and decision-making in intimate relationships may influence the magnitude of IPV. The aim of this study was to investigate the prevalence and potential risk factors of physical, sexual and psychological IPV in young men and women in Rwanda. Methods: This population-based, cross-sectional study included a representative sample of men and women from the Southern Province of Rwanda. Face-to-face interviews were performed using the World Health Organization (WHO) questionnaire for violence exposure to estimate past year and earlier in life IPV occurrence. Risk factor patterns were analyzed by use of bi- and multivariate logistic regression. Results: Women were, to a considerably higher extent, exposed to physical, sexual and psychological IPV than men. Of the women, 18.8% (n = 78) reported physical abuse in the past year, compared to 4.3% (n = 18) of men. The corresponding figures for women and men for sexual abuse were 17.4% (n = 71) and 1.5% (n = 6), respectively, and for psychological abuse, the corresponding figures were 21.4% (n = 92) and 7.3% (n = 32). Findings illustrate that violence against women was recurrent, as the highest frequency (&gt; 3 times) dominated in women for the various acts of all forms of violence. Identified risk factors for women's exposure to physical violence were being low educated, having poor social support, being poor and having many children. For men exposed to physical violence, no statistically significant risk factor was identified. Conclusions: In this setting, IPV exposure was more common in women than men in the Southern Province of Rwanda. Promotion of gender equality at the individual level is needed to make a positive difference in a relatively short term perspective. Men's lower reporting of IPV confirms women's subordinate position, but men's denial of incidents could also explain the gender role pattern