Evaluation of the Control of Water Sanitation and Hygiene Related Disease Through Community Hygiene Club Intervention in Rwanda

This article consists of a review article reporting the results of previous evaluations of the control of water, sanitation, and hygiene (WASH) related disease through the Community Hygiene Club (CHC) intervention from 2010 to 2020. CHC constitutes the main intervention for the control of WASH-related disease in Rwanda and is implemented countrywide. The study objective was to evaluate if the CHC intervention significantly reduced the prevalence of WASH-related disease after 10 years of its implementation in Rwanda. The study utilized online existing policy documents, research reports, and experiences on the CHC intervention in Rwanda published between 2010 and 2020. We selected and reviewed 12 published documents, and the evaluation followed the steps proposed by ACHI (2020) Health Impact Assessment (HIA) and related frameworks of effective implementation of community health interventions. The primary outcome measure used was the reduction of WASH-related disease while the secondary outcome measure used was the increase of household WASH practices at less than a 5% level of statistical significance. We also described the structure and the implementation process of the CHC intervention. From the case studies where frameworks of effective implementation of community health interventions were applied, the study results showed the intervention significantly (a) increased households’ WASH practices and (b) reduced WASH-related disease. Due to limited publications in the research area and the lack of association of the WASH-related diseases and practices to the CHC intervention’s evaluation for most of published research reports, we recommend additional field data for an extended conclusion and its generalization in Rwanda. The study highlights the need to use appropriate frameworks in the evaluation of community health interventions to (a) attribute the outcome to the intervention and (b) easily identify the shortcomings in case of failure to get expected outcomes

High Burden of Prevalent and Recently Acquired HIV among Female Sex Workers and Female HIV Voluntary Testing Center Clients in Kigali, Rwanda

Objectives: To estimate HIV prevalence and risk factors in population-based samples of female sex workers (FSW) and female voluntary counseling and testing (VCT) clients in Rwanda. Methods: We conducted a cross-sectional survey of 800 FSW and 1,250 female VCT clients in Rwanda, which included interviewing and testing for HIV-1/2, HSV-2 and pregnancy, and BED-CEIA and Avidity Index (AI) to identify recent infections among HIV-infected women. Results: Prevalence of HIV-1, HSV-2, and pregnancy were 24% (95% CI: 21.0-27.0), 59.8% (56.4-63.2), and 7.6% (5.8-9.5) among FSW, and 12.8% (10.9-14.6), 43.2% (40.4-46.0), and 11.4% (9.7-13.3) among VCT clients, respectively. Thirty-five percent of FSW and 25% of VCT clients had never been HIV tested. Per national guidelines, 33% of newly HIV-diagnosed FSW and 36% of VCT clients were already eligible for ART based on CD4,350 cells/ml. Condom use at last sex was higher among FSW (74%) than VCT clients (12%). In age and district of residence-adjusted models, HIV-1 seropositivity was associated with HSV-2 co-infection; recent treatment for sexually transmitted infection (STI); genital symptoms; forced sex; imprisonment; widowhood; and alcohol consumption. Eleven percent of FSW and 12% of VCT clients had recently acquired HIV-1 per BED-CEIA and AI. HSV-2 infection and recent STI treatment were associated with recent HIV infection in both groups, and being married and vaginal cleansing were associated with recent infection before last sex among VCT clients. Conclusions: This population-based survey reveals a high HIV prevalence and incidence among FSW and female VCT clients in Kigali, the scale of which is masked by the low general-population HIV prevalence in Rwanda. HIV/STI and family planning services should be strengthene

Application of a community-based participatory approach towards malaria elimination in the eastern province of Rwanda

Despite recent developments in malaria control, malaria remains one of the major public health problems across the globe with high morbidity and mortality rates in sub-Saharan Africa. The malaria elimination program in eastern Rwanda (MEPR) was designed with the aim to deploy community-driven approaches in malaria elimination using four integrated disciplines: biomedical sciences, social and behavioural science, medical entomology and health economics. In conclusion, commitment of the community in sustaining gains achieved in malaria control is of importance. The use of additional and context-based malaria control tools such as the community-based larval source management program should be envisaged and embedded under the national malaria control strategy to accelerate the country’s goal of achieving malaria pre-elimination levels by 2018. Some recommendations based on our work have been adopted by the government. We stressed the importance of community health workers to also diagnose and treat malaria in adults in addition to children under five and this has been adopted by the national malaria control program

“A calf cannot fail to pick a colour from its mother”: intergenerational transmission of trauma and its effect on reconciliation among post-genocide Rwandan youth

Abstract Background More than one million Rwandans were killed over a span of one hundred days during the 1994 genocide against the Tutsis. Many adult survivors were severely traumatized by the events, and young people, including those who were born after the genocide, have experienced similar genocide-related trauma. Building on a growing body of research on the generational transmission of trauma, our study addressed the following questions: (1) what are the possible mechanisms of trauma transmission from older generation to post-genocide Rwandan youth, and (2) what are the effects of intergenerational trauma on reconciliation processes in Rwanda. Methods A qualitative study was conducted in Rwanda among youth born after the genocide, with parents who survived the 1994 genocide against the Tutsis and among mental health and peace-building professionals. Individual interviews (IDIs) included 19 post-genocide descendants of survivors and six focus group discussions (FGDs) were conducted with 36 genocide survivor parents residing in Rwanda’s Eastern Province. Ten IDIs were also conducted with mental health and peace-building professionals in the capital city of Kigali. Respondents were recruited through five local organisations that work closely with survivors and their descendants. An inductive thematic analysis approach was used to analyse the data. Results Findings from this study suggest that the trauma experienced by genocide survivor parents is perceived by Rwandan youth, mental health and peace-building professionals, and survivor parents themselves to be transmitted from parent to child through human biology mechanisms, social patterns of silence and disclosure of genocide experiences, and children’s and youth’s everyday contact with a traumatized parent. Genocide-related trauma among survivor parents is seen as often being triggered by both life at home and the annual genocide commemoration events. Additionally, when transmitted to genocide survivor descendants, such trauma is understood to negatively affect their psychological and social well-being. Intergenerational trauma among youth with genocide survivor parents limits their involvement in post-genocide reconciliation processes. Findings specifically show that some youth avoid reconciliation with a perpetrator’s family due to mistrust as well as fear of re-traumatizing their own parents

Why (not) participate in citizen science? Motivational factors and barriers to participate in a citizen science program for malaria control in Rwanda

This study explores the motivational factors and barriers to participate in a citizen science program for malaria control in Rwanda. It assesses the changes in motivational factors over time and compares these factors among age and gender groups. Using a qualitative approach, this study involved 44 participants. At the initial stage, people participated in the program because of curiosity, desire to learn new things, helping others, and willingness to contribute to malaria control. As the engagement continued, other factors including ease of use of materials to report observations, the usefulness of the program, and recognition also played a crucial role in the retention of volunteers. Lack of time and information about the recruitment process, perceived low efficacy of the mosquito trap, and difficulties in collecting observations were reported as barriers to get and stay involved. Some variations in the motivational factors were observed among age and gender groups. At the initial phase, young adults and adults, as well as men and women were almost equally motivated to contribute to malaria control. For the ongoing phase, for age, the two groups were almost equally motivated by recognition of their effort. Also, the opportunity for learning was an important factor among young adults while ease of use of the materials was central for adults. For gender, the usefulness of the project, ease of use of materials, and learning opportunities were important motivational factors among women, while men were more motivated by recognition of their efforts. A framework including motivational factors and barriers at each stage of participation is presented. This framework may be used to explore motivations and barriers in future citizen science projects and might help coordinators of citizen science programs to determine whom to target, by which message, and at what stage of participation to retain volunteers in citizen science project

Applying citizen science for malaria prevention in Rwanda : an integrated conceptual framework

Malaria remains a major threat to public health. Long-Lasting Insecticide-treated Nets (LLINs) and Indoor Residual Spraying (IRS) have been widely adopted as important malaria prevention and control interventions and have contributed to significant reduction in malaria incidence. However, recently malaria resurgence has been reported in different countries, including Rwanda, indicating that current attempts to control and eliminate malaria may be failing due to environmental changes and changes in human behaviour. Engaging citizens in malaria prevention and control would help them to identify and prioritize their own health concerns and be able to make appropriate decisions. A citizen science approach to monitor ecological changes by providing timely information is likely to support more effective and consistent use of malaria prevention and control interventions. However, the application of citizen science in malaria prevention and control has lagged behind when comparing with areas of disease diagnosis and treatment. In addition, the determinants of participation in such a citizen science program have not been fully analyzed. This paper presents a conceptual model of likely determinants of participation in connective action (sharing and exchange of malaria-related information), effective and consistent use of malaria preventive and control measures (LLINs and IRS) and collective action (participating in public goods for malaria prevention). The model will guide future research on behavioural and contextual factors and may enhance the effective and consistent use of malaria preventive and control interventions

Role of individual perceptions in the consistent use of malaria preventive measures: Mixed methods evidence from rural Rwanda

Background: Malaria preventive measures, including long-lasting insecticide-treated bet nets (LLINs), indoor residual spraying (IRS), and controlling mosquito breeding sites, are key measures to achieve malaria elimination. Still, compliance with these recommended measures remains a major challenge. By applying a novel and comprehensive model for determinants of malaria prevention behaviour, this study tests how individual perceptions influence the intentions to use malaria preventive measures and explores strategies that stimulate their consistent use. Methods: The study was carried out in the sectors of Ruhuha and Busoro, Rwanda during October and November 2017, and these were conducted into two phases. Phase one involved a questionnaire survey (N = 742), whereas Phase two employed a qualitative approach that included nine focus group discussions, seven key informant interviews, and three in-depth interviews. Results: The findings of the quantitative study showed that participants very often use LLINs (66.6%), accept IRS (73.9%), and drain stagnant water in case of presence (62%). The intentions to use malaria preventive measures were consistently driven by perceived severity, perceived self-efficacy, perceived response efficacy, and subjective norms, and hindered by perceived barriers. The intentions were also positively associated with the actual use of LLINs, acceptance of IRS, and drainage of stagnant water. There is no evidence that either not having enough LLINs (ownership of at least one bed net in the household, here referred to as availability) or having sufficient LLINs (having one LLIN per two people in the household, here referred to as accessibility) moderated the relationship between behavioural intentions and actual use of LLINs. The qualitative study indicated that participants believed malaria risk to be high and perceived a high mosquito density. They also believed that repetitive malaria episodes are caused by the perceived low effectiveness of anti-malaria medications. Lack of LLINs increased the perceived added value of LLINs, and together with the increased malaria burden increased the perceived response efficacy. Participants highlighted the need to continuously mobilize and engage community members especially those who do not use LLINs when having one, and those who do not accept the spraying activities. Conclusion: Malaria prevention interventions should target individual perceptions to enhance consistent use of malaria preventive measures. Three strategies to improve consistent use and acceptance of these measures are highlighted: (1) ensure access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention activities.</p

Qualitative analysis of the health system effects o f a community-based malaria elimination program in Rwanda

Purpose: To identify the health system-strengthening role of a community-based malaria elimination program in Ruhuha, Rwanda, and the ways by which health system effects may have been achieved. Materials and methods: Qualitative data were collected through 14 semi-structured in-depth interviews and five focus group discussions with various stakeholders. These data were supported by analysis of project documents. Results: Use of a transdisciplinary approach allowed the program to influence several crosscutting issues spanning four broad areas – social collaboration; capacity building; structural alignment; and knowledge translation. Health system effects were identified mostly at the micro (i.e., district) level, with limited impact on strengthening national and subnational policies. Although systems thinking was not explicitly applied, the project had positive spillover effects on the health system. These include expanding the informal health workforce and introducing innovative approaches aligned to the national malaria strategy for vector control. Findings also show that the elimination program contributed to an increased understanding of the transmission dynamics of malaria in Ruhuha. Conclusion: The community-based malaria elimination program in Ruhuha successfully created a stable foundation for community mobilization toward malaria control, and explored innovative ways for long-term financing for malaria elimination. The transdisciplinary nature of the project, use of horizontal facilitation techniques for community engagement, and the sociocultural context in which the program was implemented are possible mechanisms by which systems strengthening was achieved. The knowledge gained from this assessment can be used to improve future community-focused interventions for malaria control, and develop a sustainable strategy for community engagement in health care