Management of the long term psychological effects of rape among women survivors of the 1994 genocide in Rwanda : a grounded theory approach.

Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.In the 1994 Rwandan genocide, rape was widely used as a strategic weapon against Tutsi women. This study explored the long term psychological effects of rape experienced by these women in order to develop a middle range theory to guide the management of the lasting psychological effects of rape in the context of genocide. A Grounded Theory approach using Strauss and Corbin’s paradigm (Strauss and Corbin, 1990) was used. Data collection entailed in-depth interviews of twenty nine participants, twelve of whom were rape survivors, ten were women who had not been raped, and seven were men from their community. Open coding, axial coding and selective coding were used to analyse the data. The results have shown that women were negatively affected, physically, psychologically and socially, by the rape. Genocide Rape Trauma emerged as a concept that defines these outcomes. It includes unbearable memories, overwhelming feelings, sense of helplessness, somatic distress, negative self-image, altered intimate relationships and social isolation. The extreme brutality, the humiliation that accompanied the experience of rape and multiple losses were reported as risk factors for the lasting psychological effects of rape. These negative outcomes were maintained by poverty, poor physical health, the burden of raising the children born of rape, hostility and stigma from their community, and lack of appropriate support and effective health care services. Facilitating the management of Genocide Rape Trauma emerged as the core category of the middle range developed theory. Recovery from Genocide Rape Trauma required formal and informal support, including psychological and medical care, sensitivity in dealing with genocide rape survivors, and advocacy. Economic empowerment was a key element, while educating the community contributed to the social integration of rape survivors and their children born of rape into their community. Women had developed coping mechanisms of their own to attain psychological relief, and had organized themselves into support groups. This study contributed to clinical practice by providing a holistic approach to taking care of rape survivors. The inclusion of such theory in the curriculum of health care professionals should contribute to the understanding of the lasting impact of rape and how to handle it in an efficient manner. Key words: Rwanda, Genocide, women survivors, Genocide Rape Trauma, Management of the long term psychological effects of rape and Grounded theory

Indwelling urinary catheter use and associated outcomes among adult patients undergoing surgery

Background: Indwelling Urinary catheters (IUCs) are the most utilized  devices. They are complicated into postoperative catheter-associated  urinary tract infections, urethral trauma, pain that culminate into prolonged immobility and hospital stay with associated financial implications. The aim of this review was to give an overview of the use of indwelling catheters among adult patients undergoing surgery.Methods: A systematic review approach was employed. A literature search was done using of search engines that include HINARI, PubMed, Google Scholar and Cochrane, using search words related to the title and aim of the review.Results: Eleven out of 236 articles involving 218,000,790 patients studied met the inclusion criteria. 86% to 87.3% of patients undergoing major operations were exposed to routine catheterization depending on the type of surgical procedure. Only 7.7% to 8% of patients needed postoperative IUCs. Unduly prolonged retention of IUCs was the most reason for inappropriate IUCs use with 18% without a documented removal order. IUCs contributed 80% to 87.8% of postoperative UTIs as the third most common postoperative infections.Conclusion: Use of IUCs is necessary for certain surgeries as per existing guidelines. The lack of IUC removal instructions is one of the factors contributing to CAUTIs._________________________________________________________________________Keywords: indwelling urinary catheter, CAUTI, surgery, perioperativ

Indwelling urinary catheter placement and removal practices among surgical patients at Kigali University Teaching Hospital

Background: Indwelling urinary Catheters (IUCs) are routinely used medical devices among patients undergoing surgery and their undue use is a risk factor for urinary tract infections (UTIs). The study aim was to assess IUCs placement and removal practices among patients undergoing surgery.Methods: We carried out a cross-sectional study on 207 patients operated at Kigali University Teaching Hospital (KUTH). A pretested observation checklist (Cronbach: α=0.851) was used for data collection. The data were analyzed using SPSS version 20. Chi-square test was used to determine the association between patients’ characteristics and IUCs placement and removal.Results: The IUC placement rate was 56.5% (n=117). There was significant association of IUCs use with gender, age, type and urgency of surgical procedures performed and the type of anesthesia used. Appropriate indication for IUC placement was established in 95.7% patients (n=112). Although 99.1% (n=116) patients were discharged from theatre with IUCs in situ, only 56.5% (n=66) had documented removal instructions.Conclusion: This study established that IUCs use is common and justified in surgery. However, lack of removal instruction was found to be a challenge. Therefore, the authors recommend patients’ re-evaluation for post-surgery IUC need and its early removal where inappropriate to prevent CAUTIs and other complications.Keywords: Indwelling urinary catheter use, surgical patients, surger

Umbilical Cord Care Among Postnatal Mothers in Kibungo Hospital Catchment Area, Rwanda

Background Infections contribute to 30% of the 2.5 million neonatal deaths that occur globally every year. A newly cut umbilical cord can be a pathway for bacteria to enter the vulnerable neonate and cause neonatal sepsis. Most infections are preventable with evidenced-based cord care. Objective To assess postnatal mothers’ knowledge and practice of umbilical cord care in the Kibungo Hospital catchment area in Rwanda.  Methodology A descriptive cross-sectional study design and purposive sampling strategy was used to recruit 224 postnatal mothers. Data were collected using a structured questionnaire. Descriptive and inferential statistics were used to analyze data.   Results A third of mothers (33%) had adequate knowledge, and a half (54%) had good umbilical cord care practice. The majority (70%) reported dry cord care practice, though many applied substances including Vaseline (23%) and Movit ointment (15%). There was a negative correlation between knowledge of cord care and substance applied to cord (R2=0.224, p=0.001), and days applied (R2=0.167, p=0.012).  Conclusion The study population had low cord care knowledge. Health care providers need to educate mothers on the practice of allowing the cord to dry naturally, and discourage the use of harmful substances that delay cord separation and increase risk of sepsis and subsequent neonatal mortality. Rwanda J Med Health Sci 2020;3(2):167-18

Global partnerships in transformation of nursing and midwifery education in Africa: A systematic scoping review protocol

Background In recent decades, the literature on global partnerships in nursing and midwifery education, for the purpose of enhancing quality of education, strengthening health care system, and achieving universal health coverage is on the rise in Africa. However, there is a gap regarding the best practices and barriers in the African context. The purpose of this systematic scoping review is to map the evidence on global partnerships in transforming nursing and midwifery education in Africa. Methods A search will be conducted with the use of the following electronic databases: Cumulative Index to Nursing and Applied Health Literature [CINAHL], PubMed, Cochrane Library, and Google Scholar. Grey literature will be searched via the World Health Organization’s website to locate relevant policies and guidelines. The search will be limited to work published in English from July 2013 to June 2023. All located resources will be exported to Endnote X8. All duplicates will be removed during when the abstracts are screened. Two independent reviewers will screen and extract the full text of the selected articles. Thematic analysis will be used to analyze data from this systematic scoping review. Discussion: Mapping the evidence on global partnerships in transforming nursing and midwifery education in Africa will outline the best practices and preferences for sustainable collaboration. The review will also highlight knowledge gaps and limitations that could inform for future research projects

Chronic Kidney Disease (CKD): knowledge of risk factors and preventive practices of CKD among students at a University in Rwanda

Background: Chronic Kidney Disease (CKD) is a global public health burden. Most people miss the early subtle signs that can develop at any age. CKD has severe complications, including End-stage Renal Disease.Objective: To assess the knowledge level of CKD risk factors and preventive practices among university students in Rwanda.Methods: A cross-sectional study design was used from April to May 2017. A stratified random sampling technique was used to recruit 260 university students. A 36-item questionnaire was selfadministered. Data were analyzed using descriptive and inferential statistics.Results: The mean age was 29 years and over half were female (53.4%). A great number (44%) had a low knowledge level of CKD and its risk factors, a third (34%) had moderate, and only (22%) had a high knowledge level of CKD risk factors. The majority (50.4%) had low level of preventive practices, nearly half (45%) had moderate and only (4.6%) had high level of preventive practice.Conclusion: CKD knowledge and preventive practices in this study population were low. Knowledge gained and desire for healthy preventive practices may have been a benefit of the study. CKD educational programs should be further developed to prevent this significant problem affecting the Rwandese community.Keywords: Chronic kidney disease, knowledge, preventive practices, university student

The “treatment gap” in global mental health reconsidered: sociotherapy for collective trauma in Rwanda

Background: The “treatment gap” (TG) for mental disorders refers to the difference that exists between the number of people who need care and those who receive care. The concept is strongly promoted by the World Health Organization and widely used in the context of low- and middle-income countries. Although accepting the many demonstrable benefits that flow from this approach, it is important to critically reflect on the limitations of the concept of the TG and its implications for building capacity for mental health services in Rwanda. Objective: The article highlights concerns that the evidence base for mental health interventions is not globally valid, and problematizes the preponderance of psychiatric approaches in international guidelines for mental health. Specifically, the risk of medicalization of social problems and the limited way in which “community” has been conceptualized in global mental health discourses are addressed. Rather than being used as a method for increasing economic efficiency (i.e., reducing healthcare costs), “community” should be promoted as a means of harnessing collective strengths and resources to help promote mental well-being. This may be particularly beneficial for contexts, like Rwanda, where community life has been disrupted by collective violence, and the resulting social isolation constitutes an important determinant of mental distress. Conclusions: Moving forward there is a need to consider alternative paradigms where individual distress is understood as a symptom of social distress, which extends beyond the more individually oriented TG paradigm. Sociotherapy, an intervention used in Rwanda over the past 10 years, is presented as an example of how communities of support can be built to promote mental health and psychosocial well-being

Assessment of anxiety in patients awaiting surgery in a referral hospital in Rwanda

Background: Preoperative anxiety is a common occurrence in patients awaiting surgery. Preoperative anxiety adversely affects anaesthesia and surgical process and increases the risk of postoperative complications. Level of anxiety in patients awaiting surgical procedures in Rwanda is not well known or documented.Objective: To assess preoperative anxiety and associated factors of patients awaiting surgery at a teaching hospital in Kigali.Methods: A cross-sectional study design was adopted. A convenience sampling method was used to recruit 151 adult patients, and the instrument entitled “Pre-operative Intrusive Thoughts Inventory (PITI)” anxiety scale was used to assess anxiety. Descriptive and inferential statistics were used to analyse data.Results: Nearly three quarters (72.8%) of participants had a high level of clinically significant preoperative anxiety. Patients awaiting orthopaedic surgery were 10 times more likely to have clinically significant pre-operative anxiety (OR 10.22; 95%; CI 1.144 - 91.304; P= 0.037), whereas participants with impending Cesarean (OR: 0.03; 95% CI-0.002-0.568; P=0.018), and older participants had decreased pre-operative anxiety levels (OR: 0.22; 95% CI 0.075 - 0.650; P=0.006).Conclusion: Patients awaiting surgery had clinically significant pre-operative anxiety level (72.8%) associated with age, medical diagnosis and type of surgical intervention. A preoperative intervention incorporating individual characteristics is needed to reduce preoperative anxiety.Keywords: Preoperative, anxiety, patients, educatio

Neonatal Hypothermia: Mothers’ Knowledge and Practice at a Provincial Hospital in Rwanda

Background Globally, 2.5 million neonates die each year from hypothermia. The World Health Organization (WHO) considers neonatal hypothermia as a decrease of axillary temperature in infants below 36.5° Celsius. New mothers, or the nearest caregivers, should be aware that hypothermia is a newborn danger sign, in order to apply best practices regarding neonatal hypothermia prevention to reduce subsequent mortality. Objective To assess mothers’ knowledge and practice of neonatal hypothermia at a selected provincial hospital in Rwanda. Methods A cross-sectional study design and convenience sampling method were used to select 161 mothers with living babies. Data were collected using a structured questionnaire. Descriptive and inferential statistics were used to analyze data. Results About 97% of mothers had inadequate knowledge, and the majority (83%) had inadequate neonatal hypothermia practices. Predictor variables for knowledge were ANC attendance (OR=1.884, 95% CI=1.675-2.565, p=0.042) and secondary educational level (OR=1.787, 95% CI=1.521-2.187, p=0.032). Practice was significantly associated with educational level (OR=1.787, 95% CI=1.521-2.187, p=0.032).   Conclusion There is a need to increase a mother's evidence-based practice of neonatal hypothermia. This condition unchecked leads to high-risk life-threatening complications. Prevention should emphasize on observed gaps to decrease deaths related to neonatal hypothermia. Rwanda J Med Health Sci 2020;3(2):152-16