Massive Cervico-Lingual Cystic Hygroma

Cystic Hygroma (CH) is an aberrant proliferation of lymphatic vessels  creating fluid-filled sacs that result from blockage in the abnormal lymphatic system. These benign lesions are characteristic in their capability to grow to an enormously huge size has potential pressure effects on the neighboring structures. The massive expansion can also lead to gross disfigurement of the neck and face. In this paper, we present a rare case of cervico-lingual CH in a 17-year old Rwandese boy. Though the lesion had caused massive expansion of the tongue (12cm x 10cm) and led to gross deformity of the mandible, the boy had no signs of respiratory distress. His main concerns were inability to eat solid foods and compromised speech. The management challenges and literature review on cystic hygroma of the head and neck region are discussed.Key Words: Cystic Hygroma, Cervico-Lingua

Landslides Hazard Mapping in Rwanda Using Bivariate Statistical Index Method

Landslides hazard mapping (LHM) is essential in delineating hazard prone areas and optimizing low cost mitigation measures. This study applied the Geographic Information System and statistical index method in LHM in Rwanda. Field surveys identified 336 points that were employed to construct a landslides inventory map. Ten landslides predicting factors were analyzed: normalized difference vegetation index, elevation, slope, aspects, lithology, soil texture, distance to rivers, distance to roads, rainfall, and land use. The factor variables were converted into categorized variables according to the percentile divisions of seed cells. Then, values of each factor’s class weight were calculated and summed to create landslides hazard map. The estimated hazard map was split into five hazard classes (very low, low, moderate, high, and very high). The results indicated that the northern, western, and southern provinces are largely exposed to landslides hazard. The major landslides hazard influencing factors are elevation, slope, rainfall, and poor land management. Overall, this LHM would help policy makers to recognize each area’s hazard extent, key triggering factors, and the required hazard mitigation measures. These measures include planting trees to enhance vegetation cover and reduce the runoff, and construction of buildings on low steep slope areas to reduce people’s hazard exposure; while agroforestry and bench terraces would reduce sediments that take out the exposed soil (erosion) and pollute water quality

Lived Experience-Led Research Agenda to Address Early Death in People With a Diagnosis of a Serious Mental Illness: A Consensus Statement

Importance People with serious mental illness (SMI), defined as a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or disabling major depressive disorder) die approximately 10 to 25 years earlier than the general population. Objective To develop the first-ever lived experience–led research agenda to address early mortality in people with SMI. Evidence Review A virtual 2-day roundtable comprising 40 individuals convened on May 24 and May 26, 2022, and used a virtual Delphi method to arrive at expert group consensus. Participants responded to 6 rounds of virtual Delphi discussion via email that prioritized research topics and agreement on recommendations. The roundtable was composed of individuals with lived experience of mental health and/or substance misuse, peer support specialists, recovery coaches, parents and caregivers of people with SMI, researchers and clinician-scientists with and without lived experience, policy makers, and patient-led organizations. Twenty-two of 28 (78.6%) of the authors who provided data represented people with lived experiences. Roundtable members were selected by reviewing the peer-reviewed and gray literature on early mortality and SMI, direct email, and snowball sampling. Findings The following recommendations are presented in order of priority as identified by the roundtable participants: (1) improve the empirical understanding of the direct and indirect social and biological contributions of trauma on morbidity and early mortality; (2) advance the role of family, extended families, and informal supporters; (3) recognize the importance of co-occurring disorders and early mortality; (4) redefine clinical education to reduce stigma and support clinicians through technological advancements to improve diagnostic accuracy; (5) examine outcomes meaningful to people with an SMI diagnosis, such as loneliness and sense of belonging, and stigma and their complex relationship with early mortality; (6) advance the science of pharmaceuticals, drug discovery, and choice in medication use; (7) use precision medicine to inform treatment; and (8) redefine the terms system literacy and health literacy. Conclusions and Relevance The recommendations of this roundtable are a starting point for changing practice and highlighting lived experience–led research priorities as an option to move the field forward.publishedVersio

Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda

Abstract Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals

Provider and client perspectives on the use of maternity waiting homes in rural Rwanda.

BACKGROUND: The World Health Organization recommends the implementation of maternity waiting homes (MWH) to reduce delays in access to obstetric care, particularly for high-risk pregnancies and mothers living far from health facilities, and as a result, several countries have rolled out MWHs. However, Rwanda has not implemented this recommendation on a large scale. There is only one MWH in the country, hence a gap in knowledge regarding the potential utilisation and benefits of MWHs. OBJECTIVE: To explore providers' and clients' perspectives on facilitators and barriers to the use of MWH in rural Rwanda. METHODS: We conducted a qualitative study to explore health providers' and clients' perspectives on facilitators and barriers to the use of MWH in Rwanda, between December 2020 and January 2021. We used key informant interviews and focus group discussions to collect data. Data were analysed using NVivo qualitative analysis software version 11. RESULTS: Facilitators included perceptions that the MWH offered either a peaceful and home-like environment, good-quality services, or timely obstetric services, and was associated with good maternal and neonatal outcomes. Barriers included limited awareness of the MWH among pregnant women, fear of health providers to operate the MWH at full capacity, women's lack of autonomy, uncertainty over funding for the MWH, and perceived high user fees. CONCLUSION: The Ruli MWH offers a peaceful environment for pregnant women while providing quality and timely obstetric care, resulting in positive maternal and neonatal outcomes for women. However, its existence and benefits are not widely known, and its use is limited due to inadequate resources. There is a need for increased awareness of the MWH among healthcare providers and the community, and lessons from this MWH could inform the scale up of MWHs in Rwanda