Incidence and risk factors associated with surgical site infection following cesarian section at Kibungo Referral Hospital, Rwanda – A prospective cohort study

Introduction: Cesarian section (CS) is lifesaving both for the mother and the baby. Worldwide, there has been an increase in the incidence of CS. However, complications may arise postoperatively for both mother and newborn. Our aim was to determine the incidence rate of post-CS surgical site infection (SSI), identify factors associated with SSI, and identify the most frequent microorganisms associated with the presence of post-CS SSI.Methods: This is a prospective cohort study conducted at KRH, including all CS, performed from February to April 2020. Patient’s demographics, operative management, and outcomes were analyzed. Results: A total of 201 patients aged between 15 to 47 years were operated on and 3.48% developed SSI. 90% were from Ngoma district, 47% had secondary education followed by 36% with primary education. The majority (97%) had no comorbidities. Povidone and chlorhexidine combined was the most commonly used disinfectant. 53% were emergencies and 92% of CS were performed by general practitioners. The average duration of operation was between 30 to 45minutes. Showering prior to operation (RR=0.39) at 95% CI [0.005-0.29], not shaving 30 minutes prior to incision (RR: 25.5) at 95% CI [3.5-18.7] and use of both povidone and chlorhexidine for skin preparation (RR= 0.15) at 95% CI [0.1-1.6] are associated with reduced risk of developing SSI. Obstructed labor/dystocia ((RR=4.55) at 95%, CI [1.6-45.4]) increases the infection risk. Staphylococcus aureus was the most frequently isolated microorganism in post-CS SSI patients.Conclusion: Active hospital infection services and adherence to evidence-based guidelines for SSI prevention measures would reduce the post-CS SSI incidence rate and improve patient care

Psychometric properties and longitudinal validation of the self-reporting questionnaire (SRQ-20) in a Rwandan community setting: a validation study

Background: This study took place to enable the measurement of the effects on mental health of a psychosocial intervention in Rwanda. It aimed to establish the capacities of the Self-Reporting Questionnaire (SRQ-20) to screen for mental disorder and to assess symptom change over time in a Rwandan community setting. Methods. The SRQ-20 was translated into Kinyarwanda in a process of forward and back-translation. SRQ-20 data were collected in a Rwandan setting on 418 respondents; a random subsample of 230 respondents was assessed a second time with a three month time interval. Internal reliability was tested using Cronbach's alpha. The optimal cut-off point was determined by calculating Receiver Operating Curves, using semi-structured clinical interviews as standard in a random subsample of 99 respondents. Subsequently, predictive value, likelihood ratio, and interrater agreement were calculated. The factor structure of the SRQ-20 was determined through exploratory factor analysis. Factorial invariance over time was tested in a multigroup confirmatory factor analysis. Results: The reliability of the SRQ-20 in women ( = 0.85) and men ( = 0.81) could be considered good. The instrument performed moderately well in detecting common mental disorders, with an area

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Psychotrauma, healing and reconciliation in Rwanda: the contribution of community-based sociotherapy

Introduction: In post-genocide Rwanda, many different kind of interventions have been implemented on different levels of society focusing on the healing of psychological problems and reconciliation between victims and perpetrators of the previous political violence. This article presents the practice of community-based sociotherapy and its impact in terms of healing and reconciliation as well as its specificity compared to other interventions. Methodology: A variety of qualitative research methods were used with an emphasis on the most significant-change-stories method. Results: Sociotherapy was introduced in Rwanda in 2005. Sociotherapy groups of 10-12 people living in the same neighborhood meet once a week during 2-3 hours for a period of 15 weeks. The most significant problems people suffer from due to the political violence is the destruction of social relations. It is in the phase of care that is usually reached during the 4th of 5th session that a change in people’s behavior and interaction with others, including former enemies, takes place. This change results in a rerouting of their personal, family and community life which is experienced as a release of problems previously buried in people’s hearts. While many of the interventions in Rwanda which are specifically aimed at reconciliation result at most, in ‘thin’ reconciliation, sociotherapy resulted, in many cases, in ‘thick’ reconciliation. Conclusion: Justice and care should complement each other when the aim is healing from the wounds of a violent past and reconciliation along ethnic lines