Bubble CPAP to support preterm infants in rural Rwanda: a retrospective cohort study

Background: Complications from premature birth contribute to 35 % of neonatal deaths globally; therefore, efforts to improve clinical outcomes of preterm (PT) infants are imperative. Bubble continuous positive airway pressure (bCPAP) is a low-cost, effective way to improve the respiratory status of preterm and very low birth weight (VLBW) infants. However, bCPAP remains largely inaccessible in resource-limited settings, and information on the scale-up of this technology in rural health facilities is limited. This paper describes health providers’ adherence to bCPAP protocols for PT/VLBW infants and clinical outcomes in rural Rwanda. Methods: This retrospective chart review included all newborns admitted to neonatal units in three rural hospitals in Rwanda between February 1st and October 31st, 2013. Analysis was restricted to PT/VLBW infants. bCPAP eligibility, identification of bCPAP eligibility and complications were assessed. Final outcome was assessed overall and by bCPAP initiation status. Results: There were 136 PT/VLBW infants. For the 135 whose bCPAP eligibility could be determined, 83 (61.5 %) were bCPAP-eligible. Of bCPAP-eligible infants, 49 (59.0 %) were correctly identified by health providers and 43 (51.8 %) were correctly initiated on bCPAP. For the 52 infants who were not bCPAP-eligible, 45 (86.5 %) were correctly identified as not bCPAP-eligible, and 46 (88.5 %) did not receive bCPAP. Overall, 90 (66.2 %) infants survived to discharge, 35 (25.7 %) died, 3 (2.2 %) were referred for tertiary care and 8 (5.9 %) had unknown outcomes. Among the bCPAP eligible infants, the survival rates were 41.8 % (18 of 43) for those in whom the procedure was initiated and 56.5 % (13 of 23) for those in whom it was not initiated. No complications of bCPAP were reported. Conclusion: While the use of bCPAP in this rural setting appears feasible, correct identification of eligible newborns was a challenge. Mentorship and refresher trainings may improve guideline adherence, particularly given high rates of staff turnover. Future research should explore implementation challenges and assess the impact of bCPAP on long-term outcomes

Experience with a Massive Open Online Course in Rural Rwanda

The growing utilization of massive open online courses (MOOCs) is opening opportunities for students worldwide, but the completion rate for MOOCs is low (Liyanagunawardena, Adams, & Williams, 2013). Partners In Health (PIH) implemented a “flipped” MOOC in Rwanda that incorporated in-class sessions to facilitate participant completion. In October 2013, PIH invited its employees, as well as those at the Ministry of Health, to participate in an online MOOC. Each site had at least one volunteer facilitator who accompanied participants throughout the course by providing course materials and facilitating the understanding of the online material during the weekly class sessions. Following the conclusion of the course, all participants were asked to complete an online survey. A total of 38 out of 62 registered participants completed the survey and of these 38 participants, 20 (52.6%) successfully finished the course. The number of in-person sessions attended was significantly associated with course completion (p < 0.05), and 85% who successfully completed the course attended at least three of seven sessions. Sixteen (80%) participants believed that the completion of this course would help them with career advancement. Half of the participants (19 of 38, 50%) were employed with a position related to research. Other job titles included the following: nurses (4 of 38, 10.5%), a pharmacist (1 of 38, 2.6%), a clinical psychologist (1 of 38, 2.6%), a dentist (1 of 38, 2.6%), and others (10 of 38, 26.3%). The job title was not significantly related to course completion. Our experience, with a completion rate of over 50%, yields several lessons for incorporating MOOCs into capacity-building programs to leverage the potential of online learning in resource-limited areas

Non-Obstetric Surgical Care at Three Rural District Hospitals in Rwanda: More Human Capacity and Surgical Equipment May Increase Operative Care

Background: Most mortality attributable to surgical emergencies occurs in low- and middle-income countries. District hospitals, which serve as the first-level surgical facility in rural sub-Saharan Africa, are often challenged with limited surgical capacity. This study describes the presentation, management, and outcomes of non-obstetric surgical patients at district hospitals in Rwanda. Methods: This study included patients seeking non-obstetric surgical care at three district hospitals in rural Rwanda in 2013. Demographics, surgical conditions, patient care, and outcomes are described; operative and non-operative management were stratified by hospitals and differences assessed using Fisher’s exact test. Results: Of the 2660 patients who sought surgical care at the three hospitals, most were males (60.7 %). Many (42.6 %) were injured and 34.7 % of injuries were through road traffic crashes. Of presenting patients, 25.3 % had an operation, with patients presenting to Butaro District Hospital significantly more likely to receive surgery (57.0 %, p < 0.001). General practitioners performed nearly all operations at Kirehe and Rwinkwavu District Hospitals (98.0 and 100.0 %, respectively), but surgeons performed 90.6 % of the operations at Butaro District Hospital. For outcomes, 39.5 % of all patients were discharged without an operation, 21.1 % received surgery and were discharged, and 21.1 % were referred to tertiary facilities for surgical care. Conclusion: Significantly more patients in Butaro, the only site with a surgeon on staff and stronger surgical infrastructure, received surgery. Availing more surgeons who can address the most common surgical needs and improving supplies and equipment may improve outcomes at other districts. Surgical task sharing is recommended as a temporary solution