Continuing Professional Development Program in Health Facilities in Rwanda: A Qualitative Study on the Perceptions of Health Professionals

Emmanuel Munyaneza,1 Belson Rugwizangoga,1,2 Emmanuel Rusingiza,1,2 Jean Berchmans Niyibizi,2 Simon Rutayisire Kanyandekwe,1 Jean Claude Byiringiro,1,2 Florence Masaisa1,2 1Clinical Education and Research Division, University Teaching Hospital of Kigali, Kigali, Rwanda; 2School of Medicine and Health Sciences, University of Rwanda, Kigali, RwandaCorrespondence: Emmanuel Munyaneza, Clinical Education and Research Division, University Teaching Hospital of Kigali (CHUK), KN 4 Avenue (Avenue de la Paix), P. O. Box 655, Kigali, Rwanda, Email [email protected]; [email protected]: Continuous professional development (CPD) is an important pillar in healthcare service delivery. Health professionals at all levels and disciplines must continuously update their knowledge and skills to cope with increasing professional demands in the context of a continuously changing spectrum of diseases. This study aimed to assess the CPD programs available in healthcare facilities (HFs) in Rwanda.Methodology: Semi-structured interviews were conducted using purposive sampling. Accordingly, the respondents belonged to different categories of health professionals, namely nurses, midwives, laboratory technicians, pharmacists, general practitioners, and specialist doctors. Thirty-five participants from district, provincial, and national referral hospitals were interviewed between September and October 2020. A thematic analysis was conducted using Atlas ti.7.5.18, and the main findings for each theme were reported as a narrative summary.Results: The CPD program was reported to be available, but not for all HPs and HFs, because of either limited access to online CPD programs or limited HF leaders. Where available, CPD programs have sometimes been reported to be irrelevant to health professionals and patients’ needs. Furthermore, the planning and implementation of current CPD programs seldom involves beneficiaries. Some HFs do not integrate CPD programs into their daily activities, and current CPD programs do not accommodate mentorship programs. The ideal CPD program should be designed around HPs and service needs and delivered through a user-friendly platform. The motivators for HPs to engage in CPD activities include learning new things that help them improve their healthcare services and license renewal.Conclusion: This study provides an overview of the status and perceptions of the CPD program in HFs in Rwanda and provides HPs’ insights on the improvements in designing a standardized and harmonized CPD program in Rwanda.Keywords: continuous professional development, healthcare professionals, program, Rwand

Productivity, Technical Efficiency, and Farm Size in Paraguayan Agriculture

This essay assesses the relationship between farm size and productivity. Both parametric and nonparametric methods are used to derive efficiency measures. Smaller farms are found to have higher net farm income per hectare, and to be more technically efficient, than larger farms

Predictors of molecular subtypes in women with breast cancer in Rwanda

INTRODUCTION: Breast cancer (BC) constitutes a major public health problem worldwide. It remains a major scientific, clinical and societal challenge, generally in Africa and particularly in Rwanda. The purpose of this study was to determine clinical and histopathological predictors of BC molecular subtypes in Rwandan women. METHODS: A retrospective cohort study including patients with histological confirmation of BC. Using R statistical software, a regression model for multinomial responses was developed. Univariate and multivariate logistic regression analyses were used to identify independent BC molecular subtypes predictors. A two-sided p<0.05 indicated a statistically significant difference. RESULTS: Forty seven percent of cases presented with advanced stages (Stage III and IV). Postmenopausal BC (p=0.0142), absence of infertility (p=0.018) predicted Luminal A subtype with a predictive accuracy of 0.65. Age (p=0.003), postmenopausal BC (p=0.005), absence of axillar lymph nodes (p= 0.008) and poorly differentiated tumor (p=0.012) were predictors for Luminal B subtype with a predictive accuracy of 0.86. Age (p=0.045), BMI (p=0.005), rapid progression (p=0.032), tumor size T2-T3 (p<0.001) were predictors of HER2-Enriched subtype with a predictive accuracy of 0.70. Age below 40 (p=0.005), painless mass (p=0.030), nodal involvement (p=0.008), Nottingham grade 3 (p<0.001) predicted Triple Negative tumors with a predictive accuracy of 0.71. CONCLUSION: Clinical and histopathological tumor characteristics can be used to predict BC molecular subtypes with acceptable accuracy. Further studies are needed to explore the possibility of developing a scoring system for clinical decision-making, especially in settings where immunohistochemistry testing is limited

Successful surgical separation of conjoined twins: First experience in Rwanda

Conjoined twins are identical or monozygotic twins whose bodies are joined in utero. Pygopagus or Iliopagus twins are a type of conjoined twins in which two bodies joined back to back at the buttocks. Surgical Separation of conjoined twins is extremely risk of death and life threatening. Female pygopagus twins of three months were been operated and separated at Kigali Teaching University Hospital. For both babies a posterior sagittal anorectoplasty was performed with derivated ileostomy without problem. No complications occurred during the operation, oral feedings was done at third postoperative day. Ileostomy closure was done three weeks after and babies were discharged from neonatology unit at 35th postoperative day. Adequate preoperative investigation with a well organized and trained team contributed a lot to the success of conjoined twins separation

Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score with excess hospital mortality in adults with suspected infection in low- and middle-income countries

The quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score has not been well-evaluated in low- and middle-income countries (LMICs).To assess the association of qSOFA with excess hospital death among patients with suspected infection in LMICs and to compare qSOFA with the systemic inflammatory response syndrome (SIRS) criteria.Retrospective secondary analysis of 8 cohort studies and 1 randomized clinical trial from 2003 to 2017. This study included 6569 hospitalized adults with suspected infection in emergency departments, inpatient wards, and intensive care units of 17 hospitals in 10 LMICs across sub-Saharan Africa, Asia, and the Americas.Low (0), moderate (1), or high (≥2) qSOFA score (range, 0 [best] to 3 [worst]) or SIRS criteria (range, 0 [best] to 4 [worst]) within 24 hours of presentation to study hospital.Predictive validity (measured as incremental hospital mortality beyond that predicted by baseline risk factors, as a marker of sepsis or analogous severe infectious course) of the qSOFA score (primary) and SIRS criteria (secondary).The cohorts were diverse in enrollment criteria, demographics (median ages, 29-54 years; males range, 36%-76%), HIV prevalence (range, 2%-43%), cause of infection, and hospital mortality (range, 1%-39%). Among 6218 patients with nonmissing outcome status in the combined cohort, 643 (10%) died. Compared with a low or moderate score, a high qSOFA score was associated with increased risk of death overall (19% vs 6%; difference, 13% [95% CI, 11%-14%]; odds ratio, 3.6 [95% CI, 3.0-4.2]) and across cohorts (P < .05 for 8 of 9 cohorts). Compared with a low qSOFA score, a moderate qSOFA score was also associated with increased risk of death overall (8% vs 3%; difference, 5% [95% CI, 4%-6%]; odds ratio, 2.8 [95% CI, 2.0-3.9]), but not in every cohort (P < .05 in 2 of 7 cohorts). High, vs low or moderate, SIRS criteria were associated with a smaller increase in risk of death overall (13% vs 8%; difference, 5% [95% CI, 3%-6%]; odds ratio, 1.7 [95% CI, 1.4-2.0]) and across cohorts (P < .05 for 4 of 9 cohorts). qSOFA discrimination (area under the receiver operating characteristic curve [AUROC], 0.70 [95% CI, 0.68-0.72]) was superior to that of both the baseline model (AUROC, 0.56 [95% CI, 0.53-0.58; P < .001) and SIRS (AUROC, 0.59 [95% CI, 0.57-0.62]; P < .001).When assessed among hospitalized adults with suspected infection in 9 LMIC cohorts, the qSOFA score identified infected patients at risk of death beyond that explained by baseline factors. However, the predictive validity varied among cohorts and settings, and further research is needed to better understand potential generalizability

Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide

Context: Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal. Objectives: 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services. Methods: Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce. Results: Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships. Conclusion: An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering

Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide

Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal. 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services. Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce. Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships. An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering