Birth Outcome and Maternal Risk Factors Associated with Childhood Leukemia in Rwanda: A case - Control Study

BackgroundLeukemia is the most common cancer affecting children and remains the top cause of death among children.ObjectiveThis study aimed at determining birth outcomes and maternal risk factors associated with childhood leukemia in Rwanda.MethodsA case control study was conducted at Butaro Cancer Referral hospital. The sample of 103 cases and 103 controls was recruited using the records for children diagnosed with Acute lymphocytic leukemia (ALL) and Acute myelogenous leukemia (AML) and those who were hospitalized for non-cancer treatment as controls. Semi-structured questionnaire and phone calls were used to gather information. SPSS version 21.0 was used to analyze the data. Logistic regression analysis was used to assess the risk factors.ResultsThe majority (56.8%) of children who participated in the study were aged 10-14 years. Overall 41.3% were born via C-Section. It was revealed that children who had had birth asphyxia had about three (3) times increased risk of childhood leukemia [AoR= 2.47, 95%CI: 1.167-5.262, P=0.018] compared to children that had not experienced birth asphyxia. Children who had suffered Neonatal Jaundice, had five (5) times increased risk of getting leukemia [AOR= 5.05, 95%CI: 1.738-14.664, P=0.003].ConclusionIt is important that public and private stakeholders invest more in childhood oncology researches to enable the health system deliver effective management of the cases more efficiently. Rwanda J Med Health Sci 2022;5(2):158-16

Prevalence and Determinants of Undernutrition among People Living With HIV at Ngarama Hospital, Rwanda

 Background Undernutrition is one of the important health problems in developing countries, which has undesirable health effect among people living with HIV (PLWHA). Objectives To determine prevalence and determinants of undernutrition among PLWHA in Ngarama District Hospital. Methods Cross sectional study was conducted among 267 PLWHA who were selected systematically as they came for care. Questionnaire and anthropometric measurements were used to collect data. Descriptive and inferential statistics were performed. Result The prevalence of undernutrition was 22.0%. After controlling all the possible confounders using multivariable analysis, the following variables were predictors of undernutrition: respondents’ age 21 to 30 (AOR = 17.24; 95% CI = 5.55 – 53.56; p < 0.001) and 31 to 40 (AOR = 19.15; 95%CI = 5.97 – 61.40; p <0.001) compared to those aged 41 years and above, social category one (AOR = 3.54; 95%CI = 1.18 – 10.59; p = 0.024); experienced gastrointestinal discomfort (AOR = 19.87; 95%CI = 5.09 – 77.55; p <0.001) and not received dietary counseling (AOR = 7.45; 95%CI = 2.83 – 19.62; p <0.001). Conclusion The prevalence of undernutrition among PLWHA was high. Therefore, the Ministry of Health and other stakeholders should campaign, counsel and assist with provision of dietary diversity using locally available foods. Rwanda J Med Health Sci 2022;5(3):291-30

Adherence to Recommended Regimen and Associated Factors among Type 2 Diabetes Mellitus Patients in Rwinkwavu District Hospital, Rwanda

Background The main risk factor for developing various complications and hospital admissions among type 2 diabetes is poor adherence to all recommended regimens. Objective To determine adherence to recommended regimen and associated factors among type 2 diabetes at Rwinkwavu District Hospital and its catchment area. Methods A descriptive cross-sectional study was employed. A total of 307 type 2 diabetes were selected using systematic random sampling. Data were collected using a questionnaire. Descriptive analysis (frequency and percentages) to describe the participants’ characteristics, and Chi-square test to establish associated factors with adherence to recommended regimen were performed. Then multivariable logistic regression was used to determine factors independently associated with adherence to recommended regimen. Results The result shows that 85.7%, 27.0% and 38.8% of the respondents had good adherence to medication, diet and exercise respectively. Multivariable analysis revealed that not taking alcohol [aOR= 2.21; 95%CI= 1.11-4.42], accessibility of healthcare services [aOR= 2.59; 95%CI= 1.21-5.53] and no experience of drug side effects [aOR= 5.27; 95%CI= 2.46-11.32] were associated with high medication adherence. Factors associated with high adherence level to recommended diet were accessibility to healthcare services [aOR= 2.93; 95%CI= 1.20-7.17], receiving lifestyle modification sessions [aOR= 3.56; 95%CI= 1.02-12.46] and presence of chronic comorbidities [aOR= 2.36; 95%CI= 1.37-4.08]. In addition, higher level of education [aOR= 2.64; 95%CI= 1.05-6.67], accessibility to healthcare services [aOR= 2.83; 95%CI= 1.31-6.09] and shorter time since diagnosis of type 2 diabetes [aOR= 2.09; 95%CI= 1.08-4.51] were more likely to have high adherence to recommended exercise. Conclusion Different individual and clinical factors were identified as determinants of adherence to recommended regimen among type 2 diabetes patients. Therefore, the policy makers concerned with health promotion will need to consider ways of improving access to compressive lifestyle education and healthcare services as well as availing drugs with less side effects. Rwanda J Med Health Sci 2022;5(3):276-290 &nbsp

Contribution of Complementary Elementary Education towards Transition of Nomadic Pupils from Non-Formal to Middle School Education in Habero Sub-Zone, Eritrea

Background: Education in Eritrea is a fundamental right of every person. Therefore, ensuring equal and equitable educational opportunities for every citizen is essential for upward mobility. However, enrolment in areas inhabited by the nomadic groups is far less from the national average. To boost enrolment among the nomads and to meet the Millennium Development Goals (MDGs) the government of Eritrea along with donor partners in 2007 introduced non-formal Complementary Elementary Education (CEE) targeted at out-of-school children aged 9-14 years. Nevertheless, no study was conducted since the program has started whether the children are mainstreamed to formal middle school primary education. Objective: The study was aimed to assess the enrollment and transition rate of CEE, examine challenges of transition and to identify possible alternatives to facilitate transition of pupils to formal middle school education in Habero Sub-Zone. Materials and methods: Mixed method design along with the use of both qualitative and quantitative approaches was employed. Semi-structured questionnaire was used to collect information on socio-demographic characteristics of pupils and CEE teachers, challenges and alternatives of transition to middle school. Moreover, key informant interview was carried out from the middle school director and sub-zone education officer. The sample size included were 150 pupils, 18 teachers, 1 middle school director and 1 sub-zone education officer. The data was analyzed using frequencies and percentages. Qualitative data were transcribed and coded and then analyzed thematically. Results: The study findings indicate that the transition rate of pupils from the CEE centers to formal middle school education was high (83%). However, the enrollment of pupils transited from CEE centers in the available middle schools of the sub-zone was low (35%). Conclusion: The low enrollment in middle school was contributed by distance of middle school, early marriage and economic status of the community. Finally, based on these findings, it is recommended that CEE centers at the very distance should develop to formal middle school. Establishment of at least one boarding school in Habero sub-zone to accommodate the most disadvantaged nomadic children would ease economic burden of the pupils. Furtherer, government authorities, national unions and religious bodies should play important role in sensitizing the community about benefits of education.   Keywords: Complementary Elementary Education, Nomadic Pupils, Transition to Middle Schoo

Risk of HIV Infection among Men Aged 50 to 75 Years using Erectile Dysfunction Drugs Attending at Kenyatta National Hospital: A Case Control Study, Kenya

Background: Erectile dysfunction drug (EDD) use has gained popularity among older men for enhancement and treatment of erectile dysfunction in recent years. Increased number of sexual partners and sexual activity due to EDD use concerns about the rising rate of HIV infection among older men. Men who use EDD for erectile dysfunction are found to be two to three times more likely to have sexually transmitted diseases (STDs), particularly human immunodeficiency virus (HIV) or chlamydia, than those who did not use the drugs. In Kenya, the prevalence of HIV among men of age 50 to 54 years has increased from 5.7% in 2003 to 9.1% in 2008. Objectives: This study was aimed at determining the association between EDD use and risk of HIV infection among men aged 50 to 75 years. Patients and Methods: A hospital based case-control study was conducted among men aged 50 to 75 years. A total of 274 men (137 cases confirmed as HIV positive and same number of controls confirmed as HIV negative), consented to participate in the study. Pearson’s chi-square test and odds ratio with corresponding 95% confidence interval were computed to establish the association between the dependent variable (HIV status) and independent variables (Key independent variable being EDD use). The level of statistical significance was set at p-value <0.05. Binary logistic regression analyses were performed to adjust for confounding factors in the relationship between HIV status and EDD use. Results: Out of 137 cases, 18(13.1%) used EDD before they found out that they were HIV +ve compared to 8(5.8%) of the controls. Even though the use of erectile dysfunction drugs was found to be significantly associated with serum HIV positivity in bivariate analysis (OR= 2.44; 95%CI: 1.04-5.93; p=0.039), it was not significant after adjustment for other factors at the multivariate analysis (AOR= 1.52; 95%CI: 0.43- 5.34; p=0.519). Multiple logistic regression revealed the following factors as independent predictors of HIV: having had sexually transmitted diseases (AOR=5.96; 95%CI: 2.43 – 14.63; p<0.001), taking alcohol/drunkenness (AOR=6.84; 95%CI: 3.22 – 14.56; p<0.001) and having multiple sexual partners (AOR=21.69; 95%CI: 8.82 – 53.33; p<0.001).Conclusion: This study shows that there is an increased risk of HIV infection among older men using EDD. However, this observation is not sustained after controlling for other associated factors. It is therefore recommended that a more robust study design (prospective cohort) with a large sample size to be undertaken to shed more light on this pressing topic. Keywords: Erectile Dysfunction Drugs, HIV infection, Older Men, Ris

Prevalence and risk factors of asymptomatic malaria among underfive children in Huye District, Southern Rwanda

Background: Enhanced malaria control has resulted in its reduction in some areas of Sub Saharan Africa including Rwanda. However, asymptomatic hosts serve as a reservoir for the malaria parasite for communities. The objective of this study was to determine the prevalence of malaria parasites and risk factors associated with malaria infection among children underfive years in Huye district, Rwanda.Methods: This community-based cross sectional study was conducted from May to June 2016 among underfive years children.  Asymptomatic children underfive years of age were randomly selected from 13 villages. Thick and thin blood smears were prepared from each child for malaria parasite diagnosis.  Interviews with parents or guardians were conducted to collect data on malaria associated risk factors. Observations were made of the presence of mosquito breeding sites near and around the homestead.Results: A total of 222 children were included in the study. Nearly a third (28.8%) of the children were within the age of 25-36 months. The majority (54%) of the children were females. Most of the parents/guardians were married (95.9%), nearly all (99.5%) had attended primary school and most (97.3%) were peasants. The overall Plasmodium falciparum prevalence in children was 12.2%. Children aged 1 to 12 months were 3.5 times more likely to have malaria parasites than children aged 13 to 59 months [AOR=3.56; 95%CI=1.18-10.71; p=0.024]. Children who were not sleeping under insecticide treated nets were 15 times more likely to be infected with malaria parasites compared to those who were sleeping under nets [AOR=15.27; 95%CI=4.42-52.82; p<0.001].Conclusion: Malaria parasite prevalence in under-five year children in Huye District, Rwanda is moderate.  The asymptomatic infections in the community forms a reservoir for transmission in the area. Young age of the child and not sleeping under mosquito net were associated with malaria parasite infection. The continuing use of mosquito nets needs to be emphasized

Characterization of malaria vectors in Huye District, Southern Rwanda

Background: Effective control of malaria requires knowledge of vector species, their feeding and resting behaviour as well as breeding habitats. The objective of this study was to determine malaria vector species abundance and identify their larval habitats in Huye district, southern Rwanda.Methods: Adult mosquitoes were collected indoors using light trap and pyrethrum spray catch techniques, and outdoors using light traps. Female Anopheles mosquitoes were identified to species level by morphological characteristics. Enzyme-linked Immunosorbent Assay (ELISA) was used to screen for Plasmodium falciparum circumsporozoite protein and host blood meal sources. Anopheles larvae were sampled using dippers and raised into adult mosquitoes which were identified morphologically.Results: Anopheles gambiae sensu lato comprised of 70% of the 567 Anopheles collected. Other Anopheles species identified were An. funestus 4%, An. squamosus 16.5%, An. maculipalpis 6.5%, An. ziemanni 1.7%, An. pharoensis 1.2 % and An. coustani 0.1%. The majority, 63.5% of the collected mosquitoes were from indoors collections. The overall human blood index was 0.509. The P. falciparum circumsporozoite protein was found in 11 mosquitos including 8 Anopheles gambiae s.l. and 3 secondary vectors out of the 567 tested. The overall sporozoite rate was 1.9%. A total of 661 Anopheline larvae from 22 larval habitats were collected. They comprised of An. gambiae s.l. (89%) and An. ziemanni (11%). The absolute breeding index was 86.4%. The most common larval habitats were in full sunlight with still water like rice paddies and pools of stagnant water.Conclusion: These findings show that Anopheles gambiae s.l. is the dominant malaria vector in the area with other vectors playing a secondary role in malaria transmission. Malaria interventions need to be strengthened to reduce even further the malaria transmission in the area.

A study of the transport, extraction and co-ordination chemistry of a number of thiourea ligands with a series of transition and post-transition metal ions

Thesis (MSc)--Stellenbosch University, 2003.ENGLISH ABSTRACT: In this study, a number of mono- and di-substituted acyl(aroyl)thioureas were investigated for potential application as specific carriers (ionophores) for the transport and extraction of Ag(l) from a mixture of Co(II), Ni(II), Cu(II), Zn(II), Cd(II), and Pb(lI) ions. The experimental arrangement for the transport experiments employed a liquid membrane set up involving a 3-phase system - 2 aqueous phases (source and receiving phase) separated by a chloroform membrane incorporating the ligand. Competitive metal ion transport experiments were conducted using the liquid membrane set up. The aqueous source and receiving phases were analyzed using Atomic Absorption Spectroscopy (AAS) and results were confirmed by Inductively Coupled Plasma-Optical Emission Spectroscopy (ICPOES). The transport results show that the N,N-dialkyl-substituted-N'-acyl(aroyl) (HL) thioureas studied, with the exception of the N,N-di-(2-hydroxyethyl)-N'-benzoylthiourea (HL3 ) and N-piperidyl-N'-4-nitrobenzoylthiourea (HL9 ), were efficient and selective for Ag(I). HL9 was also selective for Ag(l) but not efficient. HL3 was selective for Cu(II). Under the experimental conditions employed, 13% Cu(lI) was transported by HL3 . Among the N,Ndialkyl- N'-aroylthioureas, maximum Ag(l) transport was obtained by using N,N-diethyl-N'-4- chlorobenzoylthiourea (HL5 ) and N,N-di-n-butyl-N'-benzoylthiourea (HL \ Under the experimental conditions employed, the percentages of Ag(l) transported by HL5 and HL 1 were 48% and 42% respectively. The transport selectivity and efficiency of 3,3,3' ,3'-tetraethyl-1 ,1'-isophthaloylbisthiourea (H2L12 ) and N,N-diethyl-N'-camphanoylthiourea (HL13)for Ag(l) were also studied. We were particularly interested, in comparing the Ag(l) transport and extraction efficiency of these ligands with that of the HL and H2L ligands. The experimental results reveal that, of all the ligands we investigated in this study, HL 13 was the most efficient and selective carrier for Ag(l) transport. The interesting result is that, depending on the ligand concentration used, HL 13 transported 71-81% of Ag(I). Competitive two-phase metal ion solvent extraction experiments were also performed under conditions similar to the transport studies. The results show that by varying the ligand concentration in the membrane phase, up to 100% Ag(l) can be selectively and efficiently extracted from the mixture of the seven metal ions. Finally, the N,N-di-(n)-butyl-N'-benzoylthiourea (HL1) ligand and its complex with Ag(l) were synthesized. Single crystals of the complex were grown for X-ray crystallography and the crystal and molecular structure of the complex was determined. The crystal structure showed that Ag(l) is bonded to the deprotonated ligand through the S,O atoms forming interesting cluster [Ag (L - S, 0)] 4 in the solid state. This structure is monoclinic and crystallizes in the space group P21!c with a = 17.805 (4) A, b = 21.759 (4) A, c = 36.438 (7) A, f3= 96.34(3)°, Z = 8 and a final R-factor of 5.4%.AFRIKAANSE OPSOMMING: In hierdie proefskrif is 'n aantal mono- en di-gesubstitueerde asiel(ariel) tioureums ondersoek vir moontlike gebruik as ionofore (spesifieke draers) vir die transportasie en ekstraksie van Ag(l) vanuit 'n mengsel van Co(ll), Ni(II), Cu(II), Zn(II), Cd(II), Ag(l) en Pb(lI) ione. 'n Drie-fase selsisteem is gebruik vir die transportasie eksperimente, twee waterige fases (bron- en ontvang-fase) wat geskei is met die chloroform membraan fase wat die ligande bevat. Kompeterende metaalioon transportasie eksperimente is uitgevoer met behulp van hierdie vloeistof membraan stelsel. Die twee waterige fases is deur middel van Atoomabsorpsie Spektroskopie (AAS) ge-analiseer en resultate is bevestig met gebruik van Induktief-gekoppelde Plasma-Optiese Emissie Spektroskopie (IGP-OES). Die resultate het getoon dat elkeen van die N,N-dialkiel-gesubstitueerde-N'-asiel(ariel) (HL) tioureums, met uitsondering van N,N-di(2-hidroksie-etiel)-N'-benzieltioureum(HL 3) en Npiperidiel- N'-4-nitrobenzieltioureum(HL9 ), doeltreffend en selektief was vir Ag(l) transportasie. HL9 was selektief vir Ag(I), maar die transportasie waarde was nie hoog nie, dws. dit was nie doeltreffend nie. HL3 was selektief vir Cu(II). Met gebruik van ons eksperimentele kondisies is 13% Cu(lI) getransporteer deur HL 3. Van die N,N-dialkiel-N'- ariel tioureums, is maksimum transportasie van Ag(l) verkry met gebruik van N,N-dietiel- N'-4-chlorobenzieltioureum (HL5) en N,N-di-n-butiel-N'-benzieltioureum (HL1). Met gebruik van ons eksperimentele kondisies was die persentasie transportasie van Ag(l) deur HL5 en HL 1 48% en 42% onderskeidelik. Die selektiwiteit en doeltreffendheid van 3,3,3' ,3'-tetra-etiel-1 ,t-isoftaltelblstioureumtl+L 12) en N,N-di-etiel-N'-kamfonieltioureum (HL13) vir Ag(l) transportasie is ook onderneem. Ons was besonder ge-interesseerd om die Ag(l) transportasie en ekstraksie van hierdie ligande te vergelyk met dié van die HL en H2L tipe ligande. Die eksperimentele resultate het getoon dat van al die ligande wat bestudeer is, HL 13 die doeltreffendste en mees selektiewe ionofoor was. Van besondere, belang was dat, afhangend van die ligand konsentrasie wat gebruik is, HL13 71-81% Ag(l) getransporteer het. Kompeterende twee-fase metaalioon vloeistof-vloeistof ekstraksie eksperimente is ook uitgevoer onder toestande soortgelyk aan dié van die transportasie eksperimente. Die resultate toon dat met varierende ligand konsentrasie, tot soveel as 100% Ag(l) selektief en doeltreffend geëkstrakeer word vanuit 'n mengsel van die sewe metaal ione. N,N-di-n-butiel-N'-benzieltioureum (HL1 ) ligande en die kompleks daarvan met Ag(l) is ook gesintetiseer. Enkel-kristalle van die kompleks is verkry en X-straal kristallografiese analiese is onderneem. Die kristalstruktuur toon hoedat Ag(l) gebind is aan die gedeprotoneerde ligand deur die S en Q atome en toon ook interessante [Ag(L-S,Q)]4 groepe in die vaste toestand. Hierdie struktuur is monoklinies en kristaliseer in die ruimtegroep P21!c met a = 17.805(4) Á, b = 21.759(4)Á, c = 36.438(7)Á, P = 96.34(3t, z = 8 en 'n finale R-faktor van 5.4%

Effect of Positive Deviance Hearth Intervention on Acute Malnutrition Persistence among Children under Five in Burera District, Rwanda

BackgroundPositive Deviance Hearth is considered as a good approach to use existing and available resources to address malnutrition at the community level.ObjectiveThe present study aimed to determine the effect of Positive Deviance Hearth on persistent acute malnutrition management among children under five in Burera District.MethodsA comparative quasi-experimental study was conducted in Burera district. One hundred ninety six (196) participants were selected purposively. Nutrition status of children who attended Positive Deviance Hearth sessions for 12 consecutive days were measured and compared with children who were not in the HEARTH intervention.ResultsThe majority (55.6%) of children in both groups were male. The prevalence acute malnutrition persistence was significantly higher (52.0%) among the non-HEARTH intervention compared to those in the HEARTH intervention area (20.4%). In reduced model of the multivariate analysis, persistence of acute malnutrition was 87% higher among children in the non-Hearth intervention compared to those in Hearth intervention (AoR= 0.13; 95%CI: [0.05-0.35], p<0.001).ConclusionThe use of Positive Deviance Hearth model was significantly associated with low prevalence of malnutrition persistence; therefore, it should be adopted by the Ministry of Health. Rwanda J Med Health Sci 2022;5(2):180-18

Shisha use among students in a private university in Kigali city, Rwanda: prevalence and associated factors

Abstract Background All over the globe shisha smoking is fast growing among different age brackets. Shisha use has been reported to be increasing among youths in African major cities. Its use is documented to result in health effects such as lung cancer, cardiovascular and respiratory conditions, periodontal diseases, keratoacanthoma which are also associated with cigarette smoking. In Kigali, Rwanda’s capital, reports indicate that shisha use is increasing among the youths, particularly the university students. The study aimed at determining the prevalence, and establishing factors associated with shisha use among students in a university in Kigali Rwanda, which will be a significant step in stemming shisha fame among youths in Rwanda as there was no previously documented evidence-based study. Methods A total of 427 students were selected for this cross-sectional study using stratified sampling method. A questionnaire was used to collect data on shisha use, knowledge about shisha, attitude towards shisha, and factors associated with use of shisha. The association between the independent variables and shisha use was assessed using chi-square p value < 0.05. Binary logistic regression was used to determine variables that were independently associated with shisha smoking. Results Prevalence of ever smoking shisha among the university students was 26.1% and that of those that smoked in the last month (30 days) was 20.8%. About 40 % (39.9%) of the participants that had heard about shisha before demonstrated low level of knowledge, and 41.6% of these reported shisha use in the last 30 days. Logistic regression revealed that the followings were independently associated with shisha smoking: always drink alcohol (p = 0.003); drink alcohol occasionally (p = 0.045); having friend(s) who smoke shisha (p = 0.001); being aware of shisha’s availability in cafes, bars and restaurants in Kigali (p = 0.022); positive attitude towards shisha smoking (p < 0.001) and participants with age < 20 years (p = 0.039). Conclusions There is a relative high prevalence of shisha smoking and a poor knowledge about its impact on health among these university students. Regular medical education and health promotion targeting the youths could improve knowledge and practices about shisha use. Shisha laws and regulations should be enacted, and fines imposed on individuals or group who flout them