Lake Kivu Water Chemistry Variation with Depth Over Time, Northwestern Rwanda

The water of East African rift lakes contains large amounts of dissolved chemicals such as carbon dioxide, methane greatly and others like  phosphate, silicate, Sulfate, Sulfide, Iron, Ammonia, Alkalinity etc. Lake Kivu is a large, deep rift basin lake located in the western branch of the East African rift zone that contains a methane gas deposit of great economic interest with two main sources: Inorganic carbon dioxide CO2 + 4H2 = CH4 + 2H2O and Organic methanogenesis CH3COOH =CH4 + CO2. Lake Kivu is a stratified, meromictic lake bordering Rwanda and the Democratic Republic of the Congo (DRC). The lake has a surface area of 2,370 Km2, a volume of 580 Km3 and a maximum water depth of 485 m. To characterize the vertical variation of Lake Kivu water chemistry, 8 samples of water were collected using Niskin bottles in Lake Kivu near Gisenyi town. Water samples were therefore collected at different depths: 0 m, 40 m, 90 m, 240 m, 290 m, 340 m, 340 m, and 390 m. Hatch kits were used to analyze  water chemistry of samples taken of Sulfate, Sulfide, Iron, Ammonia, Alkalinity, Silica, PO4,andphosphorus.The results revealed that alkalinity  increases in the monimolimnion part due to the precipitation of calcium carbonate in the upper levels of the water column and dissolution in the monimolimnion. The conductivity, dissolved oxygen, temperature and pH weremeasured by CTD Sonde. Water column data from these studies showed increasing concentrations with depth. The divide between the mixolimnion and monomolimnion is estimated at a depth of around 40 m. Higher amounts of silica observed closer to the shoreline is likely a result of an influx of siliciclastic sediment and increased silica with depth is likely a result of the dissolution of diatoms below the photic zone. Keywords: Monimolimnion, mixolimnion, water stratification, chemicals agents

Rural WASH programming: experiences from Rwanda

Rwanda WASH Project was implemented in rural areas of four low-WASH access districts during 2009 - 2015 by the Government of Rwanda with support from UNICEF and the Government of the Netherlands. This project had four key components i.e. community water supply, sanitation and hygiene promotion, institutional WASH and capacity building. The project, which benefitted over 500,000 people, resulted in increase in average access to improved water supply and sanitation in the target districts from 47 per cent to 85 per cent and from 34 per cent to 70 per cent, respectively. A project sustainability assessment carried out in 2016 showed that the infrastructure built under the project was fully functional. The experiences of the project underline the importance of establishment of effective project coordination mechanism, use of existing government structures, capacity building, strong monitoring and evaluation framework and public-private partnership for management of water supply systems

Formulation of water and sanitation policies and strategies: experiences from Rwanda

This paper describes the process of formulation of Rwanda’s National Water Supply and Sanitation Policies and Strategies, which were approved by the Cabinet in December 2016. The major steps in the process included conceptualisation (preparation of a concept note and work plan); constitution of a dedicated task force to oversee the process; engagement of international consultants; literature review and information collection; preparation of background papers; stakeholders’ consultations; preparation of draft polices and strategies; review and quality assurance by the sector working group and the task force; consensus building; finalisation and approval. The process spanned almost two years and cost approximately US$ 170,000, including the cost of external consultants and stakeholders’ consultations. The case of Rwanda provides valuable lessons for other countries that plan to update their national water and sanitation policies and strategies in view of changes in the context and emerging issues and to ensure alignment with the SDGs

Pattern and clinical management of penile cancer in Rwanda

Introduction: Penile cancer is rare in developed countries but has a high prevalence in some developing countries. Surgery includes inguinal lymphadenectomy, which remains the mainstay treatment of the disease.Objective: This study reports on the epidemiological profile of penile cancer and clinical management options in Rwanda. Patients and methods: From January 2015 to June 2016, a multicenter cross-sectional, prospective cohort study was conducted involving all male patients presenting with penile cancer after two national radio campaigns and a Ministry of Health instruction to all district hospitals. All patients with positive biopsy were included. Surgical treatment aligned with published guidelines. Clinical characteristics, surgery, pathology, and early follow-up data were collected.Results: Over 18 consecutive months, 30 male patients were enrolled. The mean age was 60 years [range 33–83]. All patients were uncircumcised before symptom onset; 50% had phimosis and 20% were HIV- positive. The estimated prevalence of penile cancer in Rwanda was 0.37 per 100,000 men. At presentation, 96.7% of patients had a T2-4 disease and 43.3% were with clinically non-palpable inguinal lymph nodes (cNO). After penectomy, bilateral inguinal lymphadenectomy was performed in 10 (33.3%) patients (modified and radical in 16 and 4 limbs, respectively). Complications included surgical site infection (10%), lymphocele (10%), urethral meatus stenosis (6.7%), skin necrosis (3.3%) and two (6.7%) patients with metastatic disease died in hospital.Conclusion: Penile cancer is a rare but significant disease in Rwanda. Patients present with advanced disease. After treatment of the primary tumor, modified inguinal lymphadenectomy appears to be a safe method of cure and staging for patients with clinically impalpable inguinal lymph nodes. Our early results provide a compelling insight into this rare but serious disease

Information Systems For Monitoring The Burden Of Chronic Diseases In Public Reference Health Facilities In Rwanda, Burundi And Eastern Drc

Chronic diseases are an increasingly important cause of death in sub-Saharan Africa. Diseases such as cancer, diabetes and arterial hypertension remained for years in the background, in the shadow of pandemics such as malaria, HIV / AIDS and tuberculosis. In the past 6 years, 4 reference hospitals of Kisangani, Bukavu, Kigali and Bujumbura implemented hospital information systems enabling sophisticated analysis of the diagnostic variance of out-patient visits and in-patient admissions. Important volumes of chronic disease data have been collected in a period between 2006 and 2012, demonstrating that the problem of chronic diseases also grows rapidly in the Great Lakes region and therefore urgent steps must be taken, both by governments (Rwanda, DRC and Burundi), by the international donor community and by local hospital boards.Les maladies chroniques sont une cause de décès de plus en plus importante en Afrique sub-saharienne. Les maladies telles que le cancer, le diabète et l’hypertension artérielle sont restées pendant des années dans le fond, dans l’ombre de pandémies telles que le paludisme, le VIH / SIDA et la tuberculose. Au cours des 6 dernières années, 4 hôpitaux de référence de Bujumbura, Kisangani, Bukavu et Kigali ont implémenté des systèmes de gestion d’informations hospitalières permettant l’analyse sophistiquée de la variance diagnostique aussi bien en ambulatoire qu’en hospitalisation. Des volumes importants de données sur les maladies chroniques ont été rassemblées dans la période entre 2006 et 2012, démontrant que le problème des maladies chroniques gagne rapidement en importance dans la région des Grands Lacs et que des mesures urgentes doivent être prises, tant par les gouvernements (Rwanda, RDC et Burundi), par la communauté internationale des bailleurs de fonds et par les gestionnaires des hôpitaux

Correlates of Performance of Healthcare Workers in Emergency, Triage, Assessment and Treatment plus Admission Care (ETAT+) Course in Rwanda: Context Matters.

BACKGROUND:The Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) course, a comprehensive advanced pediatric life support course, was introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The impact of the course on improving healthcare workers (HCWs) knowledge and practical skills related to providing emergency care to severely ill newborns and children in Rwanda has not been studied. OBJECTIVE:To evaluate the impact of the ETAT+ course on HCWs knowledge and practical skills, and to identify factors associated with greater improvement in knowledge and skills. METHODS:We used a one group, pre-post test study using data collected during ETAT+ course implementation from 2010 to 2013. The paired t-test was used to assess the effect of ETAT+ course on knowledge improvement in participating HCWs. Mixed effects linear and logistic regression models were fitted to explore factors associated with HCWs performance in ETAT+ course knowledge and practical skills assessments, while accounting for clustering of HCWs in hospitals. RESULTS:374 HCWs were included in the analysis. On average, knowledge scores improved by 22.8/100 (95% confidence interval (CI) 20.5, 25.1). In adjusted models, bilingual (French & English) participants had a greater improvement in knowledge 7.3 (95% CI 4.3, 10.2) and higher odds of passing the practical skills assessment (adjusted odds ratio (aOR) = 2.60; 95% CI 1.25, 5.40) than those who were solely proficient in French. Participants who attended a course outside of their health facility had higher odds of passing the skills assessment (aOR = 2.11; 95% CI 1.01, 4.44) than those who attended one within their health facility. CONCLUSIONS:The current study shows a positive impact of ETAT+ course on improving participants' knowledge and skills related to managing emergency pediatric and neonatal care conditions. The findings regarding key factors influencing ETAT+ course outcomes demonstrate the importance of considering key contextual factors (e.g., language barriers) that might affect HCWs performance in this type of continuous medical education

Estimates of disease burden caused by foodborne pathogens in contaminated dairy products in Rwanda

Abstract Background The Girinka program in Rwanda has contributed to an increase in milk production, as well as to reduced malnutrition and increased incomes. But dairy products can be hazardous to health, potentially transmitting diseases such as bovine brucellosis, tuberculosis, and cause diarrhea. We analyzed the burden of foodborne disease due to consumption of raw milk and other dairy products in Rwanda to support the development of policy options for the improvement of the quality and safety of milk. Methods Disease burden data for five pathogens (Campylobacter spp., nontyphoidal Salmonella enterica, Cryptosporidium spp., Brucella spp., and Mycobacterium bovis) were extracted from the 2010 WHO Foodborne Disease Burden Epidemiology Reference Group (FERG) database and merged with data of the proportion of foodborne disease attributable to consuming dairy products from FERG and a separately published Structured Expert Elicitation study to generate estimates of the uncertainty distributions of the disease burden by Monte Carlo simulation. Results According to WHO, the foodborne disease burden (all foods) of these five pathogens in Rwanda in 2010 was like or lower than in the Africa E subregion as defined by FERG. There were 57,500 illnesses occurring in Rwanda owing to consumption of dairy products, 55 deaths and 3,870 Disability Adjusted Life Years (DALYs) causing a cost-of-illness of $3.2 million. 44% of the burden (in DALYs) was attributed to drinking raw milk and sizeable proportions were also attributed to traditionally (16–23%) or industrially (6–22%) fermented milk. More recent data are not available, but the burden (in DALYs) of tuberculosis and diarrheal disease by all causes in Rwanda has declined between 2010 and 2019 by 33% and 46%, respectively. Conclusion This is the first study examining the WHO estimates of the burden of foodborne disease on a national level in Rwanda. Transitioning from consuming raw to processed milk (fermented, heat treated or otherwise) may prevent a considerable disease burden and cost-of-illness, but the full benefits will only be achieved if there is a simultaneous improvement of pathogen inactivation during processing, and prevention of recontamination of processed products

Rate of failure per each criterion assessed in the scenario on neonatal resuscitation.

<p>BVM, bag valve mask.</p

Performance on Knowledge and Practical Skills Assessments.

<p>Performance on Knowledge and Practical Skills Assessments.</p

Crude and adjusted logistic regression exploring factors associated with skills performance^*.

<p>Crude and adjusted logistic regression exploring factors associated with skills performance^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0152882#t005fn001" target="_blank">*</a>}.</p