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

Converging Currents in Climate-Relevant Conservation: Water, Infrastructure, and Institutions

Ecologists and economists have long talked past each other, but climate change presents similar threats to both groups. Water may serve as the best means of finding a common cause and building a new vision of ecological and economic sustainability, especially in the developing world

Results and predictions of success of vesico-vaginal fistula repair at a national reference level in RwandaRésultats et facteurs prédicateurs du résultat chirurgical des fistules vésico-vaginales à l'échelle d'un hôpital de reference national

Objective: Vesico-vaginal fistulas (VVF's) cause enormous harm to women in developing countries. This prospective study intends to highlight epidemiological, etiological and pathological data, and to define predictors of surgical results in a national referral hospital setting. Material and Methods: All consecutive patients with VVF presenting at the Kigali Hospital Centre of Rwanda between 1997 and 2001 were included. Data on epidemiology, pathology, therapy and outcome were prospectively obtained. The risk factors for therapeutic failure were identified by multivariate analysis. Results: Ninety eight percent of all cases were of obstetrical origin. Twenty five percent of VVF were categorized as simple, 64% as complex and 11% as complicated. Complete closure and continence were obtained in 87 (77.7%) cases and closure with moderate incontinence in 7 cases (6.3%). In 18 cases (16%) closure failed even after 3 surgical attempts. The independent risk factors for therapeutic failure were vaginal fibrosis (

Patients With Noonan Syndrome Phenotype: Spectrum Of Clinical Features And Congenital Heart Defect

Mutations in components of the RAS-MAPK signaling pathway have been reported to result in an expression of Noonan phenotype. This is actually a wide-spectrum-phenotype shared by Noonan syndrome and its clinically related disorders namely, the Cranio-facio-cutaneous (CFC) syndrome, Costillo syndrome as well as LEOPARD syndrome. Patients with Noonan Syndrome (NS) have mutations in PTPN11 gene in majority of cases. Recently, mutations in SOS1, RAF1, MEK1 and KRAS genes have been reported to cause NS as well. Objective: To report patients with a Noonan phenotype followed in Rwandan University Teaching Hospitals, and to show the importance of the clinical diagnosis and challenges of making the diagnosis in resource limited settings where karyotype is almost the only genetic investigation accessible. Patients and Methods: Here we are reporting 5 patients, all with relevant NS symptoms, whose morbidity is directly related to the severity of their congenital heart disease. Van der burgt et al diagnostic criteria have been used for the clinical diagnosis, karyotype studies have been performed to exclude chromosomal aberration disorders and patients DNA extraction for mutation studies have been obtained in some cases. Results and Conclusion: we identified 5 patients with clinical features highly suggestive of NS and all of them had a normal karyotype, this excluding Turner syndrome, a clinically similar syndrome. As there are many as yet discovered mutations causing NS and the famous PTPN11 mutation being present only in 50% of cases, we maintain here that NS diagnosis should be a clinical diagnosis. The morbidity and mortality of our patients were directly correlated to the severity of their congenital cardiac defect. In conclusion, early management of such patients is highly recommended.Les mutations impliquant la voie de transduction RAS-MAPK ont étaient reconnues identifiées comme causant un « phénotype du syndrome Noonan ». Ceci est en effet un phénotype de spectre très large, partagé entre le syndrome de Noonan et d’autres conditions cliniquement semblable notamment le syndrome Crânio-Facio-Cutané (CFC), le syndrome de Costillo ainsi que le syndrome de LEOPARD. Les patients atteints du syndrome de Noonan ont des mutations dans le gène PTPN11 dans la majorité des cas. Récemment, les mutations impliquant les gènes SOS1, RAF1, MEK1 et KRAS ont étaient caractérisées comme étant aussi impliquées dans le développement du syndrome de Noonan. Objectifs: rapporter des patients atteints du syndrome de Noonan suivis dans nos hôpitaux universitaires et montrer l’importance du diagnostic clinique ainsi que le défi à faire le diagnostique dans un contexte où les ressources sont limitées, seul le karyotype étant presque le test génétique accessible. Résultats et Conclusion nous avons identifié 5 patients avec un tableau clinique suggestif du syndrome de Noonan et chez qui le karyotype a été normal, ceci excluant le syndrome de Turner qui mime la clinique du syndrome de Noonan. Compte tenu du fait qu’il y a beaucoup de mutations causant le syndrome de Noonan et les mutation du gène PTPN11 n’étant présentes que dans 50% des cas, nous plaidons pour l’importance du diagnostique clinique. La morbidité et mortalité des patients signalés dans cette revue étaient directement liées à la sévérité de leurs cardiopathies congénitales. En conclusion, une prise en charge précoce de tels patients devrait être recommandée

Management Challenges Of Pediatric Infective Endocarditis At Tertiary Level In Rwanda

Background: Management of Infective Endocarditis (IE) has been of great challenge for many years. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to good patient outcome as this condition is associated with a high morbidity and mortality in both adults and pediatric patients. In limited resources settings, management of IE is still a challenge due to early inappropriate antibiotherapy and therefore difficulties in its diagnosis and treatment. Objectives: To elicit challenges in management of patients suspected of IE at tertiary level in Rwanda. Methods: We report four patients with IE. For these patients, Duke’s criteria were considered in making the diagnosis. Results and Conclusion: IE has protean clinical symptoms and signs, and can be of challenging diagnosis. The patients reported constituted a clinical challenge in the diagnosis and management of IE but most of them had had favorable outcome. The main clinical challenge was the prolonged stay to peripheral settings with inappropriate antibiotherapy which made most of the blood cultures falsely negative. Echocardiography and serial blood cultures provide the key to diagnosis as per Dukes criteria. Being alert to this mentioned challenge is crucial. As the key investigations are not steadily available in most peripheral health facilities, we strongly recommend early referral to tertiary level for all cases of suspected IE before initiation of antibiotherapy.Introduction: Depuis plusieurs années, la prise en charge de l’endocardite bactérienne constitue un grand défi. Cette affection étant associée à une importante morbidité et mortalité tant chez l’adulte que chez l’enfant, un diagnostic rapide, un traitement efficace, et une reconnaissance rapide de complications sont des éléments essentiels pour arriver à un bon résultat thérapeutique. Dans les pays où les ressources sont limitées, la prise en charge de l’endocardite reste difficile en raison de l’antibiothérapie inappropriée initiée préalablement au niveau des structures sanitaires de base. Objectif: Identifier les défis dans la prise en charge des patients présentant une endocardite bactérienne au niveau des structures sanitaires tertiaires du Rwanda. Méthodes: Nous rapportons quatre patients qui présentaient une endocardite bactérienne. Pour tous ces patients, les critères de Duke ont été utilisés pour poser le diagnostic. Résultats et conclusion: L’endocardite infectieuse a des formes cliniques variables et peut rendre le diagnostic difficile. Bien que presque tous les patients reportés dans cette étude ont été traités avec succès, leur prise en charge n’a pas été facile d’emblée. Le plus grand défi a été un séjour prolongé sous antibiothérapie probabiliste a l’Hôpital de District, ce qui a rendu la plupart des hémocultures faussement négatives au niveau tertiaire. L’échocardiographie et une série d’au moins 3 hémocultures constituent les éléments clés des critères de Duke pour le diagnostic de l’endocardite bactérienne. Par conséquent, il est crucial pour les cliniciens de tenir compte de ces critères pour poser le diagnostic d’endocardite. Compte tenu de l’absence de moyens pour faire les hémocultures et une échocardiographie au niveau des hôpitaux de district, nous recommandons un transfert rapide au niveau de l’hôpital de référence pour tout cas suspect d’endocardite bactérienne avant d’initier l’antibiothérapie

Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda

Amon Nsengimana,1 Emmanuel Biracyaza,2,3 Joyce Isimbi,4 Charles Uwambajimana,4 Jean Claude Hategekimana,4 Vedaste Kagisha,4 Domina Asingizwe,5,6 Jean Baptiste Nyandwi4,6 1US Agency for International Development Global Health Supply Chain Program, Procurement and Supply Chain Management, Kigali, Rwanda; 2School of Rehabilitation, Faculty of Medicine, Université de Montréal, Québec, Canada; 3Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada; 4Department of Pharmacy, University of Rwanda, Kigali, Rwanda; 5Department of Physiotherapy; University of Rwanda, Kigali, Rwanda; 6East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, RwandaCorrespondence: Amon Nsengimana, Email [email protected]: This study aimed to explore the request and dispensing of antimalarial medicines without a prescription in community pharmacies in Rwanda, as well as factors associated.Methods: We employed an embedded mixed-methods design that involved a convenience sample of 235 licensed community pharmacists between February and April 2022. To simultaneously collect qualitative and quantitative data, we used a self-administered questionnaire containing a combination of close and open-ended questions. Bivariate and multivariate regression analyses were performed to examine the relationship between dispensing antimalarial medicines without a prescription and the selected independent variables. Statistical significance was set at p< 0.05, and a 95% confidence interval was applied. The factors influencing the dispensing of antimalarial medicines without a prescription were analyzed using thematic content analysis as a qualitative analysis approach.Results: Most respondents (88.5%) were asked to dispense antimalarial medicines by clients without a prescription. More than half of them (54%) agreed, but 34.5% refused; instead, they referred clients to malaria diagnostic testing facilities. Those who had rapid diagnostic tests for malaria in stock (OR=2.08, 95% CI:1.1– 3.94), and thought that antimalarials were over-the-counter medicines (OR=7.03, 95% CI:2.01– 24.5) were more likely to dispense antimalarial medicines without prescriptions. The primary reasons reported by community pharmacists for dispensing antimalarial medicines without prescriptions included their prior knowledge of malaria diagnosis, client pressure, and fear of losing clients. However, non-adherence to negative results obtained from formal health facilities and long queues at these institutions have also been cited as additional factors driving clients to seek antimalarial medicines without prescriptions.Conclusion: Dispensing antimalarial medicines without prescriptions is a common practice in community pharmacies in Rwanda. The main factors contributing to this practice include lack of awareness regarding the classification of antimalarials as prescription medicines, the availability of malaria diagnostic tests, client pressure, and fear of losing clients.Keywords: request, antimalarial medicines, dispensing, community pharmacies, Rwand

Predictors of delayed consultation in undescended testis patients at a Rwandan referral hospital

INTRODUCTION: Delayed management of undescended testes (UDT) is associated with an increased risk of malignancy and impaired fertility. To identify causes of delayed consultation of patients with UDT at a Rwandan referral hospital METHODS: This was a retrospective study of patients with delayed UDT presentations from 2012 to 2016. A delayed UDT presentation was defined as any patient presenting with UDT at >1 year of age. RESULTS: There were 44 cases of delayed UDT presentations. Most patients (n = 35, 79.5%) were born at a hospital; the rest (n = 9, 20.5%) were born at home. The patient’s parent with higher education in the family was considered. Most of the patients’ parents (n = 29, 65.9%) had a primary education, 6 (13.6%) had a secondary education (high school graduate), 1 (2.3%) had a university education, and 8 (18.2%) never went to school. The reported reasons for delays as they appear in the patient chart were 16 (36.4%) patients due to ignorance, 12 (27.3%) due to poor physical examination at birth, 7 (15.9%) due to poor guidance, 4 (9.0%) due to poverty and 5 (11.4%) due to long appointments. There were no overlapping reasons for delay reported. Patients born at home were more likely to identify ignorance as a reason for the delay (p = 0.007). Of the 16 patients who reported a delay due to ignorance, 12 of their parents had primary education, and 3 had no education. Most (n = 34, 77.3%) patients were fertile in adulthood, but 9 (20.4%) presented with infertility and 1 (2.3%) presented with testicular torsion. CONCLUSION: A number of reasons are responsible for delayed consultation in patients with UDT, including ignorance, poor physical examination, poor guidance, and poverty. Most of the causes are preventable. The urgent need for awareness of UDT and collaboration between physicians is paramount for early consult and management

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