Barriers to school attendance among children with disabilities in Rwanda

Magister Scientiae (Physiotherapy) - MSc(Physio)The number of children with disabilities under the age of 18 years around the world varies from 120 to 150 million. In many countries, throughout the world, the majority of children with disabilities either do not receive any form of education or, if they receive any, it is often inappropriate. UNESCO estimates that more than 90% of children with disabilities in developing countries do not attend schools. Rwanda has recently started inclusive education in a number of schools around the country for ensuring that children with disabilities have access to education. Despite this, in Rwanda, many children with disabilities do not attend school and this number is not known. This study aimed to identify the barriers to school attendance by children with disabilities in Rwanda.South Afric

Use of the International Classification of Functioning Disability and Health (ICF) as a theoretical framework to inform interprofessional assessment and management by health care professionals in Rwanda.: a cluster randomised control trial

Background: Effective collaboration between health professionals can reduce medical errors and assist in interpretation of health information resulting in improved patient care. The International Classification of Functioning, Disability and Health (ICF) has been suggested as a potential framework to help health professionals develop a common language for better collaboration and to provide more holistic care. In the main, Rwandan district hospitals still utilise the hierarchical medical model of health. Aim: The aim of the study was to determine whether training on interprofessional practice, using the ICF framework, resulted in improved knowledge, attitudes and behaviour(as determined by improved recording of interprofessional assessment and management in patient records) in randomly selected Rwandan District Hospitals. Methodology: This study was composed of two phases. Phase I: Preparation. The intervention programme was developed based on a literature review and input from an international panel of experts. A feasibility study in which self-designed instruments and the training programme were tested was undertaken in one district hospital. Phase II: A Cluster Randomised Control Trial. Four district hospitals were randomly allocated to receive a day’s training in interprofessional practice using the ICF (experimental hospitals) or a short talk on the topic (control hospital). Participants included medical doctors, nurses, physiotherapists, social workers, nutritionists, and mental health nurses/clinical psychologists. Using self-designed and validated measures, pre- and postmeasurements of knowledge and attitudes towards Interprofessional Practice (IPP) were performed at baseline and after training and audit of patients’ records after discharge was performed at baseline and at two, four and six months. The independent t-test and Mann-Whitney U test were used to establish if the two sets of groups were equivalent before and after training at baseline and at two, four and six months. Repeated measures ANOVA and the post-hoc Tukey test were used to compare the audit scores at each time point. The Kruskal Wallis test was used to compare rankings of the scores of attitudes of different professions before and after the intervention. Ethical approval was obtained from the Human Research Ethics Committee of the University of Cape Town and the Rwandan National Ethics Committee

The status and outcomes of interprofessional health education in sub-Saharan Africa : a systematic review

Review conducted under the Global Challenges Research Fund (GCRF) PhD scholarship at the University of St-Andrews.The increasing burden of chronic diseases, and shortage of health care workers especially in Low and Middle Income countries (LMICs) requires greater collaborative working between health professions. There is a growing body of evidence that interprofessional education (IPE) and interprofessional continuous education (IPCE) can improve collaborative practice thus strengthening health care delivery in low resource settings. The World Health Organization (WHO) promotes this educational strategy in these regions as part of wider programs to improve health care. The purpose of this systematic review was to summarize IPE and IPCE activities in sub-Saharan Africa (SSA) and its outcomes; including practice, service and patient outcomes. Standard guidelines for conducting and reporting systematic reviews were followed. The online databases searched included MEDLINE, Embase, Education Resources Information Centre (ERIC), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Science Direct. The Kirkpatrick model was used to classify IPE outcomes reported from literature. Following full text screening, 41 articles were selected for data extraction. It was found that IPE/IPCE is still a relatively new concept in SSA with 93% of studies published after 2012. Furthermore, IPE is concentrated predominantly in undergraduate institutions and mainly implemented to improve collaborative practice and address important public health concerns. Positive reaction and outcomes of IPE/IPCE were reported in terms of change of attitude and perception toward collaborative practice as well as knowledge and skills acquisition. Few studies in SSA sought to understand and measure the outcomes of IPE/IPCE relating to health care practice. More work in this important potential outcome of IPE/IPCE is recommended.Publisher PDFPeer reviewe

Profile of injuries among sitting volleyball players with disabilities in Rwanda

Background: Sports injuries are some of the risk of paralympics sport. Injuries are somewhat high compared with injury rates in able-bodied athletes. Injuries might have an impact on the participation and future health. It is paramount to investigate sports specific injuries to eliminate associated risks.Aim: To identify patterns of injuries among sitting volleyball players in Rwanda.Methods: A prospective quantitative study was conducted among 158 sitting volleyball players competing in the 2013-2014 season. The research team composed by physiotherapists used the data collection process following the consensus on injury definitions and data collection procedures. The ethical clearance and permission were obtained from relevant bodies. ANOVA or the Mann–Whitney U-test were used for continuous variables while Chi-square or Fisher’s exact tests were used for categorical variables.Results: All the 158 players aged 25±6 years participated in the study; with male predominance (66.5%). Fifty-eight players (37%) sustained at least one injury. Nearly half of injuries (n=43) were mild, consistent for both male and female. There was no statistical difference in the patterns of injuries comparing male and female participants.Conclusion: Sitting volleyball players with disability in Rwanda sustained a high prevalence of injuries. The fingers, hands and wrists were the most injured body parts. However, the health and integrative advantages should outweigh the risk of adverse effects associated with participation in sports such as injuries.Keywords: Sitting volleyball, People with disabilities (PWDs), Injur

Evaluation of a pilot interprofessional Arclight™ workshop for healthcare students in Rwanda : promoting collaborative practice in eye health

Funding: Global Challenges Research Funding awarded by the Scottish Funding Council.Preventable and treatable visual impairment affects more than 1 billion people worldwide. Rwanda has an estimated visual impairment prevalence of 3.7% amongst the 12 million inhabitants. Around one third of this demand could be addressed through a more integrated and collaborative approach, particularly in primary eye care services. Healthcare students, therefore, need to be prepared for collaborative practice in eye health through interprofessional learning. Interprofessional workshops were piloted with ophthalmic clinical officer, medical clinical officer, nursing and medical students from the University of Rwanda. The aim was to promote collaborative practice by teaching students how to assess and recognize common eye conditions using the Arclight; a low cost, solar powered, portable ophthalmoscope designed for use in low resource settings. Students reported that the workshop content was relevant to all professional groups. They valued the opportunity to learn interprofessionally, share their knowledge and perspectives, and acquire new knowledge and skills together. This pilot helped to identify the most relevant skills and knowledge for future interprofessional eye health training. It enabled the facilitators to reflect on how best to maintain a balance between a quality interprofessional experience and the more specific eye health related learning objectives.PostprintPeer reviewe

Prevalence and levels of disability post road traffic orthopaedic injuries in Rwanda

Background: Prolonged disability resulting from road traffic injuries (RTIs) contributes significantly to morbidity and disease burden. A good understanding of the prevalence and the level of disability of orthopaedic injuries in developing countries is crucial for improvement; however, such data are currently lacking in Rwanda. Objectives: To determine the prevalence and levels of disability of 2 years post-road traffic orthopaedic injuries in Rwanda. Method: A multicentre, cross-sectional study from five Rwandan referral hospitals of 368 adult RTI victims’ sustained from accidents in 2019. Between 02 June 2022, and 31 August 2022, two years after the injury, participants completed the World Health Organization Disability Assessment Schedule (WHODAS 2.0) Questionnaire for the degree of impairment and the Upper Extremity Functional Scale and Lower-Extremity Functional Scale forms for limb functional evaluation. Descriptive, inferential statistics Chi-square and multinomial regression models were analysed using R Studio. Results: The study’s mean age of the RTOI victims was 37.5 (±11.26) years, with a sex ratio M: F:3: 1. The prevalence of disability following road traffic orthopedic injury (RTOI) after 2 years was 36.14%, with victims having WHODAS score 25.0% and 36.31% were still unable to return to their usual activities. Age group, Severe Kampala Trauma Score and lack of rehabilitation contributed to disability. The most affected WHODAS domains were participation in society (33%) and life activities (28%). Conclusion: The prevalence and levels of disability because of RTOI in Rwanda are high, with mobility and participation in life being more affected than other WHODAS domains. Middle-aged and socio-economically underprivileged persons are the most affected. Contribution: This study showed that a good rehabilitation approach and economic support for the RTI victims would decrease their disabilities in Rwanda

Psychosocial Environmental Barriers to School Attendance among Children with Disabilities in Two Community Based

The purpose of this study was to determine the psychosocial environmental barriers to school attendance by children with disabilities in Rwanda. A quantitative, cross-sectional, descriptive study was conducted in one urban and one rural community-based rehabilitation centre. There was a sample of 94 parents or caregivers of children with disabilities who were not attending school. A structured closed-ended questionnaire was used. The Statistical Package for the Social Sciences (SPSS) (15.0 version) was used for data analysis. The data analysis included descriptive statistics as frequency distributions and percentages. The data were presented in the forms of cross-tables. CHI-Square was used to determine the association between variables. The level of significance (alpha) was set at 0.05. The findings indicate that in Rwanda there is a negative attitude among parents/caregivers and the community towards children with disabilities. Many parents/caregivers reported that having a child with a disability is a burden and shame in their families. A great proportion of parents/caregivers also indicated that, if they needed to make a choice, they would prioritise education for their child without the disability over their child with the disability. The majority reported the special school to be their first choice for their children with disabilities

The impact of a training programme incorporating the conceptual framework of the International Classification of Functioning (ICF) on behaviour regarding interprofessional practice in Rwandan health professionals: A cluster randomized control trial.

BACKGROUND:Appropriate collaboration between health professionals (HP) can reduce medical errors, enhance the spread of critical information, and assist in interpretation of health information resulting in improved patient care. The International Classification of Functioning, Disability and Health (ICF) may provide a useful conceptual framework to facilitate better interprofessional practice. PURPOSE:To determine whether a training programme based on the ICF framework resulted in improved interprofessional behaviour among HPs in Rwanda. METHODOLOGY:A cluster randomised control trial was used. Four district hospitals were randomly allocated to receive either a day's training in interprofessional practice based on the ICF framework (experimental) or a short talk and a booklet on the topic (control). A total of 203 participants included medical doctors, nurses, and other HPs took part in this study. Simple random sampling was used to select the hospital records of 200 patients discharged from relevant wards at both the experimental and control hospitals at baseline and at two, four and six months after training (800 patients' records from each group). A self-designed checklist has undergone some validation and was based on the ICF conceptual model was used to audit the quality of information included in the patients' records. Ethical approval was obtained from the relevant authorities. RESULTS:The demographic and medical profile of the patients in the two sets was equivalent. An ANOVA and post-hoc Tukey test indicated the mean number of items correctly filled in was not significant at baseline (p = 0.424) but the difference was significant (p < .001) for the post-intervention scores at two, four and six months. The control group scores did not improve over time. The improved behavior was still evident at six months although it had begun to decay. CONCLUSION:Behaviour change as evidenced by more comprehensive recording of patient management can result from a well-structured training programme. The ICF appeared to provide a common language and facilitate HPs interaction and patient management plans. IMPLICATION:The ICF provided an effective conceptual framework to structure the content of the training and the audit tool. It is recommended that the framework be used to facilitate interprofessional education and practice in Rwanda and that the training approach may be applicable to other health care contexts