Editorial: Patient education for the management of disease

No Abstract

Editorial: Medical waste management

No Abstrac

Editorial: Rwanda Journal of Medicine and Health Sciences: new name, increased visibility

No Abstrac

Editorial Hand washing – an essential protective measure in healthcare settings and in the community

In the framework of the quality improvement and accreditation process, Rwandan hospitals have promoted hand washing for healthcare providers, patients and visitors. This editorial elaborates on the readiness of Rwandan hospitals and the community at large to practice correct and systematic hand washing, which is of value to contain the COVID-19 pandemic. Key words: Rwanda, hand washing, COVID-1

High Prevalence of Giardia duodenalis Assemblage B Infection and Association with Underweight in Rwandan Children

Giardia duodenalis is a protozoan parasite causing gastroenteritis. Although the parasite occurs worldwide, its regional prevalence varies considerably. Using PCR as a highly sensitive molecular diagnostic tool, we detected G. duodenalis in 60% of 583 children younger than five years in southern Rwanda. It was by far the most frequent intestinal parasite detected in this population. Importantly, two out of three infections would have been undetected if only the commonly used light microscopy had been applied. Genotyping revealed the presence of two distinct types of parasites, and only the infrequent subtype showed a weak association with gastrointestinal symptoms. However, G. duodenalis infection was associated with underweight and clinically assessed severe malnutrition. The data call for the establishment of more sensitive than light microscopy, yet simple diagnostic tools to identify infected children as well as for the consideration of abundant submicroscopic infections in evaluating the significance of G. duodenalis in high endemicity areas

malaria infection among schoolchildren in highland Rwanda

Background Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections. Methods In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6–10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio- economic and behavioural parameters as well as medical histories were obtained. Results Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of −1.2 g/dL; 95% CI, −0.8 to −1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection. Conclusion Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children´s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children

Prevalence and risk factors of malaria among children in southern highland Rwanda

<p>Abstract</p> <p>Background</p> <p>Increased control has produced remarkable reductions of malaria in some parts of sub-Saharan Africa, including Rwanda. In the southern highlands, near the district capital of Butare (altitude, 1,768 m), a combined community-and facility-based survey on <it>Plasmodium </it>infection was conducted early in 2010.</p> <p>Methods</p> <p>A total of 749 children below five years of age were examined including 545 randomly selected from 24 villages, 103 attending the health centre in charge, and 101 at the referral district hospital. Clinical, parasitological, haematological, and socio-economic data were collected.</p> <p>Results</p> <p><it>Plasmodium falciparum </it>infection (mean multiplicity, 2.08) was identified by microscopy and PCR in 11.7% and 16.7%, respectively; 5.5% of the children had malaria. PCR-based <it>P. falciparum </it>prevalence ranged between 0 and 38.5% in the villages, and was 21.4% in the health centre, and 14.9% in the hospital. Independent predictors of infection included increasing age, low mid-upper arm circumference, absence of several household assets, reported recent intake of artemether-lumefantrine, and chloroquine in plasma, measured by ELISA. Self-reported bed net use (58%) reduced infection only in univariate analysis. In the communities, most infections were seemingly asymptomatic but anaemia was observed in 82% and 28% of children with and without parasitaemia, respectively, the effect increasing with parasite density, and significant also for submicroscopic infections.</p> <p>Conclusions</p> <p><it>Plasmodium falciparum </it>infection in the highlands surrounding Butare, Rwanda, is seen in one out of six children under five years of age. The abundance of seemingly asymptomatic infections in the community forms a reservoir for transmission in this epidemic-prone area. Risk factors suggestive of low socio-economic status and insufficient effectiveness of self-reported bed net use refer to areas of improvable intervention.</p

Dichloroacetate Prevents Hypoxic Lactic Acidosis in Rats

Lactic acidosis has different causes, including hypoxia. It is notably treated with dichloroacetate, which stimulates the activity of the pyruvate dehydrogenase enzyme complex in the mitochondrial inner membrane. However, there has been controversy over its efficiency in hypoxic lactic acidosis, particularly in the cerebral tissue and the cerebrospinal fluid. Assess the efficiency of dichloroacetate in the prevention of hypoxia-induced lactic acidosis.We used adult rats, 3 months old, with a weight of 250-300 grams. Anesthesia was achieved by intraperitoneal injection of pentobarbital (Nembutal®), at the dose of 50 mg/kg. For the induction of hypoxia, the rats were given to inspire a gas mixture containing 11% O2 during 45 minutes. There were 20 rats in the dichloroacetate group and 20 in the control group. The dichloroacetate group rats were given dichloroacetate 300 mg/kg in slow IV injection before the induction of hypoxia. We measured lactate concentration in the blood and in the cerebrospinal fluid before the induction of hypoxia and at the end of 45 minutes of hypoxia, by spectrophotometry based on enzymatic principle. In normoxia, the lactate concentration was 1.84 ± 0.11 mmol/L in the blood and 2.00 ± 0.15 mmol/L in the cerebrospinal fluid. After 45 minutes of hypoxia, lactate concentration was 2.15 ± 0.36 mmol/L in the blood and 2.87 ± 0.16 mmol/L in the cerebrospinal fluid for the dichloroacetate group versus respectively 5.28 ± 0.91 mmol/L and 5.33 ± 0.58 mmol/L for the control group, p < 0.01.. The study shows that Dichloroacetate is efficient for the prevention of hypoxic lactic acidosis

Clinical Chemistry Reference Intervals in a Rwandan Population

Aim: To establish clinical chemistry reference intervals for the Rwandan population. Study Design: A population-based cross-sectional study. Place and Duration of Study: The study was carried out in three blood transfusion centres: Buhanda, Ruhango and Nyaruteja, between August and December 2011. Methods: Serum clinical chemistry tests were performed on a Cobas C311 automated chemistry analyzer. Results: Results of 187 subjects (age range: 17-54 years) presented as median, with 2.5th-97.5th percentiles (95% reference interval) in brackets are as follows: For males: alanine aminotransferase: 25 (12-43) U/L; aspartate aminotransferase: 29 (16-47) U/L; gamma-glutamyl transferase: 22 (9-77) U/L; total bilirubin: 0.6 (0.2-1.7) mg/dL; direct bilirubin: 0.2 (0.1-0.4) mg/dL; creatinine: 0.8 (0.5-1.1) mg/dL; uric acid: 5 (3-7) mg/dL. For males and females: alkaline phosphatase: 71 (27-122) U/L; amylase: 144 (50-235) U/L; lactate dehydrogenase: 176 (114-237) U/L; triglycerides: 82 (32-172) mg/dL; highdensity lipoprotein: 48 (29-86) mg/dL; glucose: 87 (70-114) mg/dL; total protein: 7.6 (6.5- 8.5) g/dL; albumin: 4.4 (3.4-5.4) g/dL; sodium: 142 (137-147) mmol/L; potassium: 4.1 (3.3-5.0) mmol/L; chloride: 106 (100-112) mmol/L; phosphate: 1.16 (0.87-1.49) mmol/L. Conclusion: The clinical chemistry reference values are in agreement with those reported in other African studies, with variations

Short communication - A Rwandan spirometry and resting ventilation study

To illustrate spirometric population variation and ventilatory adaptation to moderate altitude, we report the spirometric and resting ventilation values observed in a student population in Butare, Rwanda (altitude: 1 768 m; barometric pressure: 629 mm Hg). Spirometry was carried out with a Mijnhardt Volutest VT-3 water-sealed spirometer in students aged between 20 and 30 years. The results (mean ± SD) are as follows: Vital capacity: males: 4 123 ± 537 mL, females: 2 810 ± 393 mL; Vital capacity per m2 body surface area: males: 2 352 ± 245 mL/m2, females: 1 771 ± 219 mL/m2; FEV1: males: 3 576 ± 618 mL, females: 2 347 ± 474 mL; FEV1%: males: 87.8 ± 8.5 %, females: 84.5 ± 7.7 %; tidal volume: males: 540 ± 80 mL, females: 454 ± 66 mL; respiratory frequency: 17 ± 4 both in males and in females; minute volume: males: 9.3 ± 2.7 L/min., females: 7.6 ± 2.0 L/min. The results indicate that the vital capacity and the FEV1 are lower than classical values from white populations, FEV1% is higher. The tidal volume, respiratory frequency and minute volume are increased relative to sea level