Work In Progress: The Role Of Higher Education In Post-Conflict Tourism Development, A Case Study From Rwanda

Tourism and hospitality have been recognized as a major economic factor worldwide and competition between destinations for present and future tourist has only become fiercer. Within such established markets as the East African safari & beach market it will not be easy for new destinations to discern themselves and offer a complimentary or new product. Especially in the case of Rwanda, that was plagued by a violent recent history and still suffers from an unclear image, this objective might not be easy to realize. However with the support from international partners and the dedication and ambitions of the national government in collaboration with local stakeholders, Rwanda is moving forward. Although this case study is related to an African example there might be suggestions and lessons learned that could inspire other destinations to proceed along a similar track.El turismo y la hospitalidad han sido reconocidos como un factor económico importante en todo el mundo, y la competencia entre los destinos por el turista actual y futuro sólo ha vuelto más feroz. Dentro de estos mercados establecidos, como es el caso de los mercados de safari y playa de Africa del Este, no será fácil para los nuevos destinos diferenciarse y ofrecer un producto complementario o nuevo. Especialmente en el caso de Ruanda, plagado por una historia reciente de violencia y cuya imagen todavía se ve afectada, este objetivo no puede ser fácil de realizar. Sin embargo, con el apoyo de socios internacionales y la dedicación y ambiciones del gobierno nacional, en colaboración con los actores locales, Ruanda está avanzando. Aunque este caso de estudio se refiere a un ejemplo de África puede haber sugerencias y lecciones aprendidas que podrían inspirar a otros destinos a continuar por un camino similar

The Prevalence of HIV Infection among Pregnant Women at Kabutare District Hospital - Rwanda

Background:Kabutare Hospital is a District Hospital in Rwanda. The HIV infection has been a threat to mothers and their babies since many years in Rwanda, where the prevalence countrywide is estimated at 3% (DHS 2010) and 4.7% among pregnant women (UNAIDS2009). We conducted astudy to know the sero-prevalence of HIV infection among pregnant  women who delivered at Kabutare District Hospital .The objectives were to determine the prevalence of HIV infection among pregnant women in  Kabutare Hospital and to compare the prevalence of HIV infection in  Kabutare Hospital with the prevalence at the National level.Methods:A retrospective, descriptive study conducted from July 2012 to  December 2012.The study concerned 1258 pregnant women who delivered in the Kabutare District Hospital. From the Hospital records the data were extracted and analyzed by SPSS.20 software.Results:A total of 1258 pregnant women attended and delivered at Kabutare Hospital between July 2012 and December2012.The vaginal deliveries were 680 (54.1%) and the women who delivered by Caesarean section were 578 (49.1%), the rate of deliveries per day is 7 with a mean number of pregnancy estimated at 2.14.Themajority of pregnant women is situated in age group of 21-35 years (78 %).The monthly attendance is within a range of 171 women and 246 women (December and August respectively). A total of 613 (48.7%) of women were primigravida. The foetal presentation which was dominant is the cephalic presentation with 97.1% (1226 pregnant women). The prevalence of HIV infection was 2.9 % (36 women) Among HIV infected women, the age group of >35 years old pregnant women was more affected by the HIV infection with a percentage of 4.2%.Among HIV infected women 50% had a vaginal delivery and 50% undergone a cesarean section .The women who had two or more pregnancies were infected by the HIV infection with a percent of 3.8 (24 pregnant women).Conclusion:The sero-prevalence of HIV infection among pregnant women in Kabutare Hospital is slightly below to the sero-prevalence at the national level. But persistent vigilance is needed to prevent the Mother to Child transmission.Keywords: pregnant women, Kabutare Hospital, HIV sero-prevalence.Introductio

MARRIAGE PATTERNS IN ANKOLE, SOUTH - WESTERN UGANDA

This paper studies marriage patterns and systems in Ankole. Discussed in the study are age at marriage, proportion married, marriage dissolution, remarriages, types of marriage and bridewealth. The paper finds that most of the marriage patterns are among the major causes of high fertility in the area

A note on the statistical analysis of point judgment matrices

The Analytic Hierarchy Process is a multicriteria decision making technique developed by Saaty in the 1970s. The core of the approach is the pairwise comparison of objects according to a single criterion using a 9-point ratio scale and the estimation of weights associated with these objects based on the resultant judgment matrix. In the present paper some statistical approaches to extracting the weights of objects from a judgment matrix are reviewed and new ideas which are rooted in the traditional method of paired comparisons are introduced

Low prevalence of methicillin resistant as determined by an automated identification system in two private hospitals in Nairobi, Kenya: a cross sectional study

Background: Staphylococcus aureus (S.aureus) is a major cause of both healthcare and community acquired infections. In developing countries, manual phenotypic tests are the mainstay for the identification of staphylococci with the tube and slide coagulase tests being relied upon as confirmatory tests for S. aureus. The subjectivity associated with interpretation of these tests may result in misidentification of coagulase negative staphylococci as S.aureus. Given that antibiotic resistance is more prevalent in CONS, this may result in over estimation of methicillin resistant S.aureus (MRSA) prevalence. Methods: A review of susceptibility data from all non-duplicate S.aureus isolates generated between March 2011 and May 2013 by the Vitek-2 (bioMérieux) automated system was performed by the authors. The data was generated routinely from processed clinical specimens submitted to the microbiology laboratories for culture and sensitivity at the Aga Khan University Hospital and Gertrude’s children’s hospital both situated in Nairobi. Results: Antimicrobial susceptibility data from a total of 731 non-duplicate S.aureus isolates was reviewed. Majority (79.2%) of the isolates were from pus swabs. Only 24 isolates were both cefoxitin and oxacillin resistant while 3 were resistant to oxacillin but susceptible to cefoxitin giving an overall MRSA prevalence of 3.7% (27/731). None of the isolates were resistant to mupirocin, linezolid, tigecycline, teicoplanin or vancomycin. Conclusion: The prevalence of MRSA in this study is much lower than what has been reported in most African countries. The significant change in antibiotic susceptibility compared to what has previously been reported in our hospital is most likely a consequence of the transition to an automated platform rather than a trend towards lower resistance rates

Lack of Parental Gender Socialization of Children at Family Level and its Effects on Adulthood Gender Discrimination in Rwanda

The paper discusses holistic integration of gender concepts at tender ages.  This study aimed toinvestigate parents’ participation in socializing children to gender equality and assess the effect of lack of parental socialization of children to gender equality. Three hundred and fifty (350) respondents were purposively selected from Kicukiro, Bugesera, Musanze, Nyanza and Nyamasheke. Data were collected through questionnaire, interviews and focus group discussion and qualitatively analyzed using content analysis. Findings revealed that there is lack of parental gender socialization of children as it is negatively perceived in Rwandan families. Gender equality is perceived by 75 % of respondents to be the cause of family conflicts and violence. Furthermore, 69% of all respondents accuse the theory of gender equality to divert females from their responsibilities which results in family dysfunctionality. In addition, 42% of respondents consider gender equality as a way of western people to disorganize developing countries. Lack of parental gender socialization of children at family level affects children's adulthood. It presents enormous and long-lasting consequences to both females and males. Respondents confirmed that there is a considerable number of females who did not attend school because fees were reserved to boys. On the other hand, male respondents confirmed that being overpowered in childhood negatively affects adulthood relationship with their wives. Socializing children to gender equality at family level from their tender ages would be one of the best strategies to eradicate Gender-Based Violence (GBV) and discrimination

Traitement antibiotique sélectif au tarissement des vaches laitières

Le traitement sélectif (TS) des vaches laitières au tarissement (où seuls les quartiers ou les vaches infectées sont traités avec des antimicrobiens) constitue une alternative potentielle au traitement universel (TU, où tous les quartiers de toutes les vaches reçoivent des antimicrobiens, quel que soit leur statut infectieux), pour une utilisation plus judicieuse des antimicrobiens. L'objectif de cette thèse était d’apporter plus de lumière sur les décisions de traitement antimicrobien ciblant les quartiers ou vaches infecté(e)s au tarissement. Différents devis et méthodologies ont été utilisés pour répondre à cet objectif. Un essai contrôlé randomisé a été conçu et 569 vaches (2,251 quartiers) provenant de 9 troupeaux laitiers du Québec avec un comptage de cellules somatiques (CCS) du réservoir <250 000 cellules/mL ont été systématiquement enrôlées et réparties au hasard dans 4 groupes : 1) traitement antimicrobien seul pour tous les quartiers ; 2) traitement antimicrobien combiné avec un scellant interne à trayon pour tous les quartiers ; 3) traitement antimicrobien sélectif seul basé sur les résultats de la culture bactériologique du lait sur Petrifilm® ; et 4) traitement antimicrobien sélectif combiné avec un scellant interne à trayon basé sur les résultats de la culture du lait sur Petrifilm®. Dans les groupes de TS, les quartiers non infectés n'ont reçu qu'un scellant interne à trayon. Aucune différence significative n'a été détectée entre le TS par quartier et le TU des vaches laitières au tarissement, en termes d'élimination des infections intramammaires (IIM) et de prévention de nouvelles IIM pendant la période de tarissement, de risque d'un premier cas de mammite clinique (MC), de production laitière moyenne quotidienne et de CCS au cours des 120 premiers jours de la lactation suivante. Un TS reposant sur les résultats d'une culture de lait de quartier sur Petrifilm® au tarissement a permis de réduire l'utilisation d'antimicrobiens de 52% (IC à 95%: 39 – 64) par rapport à un TU. En plus de cet essai contrôlé randomisé, la culture du lait par quartier à l'aide de Petrifilm® a été comparée à l'historique du CCS par une estimation bayésienne de leur précision pour identifier les quartiers ou les vaches qui devraient être traités avec des antimicrobiens dans des protocoles de TS au tarissement. Compte tenu de la disponibilité des données de CCS, de la facilité d'utilisation du dernier test de CCS pré-tarissement et de la valeur prédictive négative élevée qui pourrait être obtenue, les producteurs pourraient envisager d'utiliser uniquement le dernier test de CCS pré-tarissement comme outil potentiel pour identifier les vaches qui devraient être traitées avec des antimicrobiens au tarissement. Le dernier test de CCS pré-tarissement peut être utilisé seul ou en combinaison avec la culture de lait par quartier sur Petrifilm® sur les vaches avec un CCS élevé pour identifier encore plus spécifiquement les quartiers qui doivent être traités. L'ajout d'une culture de lait par quartier à la ferme sur Petrifilm® pour les vaches identifiées comme infectées à l'aide des données du CCS améliorerait la précision du test (principalement la valeur prédictive positive) et réduirait davantage l'utilisation d'antimicrobiens. Également, une revue systématique et une série de méta-analyses ont été menées pour étudier l'efficacité du TS par rapport au TU, afin de guider les décideurs et les utilisateurs qui s'engagent dans une utilisation plus efficace et judicieuse des antimicrobiens au moment du tarissement. Treize articles représentant 12 essais contrôlés, randomisés ou non, étaient disponibles pour les analyses. Le TS a permis de réduire de 66% (IC à 95%: 49 – 80) l'utilisation d'antimicrobiens au moment du tarissement. Les résultats appuient fortement l'idée que le TS réduirait l'utilisation d'antimicrobiens au moment du tarissement, sans effet négatif sur la santé du pis ou la production laitière au cours des premiers mois de la lactation subséquente, si, et seulement si, les scellant internes à trayons sont utilisés pour les quartiers non traités avec des antimicrobiens. Enfin, le suivi de l'utilisation d'un scellant interne à trayon a été effectué pour déterminer la proportion de quartiers qui ont conservé le bouchon de scellant jusqu’à la première traite après le vêlage et la persistance de résidus de scellant dans le lait après le vêlage. Un bouchon de scellant était présent jusqu'à la première traite pour 83% des quartiers, et nous pourrions émettre l'hypothèse que la perte du bouchon s'est produite près du vêlage secondaire à la tétée ou pour une autre raison (ex., la pression hydrostatique du lait), étant donné que les associations observées entre la présence ou non d'un bouchon de scellant observable et les chances de nouvelles IIM étaient relativement faibles. Les résidus de scellant pouvaient être observés dans le lait jusqu'à 12 jours après le vêlage, quoique 75% des quartiers n’excrétaient plus de scellant au bout de 5 jours en lait.Selective dry cow therapy (SDCT, in which only infected quarters or cows are treated with antimicrobials) represents an alternative to blanket dry cow therapy (BDCT, in which all quarters of all cows at dry off are treated with antimicrobials, regardless of their infection status), for a more judicious use of antimicrobials. The objective of this thesis was to shed more light on targeted antimicrobial treatment decisions of infected quarters or cows at dry-off. Different study designs and methodologies were used to meet this objective. A randomized controlled trial was designed and a total of 569 cows (2,251 quarters) from 9 dairy herds in Québec with bulk tank somatic cell count (SCC) <250,000 cells/mL were systematically enrolled and randomly allocated to 4 groups: 1) antimicrobial treatment alone of all quarters; 2) antimicrobial treatment combined with an internal teat sealant (ITS) of all quarters; 3) selective antimicrobial treatment alone based on milk bacteriological culture results on Petrifilm®; and 4) selective antimicrobial treatment combined with an ITS based on milk culture results on Petrifilm®. In the selective antimicrobial treatment groups, uninfected quarters received only an ITS. No significant differences were detected between quarter-based selective and blanket dry cow therapies, in terms of elimination of intramammary infections (IMI) and prevention of new IMI during the dry period, risk of a first case of clinical mastitis (CM), daily average milk yield and somatic cell count in the first 120 days of the subsequent lactation. A selective antimicrobial treatment relying on results of quarter milk culture using Petrifilm® at dry off enabled a reduction in antimicrobial use of 52% (95% CI: 39 – 64) as compared to blanket dry cow treatment. In addition to this randomized controlled trial, quarter milk culture using Petrifilm® was compared with SCC history through a Bayesian estimation of diagnostic accuracy to identify quarters or cows that should be treated with antimicrobials in selective treatment protocols at dry off. Considering the availability of SCC data, the easiness of using just the last Dairy Herd Improvement (DHI) test before dry off, and the high negative predictive value that could be achieved, producers may consider using just the last DHI test before dry off results as a potential tool to identify cows that should be treated with antimicrobials at dry off. The last SCC test before 7 dry off may be used alone or in combination with quarter-level on-farm Petrifilm® milk culture on high SCC cows to more specifically identify quarters that need to be treated. Adding quarter-level milk culture using Petrifilm® to cows identified as unhealthy using cow-level SCC data could improve the test accuracy (mainly the positive predictive value) and further reduced the use of antimicrobials. Also, a systematic review and a series of meta-analyses were conducted to investigate the efficacy of SDCT compared with BDCT, to guide decision-makers and users to engage in a more effective and judicious use of antimicrobials at dry-off. Thirteen articles representing 12 controlled trials, randomized or not, were available for analyses. SDCT reduced the use of antimicrobials at dry off by 66% (95% CI: 49 – 80). Evidences strongly support that SDCT would reduce the use of antimicrobials at dry off, without any detrimental effect on udder health or milk production during the first months of the subsequent lactation, if, and only if, ITS are used for healthy quarters untreated with antimicrobials. Finally, a follow up on the use of ITS was performed to determine the proportion of quarters that had retained the sealant plug until the first milking after calving and the persistence of ITS residues in milk after calving. A sealant plug was present at first milking after calving for 83% of the quarters, and we could hypothesize that the loss of the plug occurred closely around calving due to suckling or for another reason (e.g., milk hydrostatic pressure), since the observed associations between the presence or not of an observable sealant plug and the odds of new IMI were relatively small. The sealant residues could be observed in milk up to 12 days in milk, although 75% of the quarters had expelled the last ITS residues by 5 days in milk

Marriage patterns in Ankole, South-Western Uganda

This paper studies marriage patterns and systems in Ankole. Discussed in the study are age at marriage, proportion married,marriage dissolution, remarriages, types of marriage and bridewealth. The paper finds that most of the marriage patterns are among the major causes of high fertility in the area

HIV/AIDS among surgical patients in Butare University Teaching Hospital

Background: Despite the increasing number of patients with the human immunodeficiency virus (HIV) infection particularly in Sub-Saharan Africa, surgical experience with these patients remains limited. A prospective review of 165 surgical patients admitted over a period of 3 months from 20th September to 20th December 2006 was undertaken. The main objective of the study was to determine the frequency HIV among these patients and associated surgical conditions.Methods: This 3-months prospective study was undertaken at Butare Teaching Hospital Rwanda over a 3-months period starting from 20th September 2007. A total of 165 patients who after counseling gave an informed consent had their blood collected for HIV screening. Data obtained was analyzed using Epidata and SPSS 11.5. P value was P value equal to 0.05 or less was considered as statistically significant.Results: The patients’ ages ranged from 6 to 86 years with a mean of 35.2 years. The sex ratio M: F was 2.11:1. The HIV seroprevalence was 6.7%. The majority of HIV positive patients were female (54.5%) and the most affected age range was 30-39 years. Only 2 (22.2 %) affected patients were on ARV therapy. Eight of the HIV patients had musculoskeletal sepsis (72.72 %). Associated surgical diseases included infection of osteosynthetic material in, chronic osteomyelitis, Pyomyositis and osteonecrosis of the head of femur associated with pyomyositis.Conclusion: With a prevalence of 6.6%, HIV/AIDS is a real and significant problem in surgical practice and patients with HIV admitted to a surgical department require special consideration if their surgical management is to be effective. Surgeons and other health-care workers who are potentially exposed to blood and body fluids must take appropriate precautions to avoid getting infected with HIV. We found no statistically significant difference in the surgical pathologies between HIV-positive and HIV-negative patients

D-optimal designs for drug synergy.

Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.This thesis is focused on the construction of optimal designs for detecting drug interaction using the two-variable binary logistic model. Two specific models are considered: (1) the binary two-variable logistic model without interaction, and (2) the binary two-variable logistic model with interaction. The two explanatory variables are assumed to be doses of two drugs that may or may not interact when jointly administered to subjects. The main objective of the thesis is to algebraically construct the optimal designs. However, numerical computations are used for constructing optimal designs in cumbersome cases. The problem of constructing optimal designs is to allocate weights to specific points of the design space in such a way that information associated with model parameters is maximized and the variances of the mean responses are minimized. Specifically, the D-optimality criterion discussed in this thesis minimizes the determinant of the asymptotic variance-covariance matrix of the estimates of the model parameters. The number of support points of the D-optimal designs for the two- variable binary logistic model without interaction varies from 3 to 6. Support points are equally weighted only in case of the 3-point designs and in some special cases of the 4-point designs. The number of support points of the D-optimal designs for the two-variable binary logistic model with interaction varies from 4 to 8. Support points are equally weighted only in case of the 4-point designs and in some special cases of 8-point designs. Numerous examples are given to illustrate theoretical results