Editorial

No Abstrac

Editorial message

No Abstract

Towards Inclusive Education in Rwanda An assessment of the socio-political contributors to Inclusive Education developments

The impetus of the Rwandan government in developing free and accessible 9 years of basic education for all children since 2007 has notably been remarkable. The commonwealth education award-winning policy seems to have drawn along the enthusiasm of the entire Rwandan community, in making schooling more accessible to even the most disadvantaged. The present paper is concerned that despite the innovative and pro-vulnerable policy initiatives, the support to learners with disabilities and other Special Educational Needs (SEN) remains comparatively low, leading to a persistently diminished proportion of learners with SEN accessing basic education. However, in few communities, agency-led inclusive education projects have seen notable school transformations towards improved accommodation of learners with diverse SEN even where resources and awareness is modest. Yet, in even many more communities, agency-led projects have perpetuated the tradition of leaving the children unschooled and/or dependent on charity and local perceptions on disability, often resulting in exclusion from skills development and social participation. The paper reflects on ways of achieving sustained education for all children with (SEN) vis-à-vis the prevailing socio-political dynamics. It explores the local community resources, as the source of local synergies and home-grown initiatives that could benefit both ordinary and disadvantaged learners in their neighborhood schools.Key Words: Inclusive Education, Local community inputs, development agencies, socio-political dynamic

Plights of learners with Visual Impairments in Rwandan science classes: Evidencing teachers’ practice in HVP Gatagara

The Nine Year Basic Education (9YBE) program in Rwanda is seemingly a national initiative that brings free primary and secondary education services closer to local communities, and renders secondary education and ultimately professional training more accessible to all, including the many disadvantaged children. Having noted with concern that Visually Impaired Students (VIS), like other learners with Special Educational Needs (SEN), are increasingly enabled to access this standard of education, the present study has been prompted to investigate their plights, evidenced by the persistent poor academic performance of this category of students. The gap is most particularly evident in science and mathematics subjects, and becomes more conspicuous as the students progress through higher levels of their schooling. The article is thus an outcome of a study conducted in HVP Gatagara – Rwamagana, the only 9YBE school for the VIS in Rwanda, and the finding underlines the fact that the planning of alternative solutions ought not to focus on the VIS as the source of the problem, rather on their school and whole education system’s incapacity to offer appropriate adaptations and enabling provisions.Key words: Visual Impairments, special educational needs, appropriate school adaptations, alternative provisions

The Teaching Strategies used by Teachers for Learners with Autism-Blindness in Three Counties in Kenya

The learning needs of learners with multiple disabilities in Kenya are not adequately addressed because the teaching strategies used by the teachers are not customized to the individual needs of the learners. Many of the Kenyan special schools and units combine learners with multiple disabilities into one group irrespective of the fact that different multiple disabilities will require different instructional methods, specialized personnel, different teaching resources, different support services and different curriculum adaptations among others. Teachers are specifically trained to teach learners with specific disabilities such as visual, hearing, mental and physical impairments. Consequently, when they are posted to schools where learners have more than one or more disabilities, they are unable to differentiate instructions. The purpose of the present study was to investigate the teaching strategies used by teachers for learners with autism blindness in the counties of Kisumu, Kiambu and Nairobi in Kenya. The study adopted the triangulation mixed methods. The target population was made up of 10 teachers teaching learners with autism blindness, and the sample was selected purposively. One of the major findings was that teachers were inadequately trained to teach learners with autism blindness. The teaching resources and support services were found to be inadequate and the curriculum used was not catering for their needs.Key words: Multiple disabilities, autism blindness, teaching strategie

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

Controlled DCD Liver Transplantation Is Not Associated With Increased Hyperfibrinolysis and Blood Loss After Graft Reperfusion

BACKGROUND: The specific effect of donation after circulatory death (DCD) liver grafts on fibrinolysis, blood loss, and transfusion requirements after graft reperfusion is not well known. The aim of this study was to determine whether transplantation of controlled DCD livers is associated with an elevated risk of hyper-fibrinolysis, increased blood loss and higher transfusion requirements upon graft reperfusion, compared to livers donated after brain death (DBD). METHODS: A retrospective single-center analysis of all adult recipients of a primary liver transplantation between 2000 and 2019 was performed (total cohort n= 628). Propensity score matching (PSM) was used to balance baseline characteristics for DCD and DBD liver recipients (PSM cohort n= 218). Intra- and postoperative hemostatic variables between DCD and DBD liver recipients were subsequently compared. Additionally, in vitro plasma analyses were performed to compare the intraoperative fibrinolytic state upon reperfusion. RESULTS: No significant differences in median (interquartile range) postreperfusion blood loss (1.2 L [0.5-2.2] vs 1.3 L (0.6-2.2); P= 0.62), RBC transfusion (2 units [0-4) vs 1.1 units [0-3], P= 0.21), or FFP transfusion requirements (0 units [0-2.2] vs 0 units (0-0.9); P= 0.11) were seen in DCD compared to DBD recipients, respectively. Furthermore, plasma fibrinolytic potential was similar in both groups. CONCLUSIONS: Transplantation of controlled DCD liver grafts does not result in higher intraoperative blood loss or more transfusion requirements, compared to DBD liver transplantation. In accordance to this, no evidence for increased hyper-fibrinolysis upon reperfusion in DCD compared to DBD liver grafts, was found

Periodontal disease status among adults from South Africa - prevalence and effect of smoking

CITATION: Chikte, U., et al. 2019. Periodontal disease status among adults from South Africa - prevalence and effect of smoking. International Journal of Environmental Research and Public Health, 16(19):3662, doi:10.3390/ijerph16193662.The original publication is available at http://www.mdpi.comPublication of this article was funded by the Stellenbosch University Open Access FundPeriodontal diseases are among the six most prevalent non-communicable diseases (NCDs) worldwide, constituting a burden for oral and general health. There is a shortage of epidemiological data on periodontal diseases in Africa. The aim of the present cross-sectional study was to present the periodontal status and cotinine levels of a South African population of adults. This study included individuals living in the Belville South area. Bleeding on probing (BOP) and pocket depth were recorded for each tooth, and clinical attachment loss (CAL) was recorded as the highest score per sextant. Cotinine levels were measured in ng/mL. A total of 951 individuals were included. More than one third of all subjects had BOP. Regarding pocket depth, over 50% of the subjects had shallow pockets (4–5 mm), and almost 6% had deep pockets. CAL ≥ 4 mm was present in 40.1% of the subjects. Males presented worse periodontal conditions than females. In total, 52.7% of the participants had serum cotinine levels of ≥15 ng/mL. Cotinine levels had no effect on periodontal variables. Periodontal diseases were highly prevalent, and periodontal conditions were worse in males. Preventive and restorative public health programs are required to improve oral health in this populationhttps://www.mdpi.com/1660-4601/16/19/3662Publisher's versio

Dual Versus Single Oxygenated Hypothermic Machine Perfusion of Porcine Livers:Impact on Hepatobiliary and Endothelial Cell Injury

Background: Hypothermic oxygenated machine perfusion (HOPE) reduces ischemia-reperfusion injury of donor livers and is increasingly used in clinical transplantation. However, it remains unclear whether perfusion via the portal vein alone (HOPE) or via both the portal vein and hepatic artery (dual HOPE or DHOPE) is superior. Methods: Twelve porcine livers donated after circulatory death were randomized for 2 h of HOPE (n = 6) or DHOPE (n = 6), followed by 4 h of warm reperfusion with whole blood, to mimic transplantation. Hepatobiliary and endothelial cell function and injury markers were determined in perfusate and bile samples. Biopsies of bile ducts, hepatic arteries, and liver parenchyma were collected to assess histological damage and the expression of endothelial protective genes (KLF-2, eNOS, ET-1, CD31, VWF, VEGF-A). Results: There were no differences in hepatobiliary function and injury after warm reperfusion between the groups, apart from a 2-fold lower concentration of alanine aminotransferase in the perfusate (P = 0.045) and a lower peak lactate dehydrogenase in bile (P = 0.04) of livers preserved by DHOPE. Endothelial cell function and injury, as assessed by perfusate nitric oxide and von Willebrand factor antigen levels, as well as endothelial protective gene expressions, were similar between the groups. The hepatic arteries of both groups showed no microscopic evidence of injury. Conclusions: This study did not reveal major differences in hepatobiliary or endothelial function and injury after preservation by single or dual HOPE of porcine livers donated after circulatory death

Assessment of aflatoxin and fumonisin contamination levels in maize and mycotoxins awareness and risk factors in Rwanda

Mycotoxins are secondary metabolites of fungi that are toxic to humans and animals when consumed in contaminated food and feed. The Rwandan climate conditions like steady temperature and sufficient rainfall favor the growth of fungi leading to high probability of mycotoxins contamination. Mycotoxins get into maize throughout the value chain from the field to processed products. Maize is  promoted in Rwanda under the Crop Intensification Program (CIP), for nutrition and food security. The aim of the study was to evaluate mycotoxins (Aflatoxin and fumonisin) levels in maize and assess awareness and factors associated with mycotoxin contamination in Rwanda. Maize samples (227 kg) from season B 2019 were collected in 15 Districts in five provinces of Rwanda after an interview with a representative of the household or cooperative using a structured questionnaire. The samples were analyzed for aflatoxin and  fumonisin using Reveal Q+ and AccuScan Gold Reader. From the interview, most of the respondents were not aware about aflatoxin (59.7 %) and 99 % did not know the effect of mycotoxins on human health. The average of aflatoxin contamination in surveyed districts was 6.69±13 μg/kg. In general, 90.4 % of samples scored below the limit of aflatoxin level regulated in East Africa/Kenya regulation standards (10 μg/kg). The levels of aflatoxin ranged between 0 and 100.9 μg/kg. The means aflatoxin levels within districts ranged between 1.36±0.5 μg/kg and 13.75±25 μg/kg. Among 9.6 % of the samples containing aflatoxins above the EU and Kenyan regulations standard limit, 5.7 % were above the US standards of 20 μg/kg. Within clusters, the level of aflatoxin more than 10 μg/kg was 5 %, 7 % and 18 % for stores, household and market samples, respectively. From the study, as mechanical damage of grains, moisture content of grains and the temperature of the store house increased, Aflatoxin level also increased. Fumonisin analyzed in maize ranged from 0 to 2.3 μg/g and only one sample from market showed a slightly higher level of fumonisin than the EU and US limit of 2 μg/g. More effort for aflatoxin mitigation is needed at the market level. Farmers need to be aware and taught how they can improve their agricultural system and more knowledge on mycotoxin control is needed. The results point to appropriate measures to recommend for control ofmycotoxins in Rwanda and awareness creation. Key words: AccuScan, Aflatoxin, Fumonisin, Fungal, Maize, Mycotoxins, Reveal Q+, Rwand