Prevalence and risk factors of intestinal parasites among children under two years of age in a rural area of Rutsiro district, Rwanda – a cross-sectional study

Introduction: this study aimed to assess the prevalence and associated risk factors of intestinal parasite infections among children less than two years of age in Rutsiro, Rwanda. Methods: a cross-sectional parasitological survey was conducted in Rutsiro in June 2016. Fresh stool samples were collected from 353 children and examined using microscopy to detect parasite. A questionnaire was administered to collect data on hygiene, sanitation, socio-demographic and economic characteristics. Results: approximately one in two children (44.8%) were found to be infected with at least one intestinal parasite. Ascaris (28.5%) was the most prevalent infection followed by Entamoeba histolytica (25.95%) and Giardia lamblia (19.6%). Infection with more than one pathogen was noted e.g. presence of Ascaris and yeasts (8.9%), and amoeba with Trichocephale (4.4%), respectively. Children from non-farming families were less likely to be at risk of intestinal parasite infections (AOR = 0.41, p = 0.028) compared to children from farming families. Children from households with access to treated drinking water were less likely to contract intestinal parasite infections (AOR = 0.44, p = 0.021) compared with those who used untreated water. Children from families with improved sources of water were twice as likely to be diagnosed with intestinal parasitoses compared to those who did not. We postulate that the majority of families (50.1%) who have access to improved water sources do not treat water before consumption. Conclusion: the high prevalence of intestinal parasitoses in children warrants strict control measures for improved sanitation, while treatment of drinking water should be considered

Rainfall variation and child health: effect of rainfall on diarrhea among under 5 children in Rwanda, 2010

BACKGROUND:Diarrhea among children under 5 years of age has long been a major public health concern. Previous studies have suggested an association between rainfall and diarrhea. Here, we examined the association between Rwandan rainfall patterns and childhood diarrhea and the impact of household sanitation variables on this relationship.METHODS:We derived a series of rain-related variables in Rwanda based on daily rainfall measurements and hydrological models built from daily precipitation measurements collected between 2009 and 2011. Using these data and the 2010 Rwanda Demographic and Health Survey database, we measured the association between total monthly rainfall, monthly rainfall intensity, runoff water and anomalous rainfall and the occurrence of diarrhea in children under 5 years of age.RESULTS:Among the 8601 children under 5 years of age included in the survey, 13.2 % reported having diarrhea within the 2 weeks prior to the survey. We found that higher levels of runoff were protective against diarrhea compared to low levels among children who lived in households with unimproved toilet facilities (OR?=?0.54, 95 % CI: [0.34, 0.87] for moderate runoff and OR?=?0.50, 95 % CI: [0.29, 0.86] for high runoff) but had no impact among children in household with improved toilets.CONCLUSION:Our finding that children in households with unimproved toilets were less likely to report diarrhea during periods of high runoff highlights the vulnerabilities of those living without adequate sanitation to the negative health impacts of environmental events

Rainfall variation and child health: effect of rainfall on diarrhea among under 5 children in Rwanda, 2010

Background: Diarrhea among children under 5 years of age has long been a major public health concern. Previous studies have suggested an association between rainfall and diarrhea. Here, we examined the association between Rwandan rainfall patterns and childhood diarrhea and the impact of household sanitation variables on this relationship. Methods: We derived a series of rain-related variables in Rwanda based on daily rainfall measurements and hydrological models built from daily precipitation measurements collected between 2009 and 2011. Using these data and the 2010 Rwanda Demographic and Health Survey database, we measured the association between total monthly rainfall, monthly rainfall intensity, runoff water and anomalous rainfall and the occurrence of diarrhea in children under 5 years of age. Results: Among the 8601 children under 5 years of age included in the survey, 13.2 % reported having diarrhea within the 2 weeks prior to the survey. We found that higher levels of runoff were protective against diarrhea compared to low levels among children who lived in households with unimproved toilet facilities (OR = 0.54, 95 % CI: [0.34, 0.87] for moderate runoff and OR = 0.50, 95 % CI: [0.29, 0.86] for high runoff) but had no impact among children in household with improved toilets. Conclusion: Our finding that children in households with unimproved toilets were less likely to report diarrhea during periods of high runoff highlights the vulnerabilities of those living without adequate sanitation to the negative health impacts of environmental events

Maternal genitourinary infections and poor nutritional status increase risk of preterm birth in Gasabo District, Rwanda: a prospective, longitudinal, cohort study

Background Preterm birth (PTB) is a leading cause of early childhood mortality and morbidity, including long-term physical and mental impairment. The risk factors for PTB are complex and include maternal nutritional status and infections. This study aimed to identify potentially modifiable risk factors for targeted interventions to reduce the occurrence of PTB in Rwanda. Methods We conducted a prospective, longitudinal cohort study of healthy pregnant women aged 18 to 49 years. Women at 9–15 gestational weeks were recruited from 10 health centers in Gasabo District, Kigali Province between September and October 2017. Pregnancy age was estimated using ultrasonography and date of last menstruation. Anthropometric and laboratory measurements were performed using standard procedures for both mothers and newborns. Surveys were administered to assess demographic and health histories. Categorical and continuous variables were depicted as proportions and means, respectively. Variables with p <  0.25 in bivariate analyses were included in multivariable logistic regression models to determine independent predictors of PTB. The results were reported as odds ratios (ORs) and 95% confidence intervals (CI), with statistical significance set at p <  0.05. Results Among 367 participants who delivered at a mean of 38.0 ± 2.2 gestational weeks, the overall PTB rate was 10.1%. After adjusting for potential confounders, we identified the following independent risk factors for PTB: anemia (hemoglobin < 11 g/dl) (OR: 4.27; 95%CI: 1.85–9.85), urinary tract infection (UTI) (OR:9.82; 95%CI: 3.88–24.83), chlamydia infection (OR: 2.79; 95%CI: 1.17–6.63), inadequate minimum dietary diversity for women (MDD-W) score (OR:3.94; CI: 1.57–9.91) and low mid-upper arm circumference (MUAC) < 23 cm (OR: 3.12, 95%CI; 1.31–7.43). indicators of nutritional inadequacy (low MDD-W and MUAC) predicted risk for low birth weight (LBW) but only UTI was associated with LBW in contrast with PTB. Conclusion Targeted interventions are needed to improve the nutritional status of pregnant women, such as maternal education on dietary diversity and prevention of anemia pre-pregnancy. Additionally, prevention and treatment of maternal infections, especially sexually transmitted infections and UTIs should be reinforced during standard antenatal care screening which currently only includes HIV and syphilis testing

Early feeding practices and stunting in Rwandan children: a cross-sectional study from the 2010 Rwanda demographic and health survey

Introduction: in Rwanda, despite different interventions to improve child nutrition status, malnutrition in children under five years of age continue to be a public health concern. This study aimed to evaluate the factors that contribute to childhood stunting by assessing feeding practices of Rwandans in children ≤ 2 years of age. Methods: A cross-sectional study with data obtained from the 2010 Rwanda Demographic and Health Survey was conducted on 1,634 children ≤ 2 years of age with complete anthropometrical measurements. Multivariable logistic regression analysis was used to assess the association between feeding practices and childhood stunting. Results: The results revealed that 35.1% of 1,634 children were stunted. Breastfeeding for 1 year (OR = 2.77, 95% CI = 1.91-4.01, P &lt; 0.001) increased the risk of childhood stunting. After controlling for confounders, solid food initiation (OR = 1.21, 95% CI = 0.47-3.16, P≥ 0.690) and early initiation to breastfeeding (OR = 1.16, CI = 0.90-1.51, P = 0.243) were not associated with childhood stunting. Conclusion: There was a significant association between continued breastfeeding for 1 year and childhood stunting. We suggest supplementary feeding for children who are breastfed for ≥1 year

Risk factors associated with underweight status in children under five: an analysis of the 2010 Rwanda Demographic Health Survey (RDHS)

BACKGROUND: Under-nutrition contributes to childhood morbidity and mortality, particularly in low-income countries. While Rwanda is one of few countries on track to reduce the prevalence of underweight children under five years old by 50 % from 1990 to 2015 (a target of Millennium Development Goal1), underweight children remain a large public health problem with one out of ten children having low weight-for-age. METHODS: We performed a cross-sectional study using 2010 RDHS data on 4177 children under five years of age with weight and height measurements. Children were classified as underweight if their weight-for-age Z scores (WAZs) were &lt;2 standard deviations (SD) and severely underweight if WAZs were &lt;3 SD from the mean of the reference population. We used multivariable logistic regression model to identify child, maternal, and household characteristics associated with being underweight. RESULTS: Eleven percent (469) of the 4177 children sampled were underweight and 2.2 % (90) were severely underweight. After adjusting for possible confounders, we found that children were more likely to be underweight if they were male (OR = 1.42, 95 % confidence interval (CI):1.12, 1.79); had fever in the two weeks prior to survey administration (OR = 1.45, 95 % CI:1.07, 1.97) or were non-singletons compared to first-born singletons (OR = 4.04, 95 % CI:2.12, 7.71). Mothers were more likely to have underweight children if they were over 35 years of age compared to those age 17–24 years (OR = 1.67, 95 % CI:1.04, 2.70); with BMI &lt;18.5 compared to BMI between 18.5 to 24.9 (OR = 2.62, 95 % CI:1.70, 4.04), who had no education or primary education only (OR = 3.56, 95 % CI:1.83, 6.95; OR = 3.49, 95 % CI:1.87, 6.51, respectively) compared to secondary education or higher, and those who did not have delivery assisted by a skilled provider (OR = 1.33, 95 % CI:1.04, 1.72). Household characteristics associated with underweight children included status in the bottom two wealth quintiles compared to the highest (OR = 1.71, 95 % CI:1.27, 2.30). CONCLUSION: Rwanda was one of the first countries to achieve Millennium Development Goal1. However, even in light of this success, the prevalence of underweight children remains high. Our analysis of specific child, maternal and household risk factors for under-nutrition may help identify potential interventions to address this remaining burden

Applied statistical training to strengthen analysis and health research capacity in Rwanda

Background: To guide efficient investment of limited health resources in sub-Saharan Africa, local researchers need to be involved in, and guide, health system and policy research. While extensive survey and census data are available to health researchers and program officers in resource-limited countries, local involvement and leadership in research is limited due to inadequate experience, lack of dedicated research time and weak interagency connections, among other challenges. Many research-strengthening initiatives host prolonged fellowships out-of-country, yet their approaches have not been evaluated for effectiveness in involvement and development of local leadership in research. Methods: We developed, implemented and evaluated a multi-month, deliverable-driven, survey analysis training based in Rwanda to strengthen skills of five local research leaders, 15 statisticians, and a PhD candidate. Research leaders applied with a specific research question relevant to country challenges and committed to leading an analysis to publication. Statisticians with prerequisite statistical training and experience with a statistical software applied to participate in class-based trainings and complete an assigned analysis. Both statisticians and research leaders were provided ongoing in-country mentoring for analysis and manuscript writing. Results: Participants reported a high level of skill, knowledge and collaborator development from class-based trainings and out-of-class mentorship that were sustained 1 year later. Five of six manuscripts were authored by multi-institution teams and submitted to international peer-reviewed scientific journals, and three-quarters of the participants mentored others in survey data analysis or conducted an additional survey analysis in the year following the training. Conclusions: Our model was effective in utilizing existing survey data and strengthening skills among full-time working professionals without disrupting ongoing work commitments and using few resources. Critical to our success were a transparent, robust application process and time limited training supplemented by ongoing, in-country mentoring toward manuscript deliverables that were led by Rwanda’s health research leaders

Maternal genitourinary infections and poor nutritional status increase risk of preterm birth in Gasabo District, Rwanda: a prospective, longitudinal, cohort study

BackgroundPreterm birth (PTB) is a leading cause of early childhood mortality and morbidity, including long-term physical and mental impairment. The risk factors for PTB are complex and include maternal nutritional status and infections. This study aimed to identify potentially modifiable risk factors for targeted interventions to reduce the occurrence of PTB in Rwanda.MethodsWe conducted a prospective, longitudinal cohort study of healthy pregnant women aged 18 to 49 years. Women at 9-15 gestational weeks were recruited from 10 health centers in Gasabo District, Kigali Province between September and October 2017. Pregnancy age was estimated using ultrasonography and date of last menstruation. Anthropometric and laboratory measurements were performed using standard procedures for both mothers and newborns. Surveys were administered to assess demographic and health histories. Categorical and continuous variables were depicted as proportions and means, respectively. Variables with p &lt; &nbsp;0.25 in bivariate analyses were included in multivariable logistic regression models to determine independent predictors of PTB. The results were reported as odds ratios (ORs) and 95% confidence intervals (CI), with statistical significance set at p &lt; &nbsp;0.05.ResultsAmong 367 participants who delivered at a mean of 38.0 ± 2.2 gestational weeks, the overall PTB rate was 10.1%. After adjusting for potential confounders, we identified the following independent risk factors for PTB: anemia (hemoglobin &lt; 11 g/dl) (OR: 4.27; 95%CI: 1.85-9.85), urinary tract infection (UTI) (OR:9.82; 95%CI: 3.88-24.83), chlamydia infection (OR: 2.79; 95%CI: 1.17-6.63), inadequate minimum dietary diversity for women (MDD-W) score (OR:3.94; CI: 1.57-9.91) and low mid-upper arm circumference (MUAC) &lt; 23 cm (OR: 3.12, 95%CI; 1.31-7.43). indicators of nutritional inadequacy (low MDD-W and MUAC) predicted risk for low birth weight (LBW) but only UTI was associated with LBW in contrast with PTB.ConclusionTargeted interventions are needed to improve the nutritional status of pregnant women, such as maternal education on dietary diversity and prevention of anemia pre-pregnancy. Additionally, prevention and treatment of maternal infections, especially sexually transmitted infections and UTIs should be reinforced during standard antenatal care screening which currently only includes HIV and syphilis testing

Predictors of physical violence against children in Rwanda : findings from a National Cross-Sectional Survey

Background: To address the challenges of limited national data on the prevalence and nature of violence experienced by children, Rwanda conducted, in 2015–2016, the first National Survey on Violence among female and male children and youth aged 13–24 years. To further contribute to these efforts to fill existing data gaps, we used the Rwanda survey data to assess the prevalence and predictors of physical violence (PV) in children aged 13–17. Methods: A nationally representative sample of 618 male and 492 female children were analysed. Nationally representative weighted descriptive statistics were used to analyse the prevalence of PV self-reported by children, and logistic regression models were applied to investigate its predictors. Results: Sixty percent of all children, including 36.53% of male and 23.38% of female children, reported having experienced any form of PV in their lifetime. Additionally, 21.81% of male children and 12.73% of female children reported experiences of PV within twelve months before the survey date. Older children (OR: 0.53 [0.40–0.72]), female children (OR: 0.43 [0.31–0.58]), and children not attending school (OR: 0.48 [0.31–0.73]) were less likely to be physically abused. However, sexually active children (OR: 1.66 [1.05–2.63]), children in households from the middle wealth quintile (OR: 1.63 [1.08–2.47]), children living in a larger family (OR: 1.55 [1.07–2.26]), and children who reported not feel close to both biological parents (OR: 2.14 [1.31–3.49]) had increased odds of reporting physical violence. Conclusion: Higher rates of PV in children attending school were the key finding. There is an urgent need to design and implement particular national interventions to prevent and reduce the incidence of PV in schools in Rwanda. PV was also associated with poor parent-child relations. Parents and other adult caregivers should be sensitised to the consequences of PV on children and be urged to adopt positive parenting practices