How will we get there? How will we know?

Ending AIDS by 2030 is a monumental challenge. Tracking progress as incidence reaches lower levels could be just as challenging. In The Lancet HIV Sabin Nsanzimana and colleagues report progress and highlight the challenges that lie ahead on both fronts. The Rwanda HIV Incidence Survey enumerated a nationally representative sample of 13 728 HIV-negative adults in 2013, and followed up a remarkable 92% of participants 1 year later. The investigators detected 35 HIV seroconversions at follow-up. Two findings are especially noteworthy

Maternal and Perinatal Outcomes among Maternity Waiting Home Users and Non-Users in Rural Rwanda

Most maternal and perinatal deaths could be prevented through timely access to skilled birth attendants. Women should access appropriate obstetric care during pregnancy, labor, and puerperium. Maternity waiting homes (MWHs) permit access to emergency obstetric care when labor starts. This study compared maternal and perinatal outcomes among MWH users and non-users through a retrospective cohort study. Data were collected through obstetric chart reviews and analyzed using STATA version 15. Of the 8144 deliveries reported between 2015 and 2019, 1305 women had high-risk pregnancies and were included in the study. MWH users had more spontaneous vaginal deliveries compared to non-users (38.6% versus 16.8%) and less cesarean sections (57.7% versus 76.7%). Maternal morbidities such as postpartum hemorrhage occurred less frequently among users than non-users (2.13% versus 5.64%). Four women died among non-users while there was no death among users. Non-users had more stillbirths than users (7.68% versus 0.91%). The MWH may have contributed to the observed differences in outcomes. However, many women with high risk pregnancies did not use the MWH, indicating a probable gap in awareness, usefulness, or their inability to stay due to other responsibilities at home. Use of MWHs at scale could improve maternal and perinatal outcomes in Rwanda

What Kigali’s open‑air markets reveal about achieving food and nutrition security: the role of African indigenous crops

Background: Household dietary diversity in Rwanda remains low and significantly contributes to the double burden of malnutrition. Rwanda has one of the highest under five stunting rates globally, and malnutrition remains one of the most pressing public health issues; therefore, factors that shape food and nutrition security are of utmost concern. Globally, the variety of foods available in open-air markets has been shown to affect dietary diversity. Furthermore, the consumption of indigenous foods can contribute to a diverse diet and improve nutrition status. At present, there are limited data on foods available for purchase in open-air markets in Africa. Therefore, this study was designed to provide data on food availability in the largest open-air markets of Rwanda’s most populated city, Kigali, and to highlight which foods indigenous to Africa can be purchased. Methods: All consumables were inventoried between October and December of 2020 in three open-air markets of Kigali, the capital city of Rwanda. Consumables were organized by the site of domestication and the nutritional contents of some African indigenous crops were compared to similar non-indigenous items. Results: A variety of raw and processed consumables was available in the open-air markets inventoried; however, only 25.8% of available species are indigenous to Africa. All Rwanda’s staples, including sweet potatoes, plantains, beans, maize, banana, and cassava, are endemic to other continents. Indigenous plant species, which are often drought-resistant and more nutritious, for example, Africa’s pineapple fruits (Myrianthus holstii), could not be purchased in Kigali’s open-air markets. Pineapple fruits are richer in iron, vitamin C, protein, and vitamin A than banana, which is the most consumed fruit in Rwanda. Conclusions: Given rapid population growth, limited arable land, and erratic climate patterns, policies to conserve and promote indigenous species, especially those already adapted to harsh environmental conditions, should be enacted in Rwanda. The cultivation of native vegetables and fruits in home gardens, and the conservation of edible wild species, can improve dietary diversity and enhance food and nutrition security across the entire country

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

Trends in the Prevalence and Associated Contributing Factors of Stunting in Children Under Five Years of Age. Secondary Data Analysis of 2005, 2010 and 2014-2015 Rwanda Demographic and Health Surveys

Background Stunting affects more than 161 million children under five years of age worldwide. Rwanda has a high prevalence of stunted children under five years of age (~38%) according to the 2014-2015 Rwanda Demographic and Health Survey. Objectives The aim of this study is to compare the prevalence rates of stunting in Rwanda using the Rwanda Demographic and Health Survey data of 2005, 2010 and 2014-2015. Methods The three Rwanda Demographic and Health Survey cross-sectional studies into consideration were conducted in 2005, 2010 and in 2014-2015. Stunting prevalence rates from those surveys were compared using Pearson's chi-squared tests and Marascuilo procedure using STATA (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.). Results The Pearson's chi-squared tests and Marascuilo procedure used in this research confirmed a significant difference between the reported three RDHS stunting prevalence rates. The trends in the stunting prevalence rates among children under five years of age showed a decrease of 13% in stunting prevalence rate, falling from 51%in 2005 to 38%in 2014-15. Conclusion A statistical analysis based on2005, 2010 and 2014-15 RDHS surveys datasets confirmed that there is a statistically significant reduction in stunting prevalence rates  over that decade(from 51% in 2005 to 38%in 2014-2015). The main persistent associated factors with stunting were the age, sex, size at birth, residence place of the child, and the mother’s educational level and household wealth index. Keywords: Stunting; children under five years; demographic and health survey; nutrition; Rwand

Mosquito bed net use and associated factors among pregnant women in Rwanda: A nationwide survey

Background In malaria-endemic countries such as Rwanda, the appropriate use of mosquito bed nets is an effective intervention for malaria prevention. Despite being one of the demographics most impacted by malaria, there is a dearth of literature on the usage of mosquito bed nets by pregnant women in Rwanda. The study aimed to assess the prevalence and associated factors for mosquito bed net use among pregnant women in Rwanda Methods We used weighted data from the 2020 Rwanda Demographic and Health Survey of 870 pregnant women, and multistage stratified sampling was used to select participants. Multivariable logistic regression was conducted to determine the factors associated with mosquito bed net use, using SPSS (version 26). Results Of the 870 pregnant women, 57.9% (95%CI: 54.6–61.1) used mosquito bed nets. However, 16.7% did not use bed nets among those owning bed nets. On one hand, older age (AOR = 1.59, 95%CI: 1.04–2.44), primary education (AOR = 1.18, 95%CI: 1.07–2.23), being married (AOR = 2.17, 95%CI: 1.43–3.20), being from Kigali region (AOR = 1.97, 95%CI: 1.19–3.91), partner’s education (AOR = 1.22, 95%CI: 1.13–3.41), having recently visited a health facility (AOR = 2.07, 95%CI: 1.35–3.18), and being in the third pregnancy trimester (AOR = 2.14, 95%CI: 1.44–3.18) were positively associated with mosquito bed net use. On the other hand, low wealth index (AOR = 0.13, 95%CI: 0.07–0.24), and being from Eastern region (AOR = 0.42, 95% CI: 0.26–0.66) had a negative association. Conclusions About half of the pregnant women in Rwanda used mosquito bed nets and the usage was associated with various socio-demographics. There is a need for appropriate risk communication and continuous sensitisation to improve mosquito net use among pregnant women. Early antenatal care attendance and partner engagement in malaria prevention and mosquito net use, as well as consideration of household dynamics, are also crucial in improving not only mosquito net coverage but also utilization

Clin Infect Dis

Background.Malaria during pregnancy can cause serious consequences including maternal anemia and low birthweight (LBW). Routine antenatal care (ANC) in Rwanda includes malaria symptom screening at each ANC visit. This cluster randomized controlled trial investigated whether adding intermittent screening with a malaria rapid diagnostic test at each routine ANC visit and treatment of positives during pregnancy (ISTp) is more effective than routine ANC for reducing malaria prevalence at delivery.Methods.Between September 2016 and June 2018, pregnant women initiating ANC at 14 health centers in Rwanda were enrolled into ISTp or control arms. All women received an insecticide-treated bed net at enrollment. Hemoglobin concentration, placental and peripheral parasitemia, newborn outcome, birthweight, and prematurity were assessed at delivery.Results.Nine hundred seventy-five women were enrolled in ISTp and 811 in the control group. Routine ANC plus ISTp did not significantly reduce polymerase chain reaction\u2013confirmed placental malaria compared to control (adjusted relative risk [aRR], 0.94 [95% confidence interval {CI}, .59\u20131.50]; P = .799). ISTp had no impact on anemia (aRR, 1.08 [95% CI, .57\u20132.04]; P = .821). The mean birthweight of singleton newborns was not significantly different between arms (3054 g vs 3096 g, P = .395); however, women in the ISTp arm had a higher proportion of LBW (aRR, 1.59 [95% CI, 1.02\u20132.49]; P = .042).Conclusions.This is the only study to compare ISTp to symptomatic screening at ANC in a setting where intermittent preventive treatment is not routinely provided. ISTp did not reduce the prevalence of malaria or anemia at delivery and was associated with an increased risk of LBW.R01 AI152078/AI/NIAID NIH HHSUnited States/R21 TR001737/TR/NCATS NIH HHSUnited States/R01 AI150763/AI/NIAID NIH HHSUnited States/CC999999/ImCDC/Intramural CDC HHSUnited States/R01 AI111962/AI/NIAID NIH HHSUnited States

The Network Survival Method for Estimating Adult Mortality: Evidence From a Survey Experiment in Rwanda.

Adult death rates are a critical indicator of population health and well-being. Wealthy countries have high-quality vital registration systems, but poor countries lack this infrastructure and must rely on estimates that are often problematic. In this article, we introduce the network survival method, a new approach for estimating adult death rates. We derive the precise conditions under which it produces consistent and unbiased estimates. Further, we develop an analytical framework for sensitivity analysis. To assess the performance of the network survival method in a realistic setting, we conducted a nationally representative survey experiment in Rwanda (n = 4,669). Network survival estimates were similar to estimates from other methods, even though the network survival estimates were made with substantially smaller samples and are based entirely on data from Rwanda, with no need for model life tables or pooling of data from other countries. Our analytic results demonstrate that the network survival method has attractive properties, and our empirical results show that this method can be used in countries where reliable estimates of adult death rates are sorely needed