31 research outputs found
Maternal predictors of neonatal outcomes after emergency cesarean section: a retrospective study in three rural district hospitals in Rwanda
Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda
Local use of geographic information systems to improve data utilisation and health services: mapping caesarean section coverage in rural Rwanda
Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda
BACKGROUND: In 2010, Rwanda adopted ART for prevention of mother to child transmission of HIV from pregnant
women living with HIV during pregnancy and breasfeeding period. This study examines rates of mother-to-childtransmission
of HIV at 6–10 weeks postpartum and risk factors for mother-to-child transmission of HIV (MTCT)
among HIV infected women on ART during pregnancy and breastfeeding.
METHODS: A cross-sectional survey study was conducted between July 2011–June 2012 among HIV-exposed infants
aged 6–10 weeks and their mothers/caregivers. Stratified multi-stage, probability proportional to size and systematic
sampling to select a national representative sample of clients. Consenting mothers/caregivers were interviewed on
demographic and program interventions. Dry blood spots from HIV-exposed infants were collected for HIV testing
using DNA PCR technique. Results are weighted for sample realization. Univariable analysis of socio-demographic
and programmatic determinants of early mother-to-child transmission of HIV was conducted. Variables were
retained for final multivariable models if they were either at least of marginal significance (p-value < 0.10) or played
a confounding role (the variable had a noticeable impact > 10% change on the effect estimate).
RESULTS: The study sample was 1639 infants with HIV test results. Twenty-six infants were diagnosed HIV-positive
translating to a weighted MTCT estimate of 1.58% (95% CI 1.05–2.37%). Coverage of most elimination of MTCT
(EMTCT) program interventions, was above 80, and 90.4% of mother-infant pairs received antiretroviral treatment or
prophylaxis. Maternal ART and infant antiretroviral prophylaxis (OR 0.01; 95%CI 0.001–0.17) and maternal age older
than 25 years were significantly protective (OR 0.33; 95%CI 0.14–0.78). No disclosure of HIV status, not testing for
syphilis during pregnancy and preterm birth were significant risk factors for MTCT. Factors suggesting higher sociodemographic
status (flush toilet, mother self-employed) were borderline risk factors for MTCT.
CONCLUSION: ART for all women during pregnancy and breastfeeding was associated with the estimated low MTCT
rate of 1.58%. Mothers who did not receive a full package of anti-retroviral therapy according to the Rwanda EMTCT
protocol, and young and single mothers were at higher risk of MTCT and should be targeted for support in
preventing HIV infection
A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda
Measuring and modelling concurrency
This article explores three critical topics discussed in the recent debate over concurrency (overlapping sexual partnerships): measurement of the prevalence of concurrency, mathematical modelling of concurrency and HIV epidemic dynamics, and measuring the correlation between HIV and concurrency. The focus of the article is the concurrency hypothesis – the proposition that presumed high prevalence of concurrency explains sub-Saharan Africa's exceptionally high HIV prevalence. Recent surveys using improved questionnaire design show reported concurrency ranging from 0.8% to 7.6% in the region. Even after adjusting for plausible levels of reporting errors, appropriately parameterized sexual network models of HIV epidemics do not generate sustainable epidemic trajectories (avoid epidemic extinction) at levels of concurrency found in recent surveys in sub-Saharan Africa. Efforts to support the concurrency hypothesis with a statistical correlation between HIV incidence and concurrency prevalence are not yet successful. Two decades of efforts to find evidence in support of the concurrency hypothesis have failed to build a convincing case