Paediatric cancers at Butare University Teaching Hospital in Rwanda

Background: Cancer is an important cause of mortality in many of the economically developed nations of the world. More than 10% of all deaths in children below 15 years of age are caused by malignant diseases in developed countries. In the developing world, childhood cancers are yet to be recognized as a major pediatric illness due to several other competing causes of death like diarrheal illness and respiratory illness.Methods: A descriptive retrospective study of children admitted for cancer in Butare Teaching Hospital over a 7 years period (January 1999-December 2005) was carried out The study population included 36 children aged 0-15 years admitted with cancer at Butare university teaching Hospital. Data was analyzed using Epi data, SPSS11,5 computer programs.Results: The average age of our patients was 5.9 years with the youngest patient being 5 month old. The peak incidence of cancer was found in the 0-5 years age group and accounted for 21 patients (58, 3%). The Male to Female sex ratio was 1.7: 1. The most common types of cancer were: Burkett’s lymphoma, Non-Hodgkin Lymphoma and Hodgkin’s Lymphoma. Treatment included surgery for 17 patients(47.2%), chemotherapy for 4 patients (11.1%), surgery combined with post-operative chemotherapy for 1 patient (2.7%), the association of pre-operative chemotherapy + surgery + post-operative chemotherapy for 1 patient (2.7%) and palliative care for 13 patients (36.1%). The average length of hospital stay was 36.6 days ranging from 2 to 510 days. The hospital mortality rate was 27.7%.Recommendation: The creation of an oncology department and a National cancer Register are recommended

Perceived barriers to management of chronic kidney disease

INTRODUCTION: The number of patients with chronic kidney disease (CKD) is gradually increasing in developing countries such as Rwanda. Barriers to the management of CKD from nurses' perspectives is not an area that has been well explored. This study aimed to assess the perceived barriers to CKD management from the perspective of nurses working at the referral hospitals in Rwanda.METHODS: The study used a cross-sectional research design. The study setting was selected referral hospitals in Kigali. A convenience sample of 55 nurses was obtained and data was collected using a self-administered questionnaire. Analyses were done using descriptive and inferential statistics in the SPSS application.RESULTS: Respondents identified the most barriers to management of CKD as: limited knowledge of CKD (96%) and its risk factor of glomerulonephritis (93%), limited information of dialysis (98%) and fluid restriction (95%) treatment as well as a lack of further training on nephrology nursing (93%). Shortage of nephrologists and nurses (98%) and a multidisciplinary care team (95%) were resource barriers. Other barriers were limited knowledge of CKD risk factors: hypertension (78%) and HIV/AIDS (80%), limited in-service training (69%), and non-adherence (86%). The experience of respondents was associated with limited knowledge of CKD risk factors: hypertension (P =0.001), diabetes (P=0.001) and HIV/AIDS (P=0.040). The level of nursing obtained by the respondents was associated with a lack of further special training (p=0. 001), limited in-service training (P=0.028) and non-adherence of CKD patients (P=0.017).CONCLUSION: Barriers to CKD management in Rwanda are evident. There is a need for in-service training for nurses in order to improve the proper treatment of the CKD population.&nbsp

Bubble CPAP to support preterm infants in rural Rwanda: a retrospective cohort study

Background: Complications from premature birth contribute to 35 % of neonatal deaths globally; therefore, efforts to improve clinical outcomes of preterm (PT) infants are imperative. Bubble continuous positive airway pressure (bCPAP) is a low-cost, effective way to improve the respiratory status of preterm and very low birth weight (VLBW) infants. However, bCPAP remains largely inaccessible in resource-limited settings, and information on the scale-up of this technology in rural health facilities is limited. This paper describes health providers’ adherence to bCPAP protocols for PT/VLBW infants and clinical outcomes in rural Rwanda. Methods: This retrospective chart review included all newborns admitted to neonatal units in three rural hospitals in Rwanda between February 1st and October 31st, 2013. Analysis was restricted to PT/VLBW infants. bCPAP eligibility, identification of bCPAP eligibility and complications were assessed. Final outcome was assessed overall and by bCPAP initiation status. Results: There were 136 PT/VLBW infants. For the 135 whose bCPAP eligibility could be determined, 83 (61.5 %) were bCPAP-eligible. Of bCPAP-eligible infants, 49 (59.0 %) were correctly identified by health providers and 43 (51.8 %) were correctly initiated on bCPAP. For the 52 infants who were not bCPAP-eligible, 45 (86.5 %) were correctly identified as not bCPAP-eligible, and 46 (88.5 %) did not receive bCPAP. Overall, 90 (66.2 %) infants survived to discharge, 35 (25.7 %) died, 3 (2.2 %) were referred for tertiary care and 8 (5.9 %) had unknown outcomes. Among the bCPAP eligible infants, the survival rates were 41.8 % (18 of 43) for those in whom the procedure was initiated and 56.5 % (13 of 23) for those in whom it was not initiated. No complications of bCPAP were reported. Conclusion: While the use of bCPAP in this rural setting appears feasible, correct identification of eligible newborns was a challenge. Mentorship and refresher trainings may improve guideline adherence, particularly given high rates of staff turnover. Future research should explore implementation challenges and assess the impact of bCPAP on long-term outcomes

Aspects Epidemiologiques Et Anatomopathologiques Des Cancers Dans Les Centres Hospitaliers Universitaires (Chu) Du Rwanda

This is a retrospective study realized with the aim of measuring the frequency of cancers of any origin in the Teaching hospitals of Rwanda during the period from 2000 to 2004. Two thousand five hundreds and seventeen (2517) patients were included in our study and 942 cancers cases were histologically confirmed in the department of anatomy pathology. Tumors represent 38.5% of examined tissues in the laboratory of anatomy pathology, among which 20.85% are malignant tumors. Only 30.1% of cancer suspicions in the teaching hospitals are histologically verified. Among diagnosed cancers, 54.4% arise in female subjects. The average age is of 44.8 years. The main cancers of men are stomach (16.4%), Kaposi sarcoma (11.5%), liver (10.1%) and non-Hodgkin lymphomas (9.1%). In women, cervix (27.3%), breast (10.5%) and stomach (8.8%) are most frequent cancers. Children under 15 years old presented 7.7% of the total cases of malignancy; the most frequent childhood cancers are non-Hodgkin lymphomas (33.15%) and nephroblastoma (9.84%). The frequency of the malignant tumors observed in the anatomy pathology laboratory does not represent the reality of malignancy in Rwanda and the implementation of a cancer registry in Rwanda appears as needed tool for the epidemiological control of this affection.Il s’agit d’une étude rétrospective réalisée dans le but de mesurer la fréquence des cancers de toute origine dans les Centres Hospitaliers Universitaires (CHU) du Rwanda durant la période de 2000 à 2004. Deux milles cinq cents dix sept (2517) patients ont été retenus pour notre étude et 942 cas de cancers ont été histologiquement confirmés dans le service d’anatomopathologie. Les tumeurs représentent 38,5% des tissus examinés dans le laboratoire d’anatomopathologie, dont 20,85% sont des tumeurs malignes. Seuls 30,1% des suspicions de cancers dans les CHU ont été confirmées par l’histologie. Parmi les cancers diagnostiqués, 54,4% surviennent chez des sujets de sexe féminin. L’âge moyen est de 44,8 ans. Chez l’homme les cancers les plus fréquents sont : les cancers de l’estomac (16,4%), le sarcome de Kaposi (11,5%), du foie (10,1%) et les lymphomes malins non Hodgkiniens (9,1%). Chez la femme, les cancers du col utérin constituent la localisation la plus fréquente (27,3%), précédant les cancers du sein (10,5%) et de l’estomac (8,8%). Les enfants de moins de 15 ans ont présenté 7,7% des cancers diagnostiqués et les cancers de l’enfance les plus fréquents sont les lymphomes malins non hodgkiniens (33,15%) et le néphroblastome (9,84%). La fréquence des tumeurs malignes observées au laboratoire d’anatomopathologie n’est certainement pas représentative de toute la réalité cancéreuse et la mise en place d’un registre des cancers au Rwanda est nécessaire pour la surveillance épidémiologique de cette affection

Prune-Belly Syndrome: A Case Report from Rwanda

Background: Prune-Belly syndrome, Eagle-Barret syndrome and triad syndrome, all refer to congenital anomalies involving abdominal musculature, urinary tract and testicles. The syndrome consists of a triad of abdominal muscle aplasia, massive ureteral and bladder dilatation and cryptorchidism. Kidneys are often affected by secondary hydronephrosis or by polycystic dysplasia. The full manifestation of the syndrome occurs almost exclusively in boys. Available reports on the epidemiology and outcome show a high perinatal mortality due to related prematurity and associated pulmonary complications. The management of a prune-belly patient has been controversial. However nowadays, the tendency is to assist primarily prune – belly neonates in respiratory failure, and to limit radical urologic interventions. Case Report: We report hereby a full term prune-belly neonate who succumbed from this condition before being adequately investigated. Our purpose is to call clinicians’ attention to early recognition, investigation and management of the syndrome. Even though infants with a full-blown syndrome have a poor prognosis for long term survival, all patients need careful evaluation and individualized management according to the spectrum of the syndrome. In this paper, the morphogenesis and the developmental biology of the abdominal wall will be also recalled, and literature reviewed

Paediatric Cancers at Butare University Teaching Hospital in Rwanda.

Background: Cancer is an important cause of mortality in many of the economically developed nations of the world. More than 10% of all deaths in children below 15 years of age are caused by malignant diseases in developed countries. In the developing world, childhood cancers are yet to be recognized as a major pediatric illness due to several other competing causes of death like diarrheal illness and respiratory illness. Methods: A descriptive retrospective study of children admitted for cancer in Butare Teaching Hospital over a 7 years period (January 1999-December 2005) was carried out The study population included 36 children aged 0-15 years admitted with cancer at Butare university teaching Hospital. Data was analyzed using Epi data, SPSS11,5 computer programs. Results: The average age of our patients was 5.9 years with the youngest patient being 5 month old. The peak incidence of cancer was found in the 0-5 years age group and accounted for 21 patients (58, 3%). The Male to Female sex ratio was 1.7: 1. The most common types of cancer were: Burkett’s lymphoma, Non-Hodgkin Lymphoma and Hodgkin’s Lymphoma. Treatment included surgery for 17 patients(47.2%), chemotherapy for 4 patients (11.1%), surgery combined with post-operative chemotherapy for 1 patient (2.7%), the association of pre-operative chemotherapy + surgery + post-operative chemotherapy for 1 patient (2.7%) and palliative care for 13 patients (36.1%). The average length of hospital stay was 36.6 days ranging from 2 to 510 days.The hospital mortality rate was 27.7%. Recommendation: The creation of an oncology department and a National cancer Register are recommended

Morphologie des téguments de

L’étude des téguments des mâles de S. intercalatum au M. E. B. montre deux types morphologiques différents :a

Chétotaxie de la cercaire de

La cercaire étudiée est émise par un Anisus rotundatus infesté expérimentalement à partir d’un Ver adulte parasite d’un Bœuf de Vendée. Ce Trématode est identifié à Paramphistomum cervi. Le Mollusque hôte naturel est inconnu. La chétotaxie de la cercaire diffère de celle des autres espèces de Paramphistomum européens et en particulier de celles de P. leydeni et P. daubneyi espèces signalées toutes deux en Vendée. La morphologie de l’adulte exclut son appartenance à P. ichikawai présent aussi en Vendée. Il pourrait donc s’agir d’une espèce mise en synonymie avec P. cervi ou d’une espèce nouvelle