Enhancing the education of paediatric nurses: A positive step towards achieving sustainable development goals

Aim: The aim of this discursive paper was to describe and expound on how paediatric nurses will be able to address the needs of children and adolescents through the lens of selected Sustainable Development Goals (SDGs) in Rwanda. Design: A discursive analysis of SDGs relating to the roles of paediatric nurses in the context of Rwanda. Methods: A discursive method using SDGs as a guiding framework is used in this paper. We drew on our own experiences and supported them with the available literature. Results: A collection of contextually relevant examples of how paediatric nurses will be able to address the needs of children and adolescents through the lens of selected SDGs in Rwanda was discussed. The selected SDGs expounded on were: no poverty, good health and well-being, quality of education, decent work and economic growth, reduced inequalities, and partnerships for the goals. Conclusions: There is no doubt that the paediatric nurses in Rwanda play undeniable key roles in attaining SDGs and their targets. Thus, there is a need to train more paediatric nurses with the support of the interdisciplinary partners. Collaboratively, this is possible in the bid to ensure equitable and accessible care to the current and future generations. Public contribution: This discursive paper is intended to inform the different stakeholders in nursing practice, research, education and policy to support and invest in the advanced education of paediatric nurses for attainment of the SDGs

PEPFAR Public Health Evaluation - Care and Support - Phase 2 Uganda

Phase 2 consisted of a longitudinal cohort study to measure patient-reported outcomes of care and support, a costing survey, and qualitative interviews to understand patient and carer experiences

Blended teaching and learning methods in nursing and midwifery education: A scoping review of the literature

Background: Blended learning (BL) is defined as the combination of both traditional face-to-face learning and synchronous or asynchronous e-learning approaches. The aim of this scoping review was to explore the literature to obtain a broad understanding of the use of BLin nursing and midwifery education in general, in Sub-Saharan Africa (SSA), and in particular Rwanda.Methods: The literature published between 2010 and 2019 were reviewed from six electronic databases using keywords including blended learning, nursing education, midwifery education, higher education, SSA, and Rwanda. Arksey and O'Malley's framework was used in this review.Results: The initial search identified 1,283 records. Eleven articles were selected for this review after the application of predetermined inclusion criteria. Almost all reviewed articles indicated that the integration of BLmethods improved the quality of nursing and midwifery education in general, and in SSAcountries including Rwanda.Conclusions: Initial research in this area highlights that moving from traditional classroom-delivered programs to the BLapproach is feasible and can promote the quality of nursing and midwifery standards of education. This scoping review highlights a paucity of research on BL in nursing and midwifery education, particularly in SSAcountries. Keywords: Blended learning, nursing and midwifery education, SSA, Rwand

Strengthening surgical and anaesthetic services at district level in the African region: issues, challenges and proposed actions

Health care delivery systems are organized at several levels with the district hospital serving as the first referral for comprehensive care in the majority of countries worldwide. The provision of comprehensive surgical services requires several inputs and tools to be in place, among which are an adequately trained surgical, anaesthesia and obstetric healthcare workforce, infrastructure and functioning equipment, and essential medicines and supplies. These, however, are not in place in the majority of commonly received surgical cases, such as trauma, obstetric, abdominal and orthopedic emergencies, thus limiting the capacity of district hospitals to address them. Global and regional public health initiatives have traditionally neglected the necessity of the provision of surgical services despite the fact that these constitute an essential component of comprehensive primary healthcare (PHC)1. In fact, because surgery so frequently cannot be safely postponed, this deficiency prevents the transfer of patients to a secondary or tertiarylevel hospital where further care can be provided.

Local Observations of Climate Change and Adaptation Responses: A Case Study in the Mountain Region of Burundi-Rwanda

Mountain regions and their communities are particularly vulnerable to climate change impacts. However, little is known on the impacts observed and adaptation responses used in Burundi’s mountain region and if these are different to those reported in the contiguous mountain region of Rwanda. This paper aims to fill in these knowledge gaps. Semi-structured interviews were conducted with 300 smallholder farmers, 150 in northern Burundi and 150 in southern Rwanda. Farmers in both countries reported negative impacts on crops, animals, and human health, with small differences between countries driven by the main cultivated crops. More adaptation strategies were used in Burundi than in Rwanda, and more farmers in Burundi were using multiple strategies. In both countries, farmers’ wealth affected farmers’ adaptation responses and their food security. Notably, for all wealth groups (poor, average, rich), food security was lower in Rwanda than in Burundi. We relate our findings to current agricultural intensification policies in both countries and argue for the greater involvement of local farmers in adaptation planning using, for example, science-with-society approaches.We are deeply grateful to our study participants, who graciously shared their time, energy, and stories. We thank our field assistants and facilitators for making this research possible. We also acknowledge the Mountain Research Initiative for funding support

Whole-system analysis reveals high greenhouse gas emissions from citywide sanitation in Kampala, Uganda

Global estimates of emissions of greenhouse gasses do not take into account the complex service chain in rapidly growing cities in low- and middle-income countries. This paper presents an end-to-end analysis to estimate emissions from all stages of the sanitation-service chain, using Kampala in Uganda as an example. We show that emissions associated with long periods of storage of faecal waste in sealed anaerobic tanks (49%), discharge from tanks and pits direct to open drains (4%), illegal dumping of faecal waste (2%), leakage from sewers (6%), wastewater bypassing treatment (7%) and uncollected methane emissions at treatment plants (31%), are contributing to high levels of greenhouse-gas emissions. Sanitation in Kampala produces 189 kt CO2 e per year, which may represent more than half of the total city-level emissions. Significant further empirical and modelling work is required to update estimates of greenhouse-gas emissions from sanitation systems globally

Understanding effects of multiple farm management practices on barley performance

Because of the complexity of farming systems, the combined effects of farm management practices on nitrogen availability, nitrogen uptake by the crop and crop performance are not well understood. To evaluate the effects of the temporal and spatial variability of management practices, we used data from seventeen farms and projections to latent structures analysis (PLS) to examine the contribution of 11 farm characteristics and 18 field management practices on barley performance during the period 2009-2012. Farm types were mixed (crop livestock) and arable and were categorized as old organic, young organic or conventional farms. The barley performance indicators included nitrogen concentrations in biomass (in grain and whole biomass) and dry matter at two growing stages. Fourteen out of 29 farm characteristics and field management practices analysed best explained the variation of the barley performance indicators, at the level of 56%, while model cross-validation revealed a goodness of prediction of 31%. Greater crop diversification on farm, e.g., a high proportion of rotational leys and pasture, which was mostly observed among old organic farms, positively affected grain nitrogen concentration. The highest average grain nitrogen concentration was found in old organic farms (2.3% vs. 1.7 and 1.4% for conventional and young organic farms, respectively). The total nitrogen translocated in grain was highest among conventional farms (80 kg ha(-1) vs. 33 and 39 kg ha(-1) for young and old organic farms, respectively). The use of mineral fertilizers and pesticides increased biomass leading to significant differences in average grain yield which became more than double for conventional farms (477 +/- 24 g m(-2)) compared to organic farms (223 +/- 37 and 196 +/- 32 g m(-2) for young and old organic farms, respectively). In addition to the importance of weed control, management of crop residues and the organic fertilizer application methods in the current and three previous years, were identified as important factors affecting the barley performance indicators that need closer investigation. With the PLS approach, we were able to highlight the management practices most relevant to barley performance in different farm types. The use of mineral fertilizers and pesticides on conventional farms was related to high cereal crop biomass. Organic management practices in old organic farms increased barley N concentration but there is a need for improved management practices to increase biomass production and grain yield. Weed control, inclusion of more leys in rotation and organic fertilizer application techniques are some of the examples of management practices to be improved for higher N concentrations and biomass yields on organic farms

The virological durability of first-line ART among HIV-positive adult patients in resource limited settings without virological monitoring: a retrospective analysis of DART trial data

BACKGROUND: Few low-income countries have virological monitoring widely available. We estimated the virological durability of first-line antiretroviral therapy (ART) after five years of follow-up among adult Ugandan and Zimbabwean patients in the DART study, in which virological assays were conducted retrospectively. METHODS: DART compared clinically driven monitoring with/without routine CD4 measurement. Annual plasma viral load was measured on 1,762 patients. Analytical weights were calculated based on the inverse probability of sampling. Time to virological failure, defined as the first viral load measurement ≥200 copies/mL after 48 weeks of ART, was analysed using Kaplan-Meier plots and Cox regression models. RESULTS: Overall, 65% of DART trial patients were female. Patients initiated first-line ART at a median (interquartile range; IQR) age of 37 (32-42) and with a median CD4 cell count of 86 (32-140). After 240 weeks of ART, patients initiating dual-class nucleoside reverse-transcriptase inhibitor (NRTI) -non-nucleoside reverse-transcriptase (NNRTI) regimens containing nevirapine + zidovudine + lamivudine had a lower incidence of virological failure than patients on triple-NRTI regimens containing tenofovir + zidovudine + lamivudine (21% vs 40%; hazard ratio (HR) =0.48, 95% CI:0.38-0.62; p < 0.0001). In multivariate analyses, female patients (HR = 0.79, 95% CI: 0.65-0.95; p = 0.02), older patients (HR = 0.73 per 10 years, 95% CI: 0.64-0.84; p < 0.0001) and patients with a higher pre-ART CD4 cell count (HR = 0.64 per 100 cells/mm(3), 95% CI: 0.54-0.75; p < 0.0001) had a lower incidence of virological failure after adjusting for adherence to ART. No difference in failure rate between the two randomised monitoring strategies was observed (p= 0.25). CONCLUSIONS: The long-term durability of virological suppression on dual-class NRTI-NNRTI first-line ART without virological monitoring is remarkable and is enabled by high-quality clinical management and a consistent drug supply. To achieve higher rates of virological suppression viral-load-informed differentiated care may be required. TRIAL REGISTRATION: Prospectively registered on 18/10/2000 as ISRCTN13968779

The virological durability of first-line ART among HIV-positive adult patients in resource limited settings without virological monitoring: a retrospective analysis of DART trial data.

BACKGROUND: Few low-income countries have virological monitoring widely available. We estimated the virological durability of first-line antiretroviral therapy (ART) after five years of follow-up among adult Ugandan and Zimbabwean patients in the DART study, in which virological assays were conducted retrospectively. METHODS: DART compared clinically driven monitoring with/without routine CD4 measurement. Annual plasma viral load was measured on 1,762 patients. Analytical weights were calculated based on the inverse probability of sampling. Time to virological failure, defined as the first viral load measurement ≥200 copies/mL after 48 weeks of ART, was analysed using Kaplan-Meier plots and Cox regression models. RESULTS: Overall, 65% of DART trial patients were female. Patients initiated first-line ART at a median (interquartile range; IQR) age of 37 (32-42) and with a median CD4 cell count of 86 (32-140). After 240 weeks of ART, patients initiating dual-class nucleoside reverse-transcriptase inhibitor (NRTI) -non-nucleoside reverse-transcriptase (NNRTI) regimens containing nevirapine + zidovudine + lamivudine had a lower incidence of virological failure than patients on triple-NRTI regimens containing tenofovir + zidovudine + lamivudine (21% vs 40%; hazard ratio (HR) =0.48, 95% CI:0.38-0.62; p < 0.0001). In multivariate analyses, female patients (HR = 0.79, 95% CI: 0.65-0.95; p = 0.02), older patients (HR = 0.73 per 10 years, 95% CI: 0.64-0.84; p < 0.0001) and patients with a higher pre-ART CD4 cell count (HR = 0.64 per 100 cells/mm3, 95% CI: 0.54-0.75; p < 0.0001) had a lower incidence of virological failure after adjusting for adherence to ART. No difference in failure rate between the two randomised monitoring strategies was observed (p= 0.25). CONCLUSIONS: The long-term durability of virological suppression on dual-class NRTI-NNRTI first-line ART without virological monitoring is remarkable and is enabled by high-quality clinical management and a consistent drug supply. To achieve higher rates of virological suppression viral-load-informed differentiated care may be required. TRIAL REGISTRATION: Prospectively registered on 18/10/2000 as ISRCTN13968779

Geo-additive modelling of malaria in Burundi

Abstract Background Malaria is a major public health issue in Burundi in terms of both morbidity and mortality, with around 2.5 million clinical cases and more than 15,000 deaths each year. It is still the single main cause of mortality in pregnant women and children below five years of age. Because of the severe health and economic burden of malaria, there is still a growing need for methods that will help to understand the influencing factors. Several studies/researches have been done on the subject yielding different results as which factors are most responsible for the increase in malaria transmission. This paper considers the modelling of the dependence of malaria cases on spatial determinants and climatic covariates including rainfall, temperature and humidity in Burundi. Methods The analysis carried out in this work exploits real monthly data collected in the area of Burundi over 12 years (1996-2007). Semi-parametric regression models are used. The spatial analysis is based on a geo-additive model using provinces as the geographic units of study. The spatial effect is split into structured (correlated) and unstructured (uncorrelated) components. Inference is fully Bayesian and uses Markov chain Monte Carlo techniques. The effects of the continuous covariates are modelled by cubic p-splines with 20 equidistant knots and second order random walk penalty. For the spatially correlated effect, Markov random field prior is chosen. The spatially uncorrelated effects are assumed to be i.i.d. Gaussian. The effects of climatic covariates and the effects of other spatial determinants are estimated simultaneously in a unified regression framework. Results The results obtained from the proposed model suggest that although malaria incidence in a given month is strongly positively associated with the minimum temperature of the previous months, regional patterns of malaria that are related to factors other than climatic variables have been identified, without being able to explain them. Conclusions In this paper, semiparametric models are used to model the effects of both climatic covariates and spatial effects on malaria distribution in Burundi. The results obtained from the proposed models suggest a strong positive association between malaria incidence in a given month and the minimum temperature of the previous month. From the spatial effects, important spatial patterns of malaria that are related to factors other than climatic variables are identified. Potential explanations (factors) could be related to socio-economic conditions, food shortage, limited access to health care service, precarious housing, promiscuity, poor hygienic conditions, limited access to drinking water, land use (rice paddies for example), displacement of the population (due to armed conflicts).</p