Neonatal Jaundice Risk Factors at a District Hospital in Rwanda

Background Neonatal jaundice is one of the most common reasons for hospital admission in the neonatal unit, and it is associated with significant morbidity and mortality. Objective To assess risk factors associated with neonatal jaundice among newborns at a District Hospital in Rwanda.  Methods A quantitative approach has been used with a retrospective cross-sectional design. Two hundred and ten files were used as sample size. Stratified proportional sampling was used for the years 2016-2018 to select files. Data was collected using a structured questionnaire. Descriptive statistics and inferential statistics were used for the data analysis.   Results The study findings showed that nearly half (44.3%) of 210 newborns were diagnosed with neonatal jaundice. The majority (87.2%) was term, and male gender (60.5%). Nearly a third (29.5%) were Low Birth Weight. Significant risk factors for neonatal jaundice were birth weight (p=0.015), gestational age of the newborn (p=0.002), neonatal gender (p=0.004), method of delivery (p=.000), blood group incompatibility (p=0.001); infections (p =0.000), cesarean section (p= 0.000) and prematurity (p=0.017).  Conclusion There was a high prevalence of neonatal jaundice. Neonatal jaundice risk factors were predominantly demographic, maternal and neonatal. Hence there is need to formulate tailored interventions that mitigate neonatal jaundice. Rwanda J Med Health Sci 2020;3(2):204-213

Climate Change Associated with Neonatal Health Risks: Rwandan Nurses and Midwives’ Awareness and Perceptions

Background Climate change (CC) is a global public health problem. In Rwanda, it is estimated that 28% of neonatal death is attributable to CC, yet little is known about healthcare providers’ awareness of neonatal health risks. ObjectiveTo assess nurses’ and midwives’ awareness of CC and perceptions of potential neonatal health risks associated with CC at selected hospitals in Rwanda. Methods A cross-sectional survey was performed at four selected hospitals. A random sampling technique was used to select 184 of 340 nurses and midwives working in neonatology, pediatrics, and maternity departments. Descriptive and inferential statistical tests were done. ResultsThe majority of participants were females (62.1%), nurses (60.5%), advanced diploma holders (55.4%). The majority (60.4%) had low level awareness of CC, and only 2.8% obtained CC information at nursing school. The majority (61.02%) had low perception of potential CC’ related potential neonatal health risks. High education level, working in neonatology and longer working experience were found to be associated with high level awareness of CC and high perceptions of potential neonatal health risks associated with CC (p<0.05). Conclusion There was a low level awareness of CC awareness and low perceptions of potential neonatal health risks among nurses and midwives. Offering in-service training and integrating CC’ health risks in the nursing curricula could motivate climate action among Rwandan nurses and midwives.  Rwanda J Med Health Sci 2020;3(2):261-27

Breast cancer awareness: survey of participants at annual walk in Kigali

Background: Breast cancer is the leading cause of cancer death in low-income countries and the second leading cause in high-income countries. Most women in sub-Saharan Africa are diagnosed later, with limited access to timely and effective treatment.Objectives: The main objective was to identify the awareness of breast cancer warning signs among participants attending the 2016 Breast Cancer Awareness Walk.Methods: A cross-sectional study of 93 participants was conducted after the Annual Breast Cancer Awareness Walk in Kigali on 23 October 2016. Participants, 15 years or older, completed the survey. Data were analyzed using descriptive statistics and Chi-square test.Results: The breast cancer warning sign “breast lump” was identified by over half of the women (54%) and many men (41%), though the majority (70%) did not know that the lump could be painless. The majority of participants were unaware of the many other breast cancer signs, and that the risk increases with age. Threepotential barriers to delay seeking healthcare for a serious breast problem included lack of insurance or money to pay, difficulty to make appointment with doctor, and fear of removal of breast.Conclusion: Increased public awareness and early detection is imperative to help reduce the morbidity and mortality related to breast cancer in Rwandan women and men.Keywords: Breast cancer awareness, warning signs, age-related risk, breast checking, delays to care, sub-Saharan Africa, women’s healt

Retention of Helping Babies Breathe Training among Midwives and Nurses at Four Rwandan Health Centers

Background Worldwide, neonatal mortality remains a significant burden. One substantial cause of mortality is asphyxia, where neonates fail to breathe on their own at birth and need some form of assistance to initiate or maintain breathing. The Helping Babies Breathe (HBB) training program has proven to be helpful in the reduction of asphyxia-related neonatal mortality in developing countries. Objective To assess the HBB knowledge and skills retention at two-days and six-weeks post HBB training among midwives and nurses working in selected health centers in Kigali, Rwanda. Methods A quasi-experimental design with a pre-test, post-test, and intervention using HBB (2nd Edition) program was used. Sixty midwives and nurses were purposively selected from the four study sites. Knowledge and skills retention of HBB was evaluated at two-days and six-weeks post-training.  Results The majority of participants were nurses (90%), females (70%), and had advanced diploma (63%). Knowledge overall mean scores improved from pre-test (8.75) to post-test (16.90). Skills mean scores slightly dropped from 21.77 at day two to 19.73).  Conclusion Our results indicated that there was retention of knowledge and skills among the midwives and nurses at day two and six-weeks post HBB training. Refresher training programs are needed to keep providers skilled for resuscitation in order to lower neonatal mortality in Rwanda. Rwanda J Med Health Sci 2020;3(2):250-26

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Sexuality and Sexual and Reproductive Health Depiction in Social Media: Content Analysis of Kinyarwanda YouTube Channels

BackgroundSocial media platforms such as YouTube can be used to educate people of reproductive age about healthy and nonrisky sexual and reproductive health (SRH) practices and behaviors. However, there is a paucity of evidence to ascertain the authenticity of sexuality and SRH content on Kinyarwanda YouTube, making it difficult to determine the extent to which these topics are covered, the characteristics of available videos, and the themes covered by these videos. ObjectiveThe aims of this study were (1) to determine the extent to which YouTube channels in Kinyarwanda-language videos address sexuality and SRH issues, identify the general characteristics of the available videos (type of video, when published, intention for the audience, and content focus), and the aspects of sexuality and SRH covered; and (2) to identify the themes covered by retrieved Kinyarwanda videos, and the extent to which the channels have been used to communicate issues of sexuality and SRH during the COVID-19 pandemic. MethodsUsing a content analysis approach, we searched Kinyarwanda YouTube channels to analyze videos about sexuality and SRH. The adopted framework for data collection from social media platforms builds on three key steps: (1) development, (2) application, and (3) assessment of search filters. To be included, an audio and/or visual video had to be in Kinyarwanda and the video had to be directed to the general public. Descriptive statistics (frequency and percentages) were computed to characterize the basic characteristics of retrieved channels, portrayal of the videos, and presentation of sexuality and SRH themes that emerged from retrieved videos. Further analysis involved cross-tabulations to explore associations between the focus of the channel and the date when the channel was opened and the focus of the channel and who was involved in the video. ResultsThe YouTube search retrieved 21,506 videos that tackled sexuality and SRH topics. During the COVID-19 pandemic, there was a 4-fold increase (from 7.2% to 30.6%) in channels that solely focused on sexually explicit content. The majority of the 1369 retrieved channels (n=1150, 84.0%) tackled the topic of sexuality, with sexually explicit content predominantly found in the majority of these videos (n=1082, 79%), and only 16% (n=287) of the videos covered SRH topics. ConclusionsThis is the first study to analyze the use of YouTube in communicating about sexuality and SRH in the Kinyarwanda language. This study relied on videos that appeared online. Further research should gather information about who accesses the videos, and how channel owners and individuals involved in the videos perceive the impact of their videos on the Rwandan community’s sexuality and SRH

Factors affecting the prevention of unwanted pregnancies among young adolescents in secondary schools in the Eastern Province of Rwanda: An explorative qualitative study.

IntroductionThe escalating number of teenage pregnancies, especially in the Eastern province of Rwanda, continues to raise concerns regarding the sexual and reproductive health of adolescents in the country. Recent statistics indicate that 5% of adolescent girls between the ages of 15 and 19 have given birth and 4% are currently pregnant with their first child. This highlights the critical need for comprehensive sexual and reproductive health education tailored for adolescents. However, there is limited evidence on factors affecting adolescents' efforts to prevent unwanted pregnancies and sexually transmitted infections in the Eastern Province of Rwanda, and the support systems available to adolescents in secondary schools, including the role of parents in promoting their sexual and reproductive health to minimize the risky sexual practices.MethodsAn explorative qualitative study utilizing focus group discussions was conducted to garner the perspectives of 118 adolescents enrolled in six twelve-year-basic-education schools from three districts of the Eastern Province of Rwanda. Thematic analysis was employed to identify themes related to the impact of various factors on adolescents' sexual and reproductive health as they navigate through the physical and emotional changes from puberty to adolescence.ResultsAdolescents are aware of the potential consequences of engaging in unprotected sexual intercourse which include the risk of unplanned pregnancy, sexually transmitted infections, HIV/AIDS, and emotional distress. Female participants emphasized that young girls who do not receive adequate support upon becoming pregnant prematurely may encounter depression, discontinue their education, face the harsh reality of extreme poverty, and struggle significantly in assuming the responsibilities of parenthood as young single mothers. Adolescents highlighted the lack of parental guidance concerning sexual and reproductive matters as a significant obstacle in their pursuit of a healthy and safe sexual and reproductive health during adolescence.ConclusionInadequate parental engagement still hinders adolescents in navigating the physical bodily, mental, and emotional changes during adolescence. This affects their capacity to make well-informed decisions to prevent adverse consequences such as unintended pregnancies, substance misuse, sexually transmitted infections, and HIV/AIDS resulting from unsafe sexual practices. Since this study was qualitative, quantitative data necessary for a precise evaluation of the extent of the problem related to the absence of parental involvement in educating adolescents on sexual and reproductive health needs further research

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe