Knowledge and Attitude to Female Condom Use among Undergraduates of Kigali Health Institute

Background: Proper use of condom prevents Sexually Transmitted Infections (STIs) and unwanted pregnancies. Efforts have been made in Rwanda to raise the population awareness on the use of the Female Condom but little is known about the current status of its use among college students. Objectives: To assess the knowledge, attitudes and use of the female condom among undergraduates of Kigali Health Institute. Methods: A descriptive study was carried out between May and June 2010. The sample was randomly selected from the students of Kigali Health Institute. A questionnaire based study was conducted involving 429 students. It captured the sample characteristics, their knowledge, attitudes and use of the female condom. The data were entered and analysed in SPSS 16.0. Results: About 79% of the students were aware of the female condom, but only 24% knew how to use it. Most respondents believed that the female condom can prevent the unwanted pregnancies (78%), the STIs and HIV/AIDS (81%). About 8% had ever tried it and less than three percent cited it as their contraception method. Conclusion: Awareness of the female condom was high but few students knew how to use it. Overall, favourable attitudes were recorded though neutral ones were higher and use of female condom was very low.Key words: Knowledge, attitude, use, female condo

Results of a Community Mentoring Programme for Youth Heads of Household in Rwanda: Effects on Youth Sexual Risk Behaviours and Maltreatment

Background: While mentorship programmes, which connect orphans with adults to whom they can turn to for help and advice, are proliferating in an attempt to prevent high-risk behaviours in adolescents, there are few data to show that mentorship actually makes a difference among youth heads of households (YHH). The purpose of this study was to: (a) investigate the impact of mentoring relationship on sexual risk behaviours outcomes among YHH, and (b) examine the impact of the mentoring programme on youth maltreatment including sexual abuse. Methods: The research used a quasi-experimental design to assess the impact of the adult mentoring programme on sexual risk behaviours and maltreatment of youth living without adult care in four districts of the then Gikongoro province. In the design, which includes a baseline and a follow-up survey, the intervention group (Maraba and Nyamagabe districts) with youth heads of households receiving the home visitation programme were compared to a comparisongroup (Mudasomwa and Nyaruguru districts). Analyses explored linkages between exposure to the intervention and various outcomes: HIV/AIDS knowledge, perception of HIV risk infection, sexual risk behaviours, and maltreatment. Logistic regression was used to examine whether the mentoring programme predicted outcomes of maltreatment or sexual behaviours when controlling for demographic characteristics and any other variables significant at the bivariate level. Results: The overall HIV/AIDS knowledge was higher in the intervention group (16.3% versus 12.5%) and more YHH in this group knew a place where to get a condom (64.5% versus 57.8%). In this group, youth were more likely to report use of condom (20.5 versus 12.4%), to perceive a risk of HIV/AIDS infection at the follow-up survey (44.7% versus 32.8%), and less consumption of alcohol (56.3 versus 41.7%). In the logistic regression, respondents who reported more adult support had a significantly high likelihood of being sexually inexperienced (OR = 1.20, score for adult support=3.67 versus 3.53, p=.05). During the last twelve months, being in school, male gender, and less marginalization were highly associated with being abstinent (AOR=4.68, 2.72, and 1.46, respectively). The level of maltreatment has sensibly diminished in the intervention group (from 1.53 to 1.27) during the last two years. There were more youth who reported physical abuse among the comparison group (24% versus 15.9%) and labour exploitation (29.5% versus 19.6%). YHH exposed to the intervention were less likely to suffer from labour exploitation and physical abuse (AOR = .52 and .63, respectively). Conclusions: Results indicate that the utilization of community adult mentors should be supported as a key strategy in working with YHH to decrease sexual risk behaviours and maltreatment from community members. For interventions to be optimally effective, specific strategies to promote community support and decrease marginalization need to be identified.Key words: Youth heads of household, mentoring, sexual risk behaviours, maltreatment, abuse, Rwand

Maltreatment of Youth Heads of Households in Rwanda

BackgroundIn Rwanda, the combined effects of the 1994 genocide and the spread of AIDS have resulted in large numbers of orphans. Many of these are not only orphans but also youth heads of households (YHH). Orphans and YHH are particularly vulnerable to maltreatment because of marginalization from the community. The objectives of this study were to: (a) determine the prevalence of maltreatment among YHH after a two year follow-up by age and gender; (b) assess the association between certain behavioral, contextual, and socio-demographic factors and maltreatment; and (c) determine predictors of maltreatment in that community.MethodsCross-sectional survey of 692 YHH, aged 10-24, in Gikongoro, Rwanda, all beneficiaries of a World Vision basic needs program. In addition, four gender-mixed focus groups with youth with a total of 32 participants and nine gender-mixed focus groups with adults from the community with a total 61 participants were held.ResultsThe findings reveal that the prevalence of maltreatment is very high, with 71.5% of YHH self-reporting at least one type of abuse and 88% reporting having land or possessions taken or damaged. Focus group discussions identified four primary factors representing a source for violence and exploitation of YHH and results from the regression analysis showed that factors indicating community connectedness and children’s externalizing behaviors were the most salient predictors of positive treatment or maltreatment of YHH. Additionally, because of the support they had received from World Vision Program, the YHH are perceived as “better-off” or “rich” by some members of the community and this jealousy contributes in the mistreatment of orphans. Survey results are consistent with this assertion as almost 78 % of YHH reported that people were jealous of the services they were receiving.ConclusionThese findings provide new information on the issues surrounding the maltreatment of orphans in a poor, rural setting in Rwanda. Although the results should be regarded as primarily exploratory suggestive for further studies, they call for urgent need to address such a serious problem. The findings also suggest the importance of considering any new programs for orphans and YHH in the context of the wider community so as not to inadvertently add to their problems by creating resentment in the surrounding community

Opportunistic Infections and Associated Factors among HIV-Infected Adult Persons on Antiretroviral Therapy at Ruhengeri Referral Hospital, Rwanda: A cross-sectional study

Background Human Immunodeficiency Virus (HIV) is among the highest health crises that humanity ever confronted and it causes progressive weakening of the immune system leading to opportunistic infections (OIs) or malignancies during the natural course of the disease. This study aimed at assessing the prevalence and factors associated with the occurrence of OIs among adult PLWHIV on antiretroviral therapy (ART) at Ruhengeri referral hospital. Methodology A cross-sectional study was performed by reviewing records of HIV-positive adult (≥ 15 years) on ART enrolled at Ruhengeri referral hospital from 1st January 2007 to 31st December 2017. Opportunistic infections were reported based on clinical diagnosis and the prevalence of OIs was determined. Results The study reviewed records from 423 PLWHIV. Thirty-nine (9.2%) PLWHIV had been diagnosed with OIs; and frequent OIs were tuberculosis (20%), oral candidiasis, pneumonia and STI (15.6% each). The independent risk factors for developing OIs were being jobless (AOR = 5.03, 95% CI = 2.13, 32.99), spending more than five years on ART (AOR = 4.34, 95% CI = 1.12-16.78) and starting ART at WHO clinical stage III (AOR = 4.88, 95% CI = 1.65-16.78). Conclusion There is a need to strengthen the management of opportunistic infections despite the use of ART at Ruhengeri referral hospital. Rwanda J Med Health Sci 2022;5(3):323-33

Medicines Coverage and Community-Based Health Insurance in Low-Income Countries

Objectives: The 2004 International Conference on Improving Use of Medicines recommended that emerging and expanding health insurances in low-income countries focus on improving access to and use of medicines. In recent years, Community-based Health Insurance (CHI) schemes have multiplied, with mounting evidence of their positive effects on financial protection and resource mobilization for healthcare in poor settings. Using literature review and qualitative interviews, this paper investigates whether and how CHI expands access to medicines in low-income countries. Methods: We used three complementary data collection approaches: (1) analysis of WHO National Health Accounts (NHA) and available results from the World Health Survey (WHS); (2) review of peer-reviewed articles published since 2002 and documents posted online by national insurance programs and international organizations; (3) structured interviews of CHI managers about key issues related to medicines benefit packages in Lao PDR and Rwanda. Results: In low-income countries, only two percent of WHS respondents with voluntary insurance belong to the lowest income quintile, suggesting very low CHI penetration among the poor. Yet according to the WHS, medicines are the largest reported component of out-of-pocket payments for healthcare in these countries (median 41.7%) and this proportion is inversely associated with income quintile. Publications have mentioned over a thousand CHI schemes in 19 low-income countries, usually without in-depth description of the type, extent, or adequacy of medicines coverage. Evidence from the literature is scarce about how coverage affects medicines utilization or how schemes use cost-containment tools like co-payments and formularies. On the other hand, interviews found that medicines may represent up to 80% of CHI expenditures. Conclusion: This paper highlights the paucity of evidence about medicines coverage in CHI. Given the policy commitment to expand CHI in several countries (e.g. Rwanda, Lao PDR) and the potential of CHI to improve medicines access and use, systematic research is needed on medicine benefits and their performance, including the impacts of CHI on access to, affordability, and use of medicines at the household level

Social, economic and environmental risk factors for acute lower respiratory infections among children under five years of age in Rwanda

BACKGROUND:In low and middle-income countries, acute lower respiratory illness is responsible for roughly 1 in every 5 child deaths. Rwanda has made major health system improvements including its community health worker systems, and it is one of the few countries in Africa to meet the 2015 Millennium Development Goals, although prevalence of acute lower respiratory infections (4 %) is similar to other countries in sub-Saharan Africa. This study aims to assess social, economic, and environmental factors associated with acute lower respiratory infections among children under five to inform potential further improvements in the health system.METHODS:This is a cross-sectional study using data collected from women interviewed in the 2010 DHS about 8,484 surviving children under five. Based on a literature review, we defined 19 health, social, economic, and environmental potential risk factors, tested bivariate associations with acute lower respiratory infections, and advanced variables significant at the 0.1 confidence level to logistic regression modelling. We used manual backward stepwise regression to arrive at a final model. All analyses were performed in Stata v13 and adjusted for complex sample design.RESULTS:The following factors were independently associated with acute lower respiratory infections: child's age, anemia level, and receipt of Vitamin A; household toilet type and residence, and season of interview. In multivariate regression, being in the bottom ten percent of households (OR: 1.27, 95 % CI: 0.85-1.87) or being interviewed during the rainy season (OR: 1.61, 95 % CI: 1.24-2.09) was positively associated with acute lower respiratory infections, while urban residence (OR: 0.58, 95 % CI: 0.38-0.88) and being age 24-59 months versus 0-11 months (OR: 0.53, 95 % CI: 0.40-0.69) was negatively associated with acute lower respiratory infections.CONCLUSION:Potential areas for intervention including community campaigns about acute lower respiratory infections symptoms and treatment, and continued poverty reduction through rural electrification and modern stove distribution which may reduce use of dirty cooking fuel, improve living conditions, and reduce barriers to health care

Prevalence and risk factors for cervical cancer and pre-cancerous lesions in Rwanda

Introduction: Cervical cancer prevalence in Rwanda has not been well-described. Visual inspection with acetic acid or Lugol solution has been shown to be effective for cervical cancer screening in low resource  settings. The aim of the study is to understand the prevalence and risk factors for cervical cancer and pre- cancerous lesions among Rwandan women between 30 and 50 old undergoing screening.Methods: This  crosssectional analytical study was done in 3 districts of Rwanda from October 2010 to June 2013.  Women aged 30 to 50 years screened for cervical cancer by trained doctors, nurses and  midwives. Prevalence of pre-cancerous and cancerous cervical lesions was determined. Bivariate and multivariate logistic regressions were used to assess risk factors associated with cervical cancer. Results: The prevalence of pre-cancer and invasive cervical cancer was 5.9% (95% CI 4.5, 7.5) and  1.7% (95% CI 0.9, 2.5), respectively. Risk factors associated with cervical cancer in multivariate  analysis included initiation of sexual activity at less than 20 years (OR=1.75; 95% CI=(1.01, 3.03); being unmarried (single, divorced and widowed) (OR=3.29; 95% CI=( 1.26, 8.60)); Older age of participants (OR= 0.52; 95% CI= (0.28, 0.97)), older age at the first pregnancy (OR=2.10; 95% CI=(1.20, 3.67) and higher number of children born (OR=0.42; 95%CI =(0.23, 0.76)) were protective.Conclusion: Cervical cancer continues to be a public health problem in Rwanda, but screening using VIA is practical and feasible even in rural settings.Key words: Rwanda, cervical cancer, screening, VI

Assessment of Knowledge, Attitudes, and Practice on Contraceptive Use among Women Attending Family Planning Services in Some Health Centers of Muhima District Hospital, Rwanda

Introduction: In developing countries, especially in Africa, reproductive health is a great concern to many stakeholders as maternal mortality and morbidity are very high compared to that in the developed world. Moreover, reproductive health knowledge and access to quality maternal health services in Africa are poor with significant health consequences. Appropriate reproductive health knowledge and attitude can empower women to access quality family planning services (preventive and curative), which are essential for improvement of women’s reproductive health. Objectives: This research aimed to assess reproductive health knowledge, attitude, and practice on contraceptive use among women attending family planning services at Muhima district hospital.  Methods and Materials: The study was cross-sectional in nature involving 326 randomly selected respondents among women attending family planning services at Muhima district hospital. The study instrument was a self-administered questionnaire. Data was analyzed using SPSS (Statistical Package for Social Science) statistics software 17.0 version. Hypothesis: Looking at the aforementioned objective, one may wonder if the health education on contraceptive use given by health staff of Muhima district hospital is well done; we may also wonder about reproductive health beliefs and determinants of contraceptive use among women attending the family planning service; and to what extent women in Muhima district hospital have access to health education on contraceptive use. Trying to find an interim response to this question, we have come to realize that the impact of belief in personal and community health practices is strong; but individual beliefs may not be scientifically true and as such, may make one rightly or wrongly access health care. Results: The majority of the respondents knew when pregnancy can occur and believed that having sex even once with a man may result in pregnancy. 90.0% of respondents had knowledge of benefits of family planning. Consideration about personal health (86.0%) and husband’s approval (74.9%) were major determinants of respondents’ use of contraceptives.  Conclusions: Though respondents were knowledgeable about the benefits of family planning, there is the need for continuous education of women about reproductive health issues and integration of men’s participation in the family planning program to increase utilization of family planning services at Muhima district hospital.

Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda: findings from a population based study

This is the published version of a paper published in BMC Psychiatry. Citation for the original published paper (version of record): Umubyeyi, A., Mogren, I., Ntaganira, J., R E S E A R C H A R T I C L E Open Access Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda: findings from a population based study The prevalence of mental disorders was investigated using of a diagnostic tool, the "MINI: Mini International Neuropsychiatric Interview". Risk factor patterns were analysed with bi-and multivariate logistic regression. To find the proportion of mental disorders attributed to IPV, the population attributable fraction was computed