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

Effect of shortened Integrated Management of Childhood Illness training on classification and treatment of under-five children seeking care in Rwanda

Background: Integrated Management of Childhood Illness (IMCI) is an effective 11-day standard training; however, due to budgetary expenses and human resource constraints, many health professionals cannot take 11 days off work. As a result, shortened training curriculums (6-day) have been proposed. We used a cross-sectional study to evaluate the effect of this shortened training on appropriate IMCI classification and treatment of under-five childhood illness management in Rwanda. Methods: A cross-sectional study was conducted in 22 health centers in Rwanda, comparing data from 121 nurses, where 55 nurses completed the 11-day and 66 nurses completed the 6-day training. Among 768 children, we evaluated clinical outcomes from May 2011 to April 2012. Descriptive statistics were used to display the sociodemographic characteristics of health providers; including level of education, sex, age, and professional experiences. Bivariable and multivariable analyses were used to test for differences between nurses in the 6-day versus 11-day training on the appropriate classification and treatment of childhood illness. Results: Our findings show that at the bivariable level and after controlling for confounders in the multivariable analysis, the only significant differences detected between nurses in the long and short training was the classification of fever (adjusted odds ratio [aOR] 0.7, 95% confidence interval [CI] 0.64–0.75) and treatment of pneumonia (aOR 0.8, 95% CI 0.70–0.89). Nurses in the short training had lower odds of inappropriate misclassification and treatment for these two conditions. Conclusion: There was no difference in classification and treatment of childhood illness among nurses who completed the standard and short IMCI training courses. Short-training could be a more cost-saving option for health facilities without compromising the key outcomes related to case management

Measuring adherence to antiretroviral treatment in resource-poor settings: The clinical validity of key indicators

<p>Abstract</p> <p>Background</p> <p>Access to antiretroviral therapy has dramatically expanded in Africa in recent years, but there are no validated approaches to measure treatment adherence in these settings.</p> <p>Methods</p> <p>In 16 health facilities, we observed a retrospective cohort of patients initiating antiretroviral therapy. We constructed eight indicators of adherence and visit attendance during the first 18 months of treatment from data in clinic and pharmacy records and attendance logs. We measured the correlation among these measures and assessed how well each predicted changes in weight and CD4 count.</p> <p>Results</p> <p>We followed 488 patients; 63.5% had 100% coverage of medicines during follow-up; 2.7% experienced a 30-day gap in treatment; 72.6% self-reported perfect adherence in all clinic visits; and 19.9% missed multiple clinic visits. After six months of treatment, mean weight gain was 3.9 kg and mean increase in CD4 count was 138.1 cells/mm3.</p> <p>Dispensing-based adherence, self-reported adherence, and consistent visit attendance were highly correlated. The first two types of adherence measure predicted gains in weight and CD4 count; consistent visit attendance was associated only with weight gain.</p> <p>Conclusions</p> <p>This study demonstrates that routine data in African health facilities can be used to monitor antiretroviral adherence at the patient and system level.</p

A Systematic Review of African Studies on Intimate Partner Violence against Pregnant Women: Prevalence and Risk Factors

Background: Intimate partner violence (IPV) is very high in Africa. However, information obtained from the increasing number of African studies on IPV among pregnant women has not been scientifically analyzed. This paper presents a systematic review summing up the evidence from African studies on IPV prevalence and risk factors among pregnant women. Methods: A key-word defined search of various electronic databases, specific journals and reference lists on IPV prevalence and risk factors during pregnancy resulted in 19 peer-reviewed journal articles which matched our inclusion criteria. Quantitative articles about pregnant women from Africa published in English between 2000 and 2010 were reviewed. At least two reviewers assessed each paper for quality and content. We conducted meta-analysis of prevalence data and reported odds ratios of risk factors. Results: The prevalence of IPV during pregnancy ranges from 2% to 57% (n = 13 studies) with meta-analysis yielding an overall prevalence of 15.23% (95% CI: 14.38 to 16.08%). After adjustment for known confounders, five studies retained significant associations between HIV and IPV during pregnancy (OR1.48-3.10). Five studies demonstrated strong evidence that a history of violence is significantly associated with IPV in pregnancy and alcohol abuse by a partner also increases a woman's chances of being abused during pregnancy (OR 2.89-11.60). Other risk factors include risky sexual behaviours, low socioeconomic status and young age. Conclusion: The prevalence of IPV among pregnant women in Africa is one of the highest reported globally. The major risk factors included HIV infection, history of violence and alcohol and drug use. This evidence points to the importance of further research to both better understand IPV during pregnancy and feed into interventions in reproductive health services to prevent and minimize the impact of such violence

Measuring adherence to antiretroviral treatment in resource-poor settings: The feasibility of collecting routine data for key indicators

<p>Abstract</p> <p>Background</p> <p>An East African survey showed that among the few health facilities that measured adherence to antiretroviral therapy, practices and definitions varied widely. We evaluated the feasibility of collecting routine data to standardize adherence measurement using a draft set of indicators.</p> <p>Methods</p> <p>Targeting 20 facilities each in Ethiopia, Kenya, Rwanda, and Uganda, in each facility we interviewed up to 30 patients, examined 100 patient records, and interviewed staff.</p> <p>Results</p> <p>In 78 facilities, we interviewed a total of 1,631 patients and reviewed 8,282 records. Difficulties in retrieving records prevented data collection in two facilities. Overall, 94.2% of patients reported perfect adherence; dispensed medicine covered 91.1% of days in a six month retrospective period; 13.7% of patients had a gap of more than 30 days in their dispensed medication; 75.8% of patients attended clinic on or before the date of their next appointment; and 87.1% of patients attended within 3 days.</p> <p>In each of the four countries, the facility-specific median indicators ranged from: 97%-100% for perfect self-reported adherence, 90%-95% of days covered by dispensed medicines, 2%-19% of patients with treatment gaps of 30 days or more, and 72%-91% of appointments attended on time. Individual facilities varied considerably.</p> <p>The percentages of days covered by dispensed medicine, patients with more than 95% of days covered, and patients with a gap of 30 days or more were all significantly correlated with the percentages of patients who attended their appointments on time, within 3 days, or within 30 days of their appointment. Self reported recent adherence in exit interviews was significantly correlated only with the percentage of patients who attended within 3 days of their appointment.</p> <p>Conclusions</p> <p>Field tests showed that data to measure adherence can be collected systematically from health facilities in resource-poor settings. The clinical validity of these indicators is assessed in a companion article. Most patients and facilities showed high levels of adherence; however, poor levels of performance in some facilities provide a target for quality improvement efforts.</p

Intimate partner violence among pregnant women in Rwanda

<p>Abstract</p> <p>Background</p> <p>Intimate partner violence (IPV), defined as actual or threatened physical, sexual, psychological, and emotional abuse by current or former partners is a global public health concern. The prevalence and determinants of intimate partner violence (IPV) against pregnant women has not been described in Rwanda. A study was conducted to identify variables associated with IPV among Rwandan pregnant women.</p> <p>Methods</p> <p>A convenient sample of 600 pregnant women attending antenatal clinics were administered a questionnaire which included items on demographics, HIV status, IPV, and alcohol use by the male partner. Mean age and proportions of IPV in different groups were assessed. Odds of IPV were estimated using logistic regression analysis.</p> <p>Results</p> <p>Of the 600 respondents, 35.1% reported IPV in the last 12 months. HIV+ pregnant women had higher rates of all forms of IVP violence than HIV- pregnant women: pulling hair (44.3% vs. 20.3%), slapping (32.0% vs. 15.3%), kicking with fists (36.3% vs. 19.7%), throwing to the ground and kicking with feet (23.3% vs. 12.7%), and burning with hot liquid (4.1% vs. 3.5%). HIV positive participants were more than twice likely to report physical IPV than those who were HIV negative (OR = 2.38; 95% CI [1.59, 3.57]). Other factors positively associated with physical IPV included sexual abuse before the age of 14 years (OR = 2.69; 95% CI [1.69, 4.29]), having an alcohol drinking male partner (OR = 4.10; 95% CI [2.48, 6.77] for occasional drinkers and OR = 3.37; 95% CI [2.05, 5.54] for heavy drinkers), and having a male partner with other sexual partners (OR = 1.53; 95% CI [1.15, 2.20]. Education was negatively associated with lifetime IPV.</p> <p>Conclusion</p> <p>We have reported on prevalence of IPV violence among pregnant women attending antenatal care in Rwanda, Central Africa. We advocate that screening for IPV be an integral part of HIV and AIDS care, as well as routine antenatal care. Services for battered women should also be made available.</p