Perioperative Nursing Training in Rwanda in Partnership with American Universities: The Journey So Far

Nurses within a surgical team play such a fundamental role in the success of a surgery that they require specific training for the purpose. However, in Rwanda, there has been a severe scarcity of perioperative nurses. This article describes the collaborative effort for perioperative nursing training by the University of Rwanda (UR) and the Ministry of Health (MOH) with the Human Resources for Health (HRH) Program and a consortium of American Universities. The goal of the HRH program has been to build up the capacities of health professionals both in academia and clinical settings so as to address the shortage of qualified staff. In that regard, the UR in 2015 started a Masters program in nursing in eight specialties, of which one was perioperative nursing. The aim of this paper is to highlight the training process, success, and challenges of perioperative nursing training in Rwanda. The training has so far been successful, with the 19 nurses who completed the program working now in academic and clinical teaching institutions. Students in the program have also increased their number of research publications in peer-reviewed journals and international conference presentations. The UR and its partners are investing in the sustainability and excellence of this program. Using the import-of-experts approach to train Rwandans within their country, the program addresses the scarcity of specialists in various disciplines within the nursing profession. As a consequence,  countries where the lack of specialized nurses poses challenges may adopt this partnership strategy. Rwanda J Med Health Sci 2021;4(1):185-19

Bionomics of vector-borne diseases in sites adjacent to lakes Victoria and Baringo in Kenya

Philosophiae Doctor - PhDBionomics of vector-borne pathogens (VBPs) is a complex phenomenon that involves understanding the ecology of arthropod borne pathogens and vertebrate hosts potentially involved in their transmission cycles. Investigations into the bionomics of viral and bacterial VBPs circulating in Baringo and Homa Bay Counties of Kenya were carried out. Specifically, vertebrate hosts represented in mosquito bloodmeals, presence of arboviruses in blood fed mosquitoes and patients presenting with acute undiagnosed febrile illnesses in rural health facilities, and tick borne pathogens (TBPs) diversity in ticks of animals were identified. Mosquitoes were trapped by BG sentinel and CDC light traps, while ticks were sampled directly from domestic animals and tortoises close to human habitation along the shores and adjacent islands of Lakes Victoria and Baringo in Kenya. Blood and sera were also sampled from patients presenting with acute febrile illnesses visiting four rural health facilities in Homa Bay County. Mosquitoes and ticks were sorted and identified to species using standard morphological taxonomic keys. All the biological samples (blood-fed mosquitoes, ticks and blood/sera) were processed using molecular and culture procedures for detection of VBPs (arboviruses, Ehrlichia, Anaplasma, Rickettsia and protozoa). Among 445 blood-fed Aedeomyia, Aedes, Anopheles, Culex, Mansonia, and Mimomyia mosquitoes, 33 bloodmeal hosts were identified including humans, eight domestic animal species, six peridomestic animal species and 18 wildlife species. Further detection of Sindbis and Bunyamwera viruses was done on blood-fed mosquito homogenates by Vero cell culture and RTPCR in Culex, Aedeomyia, Anopheles and Mansonia mosquitoes from Baringo that had fed on humans and livestock. In TBPs assay, 585 tick pools were analysed consisting of 4,126 ticks collected in both study areas. More ticks were sampled in Baringo (80.5%), compared to Homa Bay (19.5%). In Baringo, agents of ehrlichiosis were detected from Amblyomma and Rhipicephalus ticks including Ehrlichia ruminantium (12.3%), Ehrichia canis (10.5%) and Paracoccus sp. (4.4%). Agents of anaplasmosis included Anaplasma ovis (7.2%), Anaplasma platys (4.4%) and Anaplasma bovis (4.0%), all from Hyalomma, Amblyomma and Rhipicephalus ticks, as well as agents of rickettsiosis, including Rickettsia africae, Rickettsia aeschlimannii, Rickettsia rhipicephali, Rickettsia montanensis and a Rickettsia sp. that was not conclusively characterized. Babesia caballi, Theileria sp. and Hepatozoon fitzsimonsi were also detected from both Rhipicephalus ticks and Amblyomma ticks. In Homa Bay, Ehrichia ruminantium (17.5%) and Ehrichia canis (9.3%) were isolated from Amblyomma latum and Rhipicephalus pulchellus, as well as Anaplasma platys (14.4%) and Anaplasma ovis (14.4%) from Amblyomma and Rhipicephalus species. In determination of the occurrence of arboviruses among patients presenting with acute febrile illnesses, acute Bunyamwera 3 (0.9%) and Sindbis 2 (0.6%) infections were detected by RT-PCR and cell culture and Sindbis seroprevalence was determined by plaque assay. Though a significant proportion of these patients tested positive for low Plasmodium parasitemia, none were co-infected with Plasmodium parasites and arboviruses. This study highlights the presence and relative importance of zoonotic VBPs in both study areas

Rangewide ploidy variation and evolution in Acacia senegal: a north-south divide?

Knowledge of rangewide variation in DNA content and ploidy level may be valuable in understanding the evolutionary history of a species. Recent studies of Acacia senegal report diploids and occasional tetraploids in the Sudano-Sahelian region of sub-Saharan Africa, but nothing is known about the overall extent of DNA ploidy variation within the species. In this study, we determine the DNA content and ploidy level of A. senegal across its native range, and explore whether the variation is related to its evolutionary and colonization history. We used propidium iodide flow cytometry (FCM) to estimate DNA content (2C value) and infer ploidy in 157 individuals from 54 populations on various tissues, using seeds, fresh leaves, dried leaves and twigs and herbarium specimens. The mean 2C DNA (pg ± s.d.) contents detected were 1.47 ± 0.09, 2.12 ± 0.02, 2.89 ± 0.12, and a single individual with 4.51 pg, corresponding to a polyploid series of diploid, triploid, tetraploid and hexaploid individuals. Diploids were confirmed by chromosome counts (2n = 2x = 26). Most populations (90.7 %) were of single ploidy level, while mixed ploidy populations (9.3 %) comprising mostly diploids (2x+3x, 2x+4x and 2x+6x) were restricted to the Sudano-Sahelian and Indian subcontinent regions, its northern range. The species is predominantly diploid, and no mixed ploidy populations were detected in east and southern Africa, its southern range. The geographic pattern of ploidy variation in conjunction with existing phylogeographic and phylogenetic data of the species suggests that polyploids have occurred multiple times in its evolutionary and recent colonization history, including contemporary ecological timescales. The successful use of external tissues of dried twigs in FCM is new, and presents the opportunity to study numerous other dryland woody species

Informal task-sharing practices in inpatient newborn settings in a low-income setting: A task analysis approach

Aim: To describe the complexity and criticality of neonatal nursing tasks and existing task-sharing practices to identify tasks that might be safely shared in inpatient neonatal settings. Design: We conducted a cross-sectional study in a large geographically dispersed sample using the STROBE guidelines. Methods: We used a task analysis approach to describe the complexity/criticality of neonatal nursing tasks and to explore the nature of task sharing using data from structured, self-administered questionnaires. Data was collected between 26th April and 22nd August 2017. Results: Thirty-two facilities were surveyed between 26th April and 22nd August, 2017. Nearly half (42%, 6/14) of the “moderately critical” and “not critical” (41%, 5/11) tasks were ranked as consuming most of the nurses' time and reported as shared with mothers respectively. Most tasks were reported as shared in the public sector than in the private-not-for-profit facilities. This may largely be a response to inadequate nurse staffing, as such, there may be space for considering the future role of health care assistants

De novo assembly and annotation of the Amblyomma hebraeum tick midgut transcriptome response to Ehrlichia ruminantium infection

The South African bont tick Amblyomma hebraeum is a hematophagous vector for the heartwater disease pathogen Ehrlichia ruminantium in southern Africa. During feeding, the tick’s enterocytes express proteins that perform vital functions in blood digestion, including proteins that may be involved in E. ruminantium acquisition, colonization or immunity. To delineate the molecular mechanism of midgut response to E. ruminantium infection, we performed comparative analyses of midgut transcriptomes of E. ruminantium infected engorged A. hebraeum nymphs, and infected adult male and female ticks with their corresponding matched uninfected controls, before and during feeding. A total of 102,036 unigenes were annotated in public databases and their expression levels analyzed for engorged nymphs as well as unfed and partly-fed adult ticks. There were 2,025 differentially expressed genes (DEGs) in midguts, of which 1,225 unigenes were up-regulated and 800 unigenes were down-regulated in the midguts of infected ticks. Annotation of DEGs revealed an increase in metabolic and cellular processes among E. ruminantium infected ticks. Notably, among the infected ticks, there was up-regulation in the expression of genes involved in tick immunity, histone proteins and oxidative stress responses. We also observed up-regulation of glycoproteins that E. ruminantium could potentially use as docking sites for host cell entry. Insights uncovered in this study offer a platform for further investigations into the molecular interaction between E. ruminantium and A. hebraeum

Informal task-sharing practices in inpatient newborn settings in a low-income setting-A task analysis approach.

Aim: To describe the complexity and criticality of neonatal nursing tasks and existing task-sharing practices to identify tasks that might be safely shared in inpatient neonatal settings. Design: We conducted a cross-sectional study in a large geographically dispersed sample using the STROBE guidelines. Methods: We used a task analysis approach to describe the complexity/criticality of neonatal nursing tasks and to explore the nature of task sharing using data from structured, self-administered questionnaires. Data was collected between 26th April and 22nd August 2017. Results: Thirty-two facilities were surveyed between 26th April and 22nd August, 2017. Nearly half (42%, 6/14) of the "moderately critical" and "not critical" (41%, 5/11) tasks were ranked as consuming most of the nurses' time and reported as shared with mothers respectively. Most tasks were reported as shared in the public sector than in the private-not-for-profit facilities. This may largely be a response to inadequate nurse staffing, as such, there may be space for considering the future role of health care assistants

Manure Management Practices and Policies in Sub-Saharan Africa: Implications on Manure Quality as a Fertilizer

Manure has been used as a fertilizer since ancient times and if well-managed it can be an asset, promoting sustainable agriculture, and increasing crop production, particularly for smallholder farmers in sub-Saharan Africa (SSA). However, most farmers in SSA do not apply recommended manure management practices, such as roofing animal housing, having a water-proof floor or covering manure during storage, causing large nutrient losses during manure storage, increasing greenhouse gas emissions, and reducing the quality of the manure as a fertilizer. This paper compares manure management practices in representative SSA countries, and summarizes government policies and socio-cultural practices that influence the adoption of good (recommended) manure management practices. Three steps were applied in this analysis: (i) review of manure management practices from various literature sources, (ii) interviews on manure management practices and policies with key stakeholders from 13 SSA countries, and (iii) surveys of manure management practices on small, medium, and large scale farms in Ethiopia and Malawi. The review confirms the potential of manure to improve crop yields and promote sustainable agriculture in SSA. Unfortunately, most SSA countries (a) do not explicitly mention manure management in their policies (b) have different ministries that share responsibilities on manure management, often leading to incoherent policies and abnegation of these responsibilities (c) take limited action to promote good practices or enforce legislation on manure management. Also, the field survey indicated that farmers lack knowledge on manure management. However, farmers are able to access agricultural extension services from both government and non-government agencies, although these extension services rarely included information on improved manure management practices. Extension services that encourage exchange and interaction between farmers were most successful in increasing adoption of good manure management practices, and are recommended. In addition, efforts to improve manure management in SSA should strengthen the enforcement of existing policies and provide an enabling environment for adoption of good manure management practices

N-(2,4,6-Trimethyl­phen­yl)formamide

The title compound, C10H13NO, was obtained as the unexpected, almost exclusive, product in the attempted synthesis of a manganese(I)–N-heterocyclic carbene (NHC) complex. The dihedral angle between the planes of the formamide moiety and the aryl ring is 68.06 (10)°. In the crystal, mol­ecules are linked by N—H⋯O hydrogen bonds, forming infinite chains along the c axis

Expectations for nursing care in newborn units in Kenya: moving from implicit to explicit standards.

Neonatal mortality currently accounts for 45% of all child mortality in Kenya, standing at 22 per 1000 live births. Access to basic but high quality inpatient neonatal services for small and sick newborns will be key in reducing neonatal mortality. Neonatal inpatient care is reliant on nursing care, yet explicit nursing standards for such care do not currently exist in Kenya. We reviewed the Nursing Council of Kenya 'Manual of Clinical Procedures' to identify tasks relevant for the care of inpatient neonates. An expert advisory group comprising major stakeholders, policy-makers, trainers, and frontline health-workers was invited to a workshop with the purpose of defining tasks for which nurses are responsible and the minimum standard with which these tasks should be delivered to inpatient neonates in Kenyan hospitals. Despite differences in opinions at the beginning of the process, consensus was reached on the minimum standards of neonatal nursing. The key outcome was a comprehensive list and grouping of neonatal nursing task and the minimum frequency with which these tasks should be performed. Second, a simple categorisation of neonatal patients based on care needs was agreed. In addition, acceptable forms of task sharing with other cadres and the patient's family for the neonatal nursing tasks were agreed and described. The process was found to be acceptable to policy-makers and practitioners, who recognised the value of standards in neonatal nursing to improve the quality of neonatal inpatient care. Such standards could form the basis for audit and quality evaluation

Neonatal nasogastric tube feeding in a low-resource African setting - using ergonomics methods to explore quality and safety issues in task sharing.

BACKGROUND: Sharing tasks with lower cadre workers may help ease the burden of work on the constrained nursing workforce in low- and middle-income countries but the quality and safety issues associated with shifting tasks are rarely critically evaluated. This research explored this gap using a Human Factors and Ergonomics (HFE) method as a novel approach to address this gap and inform task sharing policies in neonatal care settings in Kenya. METHODS: We used Hierarchical Task Analysis (HTA) and the Systematic Human Error Reduction and Prediction Approach (SHERPA) to analyse and identify the nature and significance of potential errors of nasogastric tube (NGT) feeding in a neonatal setting and to gain a preliminary understanding of informal task sharing. RESULTS: A total of 47 end tasks were identified from the HTA. Sharing, supervision and risk levels of these tasks reported by subject matter experts (SMEs) varied broadly. More than half of the tasks (58.3%) were shared with mothers, of these, 31.7% (13/41) and 68.3% were assigned a medium and low level of risk by the majority (≥4) of SMEs respectively. Few tasks were reported as 'often missed' by the majority of SMEs. SHERPA analysis suggested omission was the commonest type of error, however, due to the low risk nature, omission would potentially result in minor consequences. Training and provision of checklists for NGT feeding were the key approaches for remedying most errors. By extension these strategies could support safer task shifting. CONCLUSION: Inclusion of mothers and casual workers in care provided to sick infants is reported by SMEs in the Kenyan neonatal settings. Ergonomics methods proved useful in working with Kenyan SMEs to identify possible errors and the training and supervision needs for safer task-sharing