Prevalence of Periodontitis and Associated Factors among Pregnant Women: A cross sectional survey in Southern Province, Rwanda

Background The literature has shown the relationship between maternal periodontitis and complications associated with pregnancy. Thus, prevalence estimates and risk factor identification for periodontitis during pregnancy in Rwanda are paramount. Aim The aim of the current study was to determine the prevalence of periodontitis and identify related risk factors among pregnant women in Rwanda. Methods A cross sectional study was conducted to determine the prevalence of periodontal diseases in a convenience sample of 400 pregnant women in the Southern Province of Rwanda. A logistic regression analysis using a hierarchical approach was performed to assess the risk factors for periodontal disease. Socio demographic factors were put in the regression model first followed by a second step for other potential factors. Results The overall prevalence of periodontitis was 60.5%. Multivariable logistic regression showed that age OR=2.48 (95% CI. 1.18-5.22), education level OR=82.15 (95% CI. 8.21-822.11), socio economic status OR=2.28 (95% CI. 1.49-6.62), employment status OR=7.3 (95% CI. 1.38-38.74, and tobacco use OR=6.89 (95% CI. 1.78-60.65) were significantly associated with periodontitis. Conclusion Periodontitis appears to be a common problem among pregnant women in Rwanda. Risk factor screening could help identify pregnant women at higher risk of periodontal disease. Rwanda J Med Health Sci 2021;4(1):131-15

Impact of Maternal Periodontitis on Preterm Birth and Low Birth Weight in Babies: Results of a Scoping Review

Background Periodontitis has been documented as public health concern but its association with preterm and low birth weight remains uncertain, thus the objective of this scoping review is to summarize the most recent published evidence related to the impact of periodontitis on preterm birth and low birth weight in order to improve public awareness and to inform policies for oral health during pregnancy. Methods Hinari, PubMed, and Google Scholar were searched to acquire the published literature. The retrieved studies included cross-sectional, case control studies and randomized controlled trials with available full text published in English from 2008 to 2019. Results After combining the key words, 333 articles were identified with only 133 eligible articles published from 2008 to 2019. After reviewing the available 50 full text articles, duplicates were removed and 15 studies fully met the inclusion criteria. There were 13 articles that supported the association between maternal periodontitis and preterm low birth weight while 2 found no evidence to support the association. Conclusion The results of this scoping review contribute to an increasing body of evidence to support the hypothesis that maternal periodontal disease may be a risk factor for preterm delivery and low birth weight. Rwanda J Med Health Sci 2020;3(3):372-38

Prevalence and Predictors of Giving Birth in Health Facilities in Bugesera District, Rwanda

Background The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249–584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda. Methods Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18–50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities. Results Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery. Conclusions The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center. Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the health facility delivery rate observed in our study

Malaria has no effect on birth weight in Rwanda

<p>Abstract</p> <p>Background</p> <p>Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall, the incidence decreased over the last six years (2002–2007). Therefore, the impact of malaria on birth outcomes is also expected to vary over time and space.</p> <p>Methods</p> <p>Obstetric indicators (birth weight and pregnancy outcome) and malaria incidence were compared and analyzed to their association over time (2002–2007) and space. Birth data from 12,526 deliveries were collected from maternity registers of 11 different primary health centers located in different malaria endemic areas. Malaria data for the same communities were collected from the National Malaria Control Programme. Associations were sought with mixed effects models and logistic regression.</p> <p>Results</p> <p>In all health centres, a significant increase of birth weight over the years was observed (p < 0.001) with a significant seasonal fluctuation. Malaria incidence had no significant effect on birth weight. There was a slight but significant decreasing effect of malaria incidence on the occurrence of premature delivery (p-value 0.045) and still birth (p-value 0.009). Altitude showed a slight but significant negative correlation with birth weight. Overall, a decrease over the years of premature delivery (p = 0.010) and still birth (p = 0.036) was observed.</p> <p>Conclusion</p> <p>In Rwanda, birth weight and pregnancy outcome are not directly influenced by malaria, which is in contrast to many other studied areas. Although malaria incidence overall has declined and mean birth weight increased over the studied period, no direct association was found between the two. Socio-economic factors and improved nutrition could be responsible for birth weight changes in recent years.</p

A Multi-Platform Metabolomics Approach Identifies Highly Specific Biomarkers of Bacterial Diversity in the Vagina of Pregnant and Non-Pregnant Women

Bacterial vaginosis (BV) increases transmission of HIV, enhances the risk of preterm labour, and is associated with malodour. Clinical diagnosis often relies on microscopy, which may not reflect the microbiota composition accurately. We use an untargeted metabolomics approach, whereby we normalize the weight of samples prior to analysis, to obtained precise measurements of metabolites in vaginal fluid. We identify biomarkers for BV with high sensitivity and specificity (AUC = 0.99) in a cohort of 131 pregnant and non-pregnant Rwandan women, and demonstrate that the vaginal metabolome is strongly associated with bacterial diversity. Metabolites associated with high diversity and clinical BV include 2-hydroxyisovalerate and γ-hydroxybutyrate (GHB), but not succinate, which is produced by both Lactobacillus crispatus and BV-associated anaerobes in vitro. Biomarkers associated with high diversity and clinical BV are independent of pregnancy status, and were validated in a blinded replication cohort from Tanzania (n = 45), where we predicted clinical BV with 91% accuracy. Correlations between the metabolome and microbiota identified Gardnerella vaginalis as a putative producer of GHB, and we demonstrate production by this species in vitro. This work illustrates how changes in community structure alter the chemical composition of the vagina, and identifies highly specific biomarkers for a common condition

Evaluating Affordable Cranial Ultrasonography in East African Neonatal Intensive Care Units

Neuroimaging is a valuable diagnostic tool for the early detection of neonatal brain injury, but equipment and radiologic staff are expensive and unavailable to most hospitals in developing countries. We evaluated an affordable, portable ultrasound machine as a quantitative and qualitative diagnostic tool and to establish whether a novice sonographer could effectively operate the equipment and obtain clinically important information. Cranial ultrasonography was performed on term healthy, pre-term and term asphyxiated neonates in Rwandan and Kenyan hospitals. To evaluate the detection of ventriculomegaly and compression injuries, we measured the size of the lateral ventricles and corpus callosum. The images were also assessed for the presence of other cerebral abnormalities. Measurements were reliable across images, and cases of clinically relevant ventriculomegaly were detected. A novice sonographer had good-to-excellent agreement with an expert. This study demonstrates that affordable equipment and cranial ultrasound protocols can be used in low-resource settings to assess the newborn brain

Evaluating Affordable Cranial Ultrasonography in East African Neonatal Intensive Care Units

Neuroimaging is a valuable diagnostic tool for the early detection of neonatal brain injury, but equipment and radiologic staff are expensive and unavailable to most hospitals in developing countries. We evaluated an affordable, portable ultrasound machine as a quantitative and qualitative diagnostic tool and to establish whether a novice sonographer could effectively operate the equipment and obtain clinically important information. Cranial ultrasonography was performed on term healthy, pre-term and term asphyxiated neonates in Rwandan and Kenyan hospitals. To evaluate the detection of ventriculomegaly and compression injuries, we measured the size of the lateral ventricles and corpus callosum. The images were also assessed for the presence of other cerebral abnormalities. Measurements were reliable across images, and cases of clinically relevant ventriculomegaly were detected. A novice sonographer had good-to-excellent agreement with an expert. This study demonstrates that affordable equipment and cranial ultrasound protocols can be used in low-resource settings to assess the newborn brain

False-negative malaria rapid diagnostic tests in Rwanda: impact of Plasmodium falciparum isolates lacking hrp2 and declining malaria transmission

Rapid diagnostic tests (RDTs) for histidine rich protein 2 (HRP2) are often used to determine whether persons with fever should be treated with anti-malarials. However, Plasmodium falciparum parasites with a deletion of the hrp2 gene yield false-negative RDTs and there are concerns the sensitivity of HRP2-based RDTs may fall when the intensity of transmission decreases.; This observational study enrolled 9226 patients at three health centres in Rwanda from April 2014 to April 2015. It then compared the sensitivity of RDTs based on HRP2 and the Plasmodium lactate dehydrogenase (pLDH) to microscopy (thick smears) for the diagnosis of malaria. PCR was used to determine whether deletions of the histidine-rich central repeat region of the hrp2 gene (exon 2) were associated with false-negative HRP2-based RDTs.; In comparison to microscopy, the sensitivity and specificity of HRP2- and pLDH-based RDTs were 89.5 and 86.2% and 80.2 and 94.3%, respectively. When the results for both RDTs were combined, sensitivity rose to 91.8% and specificity was 85.7%. Additionally, when smear positivity fell from 46 to 3%, the sensitivity of the HRP2-based RDT fell from 88 to 67%. Of 370 samples with false-negative HRP2 RDT results for which PCR was performed, 140 (38%) were identified as P. falciparum by PCR. Of the isolates identified as P. falciparum by PCR, 32 (23%) were negative for the hrp2 gene based on PCR. Of the 32 P. falciparum isolates negative for hrp2 by PCR, 17 (53%) were positive based on the pLDH RDT.; This prospective study of RDT performance coincided with a decline in the intensity of malaria transmission in Kibirizi (fall in slide positivity from 46 to 3%). This decline was associated with a decrease in HRP2 RDT sensitivity (from 88 to 67%). While P. falciparum isolates without the hrp2 gene were an important cause of false-negative HRP2-based RDTs, most were identified by the pLDH-based RDT. Although WHO does not recommend the use of combined HRP2/pLDH testing in sub-Saharan Africa, these results suggest that combination HRP2/pLDH-based RDTs could reduce the impact of false-negative HRP2-based RDTs for detection of symptomatic P. falciparum malaria

The Comparability of Lipid-based and Body Mass Index-based Cardiovascular Disease Risk Scores: Using the Rwanda 2012-2013 Non-communicable Diseases Risk Factors Survey Data

Background In Rwanda, cardiovascular diseases (CVDs) ranked second of the most common cause of death in 2016.&nbsp; CVD risk score tools have been recommended to identify people at high risk for management. Objective To assess the comparability of body mass index (BMI)-based and lipid-based CVD risk scores in Rwandan population. Methods Secondary analysis was conducted on 4185 study participants extracted from the dataset of Rwanda 2012-2013 non-communicable diseases risk factors survey. Individual CVD risk scores were calculated using both BMI-based and lipid-based algorithms, one at a time. Spearman rank’s coefficient and Cohen’s Kappa coefficient were used to compare the two tools. Results About 63.5% of participants were women. There was a significant positive correlation between BMI-based algorithm and lipid-based algorithm vis-à-vis a 10-year CVD risk prediction (Spearman rank correlation coefficients &gt; 0.90, p&lt;0.001) considering either men, women or overall study participants. There was a moderate agreement between BMI-based and lipid-based algorithms vis-à-vis CVD risk characterization, kappa = 0.52; p-value p&lt;0.001 considering either overall study participants or men and kappa = 0.48; p-value p&lt;0.001 considering women. Conclusion The findings from this study suggest the use of BMI-based algorithm, a cost effective tool compared to lipid-based tool, can be alternatively used in resource-limited settings.&nbsp; Rwanda J Med Health Sci 2021;4(1):166-18