Risk factors associated with Type 2 Diabetes Mellitus at Kibuye Referral Hospital, Rwanda- A case control study

BackgroundType 2 Diabetes Mellitus (T2DM) is increasing globally, being among the leading cause of premature mortality. If no bold actions are taken, nine in ten persons diagnosed with diabetes will have T2DM by 2025.ObjectivesThis study aims at assessing socio-demographic characteristics and identify lifestyle factors associated with T2DM at Kibuye Referral Hospital.MethodsHospital-based case control study design was used. Food frequency, and global physical activity questionnaires adapted from WHO were used. SPSS v 23 was used for all research analysis. Descriptive statistics were used to summarize categorical variables with help of frequencies and percentages. Binary logistic regression was used to identify the factors associated with T2DM by computing odds ratio with corresponding 95% confidence interval. Logistic regression models using multivariate analysis with a significance level of 5% was used to establish the independent risk factors of T2DM by controlling the confounding variables.ResultsSmoking, level of physical activity, low level of dietary diversity were associated with T2DM. The likelihood of developing T2DM among smokers was about 9 times more [AOR= 8.9; 95%CI=2.84-27.86; p<0.001] compared to non- smokers. Respondents with low level of physical activities were 8.1 times more likely to get T2DM than those with high or moderate physical activities [AOR= 8.1; 95%CI= 2.90-22.79; p<0.001]. Similarly, respondents with low level of dietary diversity score were 6 times more likely to developT2DM [AOR= 6.03; 95%CI= 1.67-21.80; p=0.006] compared to those with high level of dietary diversity score.ConclusionLifestyle factors that showed strong association with T2DM can all be modified by public health interventions that are promoting physical activity, healthy lifestyle, and dietary diversity. Rwanda J Med Health Sci 2022;5(2):151-15

Birth Outcome and Maternal Risk Factors Associated with Childhood Leukemia in Rwanda: A case - Control Study

BackgroundLeukemia is the most common cancer affecting children and remains the top cause of death among children.ObjectiveThis study aimed at determining birth outcomes and maternal risk factors associated with childhood leukemia in Rwanda.MethodsA case control study was conducted at Butaro Cancer Referral hospital. The sample of 103 cases and 103 controls was recruited using the records for children diagnosed with Acute lymphocytic leukemia (ALL) and Acute myelogenous leukemia (AML) and those who were hospitalized for non-cancer treatment as controls. Semi-structured questionnaire and phone calls were used to gather information. SPSS version 21.0 was used to analyze the data. Logistic regression analysis was used to assess the risk factors.ResultsThe majority (56.8%) of children who participated in the study were aged 10-14 years. Overall 41.3% were born via C-Section. It was revealed that children who had had birth asphyxia had about three (3) times increased risk of childhood leukemia [AoR= 2.47, 95%CI: 1.167-5.262, P=0.018] compared to children that had not experienced birth asphyxia. Children who had suffered Neonatal Jaundice, had five (5) times increased risk of getting leukemia [AOR= 5.05, 95%CI: 1.738-14.664, P=0.003].ConclusionIt is important that public and private stakeholders invest more in childhood oncology researches to enable the health system deliver effective management of the cases more efficiently. Rwanda J Med Health Sci 2022;5(2):158-16

Adherence to Recommended Regimen and Associated Factors among Type 2 Diabetes Mellitus Patients in Rwinkwavu District Hospital, Rwanda

Background The main risk factor for developing various complications and hospital admissions among type 2 diabetes is poor adherence to all recommended regimens. Objective To determine adherence to recommended regimen and associated factors among type 2 diabetes at Rwinkwavu District Hospital and its catchment area. Methods A descriptive cross-sectional study was employed. A total of 307 type 2 diabetes were selected using systematic random sampling. Data were collected using a questionnaire. Descriptive analysis (frequency and percentages) to describe the participants’ characteristics, and Chi-square test to establish associated factors with adherence to recommended regimen were performed. Then multivariable logistic regression was used to determine factors independently associated with adherence to recommended regimen. Results The result shows that 85.7%, 27.0% and 38.8% of the respondents had good adherence to medication, diet and exercise respectively. Multivariable analysis revealed that not taking alcohol [aOR= 2.21; 95%CI= 1.11-4.42], accessibility of healthcare services [aOR= 2.59; 95%CI= 1.21-5.53] and no experience of drug side effects [aOR= 5.27; 95%CI= 2.46-11.32] were associated with high medication adherence. Factors associated with high adherence level to recommended diet were accessibility to healthcare services [aOR= 2.93; 95%CI= 1.20-7.17], receiving lifestyle modification sessions [aOR= 3.56; 95%CI= 1.02-12.46] and presence of chronic comorbidities [aOR= 2.36; 95%CI= 1.37-4.08]. In addition, higher level of education [aOR= 2.64; 95%CI= 1.05-6.67], accessibility to healthcare services [aOR= 2.83; 95%CI= 1.31-6.09] and shorter time since diagnosis of type 2 diabetes [aOR= 2.09; 95%CI= 1.08-4.51] were more likely to have high adherence to recommended exercise. Conclusion Different individual and clinical factors were identified as determinants of adherence to recommended regimen among type 2 diabetes patients. Therefore, the policy makers concerned with health promotion will need to consider ways of improving access to compressive lifestyle education and healthcare services as well as availing drugs with less side effects. Rwanda J Med Health Sci 2022;5(3):276-290 &nbsp

Environmental and Nutritional Determinants of Diarrhoea Disease Among Children Under Five Years in Rwanda: A Secondary Data Analysis of the Rwanda Demographic and Health Survey 2014-15

Background Diarrhoea remains one of the leading of causes of deaths in children under five years old globally. Children under five years are more vulnerable to diarrhea especially those from low and middle countries. The aim of this study was to explore the environmental and nuttitional factors associated with diarrhea among children underfive years in Rwanda. Methods A secondary data analysis of the  Rwanda Demographic and Heralth Survey 2014-2015 (RDHS 2014-2015) was used. A total sample of  7,558 children under five years old was included. The data were analysed using Stata 13. Bivariate with Chi-square test and multivariable logistic regression analysis were performed to assess the relashionship of factors associsted with diarreha. A 95% confidence interval and a significance level of 0.05 were set. Results Two environmental factors (Source of drinking water and shared toilets facilities with other households) were associated with child diarrhea. P-values: 0.029, OR:1.79, CI [1.06-3.01]; 0.019, OR:1.26, CI: [1.04-1.53] respectively. None of the selected nutritional factors was associated with childhood diarrhea. Conclusion Based on the findings, drinking borehole water and shared toilet facilities were associated with diarrhea. The study therefore recommends the provision of potable water and supporting/enabling the households to own toilets. Rwanda J Med Health Sci 2020;3(3):280-29

Predictors of Compliance to Hand Hygiene among Health Care Workers in Rwanda

BackgroundHand hygiene is critical to the prevention of Healthcare Acquired Infections. Compliance of health care workers to hand hygiene in developing countries is reportedly low.ObjectiveThe aim of this study was to assess predictors of hand hygiene compliance among healthcare workers in RwandaMethodsThis cross-sectional study was conducted in 26 selected hospitals. Trained hospital IPC focal points anonymously observed 1380 hand hygiene opportunities from 341 healthcare workers. Logistic regression analysis was used to identify predictors of compliance to hand hygiene among health care workers using Stata.ResultsThe overall compliance to HH was 72.4%. It was respectively 70%, 77% and 60% less likely in labor (AOR=0.30, 95% CI: 0.19-0.49), maternity (AOR= 0.27, 95% CI: 0.17-0.43), and neonatology (AOR= 0.40 95% CI: 0.25-0.65) departments than in theater. Other clinical staff than nurses/midwives were 35% less likely to comply than did medical doctors. The availability of water source and soap at hand washing station was associated with 2.5 times higher odds of compliance (AOR=2.46, 95% CI: 1.27-4.77).ConclusionThe compliance to HH is associated with the availability of hand hygiene facilities. Well-maintained water sources and soap at hand washing stations should be a priority in health care settings. Rwanda J Med Health Sci 2022;5(2):170-17

Effect of Positive Deviance Hearth Intervention on Acute Malnutrition Persistence among Children under Five in Burera District, Rwanda

BackgroundPositive Deviance Hearth is considered as a good approach to use existing and available resources to address malnutrition at the community level.ObjectiveThe present study aimed to determine the effect of Positive Deviance Hearth on persistent acute malnutrition management among children under five in Burera District.MethodsA comparative quasi-experimental study was conducted in Burera district. One hundred ninety six (196) participants were selected purposively. Nutrition status of children who attended Positive Deviance Hearth sessions for 12 consecutive days were measured and compared with children who were not in the HEARTH intervention.ResultsThe majority (55.6%) of children in both groups were male. The prevalence acute malnutrition persistence was significantly higher (52.0%) among the non-HEARTH intervention compared to those in the HEARTH intervention area (20.4%). In reduced model of the multivariate analysis, persistence of acute malnutrition was 87% higher among children in the non-Hearth intervention compared to those in Hearth intervention (AoR= 0.13; 95%CI: [0.05-0.35], p<0.001).ConclusionThe use of Positive Deviance Hearth model was significantly associated with low prevalence of malnutrition persistence; therefore, it should be adopted by the Ministry of Health. Rwanda J Med Health Sci 2022;5(2):180-18

Childhood emotional and behavior problems and their associations with cesarean delivery

Objective: To determine the prevalence of childhood emotional and behavioral problems and examine their associations with cesarean delivery. Methods: Our sample consisted of 8,900 preschoolers from 35 kindergartens in four cities in East China. Parents completed the Strengths and Difficulties Questionnaire (SDQ) and provided other information. Children’s emotional and behavioral problems were assessed using five subscales of the SDQ. Mode of delivery was classified as vaginal or cesarean section (CS); in sub-analyses, we divided CS into elective or emergency delivery. Logistic regression was used to examine associations. Results: A total of 1,209 (13.6%) children had a total SDQ score within abnormal range; 25.5% had peer problems within abnormal range, 9.0% had abnormal emotional symptoms, 13.9% had abnormal conduct problems, 18.9% had abnormal hyperactivity problems, and 16.2% were rated abnormal in pro-social behavior. Overall, 67.3% of the children who participated were delivered by CS. In fully adjusted analysis, CS was significantly associated with abnormal total SDQ score (OR = 1.27; 95%CI 1.10-1.46; p < 0.05) and pro-social behavior (OR = 1.27; 95%CI 1.12-1.45; p < 0.0001). No significant association was found between CS and risk of having conduct problems (OR 1.13; 95%CI 0.98-1.29), peer problems (OR 1.11; 95%CI 0.99-1.24), hyperactivity (OR 1.02; 95%CI 0.91-1.15), or emotional problems (OR 1.06; 95%CI 0.90-1.24). Conclusion: In this sample, CS was associated with risk of behavioral problems, but not with emotional problems. Further research is needed to better understand these associations

Maternal, obstetric and gynecological factors associated with preterm birth in Rwanda: findings from a national longitudinal study

Abstract Background Preterm birth is one of the key causes of morbidity and mortality among neonates in low-income countries. In Rwanda, at least 35,000 babies are born prematurely each year, and 2600 children under the age of five die due to direct complications of prematurity each year. A limited number of studies have been conducted locally, many of which are not nationally representative. Thus, this study determined the prevalence as well as the maternal, obstetric, and gynecological factors associated with preterm birth in Rwanda at the national level. Methods A longitudinal cohort study was conducted from July 2020 to July 2021 among first-trimester pregnant women. A total of 817 women from 30 health facilities in 10 districts were included in the analysis. A pre-tested questionnaire was used to collect data. In addition, medical records were reviewed to extract relevant data. Ultrasound examination was used to assess and confirm gestational age on recruitment. A multivariable logistic regression analysis was performed to determine the independent maternal, obstetric, and gynecological factors associated with preterm birth. Results The prevalence of preterm births was 13.8%. Older maternal age- 35 to 49 years [Adjusted odds ratio (AOR) = 2.00; 95% Confidence Interval (CI) = 1.13–3.53)], secondhand smoke exposure during pregnancy (AOR = 1.91; 95% CI = 1.04–3.51), a history of abortion (AOR = 1.89; 95% CI = 1.13–3.15), premature membrane rupture (AOR = 9.30; 95% CI = 3.18–27.16), and hypertension during pregnancy (AOR = 4.40; 95% CI = 1.18–16.42) were identified as independent risk factors for preterm birth. Conclusion Preterm birth remains a significant public health issue in Rwanda. The associated risk factors for preterm birth were advanced maternal age, secondhand smoke, hypertension, history of abortion, and preterm membrane rupture. This study therefore recommends routine antenatal screening to identify and closely follow-up of those high-risk groups, in order to avoid the short- and long-term effects of preterm birth