Improving Housing Conditions of Historically Marginalised People (HMPs) in Rwanda: Mapping Regional Performance for Directed Interventions

Historically Marginalised People (HMPs), count between 0.2 and 0.4% of the Rwandan population. For many decades, they have been living in hatched houses that are not suitable for human habitation. For improving HMPs' living conditions, the Government of Rwanda committed to providing them with decent housing, access to basic infrastructure and services. For a good capture of the effectiveness of such initiatives, a survey on HMPs' housing conditions was conducted in 11 districts. Data were processed with SPSS thereafter mapped using QGIS. The study reveals that most of the HMPs villages live close to basic infrastructure and services. However, in six districts, more than 75% of HMPs households still live in derelict houses and more than 50% have no toilet and kitchen, this results in high exposure of their occupants to various diseases. On one hand, the Government of Rwanda and local government should sensitize the HMPs to build their houses themselves even though they may be assisted, and on the other introduce specific plans for their integration. Keywords: Historical Marginalised People, Housing Comfort, Access to infrastructure, Deprivation Index

Pattern and clinical management of penile cancer in Rwanda

Introduction: Penile cancer is rare in developed countries but has a high prevalence in some developing countries. Surgery includes inguinal lymphadenectomy, which remains the mainstay treatment of the disease.Objective: This study reports on the epidemiological profile of penile cancer and clinical management options in Rwanda. Patients and methods: From January 2015 to June 2016, a multicenter cross-sectional, prospective cohort study was conducted involving all male patients presenting with penile cancer after two national radio campaigns and a Ministry of Health instruction to all district hospitals. All patients with positive biopsy were included. Surgical treatment aligned with published guidelines. Clinical characteristics, surgery, pathology, and early follow-up data were collected.Results: Over 18 consecutive months, 30 male patients were enrolled. The mean age was 60 years [range 33–83]. All patients were uncircumcised before symptom onset; 50% had phimosis and 20% were HIV- positive. The estimated prevalence of penile cancer in Rwanda was 0.37 per 100,000 men. At presentation, 96.7% of patients had a T2-4 disease and 43.3% were with clinically non-palpable inguinal lymph nodes (cNO). After penectomy, bilateral inguinal lymphadenectomy was performed in 10 (33.3%) patients (modified and radical in 16 and 4 limbs, respectively). Complications included surgical site infection (10%), lymphocele (10%), urethral meatus stenosis (6.7%), skin necrosis (3.3%) and two (6.7%) patients with metastatic disease died in hospital.Conclusion: Penile cancer is a rare but significant disease in Rwanda. Patients present with advanced disease. After treatment of the primary tumor, modified inguinal lymphadenectomy appears to be a safe method of cure and staging for patients with clinically impalpable inguinal lymph nodes. Our early results provide a compelling insight into this rare but serious disease

Converging Currents in Climate-Relevant Conservation: Water, Infrastructure, and Institutions

Ecologists and economists have long talked past each other, but climate change presents similar threats to both groups. Water may serve as the best means of finding a common cause and building a new vision of ecological and economic sustainability, especially in the developing world

Stakeholders participation in wetland management : the case study of Rugezi wetland, Rwanda

The Rugezi Wetland which is located in the Nothern Province of Rwanda lies at the headwaters of the Nile River. This wetland, designated as Ramsar site due to its ecological importance, is not only of national economic importance for the production of hydro-electricity but also of a local importance due to sustaining the local communities livelihoods through hunting, agriculture, and gathering. However, because of increasing demographic pressure and intensification of exploitation of the wetland resources in the past decades, the conflict between hydropower production and agriculture started to evolve. Following its degradation from the drainage by the hydropower utility (RWASCO-RECO), and subsistence and cash crops agriculture, the restoration policy has been put in place to recover the ecological functions of the wetland. This restoration policy has been implemented through posing a ban on the agricultural activities and the restriction of local community's access to the natural resources, which have led to the escalation of the conflict. This study has the objective to assess the stakeholders involvement in the wetland management and propose suitable options for enhanced wetland management.The stakeholders analysis was conducted using the methodology of SAS2 that helped to identify the stakeholders' power, interests and legitimacy, and the way, in which those attributes shape their behaviour and participation. In addition, the stakeholders' attitudes towards the policy, and its benefits were examined, and possible options for improved wetland management proposed by the stakeholders during 2 workshops were discussed. A simplified multicriteria matrix was presented to examine possible alternatives for improved wetland management. The results also show the losses incurred by the local communities in terms of land and income from the wetland services. Positive results obtained by the government stakeholders such as attainment of goals, increased hydropower production were demonstrated. The Power, interest and legimacy were high for central government stakeholders and medium for NGOs whereas they were low to local communities. Local communities perceive the benefits and acceptance as low and want to be guaranteed the uses rights whereas the central and decentralised governments stakeholders recognise the benefits and policy acceptance as high and propose protection and alternative income activities for improved management of the wetland.The options to improve the wetland management according to multi-criteria analysis includes alternative income activities and reallocation of resources gathering rights

Relative profitability between East African Community trading and non-trading small and medium agribusiness enterprises in Rwanda

The creation of customs Union in the East African Community (EAC) block was supposed to enhance and smoothen trade, enable traders to gain more profit from their business and encourage formal trade. However, Non-Tariff Barriers (NTBs) continue to exist and affect trade within the region. The aim of this study was to analyse relative profitability between EAC trading and Non-trading Rwanda Small and Medium Agribusiness Enterprises (SMAEs) and factors that influence the participation in the EAC cross border trade. Specifically, the present study aims at determining factors influencing SMAEs’s decisions to participate in cross-border trade, to compare profits between EAC trading and non-trading SMAEs and to analyse the effect of NTBs and transport cost on profitability of SMAEs participating in EAC cross border trade. The results from binary logistic regression show that the decision to participate is significantly influenced by distance from the border, age of the firm, number of employees, management and ownership status of the firm and decision to start the business. Results from gross margin analysis show that gross margin per kilogram of beans, Irish potato, carrot and onion is greater when they are sold in the EAC market than gross margin per unit when those commodities are sold in the domestic market. In addition, results from T-test confirmed that there is significant difference between the gross margin for beans, Irish potato and onion for EAC trading when compared with non-trading. Results from multiple linear regression proved that the profit for EAC trading SMAEs is significantly affected by transport cost, clearing fees, customs charges and bribes. Therefore, EAC trading is more profitable than non-trading. However, high transport cost and Non-Tariff barriers affect the profitability of EAC trading enterprises. Furthermore, SMAEs should be confident to participate in the EAC trade and Rwanda Ministry of Trade and Industry should enhance strategies for supporting cross border export.Africa Economic Research Consortium (AERC

Relative profitability between East African Community trading and non-trading small and medium agribusiness enterprises in Rwanda

The creation of customs Union in the East African Community (EAC) block was supposed to enhance and smoothen trade, enable traders to gain more profit from their business and encourage formal trade. However, Non-Tariff Barriers (NTBs) continue to exist and affect trade within the region. The aim of this study was to analyse relative profitability between EAC trading and Non-trading Rwanda Small and Medium Agribusiness Enterprises (SMAEs) and factors that influence the participation in the EAC cross border trade. Specifically, the present study aims at determining factors influencing SMAEs’s decisions to participate in cross-border trade, to compare profits between EAC trading and non-trading SMAEs and to analyse the effect of NTBs and transport cost on profitability of SMAEs participating in EAC cross border trade. The results from binary logistic regression show that the decision to participate is significantly influenced by distance from the border, age of the firm, number of employees, management and ownership status of the firm and decision to start the business. Results from gross margin analysis show that gross margin per kilogram of beans, Irish potato, carrot and onion is greater when they are sold in the EAC market than gross margin per unit when those commodities are sold in the domestic market. In addition, results from T-test confirmed that there is significant difference between the gross margin for beans, Irish potato and onion for EAC trading when compared with non-trading. Results from multiple linear regression proved that the profit for EAC trading SMAEs is significantly affected by transport cost, clearing fees, customs charges and bribes. Therefore, EAC trading is more profitable than non-trading. However, high transport cost and Non-Tariff barriers affect the profitability of EAC trading enterprises. Furthermore, SMAEs should be confident to participate in the EAC trade and Rwanda Ministry of Trade and Industry should enhance strategies for supporting cross border export.Africa Economic Research Consortium (AERC

Management Challenges Of Pediatric Infective Endocarditis At Tertiary Level In Rwanda

Background: Management of Infective Endocarditis (IE) has been of great challenge for many years. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to good patient outcome as this condition is associated with a high morbidity and mortality in both adults and pediatric patients. In limited resources settings, management of IE is still a challenge due to early inappropriate antibiotherapy and therefore difficulties in its diagnosis and treatment. Objectives: To elicit challenges in management of patients suspected of IE at tertiary level in Rwanda. Methods: We report four patients with IE. For these patients, Duke’s criteria were considered in making the diagnosis. Results and Conclusion: IE has protean clinical symptoms and signs, and can be of challenging diagnosis. The patients reported constituted a clinical challenge in the diagnosis and management of IE but most of them had had favorable outcome. The main clinical challenge was the prolonged stay to peripheral settings with inappropriate antibiotherapy which made most of the blood cultures falsely negative. Echocardiography and serial blood cultures provide the key to diagnosis as per Dukes criteria. Being alert to this mentioned challenge is crucial. As the key investigations are not steadily available in most peripheral health facilities, we strongly recommend early referral to tertiary level for all cases of suspected IE before initiation of antibiotherapy.Introduction: Depuis plusieurs années, la prise en charge de l’endocardite bactérienne constitue un grand défi. Cette affection étant associée à une importante morbidité et mortalité tant chez l’adulte que chez l’enfant, un diagnostic rapide, un traitement efficace, et une reconnaissance rapide de complications sont des éléments essentiels pour arriver à un bon résultat thérapeutique. Dans les pays où les ressources sont limitées, la prise en charge de l’endocardite reste difficile en raison de l’antibiothérapie inappropriée initiée préalablement au niveau des structures sanitaires de base. Objectif: Identifier les défis dans la prise en charge des patients présentant une endocardite bactérienne au niveau des structures sanitaires tertiaires du Rwanda. Méthodes: Nous rapportons quatre patients qui présentaient une endocardite bactérienne. Pour tous ces patients, les critères de Duke ont été utilisés pour poser le diagnostic. Résultats et conclusion: L’endocardite infectieuse a des formes cliniques variables et peut rendre le diagnostic difficile. Bien que presque tous les patients reportés dans cette étude ont été traités avec succès, leur prise en charge n’a pas été facile d’emblée. Le plus grand défi a été un séjour prolongé sous antibiothérapie probabiliste a l’Hôpital de District, ce qui a rendu la plupart des hémocultures faussement négatives au niveau tertiaire. L’échocardiographie et une série d’au moins 3 hémocultures constituent les éléments clés des critères de Duke pour le diagnostic de l’endocardite bactérienne. Par conséquent, il est crucial pour les cliniciens de tenir compte de ces critères pour poser le diagnostic d’endocardite. Compte tenu de l’absence de moyens pour faire les hémocultures et une échocardiographie au niveau des hôpitaux de district, nous recommandons un transfert rapide au niveau de l’hôpital de référence pour tout cas suspect d’endocardite bactérienne avant d’initier l’antibiothérapie

Patients With Noonan Syndrome Phenotype: Spectrum Of Clinical Features And Congenital Heart Defect

Mutations in components of the RAS-MAPK signaling pathway have been reported to result in an expression of Noonan phenotype. This is actually a wide-spectrum-phenotype shared by Noonan syndrome and its clinically related disorders namely, the Cranio-facio-cutaneous (CFC) syndrome, Costillo syndrome as well as LEOPARD syndrome. Patients with Noonan Syndrome (NS) have mutations in PTPN11 gene in majority of cases. Recently, mutations in SOS1, RAF1, MEK1 and KRAS genes have been reported to cause NS as well. Objective: To report patients with a Noonan phenotype followed in Rwandan University Teaching Hospitals, and to show the importance of the clinical diagnosis and challenges of making the diagnosis in resource limited settings where karyotype is almost the only genetic investigation accessible. Patients and Methods: Here we are reporting 5 patients, all with relevant NS symptoms, whose morbidity is directly related to the severity of their congenital heart disease. Van der burgt et al diagnostic criteria have been used for the clinical diagnosis, karyotype studies have been performed to exclude chromosomal aberration disorders and patients DNA extraction for mutation studies have been obtained in some cases. Results and Conclusion: we identified 5 patients with clinical features highly suggestive of NS and all of them had a normal karyotype, this excluding Turner syndrome, a clinically similar syndrome. As there are many as yet discovered mutations causing NS and the famous PTPN11 mutation being present only in 50% of cases, we maintain here that NS diagnosis should be a clinical diagnosis. The morbidity and mortality of our patients were directly correlated to the severity of their congenital cardiac defect. In conclusion, early management of such patients is highly recommended.Les mutations impliquant la voie de transduction RAS-MAPK ont étaient reconnues identifiées comme causant un « phénotype du syndrome Noonan ». Ceci est en effet un phénotype de spectre très large, partagé entre le syndrome de Noonan et d’autres conditions cliniquement semblable notamment le syndrome Crânio-Facio-Cutané (CFC), le syndrome de Costillo ainsi que le syndrome de LEOPARD. Les patients atteints du syndrome de Noonan ont des mutations dans le gène PTPN11 dans la majorité des cas. Récemment, les mutations impliquant les gènes SOS1, RAF1, MEK1 et KRAS ont étaient caractérisées comme étant aussi impliquées dans le développement du syndrome de Noonan. Objectifs: rapporter des patients atteints du syndrome de Noonan suivis dans nos hôpitaux universitaires et montrer l’importance du diagnostic clinique ainsi que le défi à faire le diagnostique dans un contexte où les ressources sont limitées, seul le karyotype étant presque le test génétique accessible. Résultats et Conclusion nous avons identifié 5 patients avec un tableau clinique suggestif du syndrome de Noonan et chez qui le karyotype a été normal, ceci excluant le syndrome de Turner qui mime la clinique du syndrome de Noonan. Compte tenu du fait qu’il y a beaucoup de mutations causant le syndrome de Noonan et les mutation du gène PTPN11 n’étant présentes que dans 50% des cas, nous plaidons pour l’importance du diagnostique clinique. La morbidité et mortalité des patients signalés dans cette revue étaient directement liées à la sévérité de leurs cardiopathies congénitales. En conclusion, une prise en charge précoce de tels patients devrait être recommandée