Perceived effects of burnout on patients and its management among nurses in the Intensive Care Unit and Emergency Department of a Rwandan University Teaching Hospital

Background: The level of burnout among nurses working in the Intensive Care Unit (ICU) and Emergency Department (ED) is high, which adversely affects health and work-related outcomes for both nurses and patients. Little is known about burnout among ICU and ED nurses in Rwanda.Objective: To explore the perceived effects of burnout among nurses and its management at a referral hospital in Rwanda.Methods: A qualitative study design was carried out using focus groups. A purposive sample of six ICU and six ED nurses were recruited from the referral hospital in the capital city of Kigali. The discussions were audio-recorded in Kinyarwanda, transcribed verbatim into English and analysed inductively using thematic analysis.Results: Burnout among the 12 nurses was high and the five main themes namely, high burnout, the Variability of care, Incomplete care, Erratic care and Improving situation to prevent burnout.Conclusion: The results of this study indicated that burnout is high between the ICU and ED study population and nurses need to be taken care of too. A good working environment addressing adequate staffing, specialty training, operational materials, and social activities are needed to improve unit functioning, and patient satisfaction and safety.Keywords: Burnout, nurses, Intensive Care Unit, emergency department, patient car

Predictors and factors associated with stunting among under- five-year children: a cross-sectional population-based study in Rwanda of the 2014-2015 demographic and Health Survey

Background: Globally, stunting affects 159 million Under-five-years-old (U-5) children. Stunting affects the physical, mental, and cognitive development of children increasing the risk of suffering and death. This paper aimed to determine the predictors and factors associated with stunting among under-five children in Rwanda.Methods: We retrieved data from the Rwanda Demographic and Health Survey (RDHS) 2014-2015 data set. A sample of 3599 U-5 eligible children with complete and valid anthropometric data was taken. Stata software was used to analyze the data extracted using a developed checklist. Descriptive statistics and Logistic regression analysis were performed to test the association between study variables.Results: Of 3599 U-5 children, 37.5% of children were stunted. The demographic characteristics: age (p< 0.001), sex (p<0.001), and place of residence (p< 0.001) and Household wealth index (p <0.001) were associated with stunting. Age, sex, and household wealth index were predictors of stunting.Conclusion: Stunting is still a burden in Rwanda. Age and sex were predictors of stunting among children under 5 years of age.Household wealth index was a predictor and significantly associated with stunting among children U-5 years in Rwanda. Investing in the interventions that target maternal and nutrition health support is imperative.Keywords: Predictors; Stunting; children; under five years; Rwanda

Hemodialysis care by nurses: exploration of performance factors at four nephrology units in Rwanda

Background: Hemodialysis is the most standard method of Renal Replacement Therapy (RRT) used in Rwanda. Nephrology nursing is a new speciality, and little is known about the nurses’ work performance while caring for patients under going hemodialysis.Objective: To explore factors influencing nurse’s work performance in the care of hemodialysis patients in four nephrology units in Rwanda.Methods: A qualitative descriptive design used a purposive sampling strategy to recruit 12 registered nurses working on the hemodialysis unit. Data were collected through interviews using a semistructured guide. Data analysis used a thematic approach with six phases.Results: Two themes and eight subthemes were revealed. Facilitating factors to increase work performance included the nurses’ education and speciality training, good working environment, good interpersonal relationships among staff, and effective management and leadership. Barriers included, self-perceived knowledge and skills insufficiencies, moral distress, logistical concerns, and poor working conditions.Conclusion: The findings revealed specific facilitating factors and barriers to nurses’ work performance. Nurses at these study sites, in conjunction with faculty in the Master’s Nephrology Track at the University of Rwanda, could become change agents and begin to increase facilitating factors and decrease barriers. Continual improvement in facilitating factors is needed to keep nurses performing well.Keywords: Nephrology, hemodialysis, nurses, work performanc

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

BLOCKCHAIN TECHNOLOGY SECURITY CONCERNS:LITERATURE REVIEW

Blockchain is a technology that allows the decentralization of data stored in a way that there is no single central actor to control or modify the data. Bitcoin is the first successful blockchain application implemented with the concept known as cryptocurrency that allows a transaction flow without any bank or government to control it. Blockchain is associated with benefits including high level of transparency, integrity, trust and confidence for the participants. Blockchain is still at early stage but it is a promising technology that has the potential to impact many more areas in the future. However, its security area is still the weakest part of it which still needs improvement. Therefore, this thesis aims to make a review of the blockchain security issues using the past published literature between 2010 and 2021. This thesis conducts a review on 20 articles to provide a scientific input that gives an overall view of existing security threats and their respective impacts on blockchain system. This thesis starts with an overview of how blockchain system works and briefly discuss on the information security of blockchain. The collection of security attacks from the literature has been carried out by using concept centric matrix approach. This process resulted to security attacks that were classified based on four layers of blockchain system architecture. Then, the security attacks are mapped to common security impacts including double spending, unauthorized code execution, denial of service, unfair income and privacy key leakage. These security impacts were analyzed which led to the conclusion that the major security issues on blockchain result from its P2P network architecture and its consensus mechanism. Besides, some possible solutions to mitigate the security threats were discussed though, more effort in developing new security measures and protocol framework is still required

BLOCKCHAIN TECHNOLOGY SECURITY CONCERNS:LITERATURE REVIEW

Blockchain is a technology that allows the decentralization of data stored in a way that there is no single central actor to control or modify the data. Bitcoin is the first successful blockchain application implemented with the concept known as cryptocurrency that allows a transaction flow without any bank or government to control it. Blockchain is associated with benefits including high level of transparency, integrity, trust and confidence for the participants. Blockchain is still at early stage but it is a promising technology that has the potential to impact many more areas in the future. However, its security area is still the weakest part of it which still needs improvement. Therefore, this thesis aims to make a review of the blockchain security issues using the past published literature between 2010 and 2021. This thesis conducts a review on 20 articles to provide a scientific input that gives an overall view of existing security threats and their respective impacts on blockchain system. This thesis starts with an overview of how blockchain system works and briefly discuss on the information security of blockchain. The collection of security attacks from the literature has been carried out by using concept centric matrix approach. This process resulted to security attacks that were classified based on four layers of blockchain system architecture. Then, the security attacks are mapped to common security impacts including double spending, unauthorized code execution, denial of service, unfair income and privacy key leakage. These security impacts were analyzed which led to the conclusion that the major security issues on blockchain result from its P2P network architecture and its consensus mechanism. Besides, some possible solutions to mitigate the security threats were discussed though, more effort in developing new security measures and protocol framework is still required

Knowledge and practices of mothers on home management of diarrhoea in under-fives children at selected primary health care Centre, Rwanda: A descriptive cross-sectional study

Background: Diarrhea remains the main cause of morbidity and mortality in children under 5 years old, accounting for nearly-two million deaths per year globally. Mothers play a significant role in prevention and management of diarrhea related diseases. Aim: The study aimed at assessing the knowledge and practice of mothers on home management of diarrhea in under five children at Ruli health centre in Gakenke district, Rwanda. Methodology: A quantitative non-experimental descriptive cross-sectional design was conducted from April to May 2019. Using simple random sampling, a sample of 160 mothers were selected. Data was collected using a structured interview schedule. Descriptive statistics were used to describe demographics, knowledge, and practice of mothers. Inferential statistics of chi squared, and correlational coefficient (r) were used in identification of significant associations and relationships between demographic factors, mother’s knowledge, and practices. Results: Poor knowledge and practices were found in 55.6 % and 52.5 % of mothers, respectively. The diarrhea treatment methods utilized included: using sweetened tea, fruits, drinks, or coffee (76 %), homemade fluids (48.1 %), breast milk, rice drained or clean water and porridge (45 %). Additionally, 31.9 % did not even wash utensils or foods and fruits. Knowledge was significantly associated with both age (p = 0.035); and wealth status (p = 0.033) whilst practice with age (p = 0.002) and a child’s caretaker (p = 0.040). There was a strong significant positive linear correlation between practice and knowledge (r = 0.755; p = 0.0001). Conclusion: The mother’s knowledge and practice regarding home management of diarrhea was poor. There is need to implement health policy and intensify effective health education approach on home management of diarrhea among mothers with children under 5 years old