Exploring depression among people living with HIV/AIDS and attending a primary health care centre in Kigali, Rwanda : a descriptive, cross-sectional study.

Thesis (MN)-University of KwaZulu-Natal, Durban, 2010.HIV is major public problem in the world and in Sub-Saharan Region in particular. The literature has shown that mental disorders and particularly depression are common among people living with HIV/AIDS, but that little is known about the prevalence of depression and factors associated with it, among people living with HIV/AIDS in Rwanda. A descriptive, cross-sectional study was done to assess the prevalence of depression, the clinical profile and the factors associated with depression among people living with HIV and attending a primary health care centre in Kigali-Rwanda. This study was informed by the stress and vulnerability framework. A questionnaire was used to collect socio-demographic and HIV related medical information, while depression was assessed using the Beck Depression Inventory Scale, with a cut off of less than 10 for no depression and above 10 scoring positive for depression. Respondents were randomly selected from the patient appointment list for patients who were scheduled during the period of data collection and according to the sample selection criteria. The sample consisted of 96 people living with HIV. Permission to conduct the study was requested and obtained from the University of Kwazulu-Natal Ethics Committee, from the CNLS Research and Ethics Committee in Rwanda and from the management of the health care centre to consult patients' files. Data was analyzed using the Statistical Package for the Social Sciences (SPSS for window, 15). Descriptive data was analyzed by means of frequencies, mean and standard deviation. Cross tabulation using Pearson' chi-square test was performed to test the association between sociodemographic factors and HIV related medical information and depression for categorical variables, while t-test for independent simple test was performed for continuous variable. Multi logistic regression analysis was performed to test further association between the above mentioned factors with depression, while controlling for confounders. The results were presented by means of tables, histograms and graphs. The findings of the study revealed that depression is very high among HIV-infected patients attending a primary health care centre in Kigali, with a prevalence of 41.7%. The most frequent depressive symptoms presented were pessimism, fatigability, sad mood; lack of satisfaction, somatic preoccupation, loss of libido, crying spells, work inhibition, irritability, social v withdrawal and loss of appetite. The majority of respondents scored mild to moderate depression, whereas few had moderate to severe depression and only very few scored severe depression. Having considered all other socio-demographic and HIV related medical factors that were studied, being a female, having presented many HIV-related symptoms in the month prior to data collection, and having less than 250 CD4 counts were statistically associated with depression. On the other hand, having high social and family support was a protector factor to depression. Although the results of this study are not generalizable to the Rwandan population living with HIV, they underscore the importance of integrating mental health in HIV/AIDS services for the care of those who present mental problems related to HIV such as depression

Values, Assumptions, Behaviours, and Practices Influencing the Professional Development of Nursing Students Within Acute Care Practice Environments in Rwanda: A Focused Ethnographic Study

The future of the nursing profession in Rwanda in large part depends on the nursing students who join the workforce and the training they have received. Preparing them to enter the profession with the necessary clinical competencies, values, and attitudes requires practice-based learning environments to become more supportive of facilitating their professional development. The current learning environments experienced by nursing students in Rwanda, and the values, assumptions, practices, and behaviours of different stakeholders involved in preparing them to enter professional practice, have not yet been explored. The aim of this study was to address that knowledge gap by exploring the values, assumptions, practices, and behaviours within acute care practice environments and an educational institution within a resource-limited context like Rwanda and how the cultural aspects of these environments influence the development of nursing students as future nurses in professional practice. Guided by a constructive lens, this study used focused ethnography to explore the values and assumptions co-constructed by multiple stakeholders involved in the professional growth of students, particularly from the perspective of students, staff nurses, clinical instructors, and nurse leaders. Individual interviews, observations, and document reviews were used as data sources. Findings from this study revealed that the acute care practice learning environment is a multifaceted entity influenced by interconnected sets of values, assumptions, behaviours, and practices that intersect at institutional, unit, and individual levels. Nurturing, professional gatekeeping and engagement emerged as positive values and assumptions that guided clinical settings and academic program members in their behaviours and practices to nurture and support nursing students as they develop into future nursing professionals. On the other hand, collaboration, structural, and interpersonal barriers prevented the acute care practice environments and the academic institution from enacting these positive beliefs and values. This disconnect between values and the actual enacted practices and behaviours within acute care practice units and by individuals constrained practice environments and academic programs from creating and sustaining enriched and positive environments conducive to preparing students for professional practice. The findings of this study illuminate that building and sustaining a nurturing and positive learning environment that fosters the professional development of nursing students requires a multifaceted approach that engages every concerned stakeholder in “co-creating” a learning culture to close the existing gap between the desired learning environment and the actual unit practices and individual behaviours. Recommendations related to policy, education, practice, and research have been formulated and addressed in this dissertation

Patients’ Experiences of Seclusion during Admission in Psychiatric Settings in KwaZulu-Natal: A Qualitative Study

Background In South Africa, seclusion is one of the practices used in the management of disruptive behaviors in psychiatric settings. Despite its continued use, seclusion is always subject to controversial debates, and patients who undergo it express a range of negative experiences. Objective To explore the experiences of patients regarding seclusion during their admission in a psychiatric hospital. Methods A qualitative descriptive design was used. In-depth interviews were conducted with ten patients attending a community psychiatric clinic in KwaZulu-Natal. Interviews were analyzed using content analysis. Results Two themes emerged from the findings: controversial views of seclusion and negative experiences of seclusion. Seclusion was considered more as a punishment measure which was often used abusively, than a therapeutic intervention. Participants expressed loneliness, humiliation, and powerlessness following their seclusion experience. Limited patient-staff interaction and communication worsened patients’ negativity towards seclusion. Conclusion Findings from this study underscore the need to review practices, policies and procedures regarding the use of seclusion. Seclusion should be only used when the need is absolute and as the last treatment option. Open communication between the care providers and the patients should be emphasized during the time of seclusion. Rwanda J Med Health Sci 2020;3(3):342-36

Motivators and Barriers for Using E-learning During the COVID-19 Pandemic among Students at the College of Medicine and Health Sciences, University of Rwanda

BackgroundTo continue delivering the courses despite school closure during the covid-19 pandemic, the University of Rwanda abruptly shifted its teaching from traditional physical to online teaching. This was the compulsory medium of teaching during the lockdown period. This sudden change did not allow for adequate preparation for students. ObjectivesTo assess the preparation of learners to use the e-learning platform, and to explore the factors that enabled or inhibited learners’ use of the e-learning platform. MethodThis was a cross-sectional quantitative research design study done between June and July 2020. An online questionnaire was sent to all students registered in the College of Medicine and Health Sciences for the academic year 2019-2020. ResultsA total of 446 students completed the questionnaire. Students reported not being adequately oriented and unprepared to effectively use e-learning. Students were motivated to use e-learning when the learning objectives were clear, interactive, with engaging materials. Inadequate e-learning infrastructure, limited access to internet connectivity and inadequate devices were identified as the strongest barriers of using e-learning. ConclusionThe covid-19 pandemic has brought a transformational opportunity to embrace a blended learning approach. To sustain such a transformation, proper and timely planning and strategies need to be invested. Rwanda J Med Health Sci 2022;5(1):99-11

Teaching and Learning during COVID-19 Crisis: Faculty Preparedness and Factors Influencing the Use of E-learning Platform at the College of Medicine and Health Sciences, University of Rwanda

BackgroundTowards the beginning of 2020, the COVID-19 pandemic spread worldwide and caused many schools to close. Many educational institutions transitioned from traditional face-to-face or blended to a total e-learning approach. The University of Rwanda rapidly shifted from a blended teaching and learning approach to a total e-learning approach. Thus,this study assessed the faculty preparedness and the factors influencing the use of e-learningplatforms at the College of Medicine and Health Sciences.MethodsThe study used a cross-sectional design. A web self-administered questionnaire was used to collect data from 450 CMHS faculty from June to July 2020, with a response rate of 34.4% (n=155). SPSS was used to describe nominal variables with frequencies and percentages. Similarly, continuous variables were analyzed by calculating median and interquartile ranges. The Chi-Square and Man-Whitney tests were also computed using SPSS.ResultsThe majority of participants (93.7%) started using the e-learning approach, and 92.4% attended e-learning training. The top motivator for e-learning use was a personal interest in technology use (93.3%) and the leading barrier to using e-learning was the concern about access to students (77.1%).ConclusionThis study found that faculty preparedness was significantly associated with e-learning use. The leading motivator and barriers were a personal interest in technology use and concern about access to students, respectively.Rwanda J Med Health Sci 2022;5(2):189-20

An International Pilot Study of Self-Reported Quality of Life in Outpatient and Inpatient Mental Health Settings

troduction: Measuring quality of life (QoL) is essential to understand how clients perceive their care. In practice, many instruments are in place to identify mental health diagnoses and measure treatment outcomes, but there are fewer standardized instruments to routinely collect information about self-reported QoL, especially across different mental health settings. Moreover, existing tools have been criticized for being built from the perspective of care professionals rather than the users' perspective. The 23-item Self-Reported interRAI-QoL Survey for Mental Health and Addictions (interRAI SQoL-MHA) tackles these issues, as it is based on self-reported measures and has proven validity across settings and countries.Objective: The aim of this study is to assess and compare QoL across settings and explore associations between dimensions of self-reported QoL and some items from the interRAI SQoL-MHA in a multinational sample.Settings: Inpatient and community mental health services.Methods: Data were collected from organizations in Belgium, Finland, Russia, Brazil, Rwanda, Canada and Hong Kong. Logistic regression models were constructed using each domain scale of the interRAI SQoL-MHA (relationship, support, hope, activities and relationship with staff) as dependent variables.Results: A total of 2,474 people (51.2% female, 56.7% of age 45 or older) were included in the study. A benchmark analysis showed the samples that performed above the benchmark line or below. The models yielded significant odds ratios among the domain scales, as well as for the items of the interRAI SQoL-MHA, with positive associations for the items “work and education opportunities” and “satisfied with services”, and inverse associations for the items “financial difficulties” and for the inpatient setting.Conclusion: The analysis of associations between the determinants offers relevant information to improve mental health care and clients' perceived quality of life. Information about the determinants can help policymakers to design interventions to improve care outcomes, as well as provide more possibilities for integration into the community. The interRAI SQoL-MHA is innovative, as it can be linked to the third generation interRAI MH and Community MH-instruments, to be used in different mental health care settings, combining the objective and subjective QoL domains.</p