The utilization of procedural sedation and analgesia at the University Teaching Hospital of Kigali, Rwanda

Introduction: In the Emergency Department (ED), safe and effective Procedural Sedation and Analgesia (PSA) is essential. The professional performing procedural sedation has to be prepared to handle any potential adverse effects. Medications are used according to their availability and based on the physician’s experience and preference. Despite the common occurrence of procedural sedation in the ED, it has not previously been studied in Rwanda. The study aimed to describe procedural sedation and analgesia utilization and common adverse events at Rwanda's University Teaching Hospital of Kigali (UTH-K) ED.Methods: This study is a prospective observational study of procedural sedations done at UTH-KED. The effectiveness of sedation was evaluated using the Richmond Agitation Sedation Score (RASS) during sedation. The pain scale was assessed before and after the procedure. Categorical data were analyzed for significant differences using Chi-squared (X) tests and continuous data with Mann-Whitney (MW) tests.Results: Two hundred fifty-one patients were recruited. Seventy-two percent (72%) of patients were male with a median age of 32 years (IQR 23to 40). The most commonly used analgesics included morphine (78%) and tramadol (17%), with ketamine least used (1%). A common adverse event was hypoxia (36%), followed by hallucination (8%). No adverse events were observed in 47% of procedures. Conclusion: Our study findings suggest that although sedation in our low-resource setting did not result in serious adverse outcomes for patients, there was a much higher incidence of minor adverse events (especially hypoxia) than in higher-resource settings

Perceived barriers to management of chronic kidney disease

INTRODUCTION: The number of patients with chronic kidney disease (CKD) is gradually increasing in developing countries such as Rwanda. Barriers to the management of CKD from nurses' perspectives is not an area that has been well explored. This study aimed to assess the perceived barriers to CKD management from the perspective of nurses working at the referral hospitals in Rwanda.METHODS: The study used a cross-sectional research design. The study setting was selected referral hospitals in Kigali. A convenience sample of 55 nurses was obtained and data was collected using a self-administered questionnaire. Analyses were done using descriptive and inferential statistics in the SPSS application.RESULTS: Respondents identified the most barriers to management of CKD as: limited knowledge of CKD (96%) and its risk factor of glomerulonephritis (93%), limited information of dialysis (98%) and fluid restriction (95%) treatment as well as a lack of further training on nephrology nursing (93%). Shortage of nephrologists and nurses (98%) and a multidisciplinary care team (95%) were resource barriers. Other barriers were limited knowledge of CKD risk factors: hypertension (78%) and HIV/AIDS (80%), limited in-service training (69%), and non-adherence (86%). The experience of respondents was associated with limited knowledge of CKD risk factors: hypertension (P =0.001), diabetes (P=0.001) and HIV/AIDS (P=0.040). The level of nursing obtained by the respondents was associated with a lack of further special training (p=0. 001), limited in-service training (P=0.028) and non-adherence of CKD patients (P=0.017).CONCLUSION: Barriers to CKD management in Rwanda are evident. There is a need for in-service training for nurses in order to improve the proper treatment of the CKD population.&nbsp

Assessment of aflatoxin and fumonisin contamination levels in maize and mycotoxins awareness and risk factors in Rwanda

Mycotoxins are secondary metabolites of fungi that are toxic to humans and animals when consumed in contaminated food and feed. The Rwandan climate conditions like steady temperature and sufficient rainfall favor the growth of fungi leading to high probability of mycotoxins contamination. Mycotoxins get into maize throughout the value chain from the field to processed products. Maize is  promoted in Rwanda under the Crop Intensification Program (CIP), for nutrition and food security. The aim of the study was to evaluate mycotoxins (Aflatoxin and fumonisin) levels in maize and assess awareness and factors associated with mycotoxin contamination in Rwanda. Maize samples (227 kg) from season B 2019 were collected in 15 Districts in five provinces of Rwanda after an interview with a representative of the household or cooperative using a structured questionnaire. The samples were analyzed for aflatoxin and  fumonisin using Reveal Q+ and AccuScan Gold Reader. From the interview, most of the respondents were not aware about aflatoxin (59.7 %) and 99 % did not know the effect of mycotoxins on human health. The average of aflatoxin contamination in surveyed districts was 6.69±13 μg/kg. In general, 90.4 % of samples scored below the limit of aflatoxin level regulated in East Africa/Kenya regulation standards (10 μg/kg). The levels of aflatoxin ranged between 0 and 100.9 μg/kg. The means aflatoxin levels within districts ranged between 1.36±0.5 μg/kg and 13.75±25 μg/kg. Among 9.6 % of the samples containing aflatoxins above the EU and Kenyan regulations standard limit, 5.7 % were above the US standards of 20 μg/kg. Within clusters, the level of aflatoxin more than 10 μg/kg was 5 %, 7 % and 18 % for stores, household and market samples, respectively. From the study, as mechanical damage of grains, moisture content of grains and the temperature of the store house increased, Aflatoxin level also increased. Fumonisin analyzed in maize ranged from 0 to 2.3 μg/g and only one sample from market showed a slightly higher level of fumonisin than the EU and US limit of 2 μg/g. More effort for aflatoxin mitigation is needed at the market level. Farmers need to be aware and taught how they can improve their agricultural system and more knowledge on mycotoxin control is needed. The results point to appropriate measures to recommend for control ofmycotoxins in Rwanda and awareness creation. Key words: AccuScan, Aflatoxin, Fumonisin, Fungal, Maize, Mycotoxins, Reveal Q+, Rwand

The Contribution of FDI Inflows on High Technological Structure of Rwanda Manufactured Exports

The contribution of Foreign Direct Investment inflows on High Technological Structure of Rwanda Manufactured Exports for the period 1987-2017. We used a Vector Autoregressive model, to analyze this relationship: determined the lag structure verified the stationarity of both series and explored co-integration and causality between High-technology manufactured exports, total exports value and Foreign Direct Investment inflows. Our findings established that a VAR (1) was the appropriate model and found that all variables have long-term or long-run equilibrium in Rwanda as confirmed by Tests of co-integration. Granger tests have suggested that technological structure of manufacturing and Foreign Direct Investment inflows are independent (no causality between them) for the Rwandan economy while Foreign Direct Investment inflows have a great contribution on Rwanda manufactured exports. The study also suggests that the policy regarding domestic efforts to enhance manufacturing exports needs reassessment in line with the FDI policy framework in order to reap maximum and long-term equilibrium

Trends and characteristics of high-frequency type II bursts detected by CALLISTO spectrometers

Solar radio type II bursts serve as early indicators of incoming geo-effective space weather events such as coronal mass ejections (CMEs). In order to investigate the origin of high-frequency type II bursts (HF type II bursts), we have identified 51 of them (among 180 type II bursts from SWPC reports) that are observed by ground-based Compound Astronomical Low-cost Low-frequency Instrument for Spectroscopy and Transportable Observatory (CALLISTO) spectrometers and whose upper-frequency cutoff (of either fundamental or harmonic emission) lies in between 150 MHz-450 MHz during 2010-2019. We found that 60% of HF type II bursts, whose upper-frequency cutoff >= 300 MHz originate from the western longitudes. Further, our study finds a good correlation (similar to 0.73) between the average shock speed derived from the radio dynamic spectra and the corresponding speed from CME data. Also, we found that analyzed HF type II bursts are associated with wide and fast CMEs located near the solar disk. In addition, we have analyzed the spatiotemporal characteristics of two of these high-frequency type II bursts and compared the derived from radio observations with those derived from multi-spacecraft CME observations from SOHO/LASCO and STEREO coronagraphs. (C) 2021 COSPAR. Published by Elsevier B.V. All rights reserved.Peer reviewe

Controlling hepatitis C in Rwanda: a framework for a national response

With the introduction of direct-acting antiviral drugs, treatment of hepatitis C is both highly effective and tolerable. Access to treatment for patients, however, remains limited in low- and middle-income countries due to the lack of supportive health infrastructure and the high cost of treatment. Poorer countries are being encouraged by international bodies to organize public health responses that would facilitate the roll-out of care and treatment on a national scale. Yet few countries have documented formal plans and policies. Here, we outline the approach taken in Rwanda to a public health framework for hepatitis C control and care within the World Health Organization hepatitis health sector strategy. This includes the development and implementation of policies and programmes, prevention efforts, screening capacity, treatment services and strategic information systems. We highlight key successes by the national programme for the control and management of hepatitis C: establishment of national governance and planning; development of diagnostic capacity; approval and introduction of direct-acting antiviral treatments; training of key personnel; generation of political will and leadership; and fostering of key strategic partnerships. Existing challenges and next steps for the programme include developing a detailed monitoring and evaluation framework and tools for monitoring of viral hepatitis. The government needs to further decentralize care and integrate hepatitis C management into routine clinical services to provide better access to diagnosis and treatment for patients. Introducing rapid diagnostic tests to public health-care facilities would help to increase case-finding. Increased public and private financing is essential to support care and treatment services