Assessing the Twinning Model in the Rwandan Human Resources for Health Program: Goal Setting, Satisfaction and Perceived Skill Transfer

Because of the shortage of health professionals, particularly in specialty areas, Rwanda initiated the Human Resources for Health (HRH) Program. In this program, faculty from United States teaching institutions (USF) twin with Rwandan Faculty (RF) to transfer skills. This paper assesses the twinning model, exploring USF and RF goal setting, satisfaction and perceptions of the effectiveness of skill transfer within the twinning model

Health Outcomes of Exposure to Extreme Stress Among Rwandan Adults Born of Genocidal Rape

Genocide has profound effects on humanity that go beyond its primary victims, to those conceived during this extremely stressful time. Rape was used systematically as a weapon of genocide against Tutsi in Rwanda in 1994; 350,000 women were raped and between 2,000 and 10,000 children were born as a result. Limited attention has been given to the lived experience of the offspring conceived through genocidal rape. Yet, this population might endure significant effects of the genocide and genocidal rape throughout their lives, including high risk of early onset of poor mental and physical conditions. I summarized the current knowledge via an integrative systematic review of the lived experience of the offspring conceived through genocidal rape. I then conducted a cross-sectional study in Rwanda, using multiple measures including adverse childhood experience and self-reported mental and physical health outcomes to characterize the adult phenotypes and estimate health disparities among the offspring of genocide survivors (aged 24 years) conceived through genocidal rape compared to age- and sex-matched offspring of genocide survivors conceived during the genocide, but not of rape age- and sex-matched offspring of women who were out of the country during genocide. The integrative review revealed that the offspring conceived through rape grapple with their identities as the children of rape perpetrators, often receive poor health care early in life and experience higher rates of mental health problem and discrimination, thus carrying an intergenerational legacy of their mothers’ rape. The cross-sectional study demonstrates that: 1) Rwandan young adults conceived during the genocide compared to sex- and age-matched young adults who were not exposed to genocide have significantly poorer mental and physical health outcomes; and 2) young adults conceived by genocidal rape compared to those exposed to genocide only had additional burdens of poorer mental and physical health outcomes; and 3) the effects of these prenatal exposures were moderated by accumulated adverse childhood experiences. Further studies could focus on mechanistic pathways linking the exposures to outcomes, and prospective studies would allow to better grasp health change as this population ages and determine whether and how genocidal trauma passes to the next generation

Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers

Background: The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores. Methods: This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 – November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey. Results: Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p \u3c 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p \u3c 0.05). Conclusions: The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic

Assessing the twinning model in the Rwandan Human Resources for Health Program: goal setting, satisfaction and perceived skill transfer.

BackgroundBecause of the shortage of health professionals, particularly in specialty areas, Rwanda initiated the Human Resources for Health (HRH) Program. In this program, faculty from United States teaching institutions (USF) "twin" with Rwandan Faculty (RF) to transfer skills. This paper assesses the twinning model, exploring USF and RF goal setting, satisfaction and perceptions of the effectiveness of skill transfer within the twinning model.MethodsAll USF and RF in the HRH Program from August 2012-May 2014 were invited to participate. An 85-item questionnaire for USF and 71-item questionnaire for RF were administered via Survey Monkey in April and May 2014. Associations among primary outcomes were assessed and factors related with outcomes were modeled using logistic regression.ResultsMost RF and USF reported setting goals with their twin (89% and 71%, respectively). Half of RF (52%) reported effective skill transfer compared to 10% of USF. Only 38% of RF and 28% of USF reported being very satisfied with the twinning model. There was significant overlap in the three operational outcomes. For RF, the following factors were associated with outcomes: for effective skill transfer, being able to communicate in a common language and working at a nursing site outside of Kigali; and for satisfaction, 7+ years of professional experience and being part of a male RF-female USF twin pair. For USF, the following factors were associated with outcomes: for setting goals, prior teaching experience; and for satisfaction, experience in low resource settings for one month or less and feeling that HRH promotes a culture of respect.ConclusionsTwinning is the cornerstone of the HRH Program in Rwanda. These findings helped the HRH team identify key areas to improve the twinning experience including better recruitment and orientation of USF and RF, consideration of additional factors during the twinning process, provide language training support, facilitate joint twin activities and cross-cultural training and improve the site leadership buy-in and support of the program. These results can inform other programs using twinning to develop skills in the health workforce

Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population

PurposeStable angina is ischemic chest pain on exertion or with emotional stress. Despite guideline-directed therapy, up to 30% of patients have suboptimal pain relief. The aims of this study were to: (1) determine the feasibility and acceptability of a randomized controlled trial (RCT) of acupuncture; and (2) evaluate preliminary efficacy of acupuncture with respect to reduction of pain and increased functional status and health-related quality of life (HRQoL).MethodsParticipants with stable angina for ⩾1 month received either a standardized acupuncture protocol, twice per week for 5 weeks, or an attention control protocol. Measures included the McGill Pain Questionnaire (average pain intensity (API), pain now) and the Seattle Angina Questionnaire-7 (functional status, symptoms, and HRQoL). Feasibility was defined as ⩾80% recruitment, ⩾75% retention following enrollment, and ⩾80% completion. Descriptive statistics and mixed-effects linear regression were used for analysis.ResultsThe sample (n = 24) had a mean age of 59 ± 12 years, was predominantly female (63%), and represented minority groups (8% White, 52% Black, 33% Hispanic, and 8% Other). Feasibility was supported by 79% retention and 89% completion rates. The recruitment rate (68%) was slightly lower than expected. Acceptability scores were 87.9% for the acupuncture group and 51.7% for the control group. Outcomes were significantly better for the acupuncture versus control groups (API, b = -2.1 (1.1), p = 0.047; functional status, b = 27.6 (7.2), p < 0.001; and HRQoL, b = 38.8 (11.9), p = 0.001).Conclusions and implicationsAcupuncture was feasible and acceptable in our diverse sample. We were slightly under the recruitment target of 80%, but participants who started the study had a high likelihood of completing it. Acupuncture shows promise for stable angina, but its effectiveness needs to be confirmed by a larger, adequately powered RCT.Trial registration numberNCT02914834 (ClinicalTrials.gov)

Additional file 1: of Assessing the twinning model in the Rwandan Human Resources for Health Program: goal setting, satisfaction and perceived skill transfer

Univariate and multivariate associations between all covariates and outcomes, by faculty type. (DOCX 77 kb