Browsing by Subject "Rwanda"
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Item Open Access Epidemiology and Predictors of Mortality of Traumatic Brain Injury at Kigali University Teaching Hospital Accident and Emergency Department(2015) Krebs, ElizabethBackground:
Traumatic Brain Injury (TBI) is a leading cause of death and disability. TBI patients in low and middle- income countries (LMIC) have twice the odds of death than in high-income countries. There is limited data describing the epidemiology and mortality predictors for TBI in LMIC.
Objective:
Determine epidemiology and predictors of mortality in TBI patients at Kigali University Teaching Hospital Accident and Emergency Department (KUTH A&E).
Methods:
Consecutive, injured KUTH A&E patients were prospectively screened for inclusion by reported head trauma, alteration in consciousness, headache, or visible head trauma. Exclusion criteria were <10 years old, presenting >48 hours after injury, or repeat visits. Data were assessed for association with death using logistic regression. Significant variables were included in an adjusted multivariable logistic regression model then refined via backwards elimination until all variables were significant at P <0.05.
Results:
684 patients enrolled between October 7, 2013 and April 6, 2014. 12 (2%) were excluded due to incomplete data. 81% were male with mean age of 31.5 years (range 10 - 89). Most patients (75%) had mild TBI (Glasgow Coma Score (GCS) 14-15), while 15% had moderate (GCS 9-13), and 10% had severe TBI (GCS 3-8). Multivariable logistic regression and refinement by backwards elimination determined that GCS <14, hypoxia, tachycardia and age >50 years predicted mortality.
Conclusion:
GCS <14, hypoxia, tachycardia and age >50 years were associated with mortality among TBI patients at KUTH A&E. These findings can guide clinicians in prioritizing care for patients at highest risk of mortality.
Item Open Access Improving the Recruitment and Retention of Teachers in Rural Rwanda(2016-04-25) Monaco, TonyThe objective of this paper is to improve the quality of rural education in Rwanda. It examines a single issue in this sector, that of problems with recruiting and retaining skilled teachers. Rural life is hard in a variety of ways, ranging from poor pay to sociocultural isolation, and for this reason highly qualified teachers are unlikely to want to work in rural regions. As a result, rural regions, which are generally the worst-performing regions scholastically, have the lowest quality teachers. Of course, this problem is not unique to Rwanda. Consequently there is a wealth of literature on this topic from around the world; there are a large variety of policy models that have attempted to address this issue. This paper examines a handful of the most promising models, specifically the hardship model, mandate model, recruitment model, distance model, and teacher resiliency model, and weighs their relative strengths and weaknesses. It then looks at how they would function within the Rwandan educational system – the success or failure of a particular model is inextricably linked to its “fit” within a particular context. After comparing the strengths and weaknesses of each model along with their relevance to the Rwandan context, this paper makes a recommendation on the models that are most likely to be both feasible and successful within Rwanda. In this case, a combination of the recruitment and teacher resiliency model is likely to be the best option.Item Open Access Post-cesarean Section Peritonitis at a Referral Hospital in Rwanda: Factors Associated with Maternal Morbidity and Mortality(2016) Halfon, JohannaBackground: Post-cesarean section peritonitis is the leading cause of maternal morbidity and mortality at the main referral hospital in Rwanda. Published data on the management of post-cesarean section peritonitis is limited. This study examined predictors of maternal morbidity and mortality for post-cesarean peritonitis.
Methods: We performed a prospective observational cohort study at the University Teaching Hospital Kigali (CHUK) from January 1 until December 31 2015, followed by a retrospective chart review of all subjects with post-cesarean section peritonitis admitted to CHUK from January 1 until December 31, 2014. All patients admitted with the diagnosis of post-cesarean section peritonitis undergoing exploratory laparotomy at CHUK were enrolled. Patients were followed to either discharge or death. Study variables included baseline demographic/clinical characteristics, admission physical exam, intraoperative findings, and management. Data were analyzed using STATA version 14.
Results: Of the 167 patients enrolled, 81 survived without requiring hysterectomy (49%), 49 survived requiring hysterectomy (29%), and 36 died (22%). In the multivariate analysis, severe sepsis was the most significant predictor of mortality (RR=4.0 [2.2-7.7]) and uterine necrosis was the most significant predictor of hysterectomy (RR=6.3 [1.6-25.2]). There were high rates of antimicrobial resistance (AMR) among the bacterial isolates cultured from intra-abdominal pus, with 52% of bacteria resistant to third-generation cephalosporins.
Conclusions: Post-cesarean section peritonitis carries a high mortality rate in Rwanda. It is also associated with a high rate of hysterectomy. Understanding the disease process and identifying factors associated with outcomes can help guide management during admission.
Item Open Access Prevalence and associated outcomes of Intimate Partner Violence (IPV) among women with HIV in Rwanda(2023) Hatoum, SandyBackground: Intimate partner violence is a preventable public health problem that disproportionality impacts women in Sub-Saharan Africa. Women with HIV have a higher burden due to HIV related stigma they may face. In Rwanda, women have higher incidences of HIV and intimate partner violence. This study aimed to estimate the prevalence of IPV among women living with HIV in Rwanda as well as measure the difference in psychological outcomes, demographic data, and HIV related outcomes. Methods: This study conducts a secondary data analysis of a Cross-sectional, descriptive observational study. 162 Rwandan women living with HIV were purposefully recruited to participate in the survey. The instrument measured demographic data, Intimate partner violence, depression, HIV related stigma, coping, self-esteem, and hope. Results: The prevalence of IPV in the sample was 26.61% with psychological being the most prevalent followed by physical then sexual. Demographic data had no statistical significance with the prevalence of IPV. Women with HIV who experienced IPV had higher HIV stigma, lower coping self-efficacy, lower self-esteem, and less hope levels. Conclusions: Women who experience IPV have worse HIV psychological outcomes which could lead to decreased overall health outcomes. Further studies are needed to look into the correlation between the two as well as interventions addressing IPV prevention and awareness.
Item Open Access Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda.(BMC Public Health, 2012-12-05) Joharifard, Shahrzad; Rulisa, Stephen; Niyonkuru, Francine; Weinhold, Andrew; Sayinzoga, Felix; Wilkinson, Jeffrey; Ostermann, Jan; Thielman, Nathan MBACKGROUND: The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249-584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda. METHODS: Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18-50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities. RESULTS: Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery. CONCLUSIONS: The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center. Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the health facility delivery rate observed in our study.Item Open Access Proposed Method to Evaluate the Impact on Health Outcomes of Capacity Building for Maintenance and Repair of Medical Equipment in Rwanda(2012) Penumetcha, Neeraja RajuIt has been shown that training biomedical equipment technicians (BMETs) improves healthcare, but it is unclear if capacity building for repair and maintenance of medical equipment leads to improved patient health outcomes, and whether that relationship between equipment service and health can be measured.
Health indicators are identified that may be used to measure an impact on patient health outcomes of Engineering World Health's biomedical equipment repair and maintenance training program in Rwanda.
Fieldwork was conducted for 9 weeks in country to identify these indicators. Providers and administrators in twelve hospitals in Rwanda were interviewed about patient health outcomes, equipment use, and procedure preference based on equipment availability for selected clinical focus areas. Equipment availability and status were also surveyed. From the existing literature, expected health outcomes were compared between procedure preferences to estimate how patients would be affected by the availability of functional medical equipment.
Neonatal jaundice treatment with phototherapy lamps, neonatal thermoregulation with incubators, and oxygen provision for acute respiratory management were identified as areas where the relationship between equipment service training and health could be measured. It is recommended that some of these areas be studied in the field to confirm and quantify the connection.
Item Open Access THE PRECEDENT OF THE CRIME OF GENOCIDE IN THE INTERNATIONAL CRIMINAL TRIBUNAL FOR RWANDA(2017-04-12) White, ElizabethFollowing the 1994 Rwandan genocide against the Tutsi ethnic group, the International Criminal Tribunal for Rwanda (ICTR) was established to prosecute those most responsible for their violations of international law. The Tribunal marked the first prosecution of the crime of genocide. The unprecedented nature of the prosecution of the crime resulted in initial inconsistencies and a lack of clarity of the definition. This study examined the evolution of the legal definition for the crime of genocide through qualitative analyses of the trial documents in selected case studies from the ICTR, as well as subsequent cases of the prosecution of genocide outside of the jurisdiction of the Tribunal. The cases highlighted a convergence over time for the establishment of group definition, intent, and witness credibility across cases in the Tribunal, with a diminishing role for witness testimonies in later cases of genocide. The eventual coherent and clear application of the definition for the crime of genocide in the ICTR provides valuable precedent for the potential of faster, more consistent future prosecutions of crimes of genocide. In their slight divergence from the ICTR’s precedent, however, later cases of genocide demonstrate the necessity of considering of the work of international courts.Item Open Access Watershed Payments for Ecosystem Services and Climate Change Adaptation(2008-04-21T19:29:37Z) Willetts, ElizabethA majority of East African nations rely heavily on hydropower for their energy supply. Climate change experts predict significant changes to total precipitation and seasonal weather patterns in this area in the near future. Consequently, these nations should expect hydrologic stress across all watershed scales. Resilience of East Africa’s energy sector to these climate change impacts will rely on coordinated environmental and economic policy. It will depend on the ability of governments to quickly improve management of important ecosystems and water basins. However, effective decision-making must balance the watershed needs of local livelihoods, such as subsistence agriculture, with national energy needs, such as expansion of electricity infrastructure. Environmental policy increasingly leans to economic mechanisms to find resolutions to ecosystem dependency conflicts. Payments for Ecosystems Services (PES) is one environmental economic mechanism that could effectively and rapidly improve environmental management in this region. This paper investigates the feasibility for using local PES schemes in a major Rwanda watershed as both a tool for community vulnerability reduction and for energy sector resilience to climate change impacts. Payments for Ecosystem Services in developing countries involves local-level environmental negotiations between the public and private sectors. The mechanism has two goals. Primarily, it gives physical value to specific resource improvements. Secondly, PES reorganizes funding streams towards particular environmental objectives using positive incentives. In effect, it can develop a sustainable, locally-driven, conservation funding mechanism. PES most strongly emerged as a conservation tool in the early 1990’s in Latin America. Uncertainty in its ability to achieve restoration targets and questions about its ability to achieve financial independence does not deter PES’ popularity. PES schemes and informational networks now exist in Latin America, Asia, Africa, and Oceania. The first portion of this paper looks at the capacity-building potential of PES mechanisms. It relates these to adaptive capacity needs for climate change given by the United Nations Framework Convention on Climate Change (UNFCCC). The second portion of this paper organizes key literature describing different feasibility criteria for PES implementation in the Rwandan context. To verify whether watershed PES is plausible, the paper then investigates the political, social, and environmental context of Rwanda’s major watershed and compares these to fourteen international PES case study sites. The final portion of the paper links potential PES scheme designs in the Rugezi area to specific capacity building potential and then to climate change adaptation objectives. Successful implementation of watershed PES in Rwanda will depend on careful scheme design and persistent trust-building in order to harmonize wetland inhabitant and electric utility needs. Existence of contextually parallel projects in Indonesia, South Africa, and Columbia, gives evidence that these challenges can be creatively overcome. Findings show that Rwandan decision-makers will need more hydrologic data to make ecologically informed and efficient decisions and also to set targets. With several necessary conditions in place, watershed PES in Rugezi may be a feasible tool for climate change adaptation and energy sector resilience. However, there is need for cost-benefit analysis to clarify short term, long term, and distributive costs and benefits of such a project.Item Open Access Women’s Land Rights and Empowerment: Impact of the Land Tenure Regularization Reform (LTR) on Contraceptive Use and Domestic Violence in Rwanda(2015-04-17) Biwott, WinnieThe Rwandan Land Tenure Regularization reform (LTR) was implemented in 2007 to clarify land ownership in the country especially for women. Specifically, the reform enabled women in married unions to obtain joint titles with their partners as proof of land ownership. Using data from the 2010 Rwandan Demographic and Health Surveys (RDHS) and the LTR progress report, I investigate the potential effect the reform could have on women’s level of empowerment within the household. The underlying assumption for this study is that joint land titling will increase the bargaining power of the woman and consequently enhance her empowerment status. I explore three forms of empowerment, all of which tell an inconsistent story. LTR does not seem to have an overall effect on women’s use of modern contraceptives, perception and incidence of physical violence among them. However, LTR has a negative impact on incidence of sexual violence. In addition, LTR positively influences women landowners’ chances of using modern methods of contraception.