Rwanda Journal of Medicine and Health Sciences

Editorial

2021-04-13T06:39:05+00:00

None

Clinical Presentation and Factors Leading to Complications of Deep Neck Space Infections at CHUK

2021-04-19T10:16:28+00:00

Background

Deep neck space infection (DNSI) mostly arise from the local extension of dental, tonsils and parotid gland infections. Early diagnosis and management is the key to avoid associated complications.

Objective

Our study aimed at evaluating the clinical presentation and factors related to complications of DNSIs at the University Teaching Hospital of Kigali.

Methods

This cross-sectional study was conducted at the University teaching hospital of Kigali from September 2017 to November 2018. It enrolled 66 participants. Patient information was recorded using a questionnaire and analyzed using Epidata 3.1 software. The data were processed using SPSS 16.0. Comparison of categorical variables were performed using the chi-square test. Associations with p-values=0.05 were considered statistically significant.

Results

Males accounted for 35 (53%) of DNSIs. The majority (97%) presented with neck pain and 21% with a history of tooth extraction. The submandibular space was the most involved in 33 (50%) cases. The average duration of symptoms at presentation was 11 days. Delayed consultation and advanced age (>40years) were associated with complications and hospital stay with (p value=0.022) and (p=0.015) respectively.

Conclusion

Neck pain on background of tooth extraction is the most common presentation of patients with DNSIs. Delayed presentation and advanced age are central factors for complications and longer hospital stay.

Rwanda J Med Health Sci 2021;4(1):8-19

Proximate Predictors of Vaginal Delivery in Primigravid women at a Tertiary Health Facility in Ibadan, Nigeria

2021-04-11T08:58:05+00:00

Background

Successful vaginal delivery (VD) is the desire of every parturient. This is however not always so especially for primigravid women. Predictive factors can help the counselling process and allay the anxiety that this group of parturients experience.

Objective

To determine the prevalence and predictors of vaginal delivery among primigravid women at a tertiary health facility.

Methods

This was a 6-month cross-sectional study of 200 primigravid women that were planned for vaginal delivery. Information was obtained using structured proforma. Bivariate and multivariable analysis was used to identify the proximate predictors of VD.

Results

The prevalence of vaginal delivery was 50.0%. Labour onset was spontaneous in 78.0%; 10.0% had engaged fetal head prior to labour onset while labour was augmented in 18.0% of the parturients. Labour lasted ≤12 hours in majority (67.5%) with about half (49.5%) having successful vaginal delivery. Factors predicting successful vaginal delivery were spontaneous labour onset (OR=3.555, 95% CI=1.626-7.774), booked pregnancy (OR=3.008, 95%CI=1.361-6.647), and early fetal head engagement (OR=6.484, 95% CI=1.686-24.943).

Conclusion

The identified predictive factors of vaginal delivery in this study will aid counselling of primigravid women regarding the likelihood of successful vaginal delivery especially in the absence of other obstetric complications.

Rwanda J Med Health Sci 2021;4(1):20-36

Prevalence and Factors Related to Depression among Adolescents Living with HIV/AIDS, in Gasabo District, Rwanda

2021-04-11T09:42:00+00:00

Background

Adolescents living with HIV are vulnerable to depression with a negative effect on treatment outcomes. However, there are little data on the factors associated with depression in adolescents with HIV infection in Rwanda.

Aim

This article aims to assess the prevalence and sociodemographic factors related to depression among adolescents living with HIV/AIDS.

Methodology

A cross sectional research was conducted with 102 adolescents living with HIV/AIDS. Depression was measured by Centre for Epidemiological Studies Depression Scale (CES-DC) in its latest version adapted to the context of Rwanda. Chi-square test and binary logistic regression were performed to determine the factors associated with depression.

Results

The prevalence of participants who had symptoms of depression was 31%. The risk to develop depression increased among HIV infected adolescent who did not attend school or who lived with another person who is not a parent or family member. Having both parents deceased increases the risk to develop depression by 25.07 times compared to when none of them is deceased.

Conclusion

The results have demonstrated that lack of social support is likely to raise the risk of development of depression symptoms among adolescent with HIV. It is clearly an urgent priority to implement programs that focus on provision and maintenance of psychosocial support to this group in order to reverse the situation.

Rwanda J Med Health Sci 2021;4(1):37-52

Workplace Stressors and Coping Strategies of Intensive Care Unit Nurses at University Teaching Hospitals, in Rwanda

2021-04-11T09:57:19+00:00

Background

Nursing is widely known as a stressful profession but intensive care unit is the most stressful; when nurses fail to cope with workplace, stresses’ complications such as burnout and depression ensue, and this can compromise the quality of nursing care. In Rwanda, there is a limited literature about workplace stress and coping strategies.

Research objectives

To assess the workplace stress and coping strategies of intensive care unit nurses at University Teaching Hospitals.

Methodology

This study used a cross-sectional study design, recruited 92 ICU nurses through the census sampling method; ENSS and Brief COPE Inventory, while SPSS was used for data analysis.

Results

Eighty percent experienced moderate to high stress, while 19.6% had low stress. Married nurses tend to experience high stress than singles, while those with Bachelors or Master’s degree were less likely to be stressed. Main stressors are care for suffering/dying, or agitated patients; and heavy workload, while main coping strategies were alcohol use, emotion support from friends and religion comfort.

Conclusions

Nurses experience workplace stress, while workplace stressors are nursing care for suffering/dying or agitated patients and heavy workload. The coping strategies were alcohol use, emotional support and comfort from religion.

Rwanda J Med Health Sci 2021;4(1):53-71

Development and Validation of a Simple HPLC-UV Method for Determination of Amoxicillin trihydrate in Bulk Drug and Pharmaceutical Dosage Forms

2021-04-11T10:05:21+00:00

Background

Many analytical methods for testing amoxicillin trihydrate from different monographs such as United States and British pharmacopoeia, use acetonitrile HPLC grade as an organic solvent in the mobile phase; however, this solvent is expensive and not environmentally friendly

Objectives

Developing and validating a simple, affordable, accurate, precise and environmentally friendly HPLC-UV method, for determining amoxicillin in formulations by using methanol HPLC grade as an organic solvent in the mobile phase

Methods

An HPLC system was used for developing and validation of laboratory test method which is less expensive and uses environmentally-friendly mixture of mobile phase solutions. Specificity, linearity, precision, repeatability, and accuracy were studied.

Results

The retention time (RT) for amoxicillin was 3.53 ± 0.020 min, and no interfering peaks were recorded with the blank, standard and sample at RT, ensuring specificity. Calibration curve of 20 to 160μg/ml was used. The correlation coefficient (r²) =0.9998, which indicates that the method has the linearity to this range of 20 to 160μg/ml. Intra- and between days' repeatability were assessed by injecting solutions three times a day and within three days. The %RSD of 0.3% and 0.7% within and between days respectively, were recorded. The %RSD was ≤ 2%, which indicates a precision of the method. An average percent recovery of 100.5±3.6% was recorded.

Conclusion

An environmentally-friendly, simple, affordable, selective, specific, rapid, sensitive, repeatable, with precision and accurate HPLC-UV method, has been developed and validated for the estimation of amoxicillin trihydrate in pharmaceutical dosage forms and can be adopted for the purpose of quality control.

Rwanda J Med Health Sci 2021;4(1):72-83

Prevalence and Correlates of Microalbuminuria among Type 2 Diabetes Patients at Muhimbili National Hospital, Dar es Salaam, Tanzania

2021-04-11T10:13:40+00:00

Background

Regular screening for microalbuminuria among type 2 diabetes patients is less common in most low-income countries while it is an early marker of diabetic nephropathy and cardiovascular complications.

Objective

This study aims to assess the need for regular screening for microalbuminuria among type 2 diabetes patients.

Methodology

with cross-sectional approach, 124 diabetic patients were recruited at Muhimbili National Hospital, in Tanzania; their age, gender, body mass index, fasting blood sugar levels (by Accu Chek Active Glucometer), random urine albumin levels (by Microalbumin 2-1 Combo Test Strips), and the duration of diabetes were recorded.

Results

The study indicated that 62.1% of the participants were microalbuminuric while 2.4% were macroalbuminuric. The risk of microalbuminuria was 4.55 higher in patients aged 60-69 years (95% CI: 1.32-16.51), and 17.4 times higher in patients aged 70 and above (95% CI: 1.49-202.86) compared to individuals aged below 50 years. Patients with high blood sugar level had a risk of 8.09 times higher compared to those with normal blood sugar (CI: 2.53-25.86). Also, the odds were 7.89 higher in patients who lived with diabetes for 10-14 years compared to those lived with the disease less than 5 years (95% CI:1.33-45.59).

Conclusion

The odds of microalbuminuria increased significantly as the patient gets older, with high blood sugar, and the duration of diabetes. Health policies need to establish programs that enhance care at the diabetic clinic through regular screening for microalbuminuria to reduce the risk of developing kidney and cardiovascular complications.

Rwanda J Med Health Sci 2021;4(1):84-97

Ophthalmic Anthropometry among Rural Dwellers in Mashonaland Central Province, Zimbabwe

2021-04-11T10:27:53+00:00

Introduction

The measures of ophthalmic anthropometric parameters may vary among races and ethnic groups but are of immense importance in clinical diagnosis and management of oculo-visual defects. There is paucity of data on these measures among the Zimbabwean population.

Purpose

The aim was to determine ophthalmic anthropometric parameters among rural dwellers in Zimbabwe.

Methods

Six ophthalmic anthropometric parameters including interpupillary distance (IPD), head width (HW), temple width (TW), length to bend (LTB), and apical radius were measured using a pupillometer, PD rule, Head width calipers, Fairbank facial gauge, and ABDO frame rule.

Results

A total of 471 participants aged 18 to 100 years (mean age = 55.13; SD± 17.33 years). Of the 471 participants, 206 (43.7%) were males and 265 (56.3%) were females. A mean interpupillary distance at far was 65.57 ± 4.80 mm, mean temple width of 12.49 ± 1.53 cm, mean head width of 13.61 ± 1.39 cm and a side length to bend of 10.24 ± 1.20 cm and the apical radius was 9.94 ± 1.37. There was a significant (P < 0.05) difference between the ophthalmic anthropometric parameters of males and females except for temple width and apical radius.

Conclusion

A narrower interpupillary distance but a wider temple width was observed among adult Zimbabweans. A significant difference in ophthalmic anthropometric parameters between males and females were observed except for temple width and apical radius. This should inform eyewear manufacturers and importers of frames on the facial and ocular parameters of Zimbabweans to improve the aesthetics and ensure a comfortable vision for wearers of already-made near vision spectacles for presbyopes.

Rwanda J Med Health Sci 2021;4(1):99-111

Stunting among Under Five Years Old Children in Rwanda: Influences of Family Planning Status and Household Size and Composition

2021-04-11T15:30:32+00:00

Background

Stunting is one of the main challenges resulting in high child mortality and morbidity thought out the world, especially in many developing countries, including Rwanda. The overall prevalence rate of stunting is estimated at around 38% of under five years old children in Rwanda.

Objective

To examine the influences of household size and composition and family planning status on stunting among children under five in Rwanda.

Methods

The current study is a nationally representative cross-sectional study that used the secondary data analysis of Rwanda Demographic and Health Survey (DHS) 2014-2015. Logistic regression analysis was used to examine the association between family planning and household size and composition.

Results

The sum-total of children under five in the household (log odds=0.373(p<.05), CI=0.0577, 0.689), maternal age at childbirth (log odds=-0.682(p<.05), CI=-1.222, -0.141), fertility preference (log odds =-0.296(p<.05), CI=-0.549, -0.0427), and unmet need for family planning (log odds = 0.297(p<.05), CI= 0.0193, 0.574) were statistically significant associated with stunting among studied children.

Conclusion

The findings of this study suggest a significant association between stunting and family planning and household size and composition.

Rwanda J Med Health Sci 2021;4(1):112-130

Prevalence of Periodontitis and Associated Factors among Pregnant Women: A cross sectional survey in Southern Province, Rwanda

2021-04-11T15:42:31+00:00

Background

The literature has shown the relationship between maternal periodontitis and complications associated with pregnancy. Thus, prevalence estimates and risk factor identification for periodontitis during pregnancy in Rwanda are paramount.

Aim

The aim of the current study was to determine the prevalence of periodontitis and identify related risk factors among pregnant women in Rwanda.

Methods

A cross sectional study was conducted to determine the prevalence of periodontal diseases in a convenience sample of 400 pregnant women in the Southern Province of Rwanda. A logistic regression analysis using a hierarchical approach was performed to assess the risk factors for periodontal disease. Socio demographic factors were put in the regression model first followed by a second step for other potential factors.

Results

The overall prevalence of periodontitis was 60.5%. Multivariable logistic regression showed that age OR=2.48 (95% CI. 1.18-5.22), education level OR=82.15 (95% CI. 8.21-822.11), socio economic status OR=2.28 (95% CI. 1.49-6.62), employment status OR=7.3 (95% CI. 1.38-38.74, and tobacco use OR=6.89 (95% CI. 1.78-60.65) were significantly associated with periodontitis.

Conclusion

Periodontitis appears to be a common problem among pregnant women in Rwanda. Risk factor screening could help identify pregnant women at higher risk of periodontal disease.

Rwanda J Med Health Sci 2021;4(1):131-150

Self-Regulated Learning in the University of Tabuk: Gender Differences in Strategy and Outcomes

2021-04-11T15:53:48+00:00

Background

Self-Regulated Learning (SRL) is defined as the adjustment of the individual's affective, meta-cognitive, and behavioral operations during learning to attain the desired level of academic achievement. It is an important skill for undergraduate students and its ignorance cause anxious behavior, a sense of potential failure, and avoidance of learning situations.

Objective

The objective of the study was to explore the pattern of SRL among medical students from a student perspective aiming to recognize the learning context and to provide recommendations for future support strategies.

Methods

This is a cross-sectional study that targeted a total coverage of medical students at the University of Tabuk, Saudi Arabia using a Self-Regulated Learning Questionnaire which composed of six constructs, namely: environment structuring, goal setting, time management, help-seeking, task strategies, and self-evaluation. An independent-samples test, ANOVA, and post-hoc analysis were conducted.

Results

Females agreed on regular practice of the four domains namely: "environmental structuring, time management, help-seeking, and self-evaluation", mean scores: 3.7(SD=1.023), 3.42(SD=1.035), 3.68(SD=0.99), 3.54(SD=0.94) respectively.

Conclusion

This study identified a remarkable difference in SRL among undergraduate medical students. Females outperformed males in self-regulation; however, both genders in the second year have shown a low level in self-regulation in comparison to fifth year medical students.

Rwanda J Med Health Sci 2021;4(1):151-165

The Comparability of Lipid-based and Body Mass Index-based Cardiovascular Disease Risk Scores: Using the Rwanda 2012-2013 Non-communicable Diseases Risk Factors Survey Data

2021-04-11T16:41:43+00:00

Background

In Rwanda, cardiovascular diseases (CVDs) ranked second of the most common cause of death in 2016. CVD risk score tools have been recommended to identify people at high risk for management.

Objective

To assess the comparability of body mass index (BMI)-based and lipid-based CVD risk scores in Rwandan population.

Methods

Secondary analysis was conducted on 4185 study participants extracted from the dataset of Rwanda 2012-2013 non-communicable diseases risk factors survey. Individual CVD risk scores were calculated using both BMI-based and lipid-based algorithms, one at a time. Spearman rank’s coefficient and Cohen’s Kappa coefficient were used to compare the two tools.

Results

About 63.5% of participants were women. There was a significant positive correlation between BMI-based algorithm and lipid-based algorithm vis-à-vis a 10-year CVD risk prediction (Spearman rank correlation coefficients > 0.90, p<0.001) considering either men, women or overall study participants. There was a moderate agreement between BMI-based and lipid-based algorithms vis-à-vis CVD risk characterization, kappa = 0.52; p-value p<0.001 considering either overall study participants or men and kappa = 0.48; p-value p<0.001 considering women.

Conclusion

The findings from this study suggest the use of BMI-based algorithm, a cost effective tool compared to lipid-based tool, can be alternatively used in resource-limited settings.

Rwanda J Med Health Sci 2021;4(1):166-184

Perioperative Nursing Training in Rwanda in Partnership with American Universities: The Journey So Far

2021-04-11T16:38:58+00:00

Nurses within a surgical team play such a fundamental role in the success of a surgery that they require specific training for the purpose. However, in Rwanda, there has been a severe scarcity of perioperative nurses. This article describes the collaborative effort for perioperative nursing training by the University of Rwanda (UR) and the Ministry of Health (MOH) with the Human Resources for Health (HRH) Program and a consortium of American Universities. The goal of the HRH program has been to build up the capacities of health professionals both in academia and clinical settings so as to address the shortage of qualified staff. In that regard, the UR in 2015 started a Masters program in nursing in eight specialties, of which one was perioperative nursing. The aim of this paper is to highlight the training process, success, and challenges of perioperative nursing training in Rwanda.

The training has so far been successful, with the 19 nurses who completed the program working now in academic and clinical teaching institutions. Students in the program have also increased their number of research publications in peer-reviewed journals and international conference presentations. The UR and its partners are investing in the sustainability and excellence of this program. Using the import-of-experts approach to train Rwandans within their country, the program addresses the scarcity of specialists in various disciplines within the nursing profession. As a consequence, countries where the lack of specialized nurses poses challenges may adopt this partnership strategy.

Rwanda J Med Health Sci 2021;4(1):185-196