Rwanda Journal of Medicine and Health Sciences

Editorial

2022-01-13T13:47:07+00:00

None

Physical Activity Levels of the Physiotherapy Students in Rwanda during the Coronavirus Disease 2019 Lockdown Period

2022-01-13T14:02:08+00:00

Background
The Coronavirus Disease 2019 (COVID-19) pandemic and related social distancing measures have an impact on physical activity levels.
Objective
To assess the physical activity (PA) levels of the physiotherapy students in Rwanda during the COVID-19 lockdown period.
Methods
We used a descriptive cross-sectional quantitative study design. Eighty-one participants were recruited, and data were collected using the International Physical Activity Questionnaire. We used descriptive statistics, Pearson Chi-Square and Kruskal-Wallis tests to assess whether there were statistically significant differences in physical activity levels according to demographic variables.
Results
The median total PA metabolic equivalent of task (MET)-minutes/week score for all the participants together was 3546 (IQR=8714), meaning high PA. The rates for high, moderate, and low PA levels were 54.4%, 31.7% and 13.9% respectively. Male and rural participants had higher median total PA MET score than females (p=0.008) and urban residents (p=0.018) respectively.
Conclusions
The PA levels of the study participants during the COVID-19 lockdown period were higher than the recommended standards. Females and urban participants appeared to be less physically active than their counterparts. Further similar studies and interventions towards PA promotion among university students in Rwanda during the pandemic are suggested.
Rwanda J Med Health Sci 2021;4(3):334-340

Prevalence of Dental Caries, its Associated Risk Factors and Treatment Needs among School Aged Children at Kimironko II Primary School, Kigali, Rwanda

2022-01-13T14:26:05+00:00

Background
Dental caries is still a health problem worldwide, its prevalence and incidence are associated with various factors like age, sex, social status, dietary patterns and oral hygiene habits.
Methodology
A Secondary data collected from outreaches done by UR CMHS, School of Dentistry at Kimironko II Primary School was analyzed. This secondary data had been obtained using structured questionnaires with close ended questions. Clinical examination had also been done to gather information. SPSS statistical software package version 22 was used to analyse data from Community outreach done at Kimironko Primary School in August 2019.
Results
The prevalence of dental caries of 42.4% was found among children aged 6-12 years old of Kimironko II Primary School. The researchers found the following to be statistically significantly associated with prevalence of dental caries: gender (p=0.042), dental visits (p=0.001), and use of chew sticks or miswaks (p=0.041). Females were 1.4 times more likely to develop dental caries (OR: 1.462; 95% CI: 1.16-2.017; p=0.021) and children who did not use toothpick were 2 times more likely to develop dental caries (OR: 2.149; 95%CI: 1.251-4.395; p=0.036), whereas visiting a dental practitioner was protective against dental caries (OR: 0.362, 95% CI: 0.251-0.516; p=0.001).
Conclusion
Dental caries is prevalent among children of Kimironko II Primary School. Appropriate preventive measures should be taken to protect those found to be exposed.
Rwanda J Med Health Sci 2021;4(3):341-346

Antibiotic use in Moshi Urban: A cross-sectional Study of Knowledge and Practices among Caretakers of Children in Kilimanjaro Tanzania

2022-01-14T06:08:30+00:00

Introduction
Antibiotics are commonly accessed and used for the management of illness in children without a prescription. We investigated the caretaker’s knowledge and practices on antibiotics and antibiotics use to their children.
Method
This was the hospital-based cross-sectional study conducted from April to July 2017 in three facilities located in Moshi Municipality. A convenience sampling was employed to select for caretakers with their sick children at KCMC, Mawenzi hospital, and Longuo dispensary. Face-to-face interviews were conducted with 224 caretakers who had visited health facilities with their children seeking health care.
Results
The majority (87.9%, 197/224) of all interviewed caretakers had good knowledge of the use of antibiotics. Irrespective of knowing that it is not safe to self-medicate a child with any antibiotics (95.1%, 213/224), most (61.6%, 138/224) caretakers practiced self-medication with the medicines. Having two children (aOR = 7.75, 95% CI: 1.89-31.67) and having three children (aOR=7.23, 95%CI: 1.08-48.51) were significantly associated with good knowledge of antibiotics.
Conclusion
This study has revealed that caretakers in Moshi had a good knowledge of antibiotic use. However, despite such good knowledge, malpractices were observed. We call upon the use of media campaigns to advocate for the importance of the rational use of antibiotics and its effect on human health and the risk of antimicrobial resistance development.
Rwanda J Med Health Sci 2021;4(3):347-356

Training Needs Assessment for a Bachelor of Science Program in Eye Care at the University of Rwanda

2022-01-18T06:12:36+00:00

Background
The University of Rwanda, established the Ophthalmology Department in 2004 to train Ophthalmic Clinical Officers (OCO). A proposal was developed towards upgrading the qualification level of the OCOs training at the University of Rwanda.
Aim
This study aimed to assess the need to upgrade the qualification of ophthalmic clinical officers to improve eye health services in Rwanda.
Methodology
A descriptive cross-sectional study was conducted among 87 participants comprised of ophthalmic clinical officers, eye health development stakeholders, and employers in Rwanda selected purposively. Data analysis was performed using SPSS version 16.
Results
The results showed that 77% of participants in the stakeholders group and 51.4% in the OCOs group were males. About 97% (n= 34) of the OCO responded “Yes” to the questions “Do you think some of the weaknesses related to quality practice are related to the level of training?” and “Does your qualification have any effect to your professional development?” Furthermore, 85% had never been promoted at any employment position, 100 % (n=35) alumni and 84 % (n=22) stakeholders agreed that there is a need for bachelor’s degree program.
Conclusion
The need for developing new programs in ophthalmology including a Bachelor of Science degree program for OCOs was evident.
Rwanda J Med Health Sci 2021;4(3):357-365

Standard Precautions among HealthCare Workers in a Tertiary Health Facility in Enugu Metropolis, South-East Nigeria

2022-01-14T06:44:53+00:00

Background
The work environment of Health Care Workers (HCWs) can be described as a potential risk zone due to numerous hazards endemic to the environment. The hospital is not just only a place where the sick people recover from their illness, but also where the healthy get infected.
Objectives
To assess the knowledge, attitude and practice of Standard Precautions (SP) among HCWs in a tertiary government health facility in Enugu Metropolis, Nigeria.
Methods
A descriptive cross-sectional design that used mixed method approach. Qualitative data was collected using an in-depth interview. The quantitative data instrument was a semi-structured, self-administered questionnaire. Manual content analysis was done for the qualitative data. Quantitative data was analysed using SPSS version 22.
Results
Sixty-four (32.0%), 131(65.5%) and 5(2.5%) had good, fair and poor knowledge of SP respectively while 117(58.5%), 70(35.0%) and 13(6.5%) had good, fair and poor attitude to SP respectively. Fifty-nine (29.5%), 140(70.0%) and 1(0.5%) had good, fair and poor practice of SP respectively.
Conclusion
There was fair knowledge and practice of SP among the studied HCWs while attitude was good.
Rwanda J Med Health Sci 2021;4(3):366-378

Incidence and Reasons for a Surgical Cancellation at a Hospital in Rwanda

2022-01-14T07:28:29+00:00

Background
Surgery cancellation is a challenging and costly event resulting in operating theatre inefficiency and psychological and financial problems for the patients and their families. This study aimed to find out the incidence and reasons for surgical cancellation at a Rwandan hospital.
Methods
A retrospective study was conducted on 736 patients’ files obtained from theatre registry lists of surgical operations done from January to March 2017. The American Association of Perioperative Nurses (AORN) checklist for documenting cancelled surgical cases was used to establish the rate and reasons for cancellation. Data were analyzed using frequency and percentage descriptive statistics.
Results
Out of the 736 surgeries booked, 179 (24.3%) were cancelled as follows: Orthopedic and general surgeries (28.2%) respectively, gynecology and obstetrics (27.4%), urology surgeries (15.5%), maxillofacial surgeries (15.9%), ENT (15.6%) and plastic surgeries (13.3%). Time constrain/long list (19.6%), acute change in medical status (10.6%), non-turn-up of the patient (8.4%), and abnormal lab findings (7.8%) were the most prevalent reasons.
Conclusion
The surgical cancellation rate at the study hospital was 24%, increasing with the number of patients booked and the type of surgical procedure. A prospective study is required to gain more insight into the reason for cancellations, mostly amenable to mitigation measures.
Rwanda J Med Health Sci 2021;4(3):379-386

Uptake of Cervical Cancer Screening and Associated Factors Among Women Attending Outpatient Services in Rwamagana Hospital, Rwanda

2022-01-14T07:43:32+00:00

Background
Cervical cancer is a global public health threat for women. Rwanda Ministry of Health recommends screening as preventive strategy. However, the screening remains low in Rwanda.
Objective
To determine the uptake level of cervical cancer screening and associated factors among Rwandan women.
Methods
A quantitative analytical cross-sectional study design was used. We recruited 178 participants using convenience sampling from an estimated 320 women who attended outpatient department in the previous month. The sample size was calculated using the Yamane’s formula. We used chi-square test, t-test and multiple logistic regression analysis to analyse data.
Results
A total of 178 (100%) participants completed the survey. Forty-one (23%) participants had undertaken cervical cancer screening. Knowledge (OR: 1.26,95% CI:1.069-1.485, p=.006) and income were predictors of cervical cancer screening uptake. Participants earning RWF ≥ 63,751 were more likely to uptake cervical cancer screening (OR:11.141, 95% CI:3.136-39.571, p< .001) compared to those earning less than RWF 25,500 monthly.
Conclusion
Cervical cancer screening uptake among study population was low. Participants with more knowledge and high-income were more likely to uptake cervical cancer screening. Improving women’s knowledge and socioeconomic situation would improve the uptake of cervical cancer screening.
Rwanda J Med Health Sci 2021;4(3):387-397

Knowledge and Skills on Triage among Nurses Working in Emergency Departments in Referral Hospitals in Rwanda

2022-01-14T08:28:54+00:00

Background
Unpredictable numbers of patients attending emergency departments highlight the need for Triage. Triage which is the prioritization of patient care based on severity of illness or injury, prognosis, and availability of resources is effective when clinicians are knowledgeable and skilled to perform it.
Objective
To assess knowledge and skills on triage among nurses working in emergency departments of Rwandan referral hospitals.
Methods
Cross-sectional analytical design was adopted. ninety-six (96) nurses working in emergency departments were selected using proportionate stratified sampling method. Each hospital was considered as a stratum. A self-administered questionnaire and observation checklist were use as instruments. Inferential and descriptive statistics were used in analysis.
Results
The majority of participants (63.6%) demonstrated low level of triage knowledge and almost a half (47.9%) of participants had low level of triage skills. Nurses experience in emergency department, level of education and triage training were not found to significantly influence triage knowledge and skills positively (P>0.05).
Conclusion
Deficit in triage knowledge and skills were revealed among nurses working in emergency departments in Rwanda. Accredited continuous educational training on triage should be regularly provided to enhance knowledge and skills of emergency department nurses on Triage.
Rwanda J Med Health Sci 2021;4(3):398-405

Reflective Practice in Anesthesia Clinical Teaching

2022-01-14T08:36:37+00:00

Background
Reflective practice is an essential aspect of knowledge generation for professional practice. By reflecting on action, professionals learn to improve their practices. Through processes of reflection, practitioners participate in a dialogue between theory and practice. Even though reflective practice is an important approach for learning from experience, its place remains unclear in anesthesia clinical education as well as anesthesia practice in a broad sense.
Aim
The aim of this paper was to examine the affordances of reflective practice in anesthesia clinical education.
Methods
Two cases, illustrating critical incidents in the anesthesia clinical teaching environment, were examined to consider how incorporating reflective practice into clinical education can advance knowledge generation in the field.
Findings
The two cases studies show how reflective practice can contribute to experiential learning, particularly through reflection on critical incidents.
Conclusion
Reflective practice can help bridge the gap between theoretical knowledge and practice in anesthesia education and practice.
Rwanda J Med Health Sci 2021;4(3):406-411

Peaceful End of Life Theory: A Critical Analysis of Its Use to Improve Nursing Practice

2022-01-14T08:47:48+00:00

Background
Provision of empathetic palliative care in agreement with patient’s favorites is an indispensable attitude of healthcare providers. A Peaceful End of Life Theory was designed by Rulandand Moore (1998),to provide theoretical framework for nurses who care for patients at end stage of their life.
Methods
Chinn and Kramer theory analysis guideline was used to analyse this theory to suggest its improvement.
Results
Five major concepts and sub-concepts are identified.This theory informs the nursing profession on the relieving interventions at the end of life. It provides a guidance to supportively manage terminally ill patients in collaboration with their families.
Conclusion
This theory is important to guide nursing practice,research, and education. However, there is a lack of an instrument to measure the desired outcomes, some subconcepts do not cleary specify the nursing interventions, and it lacks the spiritual comfort to the terminally ill patients who believe in eternal life.
Rwanda J Med Health Sci 2021;4(3):412-417

A Narrative Review of Contemporary Global Perspectives into Epidemiology, Treatment, and Prognosis of Vertebrobasilar Strokes

2022-01-14T08:53:51+00:00

Blood flow interruptions to the posterior cerebral circulation hallmark vertebrobasilar strokes (VBS), leading to mortality and significant disabilities, yet optimal therapy prevails unpublished. Recent epidemiological evidence indicates that VBS account for nearly 1/5 of all ischemic strokes globally, with acute basilar artery occlusion (BAO) contributing significant disabilities in nearly 1/3 of the victims. The prevalence of VBS in Africa is close to 5%, majorly in large intracranial vessels. Etiologically, Stenosis accounts for 20% of all VBS, while aneurysms face up to a 3% rupture rate. Furthermore, intravenous alteplase is the gold standard medical therapy for the cases presenting within 3 to 4.5 hours post-baseline regarding management options. Nevertheless, there is no consensus for BAO beyond 4.5 hours post-onset. Stent retrievers are the first-line endovascular reperfusion therapy device proposed. However, an 18% risk of in-stent restenosis is a significant drawback. Comprehensive prognostic factors are addressed in this review. However, prospective, multicenter, controlled studies are needed to clarify the time window dilemmas facing posterior circulation strokes. This narrative review explores recent VBS epidemiology, management advances, and prognosis.
Rwanda J Med Health Sci 2021;4(3):418-429

Analysis of Clinical Experience Using Kolb’s Experiential Learning Theory: Postgraduate Medical Surgical Nursing Track Students in Selected Sub-Specialties at the University Teaching Hospital of Kigali, Rwanda

2022-01-14T09:24:44+00:00

Background
Clinical experiences provide an opportunity for nursing students to integrate theoretical knowledge into practice, and analyze their learning using a theoretical model. Students do not take this opportunity unless it is intentionally included by the facilitators. These observations from the second cohort of medical surgical nursing students with their facilitators, regarding their clinical training period in selected sub-specialties at the University Teaching Hospital of Kigali (CHUK) aimed at developing students’ analytical and observational skills while developing clinical skills.
Methods
The study involved nine medical surgical nursing students who were in different subspecialties at CHUK from 7th January up to the 20th February, 2019. Informed observational approach and concomitant reporting were used to validate their learning and gain clinical experience. The students used Kolb’s Experiential Learning Theory to analyze their experience, with the focus on innovative skills.
Results
All medical surgical nursing students reported that they improved their knowledge and skills during clinical practice, while broadening their outlook.
Conclusion
Kolb’s Experiential Learning Theory is useful in validating and bridging theoretical learning to clinical practice.
Rwanda J Med Health Sci 2021;4(3):430-436