Rwanda Journal of Medicine and Health Sciences

Foreword

2020-09-08T11:13:21+00:00

No Abstract

Editorial

2020-09-08T11:10:58+00:00

No Abstract

Noise Level and its Sources in Neonatal Intensive Care Units of Selected Public Hospitals in Kigali City

2020-09-08T11:44:12+00:00

Background

Noise in the neonatal intensive care unit (NICU) has an impact on the developmental progress of neonates, especially preterm. Technology advancement has improved the life of preterm neonates, but also changed NICU into a noisy place.

Objective

To measure the noise levels and identify its sources in NICU at selected public hospitals in Kigali city`

Methods

A quantitative cross-sectional descriptive study. A sound level meter was used in recording the Sound level in six different locations of the NICUs at five different times. An observational checklist was used to identify possible sources of noise. Data were analysed using descriptive and inferential statistics (ANOVA).

Results

Sound levels recorded in all the NICUs were high ranging from 61.8 decibel (dB) to 77.0 dB, greater than the 45 dB recommended by the American Association of Pediatrics (AAP). The maximum noise level was 77.0 dB. Ward rounds had the highest noise levels, and lunchtime had the lowest noise levels in all hospitals. Noise levels were high at the station near the entrance in all NICU rooms.

Conclusion

In all NICUs, the noise level generated was greater than the standard limits established by AAP. Neonates need noise-free environment as excess noise has an impact on their wellbeing.

Rwanda J Med Health Sci 2020;3(2):115-127

Parents’ Knowledge of Neonatal Danger Signs and Associated Factors at Health Centers in Kigali, Rwanda

2020-09-08T11:50:31+00:00

Background

Globally, nearly half of all under-five deaths occur during the neonatal period. About two million dies within the first week, of which 75% come from low-resource countries, such as Rwanda. Many neonatal deaths are preventable or avoidable if parents are knowledgeable of Neonatal Danger Signs (NDS), and do not delay seeking care at a health facility.

Objective

To assess the parents’ knowledge of NDS and associated factors within the neonatal period at four health centers in Kigali.

Method

This study was a descriptive cross-sectional design. A proportionate stratified probability sampling strategy was used to select 209 parents who attended selected health centers in Kigali. Data analysis used descriptive and inferential statistics.

Results

The findings showed that 67% of participants had some information on NDS. Logistic regression showed that educational level, parity, number of antenatal visits, and information from healthcare providers was significantly associated with parents' knowledge of NDS.

Conclusion

Our findings indicate the need to enhance education of parents’ knowledge of NDS in the study population. Educational efforts also should target NDS in health centers where most Rwandan women attend antenatal care.

Rwanda J Med Health Sci 2020;3(2):128-138

Essential Newborn Care Among Postnatal Mothers at Selected Health Centers in Eastern Province, Rwanda

2020-09-08T11:54:43+00:00

Background

Rwanda's neonatal mortality rate is 20/1000 live births, and the country aims to meet the Sustainable Development Goal of 12 deaths per 1000 live births, or less, by 2030. Countries have decreased newborn deaths, infections, and intensive care unit admissions using the evidenced-based 'Essential Newborn Care' (ENC) guidelines established by the World Health Organization.

Objective

To assess postnatal mothers’ knowledge and practice of Essential Newborn Care in Kayonza District, Rwanda.

Method

A descriptive cross-sectional design was used to assess 192 postnatal mothers at the six-week vaccination services at two health facilities. Data collection using a valid questionnaire occurred from February 28 to March 2, 2019. Data analysis included descriptive and binary logistic regression.

Results

The majority (65.1%) had good ENC knowledge and practice, whereas a third (34.9%) had poor knowledge and practice. Significant gaps in ENC included timing of breastfeeding 33(17.2%), cord care 32(16.7%), and thermoregulation of small birth weight newborns 6(3.1%). Significant associations with ENC included maternal age (p=0.003), and ENC education postpartum (p=0.020).

Conclusion

The overall knowledge and practice of ENC are encouraging in this population, particularly with ENC education given postpartum, and older mothers. However, major gaps included evidenced-based cord care, thermoregulation, and breastfeeding, particularly among younger mothers.

Rwanda J Med Health Sci 2020;3(2):139-151

Neonatal Hypothermia: Mothers’ Knowledge and Practice at a Provincial Hospital in Rwanda

2020-09-08T09:55:28+00:00

Background

Globally, 2.5 million neonates die each year from hypothermia. The World Health Organization (WHO) considers neonatal hypothermia as a decrease of axillary temperature in infants below 36.5° Celsius. New mothers, or the nearest caregivers, should be aware that hypothermia is a newborn danger sign, in order to apply best practices regarding neonatal hypothermia prevention to reduce subsequent mortality.

Objective

To assess mothers’ knowledge and practice of neonatal hypothermia at a selected provincial hospital in Rwanda.

Methods

A cross-sectional study design and convenience sampling method were used to select 161 mothers with living babies. Data were collected using a structured questionnaire. Descriptive and inferential statistics were used to analyze data.

Results

About 97% of mothers had inadequate knowledge, and the majority (83%) had inadequate neonatal hypothermia practices. Predictor variables for knowledge were ANC attendance (OR=1.884, 95% CI=1.675-2.565, p=0.042) and secondary educational level (OR=1.787, 95% CI=1.521-2.187, p=0.032). Practice was significantly associated with educational level (OR=1.787, 95% CI=1.521-2.187, p=0.032).

Conclusion

There is a need to increase a mother's evidence-based practice of neonatal hypothermia. This condition unchecked leads to high-risk life-threatening complications. Prevention should emphasize on observed gaps to decrease deaths related to neonatal hypothermia.

Rwanda J Med Health Sci 2020;3(2):152-166

Umbilical Cord Care Among Postnatal Mothers in Kibungo Hospital Catchment Area, Rwanda

2020-09-08T07:04:55+00:00

Background

Infections contribute to 30% of the 2.5 million neonatal deaths that occur globally every year. A newly cut umbilical cord can be a pathway for bacteria to enter the vulnerable neonate and cause neonatal sepsis. Most infections are preventable with evidenced-based cord care.

Objective

To assess postnatal mothers’ knowledge and practice of umbilical cord care in the Kibungo Hospital catchment area in Rwanda.

Methodology

A descriptive cross-sectional study design and purposive sampling strategy was used to recruit 224 postnatal mothers. Data were collected using a structured questionnaire. Descriptive and inferential statistics were used to analyze data.

Results

A third of mothers (33%) had adequate knowledge, and a half (54%) had good umbilical cord care practice. The majority (70%) reported dry cord care practice, though many applied substances including Vaseline (23%) and Movit ointment (15%). There was a negative correlation between knowledge of cord care and substance applied to cord (R²=0.224, p=0.001), and days applied (R²=0.167, p=0.012).

Conclusion

The study population had low cord care knowledge. Health care providers need to educate mothers on the practice of allowing the cord to dry naturally, and discourage the use of harmful substances that delay cord separation and increase risk of sepsis and subsequent neonatal mortality.

Rwanda J Med Health Sci 2020;3(2):167-180

Early Initiation of Breastfeeding Among Postpartum Mothers at Two Rwandan Hospitals

2020-09-08T12:19:23+00:00

Background

Breastfeeding in the first hour post birth can decrease neonatal morbidity and mortality. Disease prevention and health outcomes differ immensely between newborns who receive human milk and those who do not. Rwanda has high breastfeeding rates, though factors associated with early initiation of breastfeeding (EIBF) are unknown.

Objective

To assess factors associated with EIBF among mothers in immediate postpartum units at two hospitals.

Methods

A cross-sectional study design and a convenience sample of 187 mothers were used. An interviewer-administered questionnaire was used for data collection. A Chi-square test showed the relationship between EIBF and sociodemographic factors.

Results

The findings showed less than one quarter (20.5%) breastfed within the first hour after birth. The majority was < 25 years (52.4%), had some primary education (27.7%) employed (66.7%), urban dweller (58.1%), attendance of one ANC visit or more (81.3%), vaginal birth (58.8%), and did not receive EIBF health education (92.0%). The majority (78.5%) was too tired to initiate breastfeeding, and many supplemented (41.9%) due to perceived insufficient breastmilk.

Conclusion

Most mothers did not initiate breastfeeding within the first hour after birth. Sociodemographic factors were associated with EIBF. A program to promote, protect, and support EIBF is urgently needed the community.

Rwanda J Med Health Sci 2020;3(2):181-192

Neonatal Outcomes from Mothers with Hypertension Disorders of Pregnancy: A Retrospective Study at a Referral Hospital in Rwanda

2020-09-08T07:44:22+00:00

Background

Globally, maternal hypertensive disorders in pregnancy significantly increase both maternal and perinatal morbidity and mortality. Maternal hypertension affects 14 percent of pregnancies. Eearly detection and management are critical for improving the health outcomes of both mother and neonate.

Objective

To assess the association between maternal hypertension disorders in pregnancy and immediate neonatal outcomes at a University Teaching Hospital in Rwanda.

Methods

A retrospective study of maternal files with hypertension disorders was conducted from January 1, 2016, to March 31, 2019. A census sample of 114 records and pretested checklist was used to collect data. Descriptive statistics were used to analyze associations between maternal factors and immediate neonatal outcomes.

Results

Neonatal outcomes included low birth weight (75.4%), prematurity (59.6%), admission to neonatal intensive care unit (50.4%), intrauterine growth restriction (32.4%), and neonatal death (22.8%). Nearly two-thirds (62%) of mothers had preeclampsia. Significant associations with immediate neonatal outcomes included gestational age, medical history, delivery mode, maternal referral status, preterm birth, prematurity, and abortion.

Conclusion

Maternal hypertensive disorders were significantly associated with adverse neonatal outcomes in our study population in Rwanda. Improving early detection, health education, and management of hypertensive disorders in pregnancy is critical to reduce maternal and neonatal morbidity and mortality.

Rwanda J Med Health Sci 2020;3(2):193-203

Neonatal Jaundice Risk Factors at a District Hospital in Rwanda

2020-09-08T12:28:38+00:00

Background

Neonatal jaundice is one of the most common reasons for hospital admission in the neonatal unit, and it is associated with significant morbidity and mortality.

Objective

To assess risk factors associated with neonatal jaundice among newborns at a District Hospital in Rwanda.

Methods

A quantitative approach has been used with a retrospective cross-sectional design. Two hundred and ten files were used as sample size. Stratified proportional sampling was used for the years 2016-2018 to select files. Data was collected using a structured questionnaire. Descriptive statistics and inferential statistics were used for the data analysis.

Results

The study findings showed that nearly half (44.3%) of 210 newborns were diagnosed with neonatal jaundice. The majority (87.2%) was term, and male gender (60.5%). Nearly a third (29.5%) were Low Birth Weight. Significant risk factors for neonatal jaundice were birth weight (p=0.015), gestational age of the newborn (p=0.002), neonatal gender (p=0.004), method of delivery (p=.000), blood group incompatibility (p=0.001); infections (p =0.000), cesarean section (p= 0.000) and prematurity (p=0.017).

Conclusion

There was a high prevalence of neonatal jaundice. Neonatal jaundice risk factors were predominantly demographic, maternal and neonatal. Hence there is need to formulate tailored interventions that mitigate neonatal jaundice.

Rwanda J Med Health Sci 2020;3(2):204-213.

Low Birth Weight Newborns and Associated Factors at Selected Referral Hospital in Rwanda

2020-09-08T12:35:57+00:00

Background

Low birth weight (LBW) is a major public health problem worldwide that is linked to childhood morbidity and mortality. Newborns considered ‘Very LBW’ have a high risk of disease and death during infancy. Maternal socioeconomic status, medical factors, and lifestyle are linked to LBW, but these factors remain unknown in Rwanda is unknown.

Objective

To describe the factors associated with LBW among newborns at a selected referral hospital in Rwanda.

Methods

A prospective, cross-sectional design study was used to assess 108 mothers who delivered a low birth weight newborn.

Results

Mothers had a mean age of 30.6 years, 79.6% married, 23.1% primary educated, 50.6% unemployed, and 61.9% lived in a rural area. The majority of LBW (63%) were in the first category of LBW (2500-1500g), and over a quarter (25.9%) with Very LBW (VLBW). Mothers were 89.7% multigravida, and 88.8% had a previous unsuccessful pregnancy, 81.3% premature birth, 97.9% LBW. Over half, 59.8% had hypertension during pregnancy. Lifestyle included 45.5% doing strenuous work, and 50.9% heavy lifting during pregnancy. The level of education (p=0.009), spouse employment (p=0.017), having previous premature baby (p=0.025), previous history of miscarriage (p=0.028), presence of hypertension (p=0.020) and antenatal care visits (p=0.025) the trimester of miscarriage were significantly associated to type of low birth weight.

Conclusion

Demographic, pregnancy history and lifestyle factors remain a concern to mothers and neonates born with low birth weight. Educational awareness campaigns among mothers with the factors above are crucial to reduce morbidity and mortality related to low birth weight.

Rwanda J Med Health Sci 2020;3(2):214-224

Quality of Basic Care During Neonatal Resuscitation Among Health Care Providers at Three District Hospitals in Kigali

2020-09-08T12:39:00+00:00

Background

Globally, about 10% of neonates require extra respiratory support to initiate breathing at birth. Over a million neonatal deaths could be prevented with quality basic care during neonatal resuscitation.

Objective

To determine the quality of care (QoC) of basic NR at birth among health care providers (HCPs) at three district hospitals in Kigali.

Methods

A descriptive cross-sectional study was conducted. Thirty-six HCPs were observed 2-3 times using a structured checklist. Descriptive and inferential statistics were used to analyze the data.

Results

The majority had ‘good’ QoC scores for drying and stimulation (74.7%), and fair scores for airway clearance (85.1%). Some had poor scores for advanced bag and mask ventilation (BMV) (13%). Maternity work experience (1-5 years) was significantly associated with good quality drying and stimulation (p = 0.03), initial BMV (p = 0.02), and advanced BMV (p = 0.03), than HCPs with less than one-year experience.

Conclusion

Maternity work experience of more than one year significantly improved the QoC during neonatal resuscitation. More NR support during the first year of work and regular NR refresher training would improve neonatal outcomes.

Rwanda J Med Health Sci 2020;3(2):225-237

Immediate Newborn Care and Associated Outcomes in the Delivery Room: An Observational Study in Rwanda

2020-09-08T12:41:06+00:00

Background

Neonatal mortality is a worldwide concern, especially in sub-Sahara Africa. Millions of newborn deaths could be prevented with quality care at birth.

Objective

To identify immediate newborn care provided by birth attendants and associated outcomes in the delivery room of a district hospital in Kabgayi, Rwanda.

Methods

This study used a descriptive cross-sectional design and convenience sampling strategy. The sample of 171 newborns and birth attendants were observed in the delivery room using a standardized checklist during April and May 2019. Descriptive statistics were used to analyze data.

Results

The majority (65.5%) of newborns were female, and at term (93.6%). The majority had mouth and nose cleared (60%), dried thoroughly (75.4%), wet cloth removed (57.3%), delayed umbilical cord clamping (67.3%), and immediate skin-to-skin contact (67.3%). Limited interventions included APGAR evaluation (28%) and breastfeeding within the first hour (36.6%). The majority of 135(78.9%) were stable, and none died.

Conclusion

The majority of the study population was stable, though all newborns did not benefit from standard immediate newborn care. To reduce neonatal mortality and morbidity in Rwanda, we need to redouble efforts to strengthen the quality of immediate newborn care. Future research is needed to identify effective training to improve newborn outcomes at birth.

Rwanda J Med Health Sci 2020;3(2):238-249

Retention of Helping Babies Breathe Training among Midwives and Nurses at Four Rwandan Health Centers

2020-09-08T09:02:10+00:00

Background

Worldwide, neonatal mortality remains a significant burden. One substantial cause of mortality is asphyxia, where neonates fail to breathe on their own at birth and need some form of assistance to initiate or maintain breathing. The Helping Babies Breathe (HBB) training program has proven to be helpful in the reduction of asphyxia-related neonatal mortality in developing countries.

Objective

To assess the HBB knowledge and skills retention at two-days and six-weeks post HBB training among midwives and nurses working in selected health centers in Kigali, Rwanda.

Methods

A quasi-experimental design with a pre-test, post-test, and intervention using HBB (2^nd Edition) program was used. Sixty midwives and nurses were purposively selected from the four study sites. Knowledge and skills retention of HBB was evaluated at two-days and six-weeks post-training.

Results

The majority of participants were nurses (90%), females (70%), and had advanced diploma (63%). Knowledge overall mean scores improved from pre-test (8.75) to post-test (16.90). Skills mean scores slightly dropped from 21.77 at day two to 19.73).

Conclusion

Our results indicated that there was retention of knowledge and skills among the midwives and nurses at day two and six-weeks post HBB training. Refresher training programs are needed to keep providers skilled for resuscitation in order to lower neonatal mortality in Rwanda.

Rwanda J Med Health Sci 2020;3(2):250-260

Climate Change Associated with Neonatal Health Risks: Rwandan Nurses and Midwives’ Awareness and Perceptions

2020-09-08T12:46:21+00:00

Background

Climate change (CC) is a global public health problem. In Rwanda, it is estimated that 28% of neonatal death is attributable to CC, yet little is known about healthcare providers’ awareness of neonatal health risks.

Objective
To assess nurses’ and midwives’ awareness of CC and perceptions of potential neonatal health risks associated with CC at selected hospitals in Rwanda.

Methods

A cross-sectional survey was performed at four selected hospitals. A random sampling technique was used to select 184 of 340 nurses and midwives working in neonatology, pediatrics, and maternity departments. Descriptive and inferential statistical tests were done.

Results
The majority of participants were females (62.1%), nurses (60.5%), advanced diploma holders (55.4%). The majority (60.4%) had low level awareness of CC, and only 2.8% obtained CC information at nursing school. The majority (61.02%) had low perception of potential CC’ related potential neonatal health risks. High education level, working in neonatology and longer working experience were found to be associated with high level awareness of CC and high perceptions of potential neonatal health risks associated with CC (p<0.05).

Conclusion

There was a low level awareness of CC awareness and low perceptions of potential neonatal health risks among nurses and midwives. Offering in-service training and integrating CC’ health risks in the nursing curricula could motivate climate action among Rwandan nurses and midwives.

Rwanda J Med Health Sci 2020;3(2):261-272