Rwanda Journal of Medicine and Health Sciences https://www.ajol.info/index.php/rjmhs <p>The <em>Rwanda Journal of Medicine and Health Sciences</em> is a peer reviewed journal published three times a year and is a continuation of the former Rwanda Journal Series F: Medicine and Health Sciences since January 2018. It publishes topics relevant to various health related fields including but not limited to medicine, pharmacy, dentistry, nursing, public health, nutrition, health management and policy, and other health sciences. The Journal accepts quantitative, qualitative, and mixed methods studies, each evaluated for their scientific rigor and validity. The following types of manuscripts will be considered for publication in the journal: original research, review articles, short communications, letters to the editor, perspective articles, lessons from the field, editorials, and case reports.&nbsp; Each of these is further elaborated below. The journal may publish supplements of conference proceedings or special editions.&nbsp;</p> University of Rwanda en-US Rwanda Journal of Medicine and Health Sciences 2616-9819 <p>During the submission, authors will be requested to complete a ‘Copyright Transfer form' to assign to the University of Rwanda the copyright of the manuscript and any tables, illustrations or other material submitted for publication as part of the manuscript (the "Article") in all forms and media (whether now known or later developed), throughout the world, in all languages, for the full term of copyright, effective when the article is accepted for publication. The Creative Commons Attribution NonCommercial-NoDerivs (CC-BY-NC-ND) license shall be applied.</p> Editorial Hand washing – an essential protective measure in healthcare settings and in the community https://www.ajol.info/index.php/rjmhs/article/view/194600 <p>In the framework of the quality improvement and accreditation process, Rwandan hospitals have promoted hand washing for healthcare providers, patients and visitors. This editorial elaborates on the readiness of Rwandan hospitals and the community at large to practice correct and systematic hand washing, which is of value to contain the COVID-19 pandemic.</p> <p><strong>Key words:</strong> Rwanda, hand washing, COVID-19</p> Jean Bosco Gahutu Copyright (c) 2020 Unversity of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 2 2 Melatonin ameliorates ketoconazole-induced increase in thyroid function https://www.ajol.info/index.php/rjmhs/article/view/194660 <p><strong>Background</strong></p> <p>The antithyroid effect of ketoconazole has been reported. The secretion and action of melatonin in the thyroid gland are also known. However, the possible effect of melatonin on ketoconazole-induced antithyroid effect is unknown.</p> <p><strong>Objective</strong></p> <p>We sought to investigate the modulatory effect of ketoconazole and/or melatonin on thyroid function in female rats.</p> <p><strong>Methods</strong></p> <p>Groups 1-4 of female rats respectively underwent 14-day treatment with normal saline, 25 mg/kg ketoconazole, 4 mg/kg melatonin and 10 mg/kg melatonin. Groups 5 and 6 both received 14-day treatment with ketoconazole and were respectively treated with 4 mg/kg melatonin and 10 mg/kg melatonin simultaneously. Groups 7 and 8 respectively underwent 14-day pretreatment with 4 mg/kg melatonin and 10 mg/kg melatonin, followed by 14-day administration of ketoconazole to both groups. Groups 9 and 10 were both treated with ketoconazole for 14 days, followed by respective 14-day administration of 4 mg/kg melatonin and 10 mg/kg melatonin.</p> <p><strong>Results</strong></p> <p>TSH, T3, T4, and iodine concentrations were increased by separate administration of ketoconazole and either dose of melatonin when compared to control. However, pre-treatment or post-treatment of ketoconazole-treated rats with melatonin abolished the ketoconazole-induced increase in TSH, T3, T4, and iodine while co-administration of ketoconazole with melatonin caused no improvement in the ketoconazole-induced increase in TSH, T3, and T4 except iodine concentration.</p> <p><strong>Conclusion</strong></p> <p>Ketoconazole increased thyroid function, which was ameliorated by pre- or post-treatment with melatonin, possibly via modulation of the iodination process.</p> <p><strong>Keywords:</strong> Iodine; Ketoconazole; Melatonin; Thyroid function; Toxicity</p> Abdullateef Isiaka Alagbonsi Luqman Aribidesi Olayaki Halimat Amin Abdulrahim Mariam Titilayo Suleiman Israel Bojuwade Noah Adavize Omeiza Sheu Oluwadare Sulaiman Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 3 10 Clinical Profile of Paediatric Head and Neck Cancers at a Tertiary Hospital in Tanzania https://www.ajol.info/index.php/rjmhs/article/view/194613 <p><strong>Background</strong></p> <p>Paediatric head and neck cancers represent an important group of childhood cancers that require maximum attention at large. They are often diagnosed at advanced clinical stages at Muhimbili National Hospital (MNH).</p> <p><strong>Objective</strong></p> <p>To describe the clinical profile of paediatric head and neck cancers at a tertiary hospital in Tanzania</p> <p><strong>Method</strong></p> <p>A hospital based descriptive cross-sectional study was conducted involving 180 paediatric patients. Data were analyzed using SPSS program version 21.</p> <p><strong>Results</strong></p> <p>A total of 180 paediatric patients were recruited where 61.1% were males and 38.9% were females. Majority belonged to the age group 0-5 years (53.9%). A total of 10 primary anatomical sites were found with the neck (cervical lymph node) predominating (36.1%), followed by the orbit/eye (34.4%) and the least anatomical sites were oral cavity (1.1%) and parapharyngeal space (0.5%). Leukocoria (93.9%), red eye (93.9%) and orbital cellulitis (77.6%) predominated in retinoblastoma but in patients with lymphomas, predominant features were night sweats (100%), weight loss (100%) and fevers (95.8%).</p> <p><strong>Conclusion</strong></p> <p>The clinical profile depicted in this study appears to correlate with advanced clinical stages.</p> <p><strong>Keywords: </strong>Paediatric; Head; Neck Cancers; Muhimbili; Tanzania</p> Zephania Saitabau Abraham Enica Richard Massawe Aveline Aloyce Kahinga Kassim Babu Mapondella Willybroad Augustine Massawe Henry Swai Siwillis Mithe James Joseph Yahaya Daudi Ntunaguzi Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 11 20 Comparative study of Pap smear test and VIA test in cervical carcinoma screening among women aged over 20 years https://www.ajol.info/index.php/rjmhs/article/view/194641 <p><strong>Objective</strong></p> <p>To compare the performance of VIA and Pap smear tests as screening tools in cervical carcinoma detection in women.</p> <p><strong>Methods</strong></p> <p>The prospective and retrospective study was conducted on 198 women. Cervical smears were collected with Ayres’s spatula. Acetic acid was used and the results were categorized as VIA positive and VIA negative. The Pap smear was reported according to the Bethesda system 2001. Cervical biopsy was done for all the cases.</p> <p><strong>Results</strong></p> <p>VIA was positive in 47.47% of the cases and Pap smear was positive in 39.89% of the cases. Among 198 cases, 61 (30, 8%) cases had cervical carcinoma. When we compared VIA and Pap smear tests, 94 cases were positive to VIA, and 61cases were confirmed positive with Pap smear. The sensitivity and specificity for VIA were 88.5% and 84.68%, respectively. The sensitivity and specificity for Pap smear were 80.45% and 91.89%, respectively. The sensitivity of VIA was higher than that of Pap smear. However, the specificity of VIA was low as compared to Pap smear.</p> <p><strong>Conclusion</strong></p> <p>VIA is a cost effective test and could be alternatively used with Pap smear in screening of cervical carcinoma but the Papanicolaou test is the most effective test for early detection of cervical carcinoma.</p> <p><strong>Keywords: </strong>Pap smear test; VIA test; cervical carcinoma; women</p> Alphonse Niyodusenga Emile Musoni Sarah Niyonsaba Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 21 29 Perioperative Fluid Management for Elective Major Surgery Patients at a Teaching Hospital in Rwanda https://www.ajol.info/index.php/rjmhs/article/view/194645 <p><strong>Background</strong></p> <p>Every year, over 312 million surgical operations are performed globally. While perioperative goal-directed fluid strategy may reduce postoperative complications among patients undergoing major surgery, poor perioperative fluids management has been linked to adverse postoperative patients’ outcome.</p> <p><strong>Methods</strong></p> <p>This study used quantitative prospective design to assess the perioperative fluids management in 133 patients operated in the theatre of University Teaching Hospital of Butare (CHUB). The SPSS 21 was used to analyze the data, Chi-square test was performed to assess the association between fluid administered and patients’ hydration status with an acceptable cutoff at p&lt;0.05.</p> <p><strong>Results</strong></p> <p>The findings showed that 108 (81.2%) and 25 (18.8%) participants were in dehydration class A and B before surgery and strongly associated with age, surgeries, type and amount of intraoperative fluids. Participants received RL and NS (67.7%), 2091.73 ml, <u>+</u>803.6 ml and lost 218.42<u>+</u>131.9 ml fluid in average. Postoperatively, 53.4% and 46.6% participants were in dehydration class A and B respectively, strongly associated with type and duration of surgery (P&lt;0.05). All participants fasted more than 6 hours.</p> <p><strong>Conclusion</strong></p> <p>The dehydration rate increased intraoperatively in relation to type and duration of surgery and type and amount of fluid administered. Reduced fasting time and effective intraoperative fluid management would improve the patients’ hydration after surgery and postoperative patients’ outcome.</p> <p><strong>Key words</strong>: Major Surgery, Elective Surgery, Perioperative care, Fluid management, patients</p> Pierre Irafasha Malachie Tuyizere Joselyne Mukantwari Lilian Omondi Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 30 39 Status of Water, Hygiene and Sanitation Practices in Southern Rwanda https://www.ajol.info/index.php/rjmhs/article/view/194646 <p><strong>Background</strong></p> <p>Increasing access to water sanitation and promoting basic hygiene behaviours can reduce the burden of diarrheal diseases. Availability of clean water and soap enables and encourages people to wash their hands, and as a result, it reduces the likelihood of disease transmission. The study intended to assess the hygiene and sanitation practices in Southern Rwanda.</p> <p><strong>Methods</strong></p> <p>A mixed method with quantitative and qualitative approach was used. A random sample of 291 households was included in the study.&nbsp; Focus Group Discussions (FGDs), Key Informant Interviews (KIIs), and observations were used. The data was analysed using SPSS 21.</p> <p><strong>Results</strong></p> <p>The findings show that 88% of respondents had knowledge on best practices of hand washing with soap; 83.5% of the respondents own latrines, and 38% and 26% had the will to improve their toilets roof and slabs respectively.</p> <p>Forty-four per cent of respondents use boiling water methods and 55% do not treat water at all. Boiling water was regarded as the main water treatment method.</p> <p><strong>Conclusion</strong></p> <p>The study concludes that lack of water and soaps, and hand washing facilities were among other factors that hinder hygiene and sanitation.</p> <p><strong>Key words</strong>: Hygiene; sanitation practice</p> Theoneste Ntakirutimana Malachie Tuyizere Olivier Ndizeye Francois Xavier Sunday Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 40 48 Functional Health Literacy and Self-Care Behaviors Among Type 2 Diabetic Patients at a University Teaching Hospital in Kigali https://www.ajol.info/index.php/rjmhs/article/view/194648 <p><strong>Background</strong></p> <p>Type 2 Diabetes Mellitus (T2DM) is a significant health burden in high-income countries and emerging in sub-Sahara African countries, including Rwanda. Prevention and treatment of T2DM are imperative and need to focus on functional health literacy and self-care practices among people with diabetes.</p> <p><strong>Objective</strong></p> <p>To determine if functional health literacy is associated with self-care behaviors among T2DM patients.</p> <p><strong>Method</strong></p> <p>This study was a descriptive cross-sectional design conducted at a University Teaching Hospital in Kigali. The sample comprised of 223 T2DM patients recruited from the university outpatient department. The questionnaire was developed from two studies.&nbsp; Descriptive statistics were used to analyse the data.</p> <p><strong>Results</strong></p> <p>Results indicated a low-level of functional health literacy, with a wide range of scores from 6.5% to 93.5%, and a mean of 51.66 (SD 15.77).The majority of 123 (55.3%) had inadequate functional health literacy and self-care behaviors. There was a strong association between functional health literacy and self-care behaviors (p &lt; 0.001).</p> <p><strong>Conclusion</strong></p> <p>The level of functional health literacy among T2DM patients needs to be increased and patients should be highly encouraged to adhere to self-care behaviors. Future research could involve an interventional study to discover the best method to educate T2DM patients.</p> <p><strong>Keywords:</strong> Type 2 diabetes mellitus; functional health literacy; self-care behaviors; patients T2DM; sub-Saharan Africa</p> Vestine Mukanoheli Marie Claire Uwamahoro Valens Mbarushimana Pamela Meharry Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 49 59 Assessing Knowledge and Factors Associated to Long Lasting Insecticide Nets use among pregnant women in southern Rwanda https://www.ajol.info/index.php/rjmhs/article/view/194650 <p><strong>Background</strong></p> <p>Around 443,000 pregnant women are at risk of malaria each year in Rwanda. LLINs are freely distributed to women at health centers during antenatal care visit and vaccination services.</p> <p><strong>Methods</strong></p> <p>A cross-sectional design was used to explore pregnant women’s knowledge and factors associated to LLINs use in five cells of Tumba sector. Data was collected through interviews and questionnaires. The data was analyzed using SPSS 21. Bivariate and multivariate analyses were performed with Chi-square test to assess the association between LLINs ownership and utilization of LLINs.</p> <p><strong>Results</strong></p> <p>All respondents had high knowledge and knew that sleeping under LLINs helps to avoid mosquito bites whereas 381 (99.2%) knew that the use of LLIN helps to fight against the burden of malaria. LLIN ownership was 323 (84.1%) while usage was 283 (87.6%) among LLINs owners. LLIN ownership is significantly influenced by the level of education (p=0.001) and utilization (p=0.001). Although LLINs coverage was high, its utilization was low. Sixty-one respondents (15.9 %) do not have LLINs and 84 (22%) of respondents had low knowledge on LLINs.</p> <p><strong>Conclusion</strong></p> <p>Regular training on LLINs may increase awareness of pregnant women on the benefits of LLIN utilization.</p> <p><strong>Keywords:</strong> Malaria; Households; Long-lasting insecticidal nets; Ownership; Rwanda</p> Amos Habimana Joseph Gikunju Dennis Magu Malachie Tuyizere Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 60 70 Trends in the Prevalence and Associated Contributing Factors of Stunting in Children Under Five Years of Age. Secondary Data Analysis of 2005, 2010 and 2014-2015 Rwanda Demographic and Health Surveys https://www.ajol.info/index.php/rjmhs/article/view/194651 <p><strong>Background</strong></p> <p>Stunting affects more than 161 million children under five years of age worldwide. Rwanda has a high prevalence of stunted children under five years of age (~38%) according to the 2014-2015 Rwanda Demographic and Health Survey.</p> <p><strong>Objectives</strong></p> <p>The aim of this study is to compare the prevalence rates of stunting in Rwanda using the Rwanda Demographic and Health Survey data of 2005, 2010 and 2014-2015.</p> <p><strong>Methods</strong></p> <p>The three Rwanda Demographic and Health Survey cross-sectional studies into consideration were conducted in 2005, 2010 and in 2014-2015. Stunting prevalence rates from those surveys were compared using Pearson's chi-squared tests and Marascuilo procedure using STATA (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.).</p> <p><strong>Results</strong></p> <p>The Pearson's chi-squared tests and Marascuilo procedure used in this research confirmed a significant difference between the reported three RDHS stunting prevalence rates. The trends in the stunting prevalence rates among children under five years of age showed a decrease of 13% in stunting prevalence rate, falling from 51%in 2005 to 38%in 2014-15.</p> <p><strong>Conclusion</strong></p> <p>A statistical analysis based on2005, 2010 and 2014-15 RDHS surveys datasets confirmed that there is a statistically significant reduction in stunting prevalence rates&nbsp; over that decade(from 51% in 2005 to 38%in 2014-2015). The main persistent associated factors with stunting were the age, sex, size at birth, residence place of the child, and the mother’s educational level and household wealth index.</p> <p><strong>Keywords:</strong> Stunting; children under five years; demographic and health survey; nutrition; Rwanda</p> Révérien Rutayisire Clémentine Kanazayire Germaine Tuyisenge Cyprien Munyanshongore Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 71 85 Contribution of fine needle aspiration and auramine tests in diagnosis of Tuberculosis lymphadenitis at Kigali University Teaching Hospital (CHUK), Rwanda https://www.ajol.info/index.php/rjmhs/article/view/194652 <p><strong>Background</strong></p> <p>Tuberculosis (TB) is an infection caused by <em>Mycobacterium tuberculosis. </em>Tuberculosis affects mainly the lungs but other organs of the body are involved. TB lymphadenitis is most common in extrapulmonary TB. Lymphadenitis is the infection or inflammation of the lymph nodes which are essential in immune response of the body.</p> <p><strong>Objective</strong></p> <p>To evaluate the contribution of fine needle aspiration (FNA) and auramine tests in the diagnosis of TB lymphadenitis.</p> <p><strong>Methods</strong></p> <p>Smears from lymph node aspirates were prepared. Air-dried smears were stained by auramine staining for AFB examination and Diff-Quick staining cytological technique to detect malignant cells and other pathology. The slides were examined by laboratory technologists and the pathologist.</p> <p><strong>Results</strong></p> <p>Results are based on a total number of 137 samples; 58 (42.33%) cases were auramine positive for TB lymphadenitis while other 79 (57.67%) suspected cases were non TB lymphadenitis. Necrotizing lymphadenitis, granulomatous lymphadenitis, chronic lymphadenitis, acute lymphadenitis and reactive lymphadenitis represented 21.19%; 13.14%; 1.42%; 2.19%; and 19.71% respectively.</p> <p><strong>Conclusion</strong></p> <p>The use of auramine test and FNA cytology should be considered as useful in the diagnosis of tuberculosis lymphadenitis. These techniques are less expensive, quick, safe and show low complication rate.</p> <p><strong>Keywords:</strong> TB lymphadenitis; fine needle aspiration; auramine test</p> Emile Musoni Alphonse Niyodusenga Sylvain Iradukunda Consolee Uwamahoro Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 86 92 Extrinsic Factors Influencing the Person’s Motivation for Engagement and Retention in the Addiction Recovery Process. A Systematic Literature Review https://www.ajol.info/index.php/rjmhs/article/view/194655 <p><strong>Background</strong></p> <p>Globally, up to 80% of patients enrolled for addiction care are lost to follow-up within the first three months of treatment. This review synthesizes evidence on extrinsic factors that influence motivation for engaging in addiction recovery and corresponding empirical definitions.</p> <p><strong>Methods</strong></p> <p>A systematic search for peer-reviewed articles was conducted through electronic databases, including Ovid MEDLINE, PsychINFO, CINHAL, and scanning references. The included articles were published in English or French between 1946 and 2018.</p> <p><strong>Results</strong></p> <p>The identified sixteen articles indicated that extrinsic factors for the person’s engagement and retention in the addiction recovery process included: motivation-enhancing healthcare structures, therapeutic relationships, and supportive social networks. Results also indicated that empirical definitions of motivation for engagement and retention in the addiction recovery process varied across studies.</p> <p><strong>Conclusion</strong></p> <p>Extrinsic factors can influence the person’s motivation for engagement and retention in the addiction recovery. Research with full operational definitions of motivation for engagement and retention in the addiction recovery is needed.</p> <p><strong>Keywords: </strong>Addiction recovery; engagement; extrinsic factors; motivation; retention</p> Boniface Harerimana Richard Csiernik Michael Kerr Cheryl Forchuk Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 93 108 Tuberculous Lymphadenitis: Early Diagnosis by GeneXpert of an Auramine-Negative Case https://www.ajol.info/index.php/rjmhs/article/view/194656 <p>Tuberculosis (TB) remains one of the major public health problems with a considerable number of new cases. Tuberculous lymphadenitis is one of the most common forms of extra-pulmonary TB whose diagnosis still faces many challenges. The case to report is a 17-year old female patient with a painful swelling in her right infra-retro-auricular area and the auramine stain was negative for acid-fast bacilli (AFB). GeneXpert was done, which confirmed the right infra-retro-auricular tuberculous lymphadenitis. The patient responded well to anti-TB treatment.</p> <p><strong>Key words</strong>: Lymphadenitis; Mycobacterium tuberculosis; Auramine; GeneXpert</p> Louise Munezero Narcisse Niyikora Fidèle Mahirane Belson Rugwizangoga Copyright (c) 2020 University of Rwanda https://creativecommons.org/licenses/by-nc-nd/4.0/ 2020-04-14 2020-04-14 3 1 108 110