Rwanda Journal of Medicine and Health Sciences

Overview of Rehabilitation in Low- and Middle-Income Countries

Jean Claude Karimwabo — 2026-07-31

None

Perceptions of Sexual and Reproductive Health and Rights among Students at a Higher Learning Institution in Rwanda

Alice Muhayimana — 2026-07-31

Background
Higher Learning Institution (HLI) students face many risks, including unintended pregnancies, sexually transmitted infections, and unsafe abortions, due to limited knowledge of Sexual and Reproductive Health and Rights (SRHR), and while this issue is documented in low- and middle-income countries, evidence from Rwanda remains scarce. This study explored the experiences and perceptions of SRHR among undergraduate students at a HLI in Rwanda.
Methods
The study conducted in February 2023 used a qualitative exploratory approach was employed, involving in-depth interviews with 10 purposively selected students, one male and one female from each of the five colleges who had participated in a prior quantitative study. The interviews, conducted in Kinyarwanda, were transcribed verbatim, translated into English, and analysed thematically.
Results
Four major themes emerged: 1) Acceptance of premarital sexual intercourse among youth, 2) Contraceptive awareness, myths, and method preferences, 3) Sources of SRHR information, and 4) Divergent views on abortion. The study found limited access to accurate SRHR information, persistent contraceptive myths, and stigma affecting contraceptive use.
Conclusion
There are gaps in SRHR among HLI students in Rwanda. They have limited understanding of contraceptive methods and side effects, misconceptions shaped by sociocultural norms, restricted access to reliable SRHR information sources, and uncertainty surrounding sexual rights, premarital sexual practices, and abortion. We recommend creating safe, non-judgmental environments where students can seek SRHR information, increasing awareness about long-acting contraceptive methods, and improving condom availability on campuses. Addressing these gaps is critical to promote informed, safe, and responsible SRHR decision-making among HLI students in Rwanda.
Rwanda J Med Health Sci 2026;9(2):266-280

State of Knowledge and Awareness of Preconception Preparedness among Premarital Couples in Rwanda: A Quantitative Cross-Sectional Survey

Richard Nsengiyumva — 2026-07-31

Background
Preconception preparedness (PP) is important for improving maternal and neonatal health outcomes by promoting health optimization before conception. However, awareness remains limited in sub-Saharan Africa. Furthermore, evidence on premarital couples as a distinct population is scarce.
Aim
To assess the status, including level of knowledge and awareness (KA), of PP and identify associated factors among premarital couples in Rwanda.
Methods
A cross-sectional survey was conducted between May and July 2024 among 600 couples (n = 1,200) recruited from civil and religious marriage registration offices in 15 districts of Rwanda. Data were collected using a structured questionnaire and analyzed using IBM SPSS Statistics for Windows version 29 (IBM Corp, Armonk, NY, USA). Descriptive statistics, independent t-tests, and multiple logistic regression were used to examine KA levels and associated factors.
Results
The mean participant age was 29.5 years (SD, 5.5), 91.2% of participants demonstrated low PP KA, while only 8.8% had fair KA. At the couple level, 95.3% of them had both partners in the low KA category. Females were more likely than males to demonstrate fair KA (12.0% vs. 2.8%). Other factors associated with fair KA included female sex (AOR = 2.1; p = 0.007), secondary or higher education (AOR = 6.3; p = 0.004), and urban residence (AOR = 1.7; p = 0.009). Prior exposure to PP information was uncommon (3.3%) but was associated with higher odds of fair KA (AOR = 3.3; p = 0.002)
Conclusion
Knowledge and awareness of PP are low among the majority of premarital couples in Rwanda. Strengthening community-based educational interventions, integrating PP into premarital counseling, and expanding information dissemination are needed to improve preconception health literacy among couples preparing for parenthood.
Rwanda J Med Health Sci 2026;9(2):281-298

Clinical Significance of Lipoprotein and Ceruloplasmin Variations in Type 2 Diabetes Mellitus: A Cross-Sectional Study in Owo, Nigeria

Adedeji David Atere — 2026-07-31

Background
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance leading to hyperglycemia, dyslipidemia, and oxidative stress. Ceruloplasmin (CP), the major oxidase and copper-binding protein, has recently been under investigation as an indicator of metabolic dysfunction. Increased CP levels cause oxidative stress and inflammation and thus promote numerous cardiovascular and renal complications. Determination of CP could serve as an early reliable biomarker for timely intervention in the holistic management of T2DM. The present study was designed to compare lipoprotein levels, CP, and oxidative stress markers between participants with diabetes and those without diabetes.
Methods
Fifty patients with T2DM were evaluated along with 30 age- and sex-matched non-diabetic controls visiting Federal Medical Centre, Owo. Standard enzymatic and ELISA techniques assessed biochemical parameters such as fasting blood sugar (FBS), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), CP, malondialdehyde (MDA), and total antioxidant status (TAS). Data were analyzed by SPSS Version 25. The independent t-test was then used to determine the difference between group means in the biochemical markers. Spearman's correlation was applied to establish relationships, and the level of significance was set at p<0.05.
Results
The FBS, CP, TC, TG, HDL, VLDL, and MDA levels were all statistically significant in patients with T2DM, while TAS decreased remarkably (p<0.05). Obese participants showed exacerbated dyslipidemia and oxidative stress. Positive correlations were observed between CP and lipid parameters, while MDA negatively correlated with TAS.
Conclusion
Ceruloplasmin was raised in T2DM, dyslipidemia, and lowered antioxidant capability were early markers that prompt intervention for oxidative stress and biochemical derangements in patients with T2DM. In this regard, CP could potentially emerge as a novel marker to monitor the progression of complications in T2DM.
Rwanda J Med Health Sci 2026;9(2):299-310

Assessment of Prehospital Emergency Care Resources in Urban and Rural Rwanda Using the WHO Health System Framework: A Cross-Sectional Study

Liberatha Rumagihwa — 2026-07-31

Background
Prehospital emergency care is essential for reducing preventable deaths and disabilities from road traffic accidents. Evidence regarding the availability and distribution of prehospital emergency care resources in Rwanda remains limited.
Objective
This study assessed prehospital emergency care resources across three prehospital systems in Rwanda.
Methods
A descriptive cross-sectional study assessed prehospital emergency care resources using a locally adapted WHO prehospital emergency assessment tool. Key informants from one rural and two urban systems were purposively selected. Data were analyzed descriptively using WHO prehospital emergency system building blocks.
Results
Prehospital emergency care resources varied across systems. The urban public system employs 99 providers, mostly nurses, and operates 510 ambulances supported by a 24/7 toll-free dispatch system (912). The urban private system has 21 permanent staff members, including 18 prehospital care providers primarily emergency care assistants, and three administrative personnel, supported by 150 volunteers. It operates 12 ambulances and a 24/7 toll-free line (2100). The rural public system has 11 nurses and six ambulances relying on the urban public dispatch system for emergency activation.
Conclusion
Rwanda’s prehospital system is expanding; however, rural and private systems continue to face resource limitations. These gaps should be addressed to ensure equitable and effective prehospital care.
Rwanda J Med Health Sci 2026;9(2):311-326

Hepatotoxic Potentials of Food Additives on Liver Enzymes and Tissues of Wistar Rats

Ude Ugomma — 2026-07-31

Background
Food additives such as monosodium glutamate (MSG), sodium benzoate (SB), and Sunset Yellow (SY) are widely consumed and have been linked to adverse hepatic effects. However, the available evidence is largely derived from in vitro or single-additive studies, with limited comparative in vivo data integrating biochemical and histopathological outcomes under uniform experimental conditions.
Objective
This study compared the hepatotoxic effects of MSG, SB, and SY in a Wistar rat model to address gaps in controlled in vivo evidence on multiple food additives.
Methods
Sixteen healthy Wistar rats were randomly assigned to four groups. The control group received a standard diet, while Groups II–IV received MSG, SB, and SY respectively. Hepatotoxicity was assessed by measuring serum activities of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase, together with histopathological examination of liver tissue.
Results
The MSG and SB significantly increased aspartate aminotransferase (AST) and alkaline phosphatase (ALP) levels compared with controls (p < 0.05), indicating hepatocellular and cholestatic injury. Sunset Yellow did not significantly alter ALT levels (p = 0.074) but showed mild histopathological changes.
Conclusion
Both MSG and SB exhibited greater hepatotoxic effects than SY in Wistar rats. These findings highlight the need for routine safety re-evaluation of commonly consumed food additives, strengthened regulatory oversight, and further long-term studies to inform evidence-based public health policies.
Rwanda J Med Health Sci 2026;9(2):327-341

Community-Delivered, Task-Shifted Trauma-Focused Intervention for Youth in Northwest Nigeria: Mental Health and Functional Outcomes of a Mixed-Methods Study

Yakubu Abdullahi — 2026-07-31

Background
Trauma affected youth in northwest Nigeria's humanitarian crisis face trauma exposure and limited mental health care; this study evaluated outcomes of a task-shifted, community delivered intervention.
Methods
A convergent parallel mixed-methods, quasi-experimental design was employed. Participants (N=412, aged 15–24) were allocated to intervention (n=206) receiving a culturally adapted 10-session group Trauma-Focused Cognitive Behavioural Therapy (CBT) delivered by trained community lay providers, or to the waitlist control (n=206). Primary outcomes were posttraumatic stress disorder (PTSD) symptoms (Child PTSD Symptom Scale [CPSS]) and functional impairment (WHO Disability Assessment Schedule for Children). Assessments occurred at baseline, post-intervention, and 3 month follow up. Analysis used intention to treat three level linear mixed models accounting for clustering within communities. Qualitative methods involved 24 key informant interviews analysed using thematic analysis following COREQ guidelines.
Results
At post-intervention, the intervention group showed significantly greater reductions in CPSS (mean difference: -8.3, 95% CI: -10.6 to -6.0, p<0.001, d=1.35) and WHODAS-Child scores (mean difference: -8.9, 95% CI: -11.5 to -6.3, p<0.001, d=1.40) compared to controls. Gains were maintained at follow-up. Qualitative themes highlighted the necessity of health system integration and community ownership for sustainability.
Conclusion
A task-shifted, community-delivered trauma-focused intervention demonstrates promising effectiveness in reducing PTSD symptoms and improving functioning among youth in northwest Nigeria, indicating potential for scale-up pending confirmatory evidence from randomised controlled trials and health system integration.
Rwanda J Med Health Sci 2026;9(2):342-355

Lived Experiences of Adolescents with Type 1 Diabetes Mellitus Receiving Treatment at Rwanda Diabetes Association: A Qualitative Study

Sandrine Niyigena — 2026-08-10

Background
Type 1 Diabetes Mellitus (T1DM) poses a significant health burden among children and adolescents, leading to lifelong dependence on insulin therapy, an increased risk of acute and chronic complications, frequent hospitalizations, reduced quality of life, and psychological and economic challenges. Managing T1DM during adolescence is particularly challenging due to hormonal changes.
Objective
This study aimed to explore the lived experiences of adolescents with type 1 diabetes mellitus receiving treatment at the Rwanda Diabetes Association.
Methods
This study follows a qualitative approach with a generic descriptive design. Ten (10) adolescents with type 1 diabetes mellitus receiving treatment at the Rwanda diabetes association were included in this study using a convenience sampling method. The data were collected using an in-depth interview guide. The final data were imported to ATLAS-ti where thematic analysis was conducted.
Results
Adolescents with T1DM experienced fear, denial, emotional distress, and social exclusion. Participants reported that family support and prayer played a vital role in facilitating their adaptation to T1DM. Recommended facilitators were strong maternal support, peer assistance, and guidance from the Rwanda Diabetes Association. Identified barriers were: lack of privacy at school, stigmatization, food insecurity, and emotional fatigue.
Conclusion
This study highlights the need to strengthen diabetes education in schools, psychosocial support, and improve access to glucometers for adolescents living with Type 1 Diabetes Mellitus.
Rwanda J Med Health Sci 2026;9(2):356-368

Breastfeeding with Extra Care: A Qualitative Insight of Mothers of Children with Down Syndrome in Rwanda

Joselyne Rugema — 2026-08-10

Background
Breastfeeding children with Down syndrome (DS) is challenging due to the infants’ physiological characteristics and increased caregiving demands. Evidence from Sub-Saharan Africa, including Rwanda, remains limited. This study aimed to explore the breastfeeding experience and coping strategies among mothers of children with DS in Rwanda.
Methods
A qualitative descriptive study was conducted using in-depth interviews with 23 purposively selected mothers of children with DS. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis to identify patterns and meanings within mothers’ breastfeeding experiences.
Results
Four main categories and eight subcategories emerged: 1. challenges in initiating and sustaining breastfeeding, 2. physical and time-related burdens, 3. emotional challenges and distress among mothers, and 4. coping strategies to sustain breastfeeding. Mothers reported delayed initiation of breastfeeding, shortened breastfeeding episodes due to persistent feeding difficulties, increased time demands, physical discomfort, financial strain, family conflicts, and significant emotional distress. Lack of adequate information and assistance, and delayed diagnosis further intensify these challenges. Despite these hurdles, mothers employed adaptive coping strategies to sustain breastfeeding.
Conclusion
Early diagnosis and management for Down syndrome and strengthening specialized lactation support may improve breastfeeding experiences and outcomes in low-resource settings.
Rwanda J Med Health Sci 2026;9(2):369-381

Parents’ Adaptation Process in Providing Care to Preterm Neonates in the Neonatal Intensive Care Units in Rwanda: A qualitative study

Marie Rose Mukarubayiza — 2026-08-10

Background
Preterm birth remains a global health issue, and prematurity poses a significant health risk to neonates and often requires prolonged care in the Neonatal Intensive Care Unit (NICU). This experience can be overwhelming for parents, who must adapt emotionally and practically to the demands of caring for their fragile infants. Investigating parental adaptation processes in caring for preterm neonates is essential for designing effective parental involvement in the Neonatal Intensive Care Unit.
Objective
This study aimed to explore parents’ adaptation process in caring for preterm neonates in the Neonatal Intensive Care Units.
Methods
A descriptive qualitative design was used. Data were collected through in-depth, semi-structured interviews with purposively selected parents of preterm neonates admitted to six hospitals in Rwanda. Interviews were conducted with 24 participants (4 per hospital), and 6 focus group discussions were held (1 per hospital). Recording, transcription, and thematic analysis were used to identify emerging themes related to parental adaptation.
Results
Five major themes emerged: 1) Initial Emotional response, 2) Adaptation and coping mechanisms, 3) Adaptation of knowledge and skills in caring for preterm neonates 4) Challenges and barriers in the adaptation process. The fifth is healthcare system adaptation to address parental experiences in NICU settings.
Conclusion
The parental adaptation process in the NICU is dynamic, shaped by emotional, social, and institutional factors. The adaptation process, clear communication from healthcare providers, and structured parental involvement in neonatal care can significantly ease this transition.
Rwanda J Med Health Sci 2026;9(2):382-399

Reproductive Health Knowledge, Contraceptive Practices and Predictors of Unprotected Sexual Intercourse among Female Undergraduates in Ogbomoso, Nigeria

Omoruan Augustine Idowu — 2026-08-10

Background
Unprotected sex among female undergraduates remains a significant reproductive health concern in Nigerian tertiary institutions, yet evidence on socio-cultural predictors remains limited. This study examined reproductive health knowledge and factors associated with contraceptive use and engagement in unprotected sex among female undergraduates at Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
Methods
A cross-sectional survey was conducted among 286 female undergraduate students selected, using multistage sampling techniques. Data were collected using a structured questionnaire and analysed using IBM SPSS version 27. Descriptive statistics, Chi-square tests, and binary logistic regression were employed, with statistical significance set at p < 0.05.
Results
The study revealed that most respondents (63.6%) demonstrated good knowledge of reproductive health, and the majority (85.0%) perceived institutional reproductive health support services as inadequate. Students in higher academic levels had lower odds of using contraceptives; on the other hand, married students and those influenced by religious values had lower odds of engaging in unprotected sex.
Conclusion
Consistent contraceptive use remains low among female undergraduates, irrespective of the relatively high reproductive health knowledge. Socio-cultural factors were significantly associated with engagement in unprotected sex. Universities should strengthen youth-friendly health services and sexuality education programmes.
Rwanda J Med Health Sci 2026;9(2):400-413

Birth Spacing and Undernutrition among Children Under Five Years in Rwanda: A Secondary Data Analysis of RDHS 2019/2020

Elisabeth Baraka — 2026-08-12

Background
Short birth intervals have been linked with increased childhood undernutrition, yet evidence in Rwanda remains limited. Using data from the 2019/2020 Rwanda Demographic and Health Survey (RDHS), this study assessed the association between birth spacing and undernutrition among children under five years.
Methods
This cross-sectional study utilized weighted data from 3,815 children under five from the 2019/2020 RDHS. Undernutrition was defined as either stunting, underweight, or wasting. Birth spacing was categorized as <24, 24–36, and >36 months and multivariable model was used to examine the association.
Results
The prevalence of undernutrition was 34.1%, and most (69.1%) had a birth interval longer than 36 months. After adjusting for confounders, longer birth spacing was associated with lower odds of undernutrition (AOR: 0.8; 95% CI: 0.6–0.9, p = 0.034). In addition, undernutrition was significantly associated with children from poor households, children of mothers with no education or primary education, and male children, while children of married or cohabiting mothers had lower odds of undernutrition.
Conclusion
Longer birth spacing is associated with a low odds of child undernutrition. Public health policies should strengthen access and utilization of family planning services, maternal education, and socioeconomic support to enhance child nutrition outcomes.
Rwanda J Med Health Sci 2026;9(2):414-425

In Vitro Evaluation of Cytotoxicity in Novel Nano-Filled Bulk-Fill Flowable Dental Composites

Muskan Shreshtha — 2026-08-12

Background
Nano-filled bulk-fill flowable composites have gained widespread use in restorative dentistry owing to their ease of manipulation, reduced polymerisation shrinkage, and improved physical and esthetic properties. Despite these advantages, the potential leaching of unreacted monomers or residual nanoparticles remains a concern, as such release may compromise the biological safety of these materials. Therefore, the present study aimed to assess the cytotoxic potential of a nano-filled bulk-fill flowable composite on 3T3-L1 fibroblast cells using the MTT assay. This evaluation was undertaken to elucidate the material’s biosafety profile and its suitability for clinical application.
Methods
The in vitro cytotoxicity assessment was performed in accordance with ISO 10993-5 guidelines. The nano-filled light-cured composite was finely ground, and serial extract concentrations of 25, 50, and 75 mg/mL were prepared in culture medium. 3T3-L1 fibroblasts were exposed to these extracts for 48 hours, after which cell viability was quantified using the MTT assay by measuring absorbance at 570 nm. Morphological alterations in fibroblasts following exposure were examined using phase-contrast microscopy. Statistical analysis was conducted using one-way ANOVA followed by post-hoc testing, with significance set at p < 0.05.
Results
Mean cell viability was over 90 per cent at all of the concentrations (96.1 per cent, 94.3 per cent, 91.9 per cent), and was not significantly different at any of the controls (p > 0.05). Cells were attached with normal spindle morphology.
Conclusion
The tested nano-filled bulk-fill composite was found to be highly biocompatible and exhibit low cytotoxic effects, confirming that it can be used in clinical restorative cases.
Rwanda J Med Health Sci 2026;9(2):426-434

Thalassemia in Iraq: Time to Reform Policy

Halima Adill Abdulrahman — 2026-08-12

Thalassemia is one of the most common hemoglobinopathies worldwide, particularly within the Middle Eastern demographics. Despite the existence of a nationwide screening program in Iraq and a decline in disease incidence, its optimal effectiveness remains uncertain, as β-thalassemia prevalence continues to rise. This paper seeks to evaluate the weaknesses of the thalassemia screening program in Iraq. It also suggests actionable strategies for policy change to further reduce disease incidence. Additionally, the discussed concepts can be applicable to other regions facing a similar burden. Factors like widespread consanguineous marriage, inadequate public knowledge, and restricted access to prenatal diagnostic services impose further burden on prevention efforts. To attain national elimination of β-thalassemia in Iraq, the Ministry of Health, in collaboration with medical organizations, must promptly address these barriers by revising policies and substantially investing in essential services.
Rwanda J Med Health Sci 2026;9(2):435-439

Complex Branching Patterns of the Left Brachial Plexus: A Case Report of Five Concurrent Anatomical Variations

Jean Paul Rugambwa — 2026-08-12

Background
Anatomical variations of the brachial plexus are common and may significantly influence surgical approaches, regional anaesthesia, and the interpretation of peripheral nerve injuries. Variations involving the musculocutaneous nerve and its relationship with the median nerve are particularly important given their clinical implications.
Case presentation
During a routine surgical anatomy dissection course on a formalin-fixed adult male cadaver, a rare variation was identified in the left upper limb. A 4 cm common trunk arising from both the medial and lateral cords of the brachial plexus bifurcated into the median and musculocutaneous nerves. The musculocutaneous nerve did not pierce the coracobrachialis muscle but supplied it via an accessory branch, with an additional branch arising directly from the lateral cord. A distal communicating ansa brachialis between the musculocutaneous and median nerves was also observed.
Conclusion
This case highlights a rare median–musculocutaneous trunk with associated neural communications and atypical muscular innervation. Awareness of such variations is essential for clinicians involved in upper limb surgery, peripheral nerve repair, and regional anaesthesia, as they may alter expected anatomical landmarks, influence surgical strategies, and affect clinical outcomes.
Rwanda J Med Health Sci 2026;9(2):440-444