Rwanda Journal of Medicine and Health Sciences

Preterm Births and Associated Factors among Women who Delivered in a District Hospital in Eastern Province, Rwanda: A retrospective study

Celestin Hakizimana — 2023-11-30

Background
Preterm birth is the primary cause of infant fatalities and is a global public health issue. In 2020, approximately 13.4 million babies were born preterm globally. Preterm birth was potentially associated with different socio-demographic factors as well as clinical and gynaeco-obstetrical factors. This study aimed at assessing the prevalence of preterm births and factors associated with them among women who delivered in Gahini District Hospital.
Methods
This study employed a cross-sectional retrospective study design and the sample size was 312 mothers. SPSS version 21 was used for data analysis. Univariate and bivariate analysis with Chi-square tests were performed. Multivariable logistic regression analysis was performed to figure out factors that were independently associated with preterm birth.
Results
This research revealed that the preterm birth prevalence in Gahini hospital was 9.6% and independently associated factors included mothers’ age >35 (AOR: 9.56; 95% CI: 1.38–66.33), being unmarried (AOR: 18.19, 95% CI: 2.96–111.59) and maternal BMI of 25–30 (AOR: 6.25, 95% CI: 1.34–29.12).
Conclusion
Preterm birth was found to be associated with different factors. Therefore, intervention strategies related to maternal and child health need to be developed and strengthened to address factors associated with preterm births.
Rwanda J Med Health Sci 2023;6(3):269-279

Factors Associated with New HIV Infection among Adolescent Girls and Young Women in the City Of Kigali Rwanda

Beata Sangwayire — 2023-11-30

Background
Globally, HIV/AIDS continues to be a serious public health issue. In Sub-Saharan Africa, the incidence of new HIV infections among adolescent girls and young women (AGYW) is gradually rising. Despite efforts being made, the high HIV infection positivity rate of 5% in Kigali among adolescent girls and young women continues to be a cause for concern.
Objective
To assess factors associated with new HIV infection among AGYW in Kigali.
Methods
The study used a case-control design, whereby cases were AGYW confirmed to HIV positive, while controls were AGYW confirmed to be HIV negative. Using SPSS Version 26, bivariate and multivariable logistic regression analyses were performed to identify HIV infection-associated factors.
Results
The majority 748 (96.6%) of the study participants were in the age category of 20-24 years and 487(63.2%) were single. Multivariable logistic regression model showed the following factors as independent predictors: being employed (aOR: 1.43; 95% CI: 1.02–2.03), being resident of Kicukiro (aOR: 1.59; 95% CI: 1.07–2.36), history of commercial sex worker (aOR: 2.04; 95% CI: 1.29–3.22) and having multiple sexual partners (aOR: .05; 95% CI: 1.41–2.98.
Conclusion
Public health interventions from key policymakers are needed to strengthen public health strategies of commercial sex workers to reduce new HIV infection including raising awareness through education for HIV Prevention.
Rwanda J Med Health Sci 2023;6(3):280-289

Music as an Adjuvant Therapy in Postoperative Pain and Physiologic Parameters: Pre-Test, Post-Test Intervention Study

Leonidah Kwamboka Amaya — 2023-11-30

Background
Poorly controlled postoperative pain remains a significant challenge. Music is a safe, inexpensive, non-invasive intervention that can be used in managing pain in surgical patients.
Objectives
To evaluate effectiveness of music intervention as an adjuvant therapy in attenuating postoperative pain among patients with tibia/fibula fractures.
Methodology
A cross-sectional pre-test, post-test intervention study design was utilized to conduct a study involving 20 tibia-fibula patients, divided equally into intervention and control groups. Self-selected music was administered for 20 minutes to the intervention group once on day-3 after surgery. Data was collected using a demographic questionnaire and Visual Analogue Scale (VAS).Data was analyzed using SPSS software version 29.0. Descriptive statistics analyzed continuous and categorical data. T-test compared means of physiologic parameters and pain levels in pre-and post-intervention. ANCOVA established the relationship between music and post-intervention pain levels.
Findings
Use of music alongside conventional therapy significantly reduced pain in the intervention group than in the control group (P = 0.014). Music had no statistically significant impact on the physiological parameters.
Conclusion
Music therapy is effective as an adjuvant therapy for pain management and can therefore reduce the use of analgesics among surgical patients.
Rwanda J Med Health Sci 2023;6(3):290-302

Knowledge, Attitude and Practices of Health Care Providers towards Disaster and Emergency Preparedness in Mtwara, Tanzania

Silvester Walles — 2023-11-30

Background
Over the past decade, the magnitude and intensity of reported natural and human-made disasters have been rising globally with substantial mortality and long-term morbidity.
Objectives
To assess the health care providers´ knowledge, attitude and practices towards disaster and emergency preparedness at Ligula Regional Referral Hospital in Mtwara, Tanzania.
Methods
A descriptive and analytical cross-sectional study was conducted among 94 health care providers; and a stratified sampling technique was employed to recruit the participants. Bivariate and multivariable regression analyses were performed using IBM SPSS Statistics for Windows version 25.0 (IBM Corp, Armonk, NY, USA) to determine the association between independent and dependent variables. A P < 0.05 was considered statistically significant.
Results
More than half 50 (53.2%) and more than three-quarters 75 (79.8%) of the participants had adequate knowledge and positive attitude towards disaster and emergency preparedness respectively. Younger participants aged 20–29 years had 5.252 (95% CI 1.313–21.016) times higher odds of having adequate knowledge of disaster and emergency preparedness than the older groups.
Conclusions
More disaster and emergency preparedness training programs and clinical simulations are needed to enhance the competencies of health care providers in handling disastrous events efficiently.
Rwanda J Med Health Sci 2023;6(3):303-314

Assessment of the Risk of Future Metabolic Syndrome among Non-Hypertensive and Non-Diabetic Nigerian Pregnant Women Presenting with either Glycosuria or Proteinuria at Different Trimesters

Oloruntoba Ayodele Ekun — 2023-11-30

Background
In pregnancy, women experience physiological changes which could increase the risk of insulin resistance, and metabolic syndrome later in life. This study assessed the risk of future metabolic syndrome among pregnant women with either glycosuria or proteinuria at different gestational ages.
Methods
Eight-Six participants were recruited from health facilities in South-west, Nigeria and they were in three categories: those with glycosuria (n = 32), proteinuria (n = 27), and control (n = 27), based on urinalysis result. Data were analyzed using IBM SPSS Statistics for Windows version 25.0 (IBM Corp, Armonk, NY, USA). Groups were compared using one way ANOVA. Association between the variables was determined using Pearson correlation. Linear regression analysis was performed to predict the risk of future metabolic syndrome.
Results
Participants with glycosuria, proteinuria and control were 29.19 (SD 6.04), 27.15 (SD 4.37) and 25.74 (SD 4.67) years respectively. Glycosuria group had higher (P = 0.01) triglycerides, HOMA-IR, and a-positive association (P = 0.001) between, FBG and HBA1C. Linear regression analysis predicted future risk of metabolic syndrome (P< 0.05) for those with glycosuria and proteinuria respectively with their plasma insulin values.
Conclusion
Healthy volunteers with glycosuria and proteinuria are at greater risk of developing metabolic syndrome.
Rwanda J Med Health Sci. 2023;6(3): 315-325

Quality of Life after Traumatic Spinal Cord Injury in Rwanda, the Impact of Personal and Contextual Factors: A Follow-Up Exploratory Study

Maurice Kanyoni — 2023-11-30

Background
Traumatic spinal cord injury (TSCI) affects quality of life (QoL) depending on the severity and access to rehabilitation. A good QoL is of paramount importance for TSCI survivors all over the world.
Objective
To assess the QoL of TSCI survivors after one year.
Methods
Adults were included who by the time of injury were 18 years or above and registered in a previous epidemiological study. “The International Spinal Cord Injury Quality of Life” standard data set was used to collect data and assess overall QoL (range 0-30) and three domains: satisfaction with life as a whole, physical- and psychological health (range 0-10). A telephone interview was conducted with 58 participants.
Results
The overall mean score of QoL was 13.12 (SD 7.17), satisfaction with life as a whole 3.91 (SD 2.73), psychological health 5.36 (SD 2.95), and physical health 3.84 (SD 2.59). Marital status significantly influenced overall QoL (P = 0.031) and its two domains; satisfaction with life as a whole (P = 0.037) and satisfaction with physical health (P = 0.022). Linear regression analysis showed that being married or widowed predicted poor QoL.
Conclusion
Low scores of overall QoL and its domains implying poor QoL and marital status may play a role, hence it is important to take it into consideration when treating patient with TSCI.
Rwanda J Med Health Sci 2023;6(3):326-334

Risk Factors Associated with Preterm Birth at a Tertiary Teaching Hospital in Dar es Salaam, Tanzania: An Unmatched Case-Control Study

Mujuni Rutasera Njunwa — 2023-11-30

Background
Preterm birth contributes to significant neonatal and under-five mortality and morbidities. This study assessed the risk factors associated with preterm births at a tertiary teaching hospital in Dar es Salaam, Tanzania.
Methods
Case-control study to compare risk factors of preterm birth amongst 140 women with preterm deliveries as cases and 280 women with term deliveries as controls. A structured interviewer-administered questionnaire was used. Univariate and multivariable logistic regression analyses were done using STATA version 17 software.
Results
The proportion of preterm deliveries was 17.9%. Women with less than four antenatal visits were three times more likely to have a preterm birth than those with four or more attendances (aOR 3.6, 95% CI 1.95–6.57, P < 0.001). The odds of preterm birth increased among women who experienced antepartum haemorrhage (aOR 25.7, 95% CI 12.72–52.03, P < 0.001), pre-eclampsia/eclampsia (aOR 29.9, 95% CI 7.78–115.41, P < 0.001) and preterm membrane rupture (aOR 62.8; 95% CI 23.51–168.21, P < 0.001). Among multiparous women, short interpregnancy intervals, prior preterm birth, or stillbirth increased the odds of preterm birth.
Conclusion
Poor antenatal attendance, obstetric complications, and premature rupture of membranes were among the identified risk factors. All could be addressed by quality antenatal care.
Rwanda J Med Health Sci 2023;6(3):335-345

Pregnant Women’s Knowledge and Expectations about Prenatal Ultrasound: A Cross-Sectional Study

Bornface Chinene — 2023-11-30

Background
Ultrasound imaging has been shown to improve maternal health outcomes through timely diagnosis of pregnancy problems. Despite ultrasound being vital for women's management in pregnancy, studies have reported low awareness among African women
Objective
To evaluate the knowledge and expectations of pregnant women in Harare about prenatal ultrasound.
Methods
A cross-sectional survey of 385 pregnant women was done at the ultrasound department of a private maternity hospital in Harare, Zimbabwe. Statistical Package for Social Sciences (SPSS) 27.0 and Windows Excel were used to analyse the data.
Results
The majority of women (85.4%) concurred that ultrasound scans are important during pregnancy, but most (79.3%) were not aware that congenital abnormalities can be detected through ultrasound. Despite low overall knowledge of congenital abnormalities, 80.2% of women were familiar with Down's syndrome, and this knowledge tended to increase with higher education levels, although not statistically significant (linear-by-linear association = 0.057). The primary expectation of ultrasound scans among pregnant women was to confirm the expected delivery date, and gender determination, with the least expectation being a diagnosis of congenital abnormalities.
Conclusion
Knowledge levels were lower in our setting relative to other similar studies, and hence this underscores the need for further public education.
Rwanda J Med Health Sci 2023;6(3):346-354

Prognostic Significance of Alpha-Fetoprotein in Staging of Chronic Hepatitis B Infection

Olubunmi Gloria Ayelagbe — 2023-11-30

Background
Ascertaining the stage of chronic hepatitis-B infection (CHBI) remains one of the major predicaments to effective therapeutic decision. There is pressing need to forestall dearth of such reliable biomarker(s). Despite the promising tendency of alpha-fetoprotein (AFP), it has not been assessed in staging CHBI.
Objective
This study was to determine the prognosis of serum AFP as a biomarker for staging CHBI.
Methods
Participants were grouped into three based on their hepatitis-B envelope antigen (HBeAg) status and alanine aminotransferase (ALT) level. By denoting HbeAg(+) as (EP), HbeAg(-) as (EN), elevated ALT as (H) and normal ALT as (I), the stages were EPH, ENH and ENI. AFP was assayed, One-way ANOVA, Multivariate linear regression and area under curve were adopted for the analysis.
Results
AFP was significantly elevated, (P < 0.05) in EPH, which equally has the highest prevalence of elevated AFP (64.7%). After adjusting for confounding factors, odds ratio was 1.438 (95% CI, 0.62–1.948), while area under the curve for predicting EPH was (0.828, 95% CI, 0.778 –0.895).
Conclusions
The finding of elevated AFP in CHBI is an independent prognostic marker of EPH. It is often associated with necroinflammation; thus, it is a reliable indicator for treatment initiation.
Rwanda J Med Health Sci 2023;6(3):355-366

The Risk of Neonatal Healthcare-Associated Infections at Three Teaching Hospitals in Rwanda

Aline Umuhoza — 2023-12-06

Background
Healthcare-acquired infections (HCAIs) are a substantial source of neonatal morbidity and mortality that also carry a financial burden on families and healthcare systems worldwide. However, little is known about common and factors related to HCAIs among neonates hospitalized in Rwanda. The study's objective was to assess the risk of neonatal HCAIs in three selected teaching hospitals in Rwanda.
Methods
A retrospective cross-sectional study was conducted and stratified simple random sampling was used. Files of 273 neonates were recruited from 15th July to 30th October 2021. The data abstraction sheet was used in data collection. The data was analysed using logistic regression analysis, and the results were presented in tables.
Results
The most common neonatal HCAI agent was Klebsiella pneumoniae affecting 142/273(52%). Neonates weighting ≥3.6kg (OR=0.09; 95% CI= 0.02—0.54), 2.6–3.5kg (OR=0.07, 95% CI = 0.01–0.42); 1.5–2.5kg (OR= 0.03 (95% CI= 0.01–0.22) were significantly less likely to have an HCAIs than neonates weighting <1.5kg. Maternal blood groups, especially AB and O, had significantly higher odds for HCAI, OR=2.37 (95% CI=1.1–5.1) and OR=3.1 (95%CI=1.32–7.26) respectively.
Conclusion
Low birth weight and maternal blood type were associated with HCAIs at the three study sites and the most common HCAI was Klebsiella pneumoniae.
Rwanda J Med Health Sci 2023;6(3):367-378

Assessment of Kidney Impairment and Related Risk Factors in Pregnant Women Attending the University Center for Public Health and Rango Health Centers in the Southern Province of Rwanda

Herbert T. Mapira — 2023-12-06

Background
Pregnant women are susceptible to kidney function impairment due to physiological and metabolic changes induced by pregnancy. A series of studies suggested an overall progressive increase in glomerular filtration rate approximating 40-50% of the non-pregnant state.
Objective
To determine the prevalence of kidney impairment and related risk factors in pregnant women attending the University Center for Public Health and Rango health centers in Rwanda.
Methods
An analytical cross-sectional study that enrolled 139 consecutive pregnant women was conducted. Serum creatinine and qualitative urine protein and glucose determinations were carried out using standard laboratory methods to assess the integrity of kidney function.
Results
The prevalence of kidney impairment in pregnant women was 20.9% comprising mainly women in the 2nd trimester of pregnancy (60.4%). Among the women with kidney impairment, 2.9% had high blood pressure. Of the overall study participants, 8.6% had glycosuria whilst 5% had proteinuria. The majority had gravida of one. There was a significant association between hypertension, glucosuria, age and gravida with kidney impairment (P = 0.001).
Conclusions
Findings show that pregnancy with or without putative risk factors is associated with kidney impairment in apparently healthy women, as shown by the high prevalence of 20.9%. We therefore recommend routine screening of kidney dysfunction during pregnancy.
Rwanda J Med Health Sci 2023;6(3):379-388

Indoor and Outdoor Air Quality Concentration Levels in Selected Hospital Environments in Kigali, Rwanda

Noel Korukire — 2023-12-06

Background
Exposure to polluted air is a significant cause of negative health effects. Air quality is crucial in hospital environments as patients and healthcare workers spend more time in such settings for treatment where they experience prolonged and repetitive exposure; however, comprehensive studies on air quality in hospital environments in Rwanda are scarce.
Objective
This study aimed to determine the indoor and outdoor air quality concentration levels in selected hospitals and investigate potential sources of air pollution.
Methods
This descriptive cross-sectional study was conducted in two public and two private hospitals in Kigali that were randomly selected using a simple random sampling technique. Real-time particulate matter (PM), PM2.5 and PM10 were measured using calibrated Purple Air PA-II sensors. An observation checklist was used to identify potential sources of air pollution. One way ANOVA and t-tests were performed.
Results
Air quality levels in selected hospitals exceeded acceptable limits. The daily average indoor PM2.5 concentration ranged from 23.52 μg/m³ to 121.60 μg/m³, and the PM10 levels varied from 25.98 μg/m³ to 131.17 μg/m³. In all hospitals, the difference in average indoor and outdoor PM2.5 and PM10 concentrations were not statistically significant.
Conclusion
All recorded concentrations exceeded the WHO air quality guidelines. The study calls for strategies to improve air quality in hospitals.
Rwanda J Med Health Sci 2023;6(3):389-397

Global View of Clinical Guidelines on Prevention of Surgical Site Infections for Health Care Professionals: A Scoping Review

Aloys Niyomugabo — 2023-12-06

Background
Even though there may be clinical guidelines for surgical site infections prevention, no review has been conducted on them. Therefore, a scoping review was undertaken to map and synthesize the available surgical site infections prevention guidelines.
Methodology
A scoping review methodology as defined by the Joanna Briggs institute was conducted. Eligible English and French published articles with guidelines were identified from data bases, search engines, and websites of professional organizations. The Search terms included: "health care professionals AND guidelines for surgical site infections prevention OR clinical practice guidelines". First level selection was based on title and abstract while full text for second level.
Results
Out of the 106 articles with guidelines, 7 were selected for the period 1999 to 2021. Four showed methods used to formulate guidelines. Five guidelines comprised recommendations for surgical site infections prevention for pre, intra and post-operative phases. WHO guideline appeared to be robust as it contained all the characteristics.
Conclusion
Of all the guidelines identified, the WHO guideline indicated population used to develop guidelines; method used and set recommendations, validation including all phases of surgical management. Hence, a recommendation to adapt WHO guideline to health care settings of low resources countries like Rwanda.
Rwanda J Med Health Sci 2023;6(3):398-410

Experiences of Patients with Advanced Chronic Disease Transitioning to Palliative Care in Low- and Middle-Income Countries: A Scoping Review

Evelyne Nankundwa — 2023-12-06

Background
Palliative care is a holistic approach aimed at improving the quality of life for patients with advanced chronic diseases by providing physical, emotional, and spiritual support. communication is crucial during every stage of an illness to ensure that patients wishes are respected. This scoping review aimed to explore the literature on experiences of patients with advanced chronic disease transitioning to palliative care in low- and middle-income countries.
Methodology
This review was guided by Arksey and O'Malley's scoping review framework. A systematic search of the literature was conducted in MEDLINE, PubMed, Cochrane Library, PsycINFO, and Google Scholar from 2012 to 2022. thematic analysis was utilized to construct themes.
Results
The review identified key themes concerning the transition of people with advanced chronic diseases to palliative care in LMICs, including poor understanding, uncertainty, need for support, and poor communication.
conclusion
This review offers valuable insights into the experiences of patients transitioning to palliative care, aiding in the development of more effective interventions for researchers, clinicians, and policymakers.