Rwanda Journal of Medicine and Health Sciences

Uptake of HIV Voluntary Counseling and Testing and Associated Factors among Students in the Higher Institutions of Learning in Kigali, Rwanda: A Cross-Sectional Study

Raissa Igiribambe, Erigene Rutayisire, Michael Habtu — Mon, 31 Jul 2023 00:00:00 +0000

Background
HIV/AIDS remains a significant global public health challenge with youth bearing the brunt of the burden. One essential method for preventing and accessing AIDS care is through Voluntary Counselling and Testing (VCT). Regardless of this, youth population continues to have low utilization of VCT services.
Objective
To assess the uptake of HIV VCT services and associated factors among university students in Kigali.
Methods
A cross-sectional study among 374 students recruited using stratified sampling was conducted. A structured questionnaire was used to gather information. A multivariable logistic regression analysis was used to assess the independent factors associated with VCT uptake.
Results
The prevalence of VCT uptake was 59.9%. The logistic regression revealed that being Catholic (AOR = 11.99, 95%CI: 5.44-26.41) and Moslem (AOR = 37.34, 95%CI: 2.67-128.36) compared to Protestant, as well as availability of VCT services (AOR = 5.15, 95%CI: 3.11 - 8.541) favored the use VCT. On the other hand, being aged 20 to 24 years (AOR = 0.112, 95%CI: 0.04 - 0.29) had low likelihood of using VCT than those more than 24 years of age.
Conclusion
VCT uptake was significantly positively associated with religion and VCT services availability, and negatively associated with age 20-24 years in the campus. Therefore, targeted actions of disseminating information on benefits of VCT and enhancing accessibility of VCT services among students are necessary for the increased VCT uptake to be attained.
Rwanda J Med Health Sci 2023;6(2):104-112

Dental Caries Risk Assessment in Primary School Children Aged 11 to 12 years: Case of Nyarugenge District, Rwanda

Usiel Nsabimana, Moses Isyagi, Reverien Rutayisire, Laetitia Nyirazinyoye — Mon, 31 Jul 2023 00:00:00 +0000

Background
Dental caries in children is a public health concern affecting 60-90% of children worldwide. Dental caries perturbs children’s eating ability, school performance as well as overall quality of life. This study aimed to determine the prevalence of dental caries and its risk factors among children aged 11 to 12 years in Nyarugenge District in Kigali, Rwanda.
Methods
The cross-sectional analytical study design involved 400 children from Nyarugenge district. By stratified sampling, we selected Gitega and Butamwa primary schools and used systematic sampling to choose the pupils into the sample. An interview and oral examination were performed. Descriptive statistics and logistic regression were done.
Results
Dental caries was observed in 25.5% of children. Deep pits and fissures carried a two-fold risk of getting dental caries than children without deep pits and fissures (OR = 2.4, 95% CI = [1.5; 4.0], P-value < 0.001). Dental plaque was identified as a risk factor for getting dental caries (OR=2.2, 95% CI = [1.2; 3.3], P-value: 0.01).
Conclusion
Dental caries is a public health concern associated with poor oral hygiene, deep pit, and fissures among children aged 11 to 12 years old. Oral hygiene education, application of ART, and regular screening programs are in need.

Rwanda J Med Health Sci 2023;6(2):113-122

Prevalence of Exclusive Breastfeeding and Associated Factors among Mothers in Karongi District, Rwanda

Francine Nyirahirwa, Germaine Tuyisenge, John Nyiligira, Michael Habtu — Mon, 31 Jul 2023 00:00:00 +0000

Background
Exclusive breastfeeding is crucial for an infant’s growth and development. In Rwanda, 47% of rural children and 27% of urban children are stunted which could be linked to poor exclusive breastfeeding. Thus, this study was carried out to assess prevalence of exclusive breastfeeding and associated factors in Karongi district of Rwanda.
Method
A cross-sectional design was used involving 261 mothers with infants of 6 to 9 months selected systematically with an interval two as they came to the health facilities. The data were collected using structured questionnaire. The factors independently associated with exclusive breastfeeding were determined using multivariable logistic regression analysis.
Results
The prevalence of exclusive breastfeeding was 87.1%. Married mothers (AOR= 3.15; 95%CI = 1.07 – 9.28), protestant mothers (AOR= 0.15; 95%CI = 0.03 – 0.69), attending prenatal care (AOR= 19.87; 95%CI = 3.00 – 131.68), receiving postnatal care (AOR = 3.07; 95%CI = 1.31 – 7.21) and receiving breastfeeding counseling (AOR= 3.16; 95%CI = 1.03 – 9.69) were identified as independent factors associated with exclusively breastfeeding.
Conclusion
The prevalence of exclusive breastfeeding was high but with various healthcare service associated factors. Therefore awareness and appropriate behavior change communication strategies on exclusive breastfeeding should be encouraged during prenatal and postpartum care for optimum practice.
Rwanda J Med Health Sci 2023;6(2):123-134

Knowledge, Attitude and Practices of Nurses towards Oral Care of Psychiatric Patients at a Teaching Hospital, Kigali, Rwanda

Mon, 31 Jul 2023 00:00:00 +0000

Background
Psychiatric patients are prone to different oral health problems. This study aimed to assess nurses’ knowledge, attitudes, and practices towards oral care of psychiatric patients due to their limited mental abilities of self-control at a Teaching Hospital.
Methods and materials
This was a cross-sectional study conducted at a Teaching Hospital using self-administered questionnaire. Sixty-five nurses were enrolled through census sampling method in December 2021. Data were analyzed using SPSS version 25 by applying descriptive statistics to assess nurse’s knowledge attitude and practices towards oral care.
Results
The results showed that 53 (93%) nurses had poor knowledge. Also 44(75%) of nurses had inappropriate practice and among them 33(57.9%) had positive attitude.
Conclusion
This study found that high number of nurses had poor knowledge and inappropriate practices and half of them had positive attitude. Therefore, there is a need training for nurses to increase their level of knowledge and improve their practice regarding oral care of psychiatric patients.
Rwanda J Med Health Sci 2023;6(2):135-142

Risk Factors of Transfusion Transmissible Infections among Blood Donors at Karongi Regional Centre for Blood Transfusion in Rwanda

Mon, 31 Jul 2023 00:00:00 +0000

Background
Blood transfusion saves human lives, but also it can be a route for Transfusion-Transmissible Infections (TTIs) including Human Immuno-Deficiency Virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), and syphilis.
Objective
This study aimed to explore the risk factors associated with TTIs among blood donors at Regional Centre for Blood Transfusion (RCBT) of Karongi, Rwanda.
Methods
This was a retrospective cross-sectional study design conducted among 36,708 blood donors from 2015 to 2019. Data were extracted from the system known as eProgesaused and the outcome variable were TTIs including HBV, HCV and HIV (measured using Enzyme Immuno-Assay/Chemiluminescence Immunoassay) and syphilis (determined by Rapid Reagin Plasma). Descriptive statistics was computed to describe the characteristics of the blood donors. Bivariate and multivariable logistic regression were performed to assess the risk factors associated with TTIs. P value less than 0.05 was considered statistically significant.
Results
The study found that the overall prevalence of TTIs was 2.1%, while the prevalences of HBV, HCV, HIV, and syphilis were 1.3%, 0.4%, 0.06%, and 0.34%, respectively. Multivariable analysis showed that the factors associated with HBV, HCV, HIV and syphilis were being male, age more than 25 years, being married, living in urban areas, first time blood donors and blood donors living in Rusizi, Rusizi, Nyamasheke and Karongi districts.
Conclusion
This study revealed that the most frequent TTI was HBV among blood donors and the main risk groups were males, age group of 26-35 years, married and first time donors. Hence, while developing health policies to reduce the effects of HBV infection on safe blood transfusion, these study findings should be taken into account.

Rwanda J Med Health Sci 2023;6(2):143-153

An Adapted Collaborative Care Model to Manage Co-morbidities of Depression and Chronic Non-Communicable Diseases in Rwanda

Madeleine Mukeshimana, Holli A. DeVon — Mon, 31 Jul 2023 00:00:00 +0000

Background
The World Health Organization has recommended the implementation of the Collaborative Care Model in all countries to manage the comorbidities of depression and chronic non-communicable diseases. In Rwanda depression is major problem not only among patients with chronic illnesses but also in general population considering the unique history of war and genocide in Rwanda.
Purpose
The purpose of this paper is to describe the process of adaptation and testing of the Collaborative Care Model in the Rwandan healthcare context.
Methods
The larger study used the Action Research design with mixed method –sequential explanatory design. A research-practice partnership method and an iterative process was used to adapt and test the Collaborative Care Model. Qualitative content analysis was used to analyse the data.
Results
Four structural components to the model were adapted including the addition of a registered nurse to the team, relocation of the model to the district level, consultation with a psychiatrist every 3 months and involvement of community health workers. The evaluation indicated that the model was applicable and acceptable.
Conclusions
Initial evaluation of the Adapted Collaborative Care Model shows promise in Rwanda. Implementation of this model in other Rwandan districts is warranted.
Rwanda J Med Health Sci 2023;6(2):154-160

Graduate Nurses’ Perception and Experiences of Assessment Feedback in Blended Learning Courses at the University of Rwanda

Jean de Dieu Uwimana, Evode Mukama — Mon, 31 Jul 2023 00:00:00 +0000

Background
Constructive assessment feedback is considered one of the learner-centred pillars in the blended learning mode.
Purpose
Explore graduate nurses’ perceptions and experiences on assessment feedback in blended learning courses.
Methodology
Qualitative descriptive design with semi-structured interviews was used to collect data from 15 enrolled learners in a Master’s Programme of Nursing at the University of Rwanda. Interviews were recorded and transcribed verbatim. Purposive sampling and thematic data analysis were use.
Findings
Eight females against seven male graduate nurses participated in this study, 67% worked in health facilities and 33% worked as lecturers in Bachelor of Nursing. The graduate nurses at the University of Rwanda perceived that lecturer in blended learning used different types of assessment feedback. They experienced the reception of assessment feedback through synchronised and asynchronised channels or via paper-based mode. Effective feedback is hindered by delays, inadequate digital infrastructure, and using marks as the only form of feedback. Accordingly, the graduate nurses perceived that learners’ preparedness and involvement in the assessment feedback process are critical to establishing and enhancing deep and lifelong learning.
Conclusion
The findings revealed that different types of assessment feedback were used, while different ways were utilised to deliver assessment feedback; graduate nurses perceived and experienced that prompt and sandwich feedback are pillars of effective feedback to enhance blended learning for graduate learners.
Rwanda J Med Health Sci 2023;6(2):161-174

Prevalence of Plasmodium Falciparum Gametocytes among Malaria Positive Cases at Korogwe District Hospital: The Use of Molecular Techniques in Comparison with Light Microscopy

Mon, 31 Jul 2023 00:00:00 +0000

Background
Monitoring gametocytes in the population can inform about the human infective reservoir, which greatly aids malaria transmission, and provide relevant data for transmission models. Using molecular techniques in preference to light microscopy to detect gametocytes may lead to most reliable results. Effective determination of gametocytes is inevitable to achieve the transmission-blocking interventions as a prime target to end malaria. We aimed to determine the prevalence of P. falciparum gametocytes in malaria-positive cases from Korogwe district hospital
Methodology
Archived DNA samples collected from Korogwe district hospital collected in a cross-sectional study were used to determine the prevalence of P. falciparum gametocytes using specific primers for cPCR targeting a Pfg27 gene. Demographic data, including blood slides data were retrieved from the database for statistical analysis.
Results
With light microscopy, prevalence of P. falciparum gametocytes was 9.8%; sensitivity and specificity were 35.6% and 99.2% respectively. The cPCR gave a prevalence of 25.9%, with a sensitivity of 94.1% and specificity of 81.5%. The cPCR was diagnostically found to be significantly superior over light microscopy technique (X2=45.780, P < 0.001).
Conclusion
cPCR is superior to light microscopy technique in detecting P. falciparum gametocytes when one considers a successive malaria transmission-blocking intervention.

Rwanda J Med Health Sci 2023;6(2):175-183

Outcomes of the Icare Rebound Tonometer versus the Gold Standard Tonometer in Measuring Intraocular Pressure among Mzuzu University Students, Malawi

Mon, 31 Jul 2023 00:00:00 +0000

Introduction
The Goldmann Applanation Tonometer (GAT) is accepted as the gold standard tool to measure Intraocular Pressure (IOP). Besides, there is an emerging Icare Rebound Tonometer (RBT) which can be an alternative in terms of measuring IOP.
Objective
This research aimed to analyze the agreement, and repeatability of intraocular pressure (IOP) measurements and compare the outcomes of RBT and GAT among Mzuzu University Students in Malawi.
Methods
For this cross-sectional study, 107 participants aged 18 to 29 years underwent ophthalmic examination with three IOP measurements taken by two examiners using the RBT and the GAT.
Results
The RBT and GAT were found to have a strong correlation (r=0.809, p>0.001), with an intra-class correlation of 0.787 (p>0.001). The mean difference of IOP measured by the two machines was 1.99±1.05mmHg, which was statistically significant. However, according to Bland-Altman analysis, there was no agreement between the results given by the two machines, with a bias of -1.979 (CI -2.28, -1.68, p > 0.001). In terms of repeatability, GAT was found to be better than RBT, with a CR of 7.512 and 10.418 respectively.
Conclusion
The RBT and GAT can offer comparable IOP measures. Therefore, RBT can be recommended for community outreach programs where GAT cannot be employed.

Rwanda J Med Health Sci 2023;6(2):184-190

Functional Outcomes of Stroke Survivors after Physiotherapy Rehabilitation Program at a Tertiary University Teaching Hospital in Rwanda

Mon, 31 Jul 2023 00:00:00 +0000

Background
After suffering from a stroke, serious long-term disability occurs and physiotherapy is one part of rehabilitation for stroke survivors that plays a significant role in improving functional recovery, mobility and has positive impact on outcome.
Objective
To identify functioning outcomes of stroke survivors after physiotherapy rehabilitation.
Methodology
By using both retrospective and cross-sectional study designs, 71 stroke cases were identified, and a Modified Barthel Index (MBI) was applied to score functioning outcomes. Data were managed and analyzed using IBM SPSS Statistics for Windows version 21.0 (IBM Corp, Armonk, NY, USA).
Results
The findings showed that patients who received physiotherapy rehabilitation improved in activities of daily living (ADL). This was demonstrated by changes in the total MBI that were 0.72 ± 1.59 on admission and 15.3 ±4.89 on current status (after physiotherapy rehabilitation). However, some failed to achieve expected outcomes even though they received physiotherapy rehabilitation. This could be attributed to delayed onset, frequency and duration of rehabilitation.
Conclusion
Stroke survivors after physiotherapy rehabilitation showed improvement in activities of daily living. Hypertension has been identified as the most influencing risk factor of stroke. Financial constraints were also identified for those who struggle to achieve the highest outcomes due to poor attendance at physiotherapy rehabilitation. Appropriate management of hypertension is necessary to reduce stroke; and facilitation of those under rehabilitation will improve their participation in the rehabilitation for better outcome.
Rwanda J Med Health Sci 2023;6(2):191-198

Seroprevalence and Associated Risk Factors for Hepatitis B Virus among Pregnant Women Attending a Public Health Facility in Osogbo, Nigeria

Mon, 31 Jul 2023 00:00:00 +0000

Background
Hepatitis B virus (HBV) infection among pregnant women has a high rate of vertical transmission and consequential effects on fetal and neonatal outcomes. The aim of this study was to determine the prevalence and associated risk factors of infection among pregnant women attending antenatal care services in Osogbo, Nigeria.
Methodology
This hospital based cross-sectional study was conducted among pregnant women attending routine antenatal care clinic between April and June 2021. Systematic random sampling technique was used to recruit 240 pregnant women, their data were collected by face to face interview using a pretested questionnaire, while blood sample was collected aseptically to determine hepatitis B surface antigen by enzyme linked immunosorbent assay test kit. Univariate and multivariate logistic regression were used to examine the association between explanatory variables and outcome variable.
Results
The mean age and seroprevalence of the study population were 27.50 ± 4.4 years and 5.8% respectively. The significant risk factors for HBV infection were tattooing (aOR = 5.22; 95% CI = 0.52–8.01; p = 0.0000), history of multiple sexual partners (aOR = 2.88; 95% CI = 1.92–12.42; p = 0.0044); and past history of contact with HBV patient (aOR = 2.17; 95% CI = 1.21–15.32; p = 0.0310) were significant predictors of HBV infection.
Conclusion
The seroprevalence of HBV from this study was of intermediate endemicity. We therefore, advocate for continuous health education programs on the mode of HBV transmission, high-risk behaviors and methods of preventions at antenatal care clinics to raise the awareness of mothers and limit the spread of infection.
Rwanda J Med Health Sci 2023;6(2):199-207

Prevalence of Human Immunodeficiency Virus among Female Sex Workers and Associated Risk Factors in Rwanda, 2019

Mon, 31 Jul 2023 00:00:00 +0000

Background
Female sex workers (FSWs) are more likely to be infected by Human immunodeficiency virus (HIV) than the general population. In Sub-Saharan countries, 18% of new HIV infections is attributed to FSWs.
Study objective
To determine HIV prevalence and its determinants among FSWs in Rwanda.
Methodology
A cross-sectional biological and behavioral surveillance survey in hotspots was conducted among FSWs countrywide. HIV laboratory tests were performed. Proportions and 95% confidence interval (CI) were calculated. Multivariable logistic regression was performed to determine factors associated with HIV in FSWs.
Results
The survey enrolled 1,883 FSWs. Of 1,770 FSWs who consented for HIV testing, 607 were HIV positive, giving the prevalence of 34% (95%CI= 32.11-36.54). High HIV prevalence was associated with age of 25 years or more (aOR = 3.68; 95%, CI: 2.62–5.18) and more than 5 years of sexwork (aOR = 1.31; 95% CI: 1.05–1.63). HIV prevalence and having more than three dependents (aOR= 0.34; 95%CI=0.23-0.5) and completing secondary and beyond education (aOR=0.50; 95%CI=0.36-0.71) were inversely related.
Conclusion
HIV prevalence is still high among FSWs in Rwanda. Prevention strategies should target the old ones in five first years of sex work and the less educated.
Rwanda J Med Health Sci 2023;6(2):208-214

Factors Influencing the Health Seeking Behaviour of Men in Gasabo District, Rwanda

Sophie Uwimana, Rosemary Okova, Michael Habtu — Mon, 31 Jul 2023 00:00:00 +0000

Background
Various studies conducted on factors influencing men’s health seeking behavior suggested that men are less likely to seek professional medical help for diverse health problems and also pointed out that their reluctance to seek health is a major hindrance to their well-being.
Objective
To determine factors influencing men’s health seeking behavior and use of health services in Gasabo District.
Methods
The 247 men aged above 18 years residing in Gasabo District participated in this cross sectional study for quantitative data and ten in-depth interviews were conducted. Univariate, bivariate and multivariable logistic regression analysis were also computed.
Results
Among the key findings, 61.5% of the respondents had high level of health seeking behavior and for multivariable logistic analysis the following variables were independently associated with high level of health seeking behavior: men whose age was above 40 years (AOR = 3.00; 95%CI= 1.26-7.14; p value=0.013); men with tertiary level of education (AOR = 3.78; 95%CI= 1.29-11.05; p value=0.015); men with casual work (AOR = 2.30; 95%CI= 1.23-4.31; p value=0.09); and men with health insurance (AOR = 4.33; 95%CI= 1.08-17.32 ;p value=0.038).
Conclusion
Men moderately utilize healthcare services and there are modifiable characteristics, perceptions and beliefs among men that hinder them from utilizing health care services.
Rwanda J Med Health Sci 2023;6(2):215-227

Feeding Practices and Nutritional Status among Children Aged from Six to 23 Months in Western Province, Rwanda: A cross-sectional study

Mon, 31 Jul 2023 00:00:00 +0000

Background
Rwandan children's nutritional status is characterized by higher undernutrition rates. Infant and young child feeding practices (IYCF) have a direct impact on how well-nourished youngsters under two years old are.
Objectives
This study aimed to assess feeding practices and nutritional status among children aged six to 23 months in Nyabihu district.
Methods
A cross-sectional study was conducted in 164 households having children aged six to 23 months in December 2020. A structured questionnaire was used to collect infants' and young children's feeding practices. Using SPSS version 20.0, data were entered and analysed. Binary logistic regression was utilized to identify association between feeding practices and nutritional status.
Results
Breastfeeding initiation within the first hour of life was 94.5%, and exclusive breastfeeding was 79.9%. Complementary foods were given timely to 73.2% of children, 47.6% had minimum meal frequency (MMF), 23.2% had minimum dietary diversity (MDD), and 15.9% were fed a minimally acceptable diet (MAD). However, 4.3% of children were wasted, 6.7% were underweight, and 23.2% were stunted. There was no significant association when variables were passed to a binary logistic regression-adjusted model.
Conclusion
Complementary feeding practices remain suboptimal. These practices should be improved to sustain children's nutritional status.
Rwanda J Med Health Sci 2023;6(2):228-238

First Trimester Antenatal Care Utilization and Associated Factors among Adolescent Mothers in Rwanda

Theogene Kubahoniyesu, Clemence Nishimwe, Michael Habtu — Mon, 31 Jul 2023 00:00:00 +0000

Background
First trimester antenatal care (ANC) initiation has been shown to improve the health outcomes for both mothers and unborn children. This study aimed at determining the prevalence of first trimester ANC use and associated factors among adolescent mothers in Rwanda.
Methods
This study was a cross-sectional study and analyzed the data of 6th Rwanda demographic and health survey (RDHS 2019-2020). Proportion, bivariate and multivariable analysis were employed to identify factors associated with first ANC use.
Results
The prevalence of first trimester antenatal care utilization among 354 adolescent mothers was 46%. Advanced age (AOR=1.82; 95%CI = 1.096-2.305), secondary education level (AOR=1.36; 95%CI = 1.080 - 1.960), coming to rich family (AOR = 2.10; 95%CI = 1.830 – 5.162), residing near health facility (AOR=1.17; 95%CI= 1.065 - 2.011), permitted to go to health facility (AOR=2.13; 95%CI = 1.857 – 3.363) were positively associated with ANC services use. However, the negative association was found with later pregnancy desire (AOR = 0.42; 95%CI = 0.149 – 0.781).
Conclusion
The prevalence of first trimester ANC was low. In view of that, more effort should be made to increase adolescent mothers' knowledge regarding the ANC services utilization and timely booking.
Rwanda J Med Health Sci 2023;6(2):239-250

Are the Offspring Still Affected by their Mothers’ Genocidal Rape 28 Years Ago? : Thematic Analysis of Offspring Experience

Tue, 08 Aug 2023 00:00:00 +0000

Background
There has been little attention paid by researchers on how the mothers’ rape trauma may still affect the offspring born of that rape even in adulthood. This study, therefore, aimed to assess the perceived effects of being born of genocidal rape among adult offspring conceived from the genocidal rape against the Tutsi in 1994.
Methods
A purposive sample of 32 participants (16 dyads of mothers and their offspring) selected nationwide was considered for this qualitative study. In-depth individual interviews were conducted and audio-recorded with permission. Codebook thematic analysis was applied to analyse the transcribed verbatim inductively within the NVivo 12 software.
Results
The primary themes emerging from participants’ accounts of the effects of rape trauma on the offspring included feeling controlled by mothers, being affected by the history of their mothers, family and social problems, a lack of personal growth, psychological problems, and self-stigma that emerged with several sub-themes.
Conclusion
The results from this assessment indicate that genocidal rape affected not only the mothers but also the offspring born of this rape, who are severely affected by the rape history of their mothers and feel hatred and rejection from them. Our findings will assist the health professionals and other stakeholders working with the adult offspring born of the genocidal rape in designing and strengthening the intervention targeted at this population.
Rwanda J Med Health Sci 2023;6(2):251-263