Rwanda Journal of Medicine and Health Sciences <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> en-US <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> (Dr. Stefan Jansen) (Emile Nisingizwe (Managing Editor)) Tue, 20 Dec 2022 13:05:06 +0000 OJS 60 Factors Influencing Adherence to Antiretroviral Therapy (ART) among Adolescents Living with Human Immunodeficiency virus (HIV) in Rwanda <p><strong>Background</strong></p> <p>HIV continues to be an important public health concern among adolescents. To reduce the high rate of mortality and improve the quality of life among people with HIV, WHO guidelines emphasize the early initiation of ART drugs in HIV-infected persons regardless of their CD4 count and clinical status. However, adherence to ART remains low in adolescents between 10 to 19 years from low and middle-income countries (LMICs).</p> <p><strong>Objective</strong></p> <p>To determine the factors influencing adherence to ART among adolescents with HIV in Rwanda.</p> <p><strong>Method</strong></p> <p>A cross-sectional design using proportional stratified random sampling to select 166 adolescents was conducted. Data were analyzed using descriptive and inferential statistics with a p-value &lt;0.05 and a CI of 95%.</p> <p><strong>Results </strong></p> <p>The overall adherence to ARTs was 38%. Assistance of clinical staff in taking medication (p&lt;0.001) and the help of parents in taking medication (p&lt;0.001) positively influenced adherence to ART. Insufficient health care providers, forgetfulness (p=0.009), and dosage too complex (p=0.044) negatively influenced adherence to ART.</p> <p><strong>Conclusion</strong></p> <p>Factors such as someone reminding adolescents to take medication, non-stigmatization, and absence of side effects were positively associated with ART adherence. On the other hand, forgetfulness, complex dosage, being isolated and inadequate education about medications negatively affect adherence to ARTs. There is a need to set strategies to increase adherence to ARTs, including expert clients and trustable guardians in care provision. All adolescents should receive adequate counselling and health education before the initiation of ARTs.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):251-263</em></p> Emmanuel Habumugisha, Sylvie Nyishimirente, Godfrey Katende, Aimable Nkurunziza, Madeleine Mukeshimana, Innocent Ngerageze, Joella Mukashyaka Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Evaluation of HIV Non-occupational Post-exposure Prophylaxis Utilisation in a Tertiary Health Facility in Nigeria <p><strong>Background </strong></p> <p>The Sub-Saharan Africa accounts for more than 70% of the global burden of HIV infections. Non-occupational post-exposure prophylaxis, when initiated within 72 hours of HIV exposure for 28 days, can prevent seroconversion in 80% of HIV exposures.</p> <p><strong>Objectives </strong></p> <p>To evaluate the characteristics, prevalence and outcome of non-occupational HIV post-exposure prophylaxis utilization in a tertiary hospital.</p> <p><strong>Method </strong></p> <p>This was a retrospective study that involved the medical records of 143 patients who sought HIV non-occupational post-exposure prophylaxis between 1st June 2011 and 31st May 2021. A questionnaire was used to collect information about the socio-demographic data, profiles of both the source and exposed persons, antiretroviral completion rate and outcome at follow-up.</p> <p><strong>Results </strong></p> <p>Females accounted for 125 (87.4%). Sexual assaults were the main reasons for seeking non-occupational post-exposure prophylaxis in 119 (83.2%). High-risk exposures were observed in 134 (93.7%). HIV status of the sources was unknown in 126 (88.1%). 123 (86.0%) initiated antiretroviral within 72 hours of exposure and antiretroviral completion rate was 70.6%. Only 28 (19.6%) reported for follow-up scheduled HIV screening and were all negative.</p> <p><strong>Conclusion </strong></p> <p>Early initiation of postexposure prophylaxis, improvement in baseline HIV testing of the source, and follow-up HIV screening, will significantly improve services and outcomes.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):264-275</em></p> Olanrewaju Fatai Olatunde, Oripelaye Muphy Mufutau, Ajani Atinuke Arinola, Enitan Ademola Olusegun Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Adherence to Recommended Regimen and Associated Factors among Type 2 Diabetes Mellitus Patients in Rwinkwavu District Hospital, Rwanda <p><strong>Background</strong></p> <p>The main risk factor for developing various complications and hospital admissions among type 2 diabetes is poor adherence to all recommended regimens.</p> <p><strong>Objective </strong></p> <p>To determine adherence to recommended regimen and associated factors among type 2 diabetes at Rwinkwavu District Hospital and its catchment area.</p> <p><strong>Methods</strong></p> <p>A descriptive cross-sectional study was employed. A total of 307 type 2 diabetes were selected using systematic random sampling. Data were collected using a questionnaire. Descriptive analysis (frequency and percentages) to describe the participants’ characteristics, and Chi-square test to establish associated factors with adherence to recommended regimen were performed. Then multivariable logistic regression was used to determine factors independently associated with adherence to recommended regimen.</p> <p><strong>Results</strong></p> <p>The result shows that 85.7%, 27.0% and 38.8% of the respondents had good adherence to medication, diet and exercise respectively. Multivariable analysis revealed that not taking alcohol [aOR= 2.21; 95%CI= 1.11-4.42], accessibility of healthcare services [aOR= 2.59; 95%CI= 1.21-5.53] and no experience of drug side effects [aOR= 5.27; 95%CI= 2.46-11.32] were associated with high medication adherence. Factors associated with high adherence level to recommended diet were accessibility to healthcare services [aOR= 2.93; 95%CI= 1.20-7.17], receiving lifestyle modification sessions [aOR= 3.56; 95%CI= 1.02-12.46] and presence of chronic comorbidities [aOR= 2.36; 95%CI= 1.37-4.08]. In addition, higher level of education [aOR= 2.64; 95%CI= 1.05-6.67], accessibility to healthcare services [aOR= 2.83; 95%CI= 1.31-6.09] and shorter time since diagnosis of type 2 diabetes [aOR= 2.09; 95%CI= 1.08-4.51] were more likely to have high adherence to recommended exercise.</p> <p><strong>Conclusion</strong></p> <p>Different individual and clinical factors were identified as determinants of adherence to recommended regimen among type 2 diabetes patients. Therefore, the policy makers concerned with health promotion will need to consider ways of improving access to compressive lifestyle education and healthcare services as well as availing drugs with less side effects.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):276-290</em></p> <p>&nbsp;</p> Emmanuel Ufitamahoro, Erigene Rutayisire, Michael Habtu Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Prevalence and Determinants of Undernutrition among People Living With HIV at Ngarama Hospital, Rwanda <p>&nbsp;<strong>Background </strong></p> <p>Undernutrition is one of the important health problems in developing countries, which has undesirable health effect among people living with HIV (PLWHA).</p> <p><strong>Objectives</strong></p> <p>To determine prevalence and determinants of undernutrition among PLWHA in Ngarama District Hospital.</p> <p><strong>Methods</strong></p> <p>Cross sectional study was conducted among 267 PLWHA who were selected systematically as they came for care. Questionnaire and anthropometric measurements were used to collect data. Descriptive and inferential statistics were performed.</p> <p><strong>Result</strong></p> <p>The prevalence of undernutrition was 22.0%. After controlling all the possible confounders using multivariable analysis, the following variables were predictors of undernutrition: respondents’ age 21 to 30 (AOR = 17.24; 95% CI = 5.55 – 53.56; p &lt; 0.001) and 31 to 40 (AOR = 19.15; 95%CI = 5.97 – 61.40; p &lt;0.001) compared to those aged 41 years and above, social category one (AOR = 3.54; 95%CI = 1.18 – 10.59; p = 0.024); experienced gastrointestinal discomfort (AOR = 19.87; 95%CI = 5.09 – 77.55; p &lt;0.001) and not received dietary counseling (AOR = 7.45; 95%CI = 2.83 – 19.62; p &lt;0.001).</p> <p><strong>Conclusion </strong></p> <p>The prevalence of undernutrition among PLWHA was high. Therefore, the Ministry of Health and other stakeholders should campaign, counsel and assist with provision of dietary diversity using locally available foods.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):291-301</em></p> Joselyne Gitego, Rosemary Okova, Michael Habtu Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Sexual Violence against Children in Rwanda: Prevalence and Associated Factors <p><strong>Background</strong></p> <p>Information and data on the burden and factors associated with violence against children are critical in designing and implementing preventive strategies and interventions. This study aimed to examine patterns of the prevalence of sexual violence (SV) against children in Rwanda and investigate associated factors to contribute to the knowledge about violence against children in Rwanda.</p> <p><strong>Methods </strong></p> <p>A sample of 1,110 children aged 13-17 years from a cross-sectional national survey done in Rwanda in 2015 was analysed. Weighted descriptive statistics were applied to describe the prevalence of SV against children, and weighted logistic regression allowed us to investigate factors associated with it.</p> <p><strong>Results </strong></p> <p>Over eight percent (8.4%) of all children, including about three percent (2.8%) of male children and around five percent (5.6%) of female children, reported having experienced SV within the last twelve months. Being a female child, having a romantic partner, and not attending school were some factors associated with SV against children in Rwanda.</p> <p><strong>Conclusion </strong></p> <p>Female children reported more SV than male children. Factors associated with sexual violence pertained to the child’s characteristics, family or household background characteristics, and community relations. The study findings call for an urgent need to prevent SV against children through awareness raising about it amongst children and the general public.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):302-314</em></p> Alypio Nyandwi, Fredinah Namatovu, Vincent Rusanganwa, Cyprien Munyanshongore, Laetitia Nyirazinyoye, Prata Ndola, Jean Damascene Nshimiyimana, Marie-Gloriose Ingabire, Anastasie Nyirabahinde, Natasha Salant, Mecthilde Kamukunzi Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Prevalence of Dental Traumas and Mouthguard use Among Contact Sports’ Players in Kigali, Rwanda <p><strong>Background</strong></p> <p>Dental traumas are widely prevalent in contact sports and are among the main public oral health concerns. They are attributed to nonuse and/or insufficient use of mouth guards, as protective means, for players in the game.</p> <p><strong>Objectives</strong></p> <p>The study aims to assess the prevalence of dental traumas among the contact sports and to determine the significance of using mouth guards in the prevention of such traumas.</p> <p><strong>Methodology</strong></p> <p>This was a cross sectional study conducted on the selected sports games in Kigali city, Rwanda. Data were collected using semi-structured questionnaires and analysed for any associations between independent variables and dependent variable with chi-square and logistic regression tests. Statistical Package for Social Sciences (SPSS) version 21 was used for the analysis.</p> <p><strong>Results</strong></p> <p>The prevalence of dental trauma was 58.9% among contact sports players in Kigali. Most respondents had information about mouth guards (94.7%) and many of them (62.2%) affirmed they could prevent dental traumas. This study has shown a significant association between dental traumas and mouth-guard use where players who did not use mouthguards were 5.8 times more likely to have dental traumas compared to those who used them regularly [OR=5.81;95% CI=2.44-13.82; p&lt;0.001].</p> <p><strong>Conclusion</strong></p> <p>A high prevalence of dental traumas was observed among the players despite the proven protection of using mouthguards. Therefore, putting emphasis on regular use of mouthguards would result in a huge reduction of risk and keep those traumas to a minimum.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):315-322</em></p> Donat Uwayezu, Emmanuel Nzabonimana, Emmanuel Dufitinema, Egide Dushimirimana, Alexandre Tuyishimire, Claude Dukuzumuremyi, Eustache Ntigura, Agnes Gatarayiha, Peace Uwambaye Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Opportunistic Infections and Associated Factors among HIV-Infected Adult Persons on Antiretroviral Therapy at Ruhengeri Referral Hospital, Rwanda: A cross-sectional study <p><strong>Background </strong></p> <p>Human Immunodeficiency Virus (HIV) is among the highest health crises that humanity ever confronted and it causes progressive weakening of the immune system leading to opportunistic infections (OIs) or malignancies during the natural course of the disease.</p> <p>This study aimed at assessing the prevalence and factors associated with the occurrence of OIs among adult PLWHIV on antiretroviral therapy (ART) at Ruhengeri referral hospital.</p> <p><strong>Methodology</strong></p> <p>A cross-sectional study was performed by reviewing records of HIV-positive adult (≥ 15 years) on ART enrolled at Ruhengeri referral hospital from 1st January 2007 to 31st December 2017. Opportunistic infections were reported based on clinical diagnosis and the prevalence of OIs was determined.</p> <p><strong>Results </strong></p> <p>The study reviewed records from 423 PLWHIV. Thirty-nine (9.2%) PLWHIV had been diagnosed with OIs; and frequent OIs were tuberculosis (20%), oral candidiasis, pneumonia and STI (15.6% each). The independent risk factors for developing OIs were being jobless (AOR = 5.03, 95% CI = 2.13, 32.99), spending more than five years on ART (AOR = 4.34, 95% CI = 1.12-16.78) and starting ART at WHO clinical stage III (AOR = 4.88, 95% CI = 1.65-16.78).</p> <p><strong>Conclusion</strong></p> <p>There is a need to strengthen the management of opportunistic infections despite the use of ART at Ruhengeri referral hospital.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):323-331</em></p> Inès Itanga, Albert Ndagijimana, Clarisse Marie Claudine Simbi, Joseph Ntaganira Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Prevalence and Risk Factors For Intestinal Nematodes Infections among Primary School Children at Kigeme Refugee Camp, Southern Province, Rwanda <p><strong>Background</strong></p> <p>Intestinal parasitic infections are common in camps of internally displaced people or refugees. Although, much has been done in Rwanda for their control in the general population, little is known about the prevalence among children in refugees’ camps.</p> <p><strong>Objective</strong></p> <p>The aim of this study was to determine the prevalence of intestinal nematodes infections and associated risk factors among primary school children at Kigeme refugee camp, southern province of Rwanda in 2021.</p> <p><strong>Methods</strong></p> <p>A cross sectional study was conducted; a total number of 383 stool samples were collected and examined using formal ether concentration technique.</p> <p><strong>Results</strong></p> <p>Approximately, one out of two participants (48.0%) were found to be infected with at least one intestinal nematode. Ascaris lumbricoides was found to be most prevalent (81%), followed by Trichirus trichiura (7.1%) and hookworm (3.8%). Parental illiteracy was identified as a risk factor, while knowledge on transmission roots of intestinal nematodes was seen as a protective factor.</p> <p><strong>Conclusion</strong></p> <p>Family members and parental education in particular is key as far as prevention of intestinal nematodes infections is concerned. Enhancement of public health education about hygiene and sanitation as well as regular mass drug administration could be important in fighting against intestinal parasitic infections.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):332-339</em></p> Augustin Nzitakera, Jean d’Amour Turinayo, Jean Baptiste Uwiragiye, Doreen Mukakalisa, Emmanuel Dushimirimana, Philbert Kanimba Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Emotions and Feelings as Predictors of Depression and Attention Deficit Hyperactivity Disorders among Children and Adolescents with Complete Blindness <p>&nbsp;<strong>Introduction</strong></p> <p>Although blindness is a detrimental physical condition affecting almost all aspects of the lives of children and adolescents with blindness, little is known about the negative emotions and feelings they express and how they are linked with psychological disorders. Thus, this study aimed at examining the links between negative basic emotions, feelings, depression, and attention deficit and hyperactivity disorders (ADHD).</p> <p><strong>Methods</strong></p> <p>Sixty children and adolescents with blindness were selected from HVP Gatagara-Rwamagana. We computed the regression analysis to identify the associations between emotions and feelings and depression and ADHD symptoms.</p> <p><strong>Results</strong></p> <p>Results indicated clinical levels of sadness in 29 of 60 (48.3%), low self-esteem in 27 of 60 (45%), anger in 26 of 60 (43.3%), guilt and shame in 25 of 60) 41.6%, depression in 26 of 60 (43.3%), inattention in 11 of 60 (18.3%) and hyperactivity in 3 of 60 (5%). This study revealed that self-esteem (β = -0.81, p &lt; 0.001), anger (β = 0.76, p &lt; 0.001), sadness (β = 0.75, p &lt; 0.001), low happiness (β = -0.53, p &lt; 0.001), guilt and shame (β = 0.70, p &lt; 0.001) predicted depressive symptoms. Only sadness (β = 0.540, p = 0.04) and anger (β =- 0.556, p = 0.04) were significant predictors of attention deficit hyperactivity disorder (ADHD) in children with blindness.</p> <p><strong>Conclusion</strong></p> <p>Interventions designed to elevate self-esteem and happiness as well as decrease anger, sadness, shame and guilt are needed for decreasing the risk of depression and ADHD.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):340-349</em></p> Marie Louise Nyirahabimana, Benjamin Tuyishimire, Japhet Niyonsenga, Jeanne Marie Ntete, Ignatiana Mukarusanga, Jean Mutabaruka Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000 Occupational Therapy Role in Improving Health and Slowing down age-related declines: A systematic review <p><strong>Background</strong></p> <p>From a global perspective, aging people from 60 years and over were 962 million in 2017 and it is expected to reach 2.1 billion by 2050. When elderly people are not engaged in daily life, they become physically, socially and mentally impaired. The occupation-based interventions in elderly people improve their health and self-satisfaction in daily activities.</p> <p><strong>Objective</strong></p> <p>The aim was to analyse the role of Occupational Therapy in improving health and slowing down age-related declines.</p> <p><strong>Methods</strong></p> <p>The study was a systematic review of literature. Information on Occupational Therapy interventions was systematically searched from Cochrane library, MEDLINE and EMBASE database publications. The selection process of the studies was documented using PRISMA guidelines for intervention protocols.</p> <p><strong>Results</strong></p> <p>Literature search yielded 68 titles of relevant records. Of these five studies met inclusion criteria. One study explored the difference between group intervention and individual intervention; the results favoured group intervention. Comparison of Inter-professional approach with Occupational Therapy, the results favoured inter-professional practice in this population.</p> <p><strong>Conclusions</strong></p> <p>Occupational Therapy interventions seem to be effective in slowing down age related declines. However due to the heterogeneity in the intervention procedures, and duration of intervention, we suggest rigorous RCTS be undertaken to confirm that OT interventions delay age related declines.</p> <p><em>Rwanda J Med Health Sci 2022;5(3):350-360</em></p> Joseph Nshimiyimana, Maurice Kanyoni, Jean Claude Muhigirwa Copyright (c) 2022 University of Rwanda Tue, 20 Dec 2022 00:00:00 +0000