Rwanda Public Health Bulletin

Beyond Psychotherapy: Addressing Socio-Economic and Psychological Needs in PTSD Recovery among Survivors of the 1994 Genocide against the Tutsi

Antoine Hagenimana — 2025-05-11

INTRODUCTION: Post-Traumatic Stress Disorder (PTSD) is a significant mental health concern, particularly among the survivors of the 1994 genocide against the Tutsi who were left with deep psychological and physical scars. This study aimed to explore perceptions regarding factors associated with the evolution of PTSD, focusing on the role of psychological support, socio-economic assistance, access to education, and healthcare.

METHODS: A mixed-methods research study was conducted, combining qualitative and quantitative approaches. The study was conducted in Kigali, Rwanda, on 20 survivors of the 1994 genocide against Tutsi aged 25-65 years who were beneficiaries of psychological support services and 10 mental health professionals from the Association of Genocide Widows Agahozo (AVEGA).

RESULTS: All respondents (100%) reported experiencing trauma-related symptoms, with commemoration events (40%), poverty (35%), and lack of social support (25%) identified as primary triggers. Psychological support combined with social assistance was the most effective intervention (60%), followed by access to education and healthcare (25%). Psychological support alone was less effective (20%). Survivors emphasized the importance of multidimensional interventions, including income-generating activities (IGA) and social assistance, in their recovery. Mental health professionals highlighted the challenges of treatment adherence and the need for holistic approaches addressing both psychological and socio-economic needs.

CONCLUSION: The study highlights the intricate link between psychological, social, and economic factors in the development of PTSD in genocide survivors, suggesting that multidimensional interventions, community-based support, economic stability, and social networks are more effective, and targed strategies should be reinforced to ease the PTSD burden among survivors of the 1994 genocide against Tutsi.

Intimate partner violence prevalence and its effect on medication adherence and relapses among patients with chronic mental disorders at Ndera Neuropsychiatric Hospital, Kigali, Rwanda

Jeannette Ntirabahizi — 2025-05-11

INTRODUCTION: Intimate Partner Violence (IPV) is a global public health issue with severe consequences, particularly for individuals with chronic mental disorders. This study aimed to assess the prevalence of IPV among patients with chronic mental disorders at Ndera Neuropsychiatric Hospital in Rwanda and examine its impact on medication adherence and relapse rates.

METHODS: A cross-sectional study was conducted with 384 adult patients diagnosed with chronic mental disorders. Participants were screened for IPV using the Hurt, Insult, Threaten, Scream (HITS) tool, while medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Relapse rates were determined through a retrospective review of medical records. Descriptive and inferential statistics, including logistic regression, were used for data analysis.

RESULTS: The prevalence of IPV among participants was 28%, with women more affected than men (40.6% vs. 10.6%). Poor medication adherence was reported by 32% of participants, and 51% had at least one relapse in the past 12 months. Patients experiencing IPV were 2.8 times more likely to be non-adherent to medications (OR=2.85; 95% CI: 1.74- 4.65; p<0.001) and 3.48 times more likely to relapse (OR=3.48; 95% CI: 2.14-5.65; p<0.001).

CONCLUSION: The study highlights the high prevalence of IPV among individuals with chronic mental disorders, particularly women, and its detrimental effects on treatment outcomes. Integrated interventions addressing IPV and mental health, alongside gender-sensitive policies and community support programs, are urgently needed to improve medication adherence and reduce relapse rates in this vulnerable population.

Assessment of Nutrition Knowledge, Attitudes, and Practices for Cardiovascular Disease Prevention among Attendees of Remera Health Centre, Kigali, Rwanda

Okesina Akeem Ayodeji — 2025-05-11

INTRODUCTION: Cardiovascular diseases (CVDs) represent a significant global health burden, particularly in low- and middle-income countries. This study aimed to assess the levels of knowledge, attitudes, and practices regarding nutrition for CVD prevention among attendees of Remera Health Centre in the Gasabo District, Kigali, Rwanda.

METHODS: A cross-sectional study was conducted, employing face-to-face interviews for data collection. Variables, including knowledge, attitudes, and practices, were analyzed using SPSS, and results were presented using tables and graphs. Study participants were selected through random sampling methods.

RESULTS: The study revealed that 52.3% of participants had a moderate level of knowledge, 22.8% had a low level, and 24.9% exhibited a high level of knowledge regarding nutrition and CVD prevention. Moreover, 95.4% of participants demonstrated positive attitudes, with 4.1% holding neutral attitudes and only 0.5% expressing negative attitudes. However, concerning practices, 65.5% of participants exhibited poor nutrition-related practices, while 32.5% displayed moderate practices, and only 2% demonstrated good practices.

CONCLUSION: The findings suggest that while most participants possess a high level of knowledge and positive attitudes toward nutrition for CVD prevention, there is a significant gap in translating this knowledge into practice. Efforts to improve nutritional practices among attendees of Remera Health Centre are warranted to effectively mitigate the risk of CVDs in the community.

Employee Turnover in a Tertiary Hospital in Rwanda: Baseline Analysis of the Trend

Belson Rugwizangoga — 2025-05-11

INTRODUCTION: Turnover is an important issue to monitor properly as it is associated with many consequences, including monetary costs. This study aimed to determine the rate, types, and factors of employee turnover in the largest public teaching hospital in Rwanda.

METHODS: Archival documents were used to document rates, types, and factors of employee turnover at the University Teaching Hospital of Kigali (CHUK) during the 2012–2022 period. Ethical clearance was acquired before data collection.

RESULTS: The overall turnover rate was 4.87%. Higher annual rates were attributed to either decreased staff fringe benefits, massive recruitment in facilities offering better payments, or restructuring. The median age of employees at exit was 40.45 years, mostly female employees (58.5%). Most cases were married (55%), Rwandans (95%), and residing in Kigali City (47%). Surgery (17%), Administration (13%), and Obstetrics and Gynecology (11%) were the most implicated units. Median for work experience was 9 years. The main reasons for separation are personal or resignation (42%), leave of absence (14%), restructuring (12%), retirement (11%) and dismissal (11%). Highly qualified employees and those with experience ≥20 years represented 14% and 30% of the exiting staff, respectively. Involuntary turnover (31%) was the main type of turnover. Involuntary and voluntary unavoidable turnover types were associated with higher age (P<0.0001) and long work experience (P<0.0001).

CONCLUSION: The overall turnover rate at CHUK is within an acceptable range, but annual fluctuations reflect experienced negative motivational factors. Moreover, avoidable departure of high- or rare-skill staff was noted, sparking the need to implement staff retention strategies.

Bridging the Gap: Fostering the Positive Impact of Expanding Medical Training Facilities on Rwanda’s Rural Healthcare: A review

Yves Gashugi — 2025-05-11

Rural healthcare disparities in Rwanda remain a critical challenge, driven by insufficient infrastructure, a shortage of trained healthcare professionals, and geographical isolation. This manuscript explores the transformative potential of expanding medical training facilities to address these inequities. With only 0.118 physicians per 1,000 people as of 2019, Rwanda falls far below the World Health Organization (WHO)'s recommended ratio. Current initiatives, such as the "4X4" strategy, aim to scale up the healthcare workforce and address rural challenges, yet gaps persist.

Drawing lessons from successful global models, including India’s district-based medical colleges, Ethiopia’s rural health extension programs, and South Africa’s rural clinical training programs, the manuscript contextualizes their relevance to Rwanda. Expanding training facilities in rural areas would enhance healthcare access, reduce patient-to-provider ratios, and improve outcomes in maternal and neonatal care, chronic disease management, and preventive health services. The positive impacts extend beyond healthcare delivery, contributing to economic empowerment through job creation and fostering retention of locally trained professionals in underserved areas. By prioritizing strategic investments in rural medical education and supporting measures such as scholarships and career incentives, Rwanda can build a resilient, community-centered healthcare system.

This work advocates for immediate action to expand training facilities, emphasizing their role in bridging rural healthcare gaps, enhancing service quality, and empowering communities. It envisions Rwanda as a place where equitable healthcare access is a reality, uplifting rural regions and ensuring a healthier, more productive population.