Browsing by Subject "Rwanda"
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- ItemOpen AccessDeveloping, implementing, and monitoring tailored strategies for integrated knowledge translation in five sub-Saharan African countries(BioMed Central, 2023-09-04) Sell, Kerstin; Jessani, Nasreen S.; Mesfin, Firaol; Rehfuess, Eva A.; Rohwer, Anke; Delobelle, Peter; Balugaba, Bonny E.; Schmidt, Bey-Marrié; Kedir, Kiya; Mpando, Talitha; Niyibizi, Jean B.; Osuret, Jimmy; Bayiga-Zziwa, Esther; Kredo, Tamara; Mbeye, Nyanyiwe M.; Pfadenhauer, Lisa M.Background Integrated knowledge translation (IKT) through strategic, continuous engagement with decision-makers represents an approach to bridge research, policy and practice. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA +), comprising research institutions in Ethiopia, Malawi, Rwanda, South Africa, Uganda and Germany, developed and implemented tailored IKT strategies as part of its multifaceted research on prevention and care of non-communicable diseases and road traffic injuries. The objective of this article is to describe the CEBHA + IKT approach and report on the development, implementation and monitoring of site-specific IKT strategies. Methods We draw on findings derived from the mixed method IKT evaluation (conducted in 2020–2021), and undertook document analyses and a reflective survey among IKT implementers. Quantitative data were analysed descriptively and qualitative data were analysed using content analysis. The authors used the TIDieR checklist to report results in a structured manner. Results Preliminary IKT evaluation data (33 interviews with researchers and stakeholders from policy and practice, and 31 survey responses), 49 documents, and eight responses to the reflective survey informed this article. In each of the five African CEBHA + countries, a site-specific IKT strategy guided IKT implementation, tailored to the respective national context, engagement aims, research tasks, and individuals involved. IKT implementers undertook a variety of IKT activities at varying levels of engagement that targeted a broad range of decision-makers and other stakeholders, particularly during project planning, data interpretation, and output dissemination. Throughout the project, the IKT teams continued to tailor IKT strategies informally and modified the IKT approach by responding to ad hoc engagements and involving non-governmental organisations, universities, and communities. Challenges to using systematic, formalised IKT strategies arose in particular with respect to the demand on time and resources, leading to the modification of monitoring processes. Conclusion Tailoring of the CEBHA + IKT approach led to the inclusion of some atypical IKT partners and to greater responsiveness to unexpected opportunities for decision-maker engagement. Benefits of using systematic IKT strategies included clarity on engagement aims, balancing of existing and new strategic partnerships, and an enhanced understanding of research context, including site-specific structures for evidence-informed decision-making.
- ItemOpen AccessThe impact of a training programme incorporating the conceptual framework of the International Classification of Functioning (ICF) on knowledge and attitudes regarding interprofessional practice in Rwandan health professionals: a cluster randomized control trial(2021-03-01) Sagahutu, Jean B; Kagwiza, Jeanne; Cilliers, Francois; Jelsma, JenniferBackground The first step in improving interprofessional teamwork entails training health professionals (HP) to acknowledge the role and value the contribution of each member of the team. The International Classification of Functioning, Disability and Health (ICF) has been developed by WHO to provide a common language to facilitate communication between HPs. Objective To determine whether ICF training programme would result in improved knowledge and attitudes regarding interprofessional practice within Rwandan district hospitals. Design, setting and participants A cluster randomised, single blinded, control trial design was used to select four district hospitals. Participants included physicians, social workers, physiotherapists, nutritionists, clinical psychologists/mental health nurses. Intervention Health professionals either received one day’s training in interprofessional practice (IPP) based on the ICF (experimental group) as a collaborative framework or a short talk on the topic (control group). Outcome measures Validated questionnaires were used to explore changes in knowledge and attitudes. Ethical approval was obtained from the relevant authorities. Results There were 103 participants in the experimental and 100 in the control group. There was no significant difference between Knowledge and Attitude scales at baseline. Post-intervention the experimental group (mean = 41.3, SD = 9.5) scored significantly higher on the knowledge scale than the control group (mean = 17.7, SD = 4.7 (t = 22.5; p < .001)). The median scores on the Attitude Scale improved in the Experimental group from 77.8 to 91.1%, whereas the median scores of the control remained approximately 80% (Adjusted Z = 10.72p < .001). Conclusion The ICF proved to be a useful framework for structuring the training of all HPs in IPP and the training resulted in a significant improvement in knowledge and attitudes regarding IPP. As suggested by the HPs, more training and refresher courses were needed for sustainability and the training should be extended to other hospitals in Rwanda. It is thus recommended that the framework can be used in interprofessional education and practice in Rwanda and possibly in other similar countries. Trial registration Name of the registry: Pan African Clinical Trial Registry. Trial registration number: PACTR201604001185358 . Date of registration: 22/04/2016. URL of trial registry record: www.pactr.org
- ItemOpen AccessPerceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: a qualitative study(2022-05-09) Niyibizi, Jean B.; Okop, Kufre J.; Nganabashaka, Jean P.; Umwali, Ghislaine; Rulisa, Stephen; Ntawuyirushintege, Seleman; Tumusiime, David; Nyandwi, Alypio; Ntaganda, Evariste; Delobelle, Peter; Levitt, Naomi; Bavuma, Charlotte MBackground In Rwanda, cardiovascular diseases (CVDs) are the third leading cause of death, and hence constitute an important public health issue. Worldwide, most CVDs are due to lifestyle and preventable risk factors. Prevention interventions are based on risk factors for CVD risk, yet the outcome of such interventions might be limited by the lack of awareness or misconception of CVD risk. This study aimed to explore how rural and urban population groups in Rwanda perceive CVD risk and tailor communication strategies for estimated total cardiovascular risk. Methods An exploratory qualitative study design was applied using focus group discussions to collect data from rural and urban community dwellers. In total, 65 community members took part in this study. Thematic analysis with Atlas ti 7.5.18 was used and the main findings for each theme were reported as a narrative summary. Results Participants thought that CVD risk is due to either financial stress, psychosocial stress, substance abuse, noise pollution, unhealthy diets, diabetes or overworking. Participants did not understand CVD risk presented in a quantitative format, but preferred qualitative formats or colours to represent low, moderate and high CVD risk through in-person communication. Participants preferred to be screened for CVD risk by community health workers using mobile health technology. Conclusion Rural and urban community members in Rwanda are aware of what could potentially put them at CVD risk in their respective local communities. Community health workers are preferred by local communities for CVD risk screening. Quantitative formats to present the total CVD risk appear inappropriate to the Rwandan population and qualitative formats are therefore advisable. Thus, operational research on the use of qualitative formats to communicate CVD risk is recommended to improve decision-making on CVD risk communication in the context of Rwanda.
- ItemOpen AccessPrevalence of hepatitis B and C infection in persons living with HIV enrolled in care in Rwanda(2017) Umutesi, Justine; Simmons, Bryony; Makuza, Jean D; Dushimiyimana, Donatha; Mbituyumuremyi, Aimable; Uwimana, Jean Marie; Ford, Nathan; Mills, Edward J; Nsanzimana, SabinBACKGROUND: Hepatitis B (HBV) and C (HCV) are important causes of morbidity and mortality in people living with human immunodeficiency virus (HIV). The burden of these co-infections in sub-Saharan Africa is still unclear. We estimated the prevalence of the hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCVAb) among HIV-infected individuals in Rwanda and identified factors associated with infection. METHODS: Between January 2016 and June 2016, we performed systematic screening for HBsAg and HCVAb among HIV-positive individuals enrolled at public and private HIV facilities across Rwanda. Results were analyzed to determine marker prevalence and variability by demographic factors. RESULTS: Overall, among 117,258 individuals tested, the prevalence of HBsAg and HCVAb was 4.3% (95% confidence interval [CI] (4.2-4.4) and 4.6% (95% CI 4.5-4.7) respectively; 182 (0.2%) HIV+ individuals were co-infected with HBsAg and HCVAb. Prevalence was higher in males (HBsAg, 5.4% [5.1-5.6] vs. 3.7% [3.5-3.8]; HCVAb, 5.0% [4.8-5.2] vs. 4.4% [4.3-4.6]) and increased with age; HCVAb prevalence was significantly higher in people aged ≥65 years (17.8% [16.4-19.2]). Prevalence varied geographically. CONCLUSION: HBV and HCV co-infections are common among HIV-infected individuals in Rwanda. It is important that viral hepatitis prevention and treatment activities are scaled-up to control further transmission and reduce the burden in this population. Particular efforts should be made to conduct targeted screening of males and the older population. Further assessment is required to determine rates of HBV and HCV chronicity among HIV-infected individuals and identify effective strategies to link individuals to care and treatment.
- ItemOpen AccessScalling up ART in Rwanda: the financial and economic costs(2007) Karengera, Stephen; Cleary, SusanRwanda has been rolling-out free antiretroviral treatment (ART) since 2004. This scale up could only be realised through significantly increased funding to the HIV/AIDS sub-account. Funding grew from US$9 million in 2003 to US$43 million in 2004 (UNAIDS, 2006b) and has continued to grow since this time given increased grants from GFATM and PEPFAR. Although international funding has been pivotal in the initiation of ART roll-out in resource poor settings, national programmes must look inwards for long term sustainability. This raises the question of whether the country will be able to sustain this level of funding once these grants cease or are significantly reduced. This question could be answered to a large extent if one knew the lifetime costs of providing ART in Rwanda and the capacity of the country to raise domestic revenue. Unfortunately the body of evidence on unit and lifetime costs for providing ART in Rwanda is nonexistent. The study aimed to determine the economic costs of scaling up ART in Rwanda. Costing from the provider's perspective was undertaken based on data from 3,310 patients in 3 ART sites. The health care utilisation and cost data obtained, supplemented by appropriate secondary data, were used to estimate the cost per-patient period and lifetime costs. These were then used to model the costs of scaling up and to explore the financial sustainability of ART in Rwanda. Key findings: The modelled costs per-patient period were US$244 for patients during the first six months on the first-line regimen and US$306 annually thereafter. Once firstline had been failed, costs increased to US$792 for the first six months on second-line and were US$1,299 during each annual period thereafter. Costs were US$680 per annum once both treatment regimens had been failed. Lifetime costs were determined to be $4,440 discounted at 3% and US$4,815 undiscounted. This corresponded to an annual average cost of US$741 or US$683 discounted at 3%. The 5-year cumulative costs of rolling-out ART, based on policy targets of initiating 153,014 adults on ART by 2011, were estimated to be US$206 million, or US$192 discounted at 3%. The cumulative total costs for scaling up was US$187 million or US$173 million discounted at 3%. The percentage composition of these costs was 70% ARVs, 12% clinical staff, 9% monitoring laboratory tests and 4% overheads. Over the period annual total costs increased from US$19 million in 2007 to US$62.5 million in 2011, an increase of 328%. Most of this increase was accounted for by increases in the costs of ARVs corresponding to 376%. The study established that 98.6% of ART provider costs were funded from public sources, of which 20% was domestic (central government) revenue and 80% foreign aid. Ceteris paribus, the ratio of domestic to foreign funding would rise to 1 to 5 or 17% to 83% by 2011. The ratio widens to about 2% to 98% when financial costs are considered. The combined commitment of US$243.4 million from Global Fund and PEPFAR is expected to cover nearly all patient specific costs during the scaling up period. The total health care resource envelope allocated to the Ministry of Health from public revenue in the financial year 2006/07 was US$73.5 million, of which 2.3% was from taxes and 97.7% from foreign aid. This is 7.8% of the total government budget (including donor funds). Total budgetary allocations to the Ministry of Health grew from US$50.1 in 2005 to US$73.5 million by 2007, equivalent to an increase of 46.7%. This growth was mainly accounted for by external resources, which grew by 50% while domestic resources fell by 40% during the same period. This finding does not augur well for sustainability of the ART programme in Rwanda. The total number of doctors in the public and the quasi-public sector is 204 and there are 465 unfilled posts (Ministry of Health 2006). The total number of full-time-equivalent (PTE) doctors (OPs) required for scale up was estimated to be 68 in 2007 rising to 164 in 2011. This would consume up to 33% of available physician time in 2007 and 80% in 2011 holding other things constant. A similar number of PTE counsellors would be required over the same period. The number xu of nurses was estimated to be 204 and 491 . in 2007 and 2011 respectively. Considering the human resource deficit in Rwanda and the number required to scale up ART there are serious con˜erns of ART crowding out other services. Although this cost analysis only includes ART provider costs for adult outpatients in public facilities in Rwanda, costs are projected to exceed US$62 million by 2011 if scaling up achieves 130,000 patients in care. At this level of scale, ART funding would need to grow by a rate exceeding 50% annually. It is difficulty to sustain such a level of funding from public revenue alone. Innovative health care financing mechanisms that exclude user fees need to be devised. Given that user-fees paid at the point of treatment have negative equity implications, other innovative financing approaches are needed to improve the financial sustainability of the ART programme.
- ItemOpen AccessSoccer injury surveillance and implementation of an injury prevention programme in Rwanda(2018) Nuhu, Assuman; Burgess, Theresa; Jelsma, JenniferBackground: There is growing participation in soccer at all levels of sport. Soccer increases the physical and psychological demands on players, which subsequently increase the risk of injuries. There are limited prospective epidemiological studies in Africa, and studies that have been conducted to date often fail to incorporate standardised injury definitions or reporting methods. Therefore, there is an urgent need to conduct epidemiological studies within the context of low to middle-income countries, where resources may be limited, and taking into consideration exposure times to design appropriate preventive measures. Aim: The purpose of the study was to explore the nature and incidence of soccer-related injuries in first division players in Rwanda, and to establish intrinsic risk factors for injuries. Methods: A prospective cohort study was conducted for two seasons. Eleven teams (326 players) and 13 teams (391 players) were followed for the seasons 2014-2015 and 2015-2016. Anthropometric and musculoskeletal screening composed of flexibility tests, strength and endurance, balance and proprioception tests, and lower limb function tests were conducted as well as training and match exposure were recorded. Team medical personnel recorded the location, type, duration and mechanism of time-loss injuries following the suggestion of the International Federation of Football Associations (FIFA). The primary outcome was the incidence of overall, training and match injury as well as body part, type, patterns and severity of injuries. Multivariate model using the Chi-squared Automatic Interaction Detection (CHAID) was used to assess intrinsic predictors of injury. Significance was accepted as p<0.05. Results: There were 455 injuries and approximately 46% of the players were injured in each of the two seasons. The team weighted mean incidence of match injuries was significantly lower during season one (14.2 injuries/ 1000 hours) compared to season two (21.9 injuries/ 1000 hours) (t(22)= -2.092, p=0.048). No difference was observed in the team-weighted incidence for overall and training injuries between the two seasons. There was increased injury incidence with increased acute: chronic training and match workload ratios. Lower extremities were the most frequently affected over the two seasons (80% of all injuries), with the knee joint most commonly injured (28% off all injuries) followed by the ankle joint (25% of all injuries). Ligament strains were the most common form of injury followed by muscle strains and contusions. The most common mechanisms of injury were collisions between players and receiving a tackle. About three quarters of the reported injuries were mild or moderate in severity and injuries to the Achilles tendon lead to the longest median lay-off time. The greatest incidence of injuries was sustained between the 46thand 60thminute of match play. A score of 11cm or less on the Sit and Reach test, more than one year in the current club and a timed hop of more than 2.5 seconds were all associated with injury. Conclusions: The rate of injuries found in this study is lower compared to the studies that reported injuries in adult male at either professional or amateur level. The patterns of training and match injuries, location, type and severity of injuries are similar to previous studies. Flexibility and balance, and coordination emerged as being significant predictors of increased risk of injury. More studies with emphasis on intrinsic and extrinsic factors are needed to attain wider knowledge concerning injuries among soccer players in Africa. Prevention intervention is necessary to minimise the of lower limb injuries.