Rwanda Meteorological Service

Communicable diseases remain a major public health challenge in Rwanda, contributing significantly to morbidity and mortality. Despite notable progress in reducing the burden of infectious diseases such as malaria, HIV/AIDS, and tuberculosis, recent threats, including Marburg virus infections and other emerging outbreaks, underscore the need for renewed vigilance and strengthened disease control strategies. Transmission occurs through direct or indirect contact and is influenced by socioeconomic, environmental, and demographic factors. This study provides a comprehensive analysis of the prevalence of selected communicable diseases (Malaria, Tuberculosis, HIV/AIDS, Diarrheal Illnesses, and Neglected Tropical Diseases (NTDs) in Rwanda, highlights past successes, and proposes evidence-based recommendations for future control efforts. A comprehensive search was conducted using multiple sources, including PubMed/Medline, the World Health Organization (WHO) database, demographic surveys, scientific journals, the Centers for Disease Control and Prevention (CDC) databases, and Rwanda's Health Management Information System (HMIS). Studies were included if they were published between 2010 and 2024, focused on Africa, particularly Rwanda, and were available as free full-text. The most reported diseases across these studies were HIV/AIDS, malaria, tuberculosis, and diarrhoeal illnesses, reflecting their dominance in Rwanda's epidemiological profile. Findings relevant to the review objectives were summarised and organized thematically as a narrative literature review. The incidence of malaria has dramatically decreased from 5.9million in 2017 to 857,000 in 2022, highlighting the effectiveness of public health efforts in addressing this issue. However, HIV/AIDS continues to be a serious public health concern, with an adult prevalence rate of 3.0%. Although the distribution of highly active antiretroviral therapy (HAART) has been extremely successful, the programmes dependence on external funding threatens long-term sustainability. Inadequate sanitation and hygiene practices have resulted in high rates of diarrhoeal infections among children under five, most of which are caused by microorganisms in contaminated water. Public health initiatives successfully implemented in Rwanda have controlled infectious diseases. The techniques used include providing long-lasting insecticide-treated nets, indoor residual spraying, engaging community health workers in detecting illnesses, and directly monitoring tuberculosis treatment adherence. However, to further reduce mortality, issues such as the need for sustained funding, the reliance of HIV/AIDS programmes on external financing, and antimicrobial resistance in malaria and tuberculosis must be addressed more effectively. Not applicable.

How acute coronary syndrome (ACS) mortality has evolved among people with cirrhosis at the national level is unclear, and the clinical implications for cardio-hepatic care are underdefined. Using CDC WONDER mortality files (1999-2020), we identified deaths with ACS as the underlying cause and cirrhosis listed among multiple causes, computed age-adjusted mortality rates (AAMRs; per 100,000), and modeled trends with Joinpoint regression. Subgroups included sex, race/ethnicity, urbanization, and place of death. We identified 10,319 cirrhosis-associated ACS deaths; the overall AAMR was 0.22. Rates were higher in men than women (0.33 vs. 0.12) and higher in Hispanic than non-Hispanic individuals (0.31 vs. 0.20). American Indian/Alaska Native had the highest AAMR (0.34). Rural noncore counties had the highest AAMR (0.28). Joinpoint detected a national inflection in 2014: AAMR declined from 1999 to 2014 (APC - 3.49%) and increased thereafter (APC + 5.38%), with an overall AAPC of -1.03%. After years of decline, cirrhosis-associated ACS mortality has risen since 2014, with persistent disparities by sex, race/ethnicity, and rurality. These data support integrated cardio-hepatic pathways, targeted outreach to rural and historically underserved groups, and system-level quality improvement focused on time-sensitive ACS care in cirrhosis.

Background:Surgical care in the continent of Africa encounters a wide array of issues, comprising a lack of access to emergency and essential surgery. Optimal pre-, peri-, and post-operative care is guided by the four pillars of medical ethics: beneficence, non-maleficence, autonomy, and justice. This may not be the case for low-resource domiciles as issues circumventing low literacy levels, poor infrastructure, poverty, and inequities in social health are cumbersome. Moreover, there is no homogeneity in the cultures and religious diversity that Africa has to offer which has led to a variety of healthcare decisions being made alongside an influence on the relationships developed between patients and their healthcare providers.Objectives:This study aims to address the influences of diverse cultural and religious backgrounds in ethical decision-making in African surgical care. Moreover, the study suggests strategies for mitigating diversity issues through developing environment-based protocols that promote ethically acceptable and culturally sensitive local surgical care.Methods:A comprehensive literature review was conducted to explore the present state of surgical care in Africa alongside the ethical principles guiding surgical care and cultural/religious considerations that may affect healthcare decisions when establishing patient-provider rapport. The databases used are PubMed/MEDLINE and EBSCOhost. Our search terms were “surgical care,” “ethical consideration,” “Africa,” and “culture and religion in Africa.” This enabled us to meticulously look into the existing findings to develop suggestions based on the gaps.Result:The literature review demonstrated the complex interplay between moral principles, cultural and religious outlooks, and surgical care provision in Africa. Some of the strategies found useful in this case are strengthening health systems, resources adequacy alongside context-based directives as well as capacity building. Additionally, cultural understanding, active listening and appreciation of diversity is critical since patients will receive culturally competent care and minimize chances for medical errors.Conclusion:Tackling Ethical challenges in African surgical care requires multiple approaches that accommodate religion’s diverse culture. To do this, healthcare workers must cooperate with community members and policymakers to develop policies for ethically and culturally acceptable surgical approaches. Further research is warranted to evaluate the efficacy of these interventions.

ABSTRACTBackground and AimsCoronary artery disease (CAD), a leading cause of death globally, is among the most commonly diagnosed manifestations of heart disease. Although invasive coronary angiography (ICA) remains the “gold standard” to detect CAD, it is accompanied by several limitations. This review aims to present recent Noninvasive diagnostic modalities in CAD, report and compare the diagnostic accuracy of different invasive and noninvasive tests in CAD, and analyze both the current and future clinical implications of noninvasive modalities that regularly evaluate CAD in modern cardiology.MethodsGiven this background and purpose, various, reliable online sources were searched to find relevant data for our narrative review. To this end, several databases were consulted including Google Scholar, PubMed, and Embase.ResultsThe weight of the evidence highlights that the accuracy of several noninvasive diagnostic modalities in CAD is high and the choice of the most suitable noninvasive diagnostic testing mainly depends on local resources, tests' features, and patients' characteristics, which determine the pretest probability of CAD. For patients presenting an intermediate pretest probability of the disease noninvasive testing seems to be appropriate.ConclusionNoninvasive diagnostic modalities could limit the usage of invasive modalities in CAD. Nowadays, noninvasive diagnostic modalities are increasingly being promoted as they provide useful and reliable information about the various aspects of CAD. Undoubtedly, more efforts are needed to optimize noninvasive diagnostic tests to demonstrate their full potential in CAD.

The role of community pharmacies has been transitioning from traditional drug dispensing methods to include more patient-centered services such as pharmacotherapeutic monitoring. With the increasing complexity of medication regimens and the rising prevalence of chronic diseases, pharmacotherapeutic monitoring plays a crucial role in preventing medication-related problems. This study aims to review patient outcomes of community pharmacies' involvement in pharmacotherapeutic monitoring services. It also highlights advances in the monitoring process, the challenges involved, and relevant solutions. A narrative review was conducted from 8 April 2024 to 9 May 2024, where data were extracted from multiple research studies indexed in PubMed, EBSCOHost, and Google Scholar databases. This review included only previous articles written in English and had information relevant to community pharmacy, patient care, innovations in pharmacotherapeutic monitoring, and challenges associated with the monitoring process in community pharmacies. Implementation of pharmacotherapeutic monitoring in community pharmacies improves patient outcomes and satisfaction. It minimizes adverse events by ensuring optimal dosing and patient adherence, which in turn reduces medical expenses and duration of hospitalization. However, factors such as inefficient analytical resources, lack of skilled personnel, and huge financial costs complicate implementation of pharmacotherapeutic monitoring in community pharmacies. Community pharmacies' participation in therapeutic drug monitoring is a promising development that prioritizes tailored patient care, eliminating the need for hospital visits. We recommend a multidisciplinary collaboration, robust electronic medical record systems, and large-scale research studies to provide sufficient evidence on the application of therapeutic drug monitoring in community pharmacies, to leverage this service. Also, policy and decision-makers should facilitate this practice by investing more in pharmacotherapeutic monitoring tools and training for community pharmacists.

Non-Alcoholic Steatohepatitis (NASH), a severe form of Non-Alcoholic Fatty Liver Disease (NAFLD), is characterized by inflammation and fibrosis in the liver, often progressing to cirrhosis and hepatocellular carcinoma. Despite its rising prevalence and significant disease burden, effective pharmacological treatments have been limited to lifestyle modifications and surgical interventions. Recently, resmetirom, a thyroid hormone receptor-β agonist, received FDA approval for treating NASH, offering new hope to patients. This review explores the current understanding of NASH and the role of resmetirom as a breakthrough therapeutic option. This study is a comprehensive literature review analyzing peer-reviewed articles, clinical trial data, and public health reports. No original analyses were conducted, and no statistical software was utilized in this review. Resmetirom demonstrated efficacy in resolving NASH without fibrosis progression and improving fibrosis scores in patients with biopsy-confirmed NASH. In a randomized Phase 3 trial, significant histological improvements were observed in 25.9% and 29.9% of patients receiving 80 and 100 mg doses, respectively, compared to 9.7% in the placebo group. Similar trends were noted in fibrosis improvement, with 24.2% and 25.9% of patients showing ≥ 1 stage improvement compared to 14.2% in the placebo group. Adverse effects, including nausea and diarrhea, were reported more frequently in the treatment groups, but the rates of serious adverse events were comparable across groups. The approval of resmetirom marks a significant advancement in the treatment of NASH, addressing the limitations of lifestyle-based interventions. As the obesity epidemic drives the increasing prevalence of NASH, resmetirom provides a promising therapeutic option, paving the way for improved patient outcomes and future research.

ABSTRACTIntroductionLaparoscopic surgery (LS) has been a promising development in surgical practice globally ever since its introduction. LS has exhibited many an advantage, including bettering patient outcomes, lowering the risk of postoperative infection, and displaying economical affluence. However, its implementation in the African continent still faces various challenges. In this review, we investigated the status of laparoscopic surgery integration in Africa.ObjectivesIn this review, we aimed to investigate the challenges posed by the implementation of LS in low resource countries as well as critically evaluating initiatives and their impact within said domiciles. We also provide recommendations that may assist in LS prosperity in these settings by focusing efforts on improving training and financial incentives.MethodsA comprehensive literature review was conducted to garner up‐to‐date evidence concerning the fate of LS adoption in low‐ to middle‐income countries. This comprised the analysis of different case studies from countries including Nigeria and Botswana, and investigated relevant recommendations and policies provided by other African countries.ResultsVarious challenges face the implementation of LS in countries with low resources comprising poor infrastructure, scarce training programs, and expert training personnel alongside financial boundaries. The adoption of LS in Africa has proved its benefits in improving patient outcomes and reducing hospital admissions. From a perspective of policy, it is crucial to sustain strong ties amongst institutions, stressing the importance of dynamic collaboration and locally tailored policies.ConclusionIt has been demonstrated that LS implementations in African nations lower infection rates and expedite recovery. A strong collaboration between governments, stakeholders, and healthcare providers is fundamental for successful integration of LS. Such extension in low‐resource environments may be achieved by providing proper training programs, funding infrastructure and equipment, and fostering effective financial initiatives.

Skin diseases in remote African regions are often exacerbated due to a lack of resources and expertise with little current research addressing the challenges that patients and healthcare systems experience. Although skin diseases in remote African regions are prevalent and pose a substantial health burden, they remain neglected and understudied. This review aims to explore current challenges in the diagnosis and management of skin diseases in African regions and focus on the need for enhanced understanding and improved healthcare strategies. We reviewed papers that were retrieved from PubMed, Google Scholar, and other relevant academic search sites to analyze the prevalence, screening techniques, as well as management strategies and obstacles associated with dermatological diseases in remote African regions. Current literature suggests there is indeed a high prevalence of skin diseases where other infections are predominant. Further, different factors, such as socioeconomic status and environmental conditions, make it challenging for optimal screening and treatment of skin diseases in remote African regions. Common screening methods for skin diseases involve clinical examination and laboratory tests, while management includes pharmacotherapy, surgery, and counseling approaches. Overall, access to medications and adequate healthcare services remains limited. Early diagnosis and management of skin diseases in remote African regions have significant challenges, including a lack of funding for dermatology, education, and research. Future promising strategies such as teledermatology, point-of-care diagnostic technologies, and task shifting show promise in improving access to care. However, there is a need for sustained efforts to address the underlying socioeconomic factors and improve healthcare delivery in remote African regions.

PCSK9 inhibitors are a novel class of medications that lower LDL cholesterol (LDL-C) by increasing LDL receptor activity, promoting clearance of LDL-C from the bloodstream. Over the years, PCSK9 inhibitors have been explored as adjunct therapies to statins or as monotherapy in high-risk cardiovascular patients. This review aims to provide an updated perspective on PCSK9 inhibitors, assessing their clinical efficacy, safety, and significance, especially in light of recent clinical trials. The review examines the role of PCSK9 in cholesterol regulation and summarizes the results of major cardiovascular trials, including FOURIER, SPIRE-1, SPIRE-2, and ODYSSEY Outcomes. It also discusses emerging treatments like small interfering RNA (siRNA) therapies and evaluates PCSK9 inhibitor effects on LDL-C and lipoprotein(a) levels. Clinical trials have shown PCSK9 inhibitors reduce LDL-C by up to 60%. In the FOURIER trial, evolocumab reduced LDL-C by 59% and major cardiovascular events by 15%-20%. The SPIRE-2 trial, despite early termination, showed a 21% risk reduction in the primary composite endpoint with bococizumab. The ODYSSEY Outcomes trial reported a 57% LDL-C reduction with alirocumab, alongside a 15% reduction in adverse events. Emerging treatments like Inclisiran offer long-term LDL-C control with fewer doses. PCSK9 inhibitors are generally well-tolerated, with the most common side effect being injection site reactions. PCSK9 inhibitors significantly lower LDL-C and reduce cardiovascular events, offering promising therapies for high-risk patients, including those with familial hypercholesterolemia (FH) and those who cannot tolerate statins. Future research will focus on optimizing these inhibitors, integrating complementary therapies, and exploring gene-editing technologies to improve patient outcomes.