Rwanda Military Hospital

IntroductionHead and neck cancer (HNC) is the seventh most prevalent cancer globally. Chemoradiotherapy (CRT) and radiotherapy (RT) are the two most common treatment modalities for HNC. However, both treatments are associated with adverse side effects, including hearing loss. This systematic review and meta-analysis aim to evaluate the pooled prevalence of sensorineural hearing loss (SNHL) among HNC patients undergoing CRT versus RT.MethodologyA comprehensive search of PubMed/MEDLINE, Google Scholar, DOAJ, AJOL, and the Cochrane Library was conducted using predefined key terms to identify original articles reporting the prevalence of SNHL in HNC patients treated with CRT or RT. Additionally, manual Google searches were performed to uncover relevant grey literature. The results were screened and included or excluded according to preset criteria. The Restricted Maximum Likelihood (REML) random-effects model was employed to calculate the overall pooled prevalence and separate prevalences in CRT and RT groups, as well as their respective heterogeneities, using Jamovi 2.3.28 software. Statistical significance was set at p < .05 for all analyses.ResultsThe overall prevalence of SNHL among HNC patients treated with CRT or RT was 54.5% (95% CI: 44.9% − 64.0%; I² = 90.35%, p < .001). For CRT, the prevalence was 60.4% (95% CI: 50.5% − 70.2%; I² = 88.82%, p < .001). In contrast, the prevalence for RT was 32.9% (95% CI: 21.3% − 44.4%; I² = 60.15%, p = .063). The risk of developing SNHL was nearly twice as high in patients treated with CRT compared to those treated with RT alone, with a prevalence ratio of 1.83.ConclusionBoth CRT and RT are associated with SNHL in HNC patients, with a significantly higher prevalence observed in those undergoing CRT compared to RT.

Abstract Background Traumatic brain injury (TBI) is a global health priority due to its preventability and its related expensive medical care. This research assessed the determinants, management and outcomes of TBI in Rwanda. Methods A multicentre cross-sectional study combined with a community-based telephone survey was implemented on a sample of 84 patients selected through a multi stage sampling technique. The data were collected in two reference hospitals through a standardized pre-tested questionnaire developed by the researcher who who included all the items of GOSE to determine the functional outcomes of TBI patients. Data collected were characteristics of the study participants, type of TBI, mode, mechanism, time and venue of the injury, mode of referencing from injury site to emergency department, clinical presentation and investigations on admission, treatment administrated, and outcomes of the management. The data were managed in SPSS23 and geo-referenced in Google Earth Pro. Descriptive statistics was implemented followed by determining association through Chi-square tests, correlation analysis and ANOVA. A multinomial regression established the relationship between determinants, management and outcomes of TBI. A spatial analysis through the kriging method of ArcGIS delineated TBI risk areas. A significance level of p &lt; 0.05 was set for all the statistical tests. Results More than half (51.2%) of the TBI cases were aged 25–49 years; TBI affected predominantly male gender (77.4%). The identified types of TBI were mild (50.0%), moderate (39.7%) and severe (10.3%). The GOSE scores revealed that 69.0% of the TBI patients had good outcomes. The statistically significant determinants of TBI were conscious status in moderate (OR = 51.2,95%[CI:6.6-397.2], p = 0.000) and severe TBIs (OR = 48.8, 95%[CI: 1.8–1297.0], p = 0.020) and the length of stay in hospital in severe TBI (OR = 1.142. 95%[CI:1.013–1.287],p = 0.030). Three TBI risk areas were delineated in Rwanda through the kriging method; a high TBI risk area, an intermediate TBI risk area and low TBI risk area. Conclusion Traumatic brain injury is a country-wide public health concern in Rwanda. Its control and ultimately elimination indicate a public-private partnership between the affected communities, the public and private sectors, the armed forces, the Ministries of Transport, Education, and Health, the international organizations and non- governmental organizations.

Training and professional development programs for surgeons, anesthetists, obstetricians, and perioperative nurses in low-resource settings are often constrained by lack of access to appropriate training materials. Potential learners looking to access online content are faced with internet connectivity issues, difficulties in finding and accessing resources, resources that are inappropriate for their context and training, and opaque content quality control processes. The United Nations Global Surgery Learning Hub (SURGhub) was launched on June 28, 2023 to address this need. SURGhub curates high-quality surgical, anesthetic, obstetric, and perioperative nursing e-learning courses and makes them freely available on one integrated online platform, optimized for low-bandwidth settings. It is a product of the global surgery community, powered by over 200 volunteers and anchored in the United Nations. In little over 18months since its launch, SURGhub has enrolled 11,451 registered learners from 190 countries. Fifty-five percent of users are based in low- or lower-middle income countries. Learners can access 76 interactive e-learning courses, provided by 20 different institutions. Median course user rating is 4.6/5. SURGhub is addressing the needs of underserved surgical learners through innovative, participatory technological solutions. To address the unmet need, SURGhub must expand its educational offering, including through the addition of new content types, personalized learning, and increased provision of content in languages other than English. The translation of SURGhub educational content into improvements in clinical practice and patient outcomes must be measured.

Gay, bisexual and other men who have sex with men (GBMSM) and cisgender female sex workers (FSW) are increasingly and disproportionately impacted by HIV in sub-Saharan Africa, yet current PrEP care models in this region are not optimized for these communities. Limited data exist describing experiences and preferences of GBMSM and FSW with respect to accessing and using PrEP. We conducted qualitative, semi-structured interviews with GBMSM and FSW recruited from three health centers and seven community organizations in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive approach to describe key themes related to initiating and adhering to PrEP. Participants included 18 GBMSM and 14 FSW; 12 were using PrEP at the time of interview, 9 had previously used PrEP, and 11 had never used it. Participants highlighted the central role of their social networks as key sources of information about and support for PrEP use, and described a strong motivation to use PrEP as a way to protect both themselves and their communities from HIV. While stigma and discrimination were pervasive, these were experienced differently by GBMSM and FSW. Participants suggested community access points that allowed more discreet and less frequent contact with health care workers as important and desired strategies to improve engagement. These findings suggest that leveraging community resources for disseminating information about HIV prevention and delivering PrEP could contribute to successful implementation of PrEP for GBMSM and FSW in Rwanda and other settings in SSA.

Cancer care involves disclosing difficult information, making treatment decisions, and advance care planning. Communication practices and preferences are strongly influenced by sociocultural context. This scoping review aims to identify, map, and appraise the available evidence on clinical communication in cancer care in Africa and recommend priorities for future work. A search strategy was developed to identify studies conducted in Africa with a primary focus on patient-clinician communication in cancer care and performed in PubMed, Embase, Web of Science, CINAHL, African Index Medicus, and PsycINFO. Two reviewers independently screened titles and abstracts, full texts, and cited references. Study characteristics were analyzed using descriptive statistics and content analysis. Critical appraisal was performed using the Mixed Methods Appraisal Tool. Our search yielded 58 articles from 19 countries. Study designs were quantitative survey (53%), qualitative (38%), non-randomized experimental (5%), and mixed methods (3%), with no randomized trials. Populations included patients with cancer (n = 25), doctors (n = 24), nurses (n = 16), family/caregivers (n = 16), and/or others. Seven studies (12%) focused on pediatrics. Most studies (60%) focused on clinicians' disclosure of information, often framed as "breaking bad news" or "truth-telling." The remainder focused on information preferences (14%), advance care planning (10%), illness understanding (5%), shared decision making (5%), and communication training (3%). Critical appraisal demonstrated higher quality among qualitative than quantitative studies. Future work should explore underexamined research areas such as patient-centered communication, translate observational findings into intervention development and testing, implement communication skills training, and evaluate outcomes related to communication in cancer care in Africa.

Abstract Introduction Post-burn contractures (PBC) are among the major complications of burn injuries yet knowledge about the factors affecting healthcare access among patients with PBC is limited. This study aims to assess the barriers and facilitators to care among pediatric post-burn contracture patients. Methods A cross-sectional study including patients admitted for PBC between April -August 2022. A pre-established questionnaire was administered to assess socio-demographic characteristics and probable factors determining access to care. Logistic regression was used to assess model fit of missed follow-up appointments against independent variables. The area under the curve and goodness of fit were computed. A p-value &amp;lt; 0.05 was considered significant. Results A total of 390 pediatric patients have been included in this study. The majority of patients were female (53.5%) with a median age of 7 years. Most patients had health insurance (97.5%) and belonged to Ubudehe categories 2 (48.8%) or 3 (39.3%). Scalds were the most common burn type (60.4%). The proximal interphalangeal joint (PIP) and elbow were the most frequently affected areas. The most common post-burn contracture type was MASCCA B (48.2%). Regular exercise in the affected region was the most reported facilitator for attending follow-up appointments (76.4%). Lack of money was the most prevalent barrier among those who missed appointments (100%). Patients from lower socio-economic backgrounds (Ubudehe 1) had access to fewer facilitators and reported more geographical barriers. Attending physiotherapy sessions post-discharge significantly reduced the odds of missing follow-up appointments (OR = 0.41, p = 0.02). Conclusions Geographical, educational, and financial barriers emerged as the most important issues to access burn care. We recommend increasing burn prevention measures, improving burn care at lower levels of the Rwanda Health system, enhancing patients’ and families’ education, regular exercise, and better access to occupational therapy. Applicability of Research to Practice These results highlight the need for interventions that promote physiotherapy adherence and address financial limitations to improve post-burn contracture care, decentralization of particularly for those from lower socioeconomic backgrounds. Funding for the Study N/A

BackgroundBuilding research capacity can strengthen health systems through evidence-based interventions. However, evaluating the current research capacity and increasing it is a layered process that needs to consider different institutional structures, as well as internal factors. This study collects baseline data on the research capacity and culture at King Faisal Hospital Rwanda (KFH), a tertiary-level teaching hospital in Rwanda. It also proposes ways to further strengthen it and recommends ways for other institutions in Rwanda to strengthen research capacity.MethodsThe Research Capacity and Culture Tool was distributed to full-time clinical and non-clinical KFH staff in September 2021. Participants were required to hold a position that minimally requires an Advanced Diploma. The quantitative survey data were analyzed in SPSS Version 27 and analyzed via descriptive statistics across all domains, including the individual, organizational, and team levels.Findings152 participants completed the questionnaire. On a 5-point Likert scale, the highest ranked skills were designing questionnaires (3.34) and using digital referencing systems (3.29), while the lowest ranked skills were securing research funding (2.40) and writing for publication in peer-reviewed journals (2.46). Perceptions about the organizational level’s research system were overall stronger than those at the team level, with the weakest team-level system being having regular research forums and bulletins (2.14) and having digital tools for conducting research (2.14). Motivators to conducting research included skills development (87%) and career advancement (74%), while barriers included a lack of time (64%) and access to funding (56%).DiscussionTo strengthen the research capacity and culture at KFH, focus should be on allocating tools, resources, and training opportunities to staff. Research should be integrated into staff job descriptions, with a time audit conducted to ensure they have adequate time for these activities. Finally, decentralizing research and ensuring team-level ownership will help with staff buy in.

Cancer genetic data from Sub-Saharan African (SSA) are limited. Patients with female breast (fBC), male breast (mBC), and prostate cancer (PC) in Rwanda underwent germline genetic testing and counseling. Demographic and disease-specific information was collected. A multi-cancer gene panel was used to identify germline Pathogenic Variants (PV) and Variants of Uncertain Significance (VUS). 400 patients (201 with BC and 199 with PC) were consented and recruited to the study. Data was available for 342 patients: 180 with BC (175 women and 5 men) and 162 men with PC. PV were observed in 18.3% fBC, 4.3% PC, and 20% mBC. BRCA2 was the most common PV. Among non-PV carriers, 65% had ≥1 VUS: 31.8% in PC and 33.6% in BC (female and male). Our findings highlight the need for germline genetic testing and counseling in cancer management in SSA.

Abstract OBJECTIVE brain tumors are a global problem, leading to higher cancer-related morbidity and mortality rates in children. Despite the progressive though slow advances in neuro-oncology care, research, and diagnostics in sub-Saharan Africa (SSA), the epidemiological landscape of pediatric brain tumors (PBTs) remains underestimated. This study aimed to systematically analyze the distribution of PBT types in SSA. METHODS major databases and grey literature were searched for literature on PBTs in SSA published before October 29, 2022. A proportional meta-analysis was performed. RESULTS forty-nine studies, involving 2360 children, met the inclusion criteria for review; only 20 (40.82%) were included in the quantitative analysis. South Africa and Nigeria were the countries with the most abundant data. Glioma not otherwise specified (NOS) was the common PBT in the 4 SSA regions combined. However, medulloblastoma was more commonly reported in Southern-SSA(p=0.01) than in other regions. The prevalence and the overall pooled proportion of the 3 common PBTs was estimated at 46.27% and 0.41 (95%CI 0.32–0.50, 95% prediction interval [PI] 0.11–0.79), 25.34% and 0.18 (95%CI 0.14–0.21, 95%PI 0.06–0.40), and 12.67% and 0.12 (95%CI 0.09–0.15, 95%PI 0.04–0.29) for glioma-NOS, medulloblastoma, and craniopharyngioma, respectively. Sample size moderated the estimated proportion of glioma-NOS (p = 0.02). The highest proportion of craniopharyngiomas was in Western-SSA, and medulloblastoma and glioma-NOS in Central-SSA. CONCLUSION these findings provide insight into the trends of PBT types and the proportion of the top 3 most common tumors across SSA. Although statistical conclusions are difficult due to the inconsistency in the data. We identify critical areas for policy development and collaborations that can facilitate improved outcomes in PBTs in SSA. More accurate epidemiological studies are needed to better understand the burden of the disease and the geographic variation in their distribution, and to raise awareness in their subsequent management.

Research on intergenerational trauma (IGT) indicates a link between parent and offspring PTSD symptoms. Studies suggest that parents’ PTSD symptoms could contribute to harsh parenting practices, such as childhood maltreatment, in turn increasing risk for PTSD symptoms in their offspring. However, the potential mediating role of cumulative and subtypes of offspring childhood trauma in intergenerational PTSD symptom transmission, along with the impact of parental sex, remain understudied. This cross-sectional study examined whether the link between parent and offspring PTSD symptoms among survivors of the 1994 genocide against the Tutsi in Rwanda to their offspring was mediated by cumulative and subtypes of offspring childhood trauma, and how these relationships vary by parental sex. Adult children of genocide survivors, all born after the genocide (N = 166; M age=23.03, SD = 1.94; 47.6% female), completed an online survey. We performed a series of models investigating childhood trauma as a mediator of maternal and paternal IGT transmission. We found significant indirect effects of maternal PTSD symptoms on offspring secondary PTSD symptoms via sexual abuse and physical neglect, and of paternal PTSD symptoms on offspring secondary PTSD symptoms via cumulative childhood trauma, sexual abuse, and physical abuse. The findings demonstrate variation in IGT via childhood trauma subtypes and parental sex. Future research, including longitudinal and multi-informant studies, should examine these sources of variation further to provide insight into how interventions could be tailored to prevent and mitigate the intergenerational transmission of PTSD symptoms.