Care In Rwanda Research Articles

Abortion Incidence and Postabortion Care in Rwanda

Abortion is illegal in Rwanda except when necessary to protect a woman's physical health or to save her life. Many women in Rwanda obtain unsafe abortions, and some experience health complications as a result. To estimate the incidence of induced abortion, we conducted a national sample survey of health facilities that provide postabortion care and a purposive sample survey of key informants knowledgeable about abortion conditions. We found that more than 16,700 women received care for complications resulting from induced abortion in Rwanda in 2009, or 7 per 1,000 women aged 15-44. Approximately 40 percent of abortions are estimated to lead to complications requiring treatment, but about a third of those who experienced a complication did not obtain treatment. Nationally, the estimated induced abortion rate is 25 abortions per 1,000 women aged 15-44, or approximately 60,000 abortions annually. An urgent need exists in Rwanda to address unmet need for contraception, to strengthen family planning services, to broaden access to legal abortion, and to improve postabortion care.

Primary eye care in Rwanda: gender of service providers and other factors associated with effective service delivery

To assess factors associated with high output of recently trained medical personnel in Rwanda. Nurses and village health workers (VHW) from all health centres in Rubavu district were included. Data were collected during focus group discussions and through one-to-one interviews. Follow-up interviews were carried out in January 2009. There was a wide range from none to all VHW referring people to a health centre. VHW brought more people to the health centre if there was a visiting ophthalmic clinical officer from the Eye Unit offering free screening. VHW output varied; male VHW brought 66.7% of patients identified (regardless of the sex of the health centre nurse), while female VHW brought 5.2 times as many people if the health centre nurse was male compared to if the nurse was female. Changes in training curriculum and support and supervision of health workers trained in primary eye care (PEC) are likely to lead to improved outputs. Information efforts should reinforce that male and female nurses have the same training and skills in PEC.

Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects

Background. With the intensive scale-up of care and treatment for HIV/AIDS in developing countries, some fear that intensified attention to HIV programs may overwhelm health care systems and lead to declines in delivery of other primary health care. Few data exist that confirm negative or positive synergies on health care provision generally resulting from HIV-dedicated programs. Methods. Using a retrospective observational design we compare aggregate service data in Rwandan health facilities before and after the introduction of HIV care on selected measures of primary health care. The study tests the hypothesis that non-HIV care does not decrease after the introduction of basic HIV care. Findings. Overall, no declines were observed in reproductive health services, services for children, laboratory tests, and curative care. Statistically significant increases were found in utilization and provision of some preventive services. Multivariate regression, including introduction of HIV care and two important health care financing initiatives in Rwanda, revealed positive associations of all with observed increases. Introduction of HIV services was especially associated with increases in reproductive health. While hospitalization rates increased for the whole sample, declines were observed at health facilities that offered basic HIV care plus highly active antiretroviral therapy. Interpretation. Our results partially counter fears that HIV programs are producing adverse effects in non-HIV service delivery. Rather than leading to declines in other primary health care delivery, our findings suggest that the integration of HIV clinical services may contribute to increases.

Sharing the burden of sickness: mutual health insurance in Rwanda

Mandatory participation in mutual health insurance schemes and public subsidies for poor have led to considerable improvement in public health and health care in Rwanda, but even at US$ 2 a year, price for some members of population remains prohibitively high. Aimable Twahirwa reports from Kigali. [ILLUSTRATION OMITTED] Rwanda's Ministry of Health plans, to boost community participation in financing of health-care services in 1980s and 1990s, were hampered in immediate aftermath of war and genocide of 1994. But since those dark days, Rwandan authorities have engaged in an effort to strengthen communities' role in managing and co-financing health-care provision. One of ways it has done this is through mutual health insurance schemes, known in as mutuelles de sante or mutuelles. Mutuelles were reinitiated as pilot projects in in 1999 and uptake accelerated sharply in 2004-2005 with adoption of a national policy on mutuelles and a roll-out of schemes with financial and technical support of development partners. As of April this year, every Rwandan is obliged by law to have some form of health insurance. There are currently several health insurance programmes in targeting specific groups of However, biggest in terms of membership is mutuelles scheme, participation in which is organized on a per household basis, with an annual payment of 1000 Rwandan francs (US$ 2) per family member. [ILLUSTRATION OMITTED] For WHO's Laurent Musango, former director of School of Public Health at National University of Rwanda, growth of mutual health insurance system has been a great success from point of view of affordability of programme, and fact that all comers are covered: Rwanda is only country in sub-Saharan Africa in which 85% of population participates in mutual insurance programmes for their health coverage, he says, adding that coverage is afforded to, the rich as well as poor, young as well old, urban as well as rural population. Musango argues that mutualization has also led to a reduction in health-care costs, and increased use of healthcare services. Taken together with other reforms such as decentralization of health-care services, performance-based financing, quality insurance and improvements in quality control through supervision, Musango believes mutualization has made a significant contribution to well-being of But there have been suggestions that people are being pressured into participating in a scheme they can ill-afford. In poorest regions of there are people who are finding it difficult to pay for mutuelle, but government is doing a lot to help, says Didi Bertrand Farmer, director of community health and social development with Partners in Health, a nongovernmental organization that is working in eastern Rwanda. …

Intimate partner violence among pregnant women in Rwanda

BackgroundIntimate partner violence (IPV), defined as actual or threatened physical, sexual, psychological, and emotional abuse by current or former partners is a global public health concern. The prevalence and determinants of intimate partner violence (IPV) against pregnant women has not been described in Rwanda. A study was conducted to identify variables associated with IPV among Rwandan pregnant women.MethodsA convenient sample of 600 pregnant women attending antenatal clinics were administered a questionnaire which included items on demographics, HIV status, IPV, and alcohol use by the male partner. Mean age and proportions of IPV in different groups were assessed. Odds of IPV were estimated using logistic regression analysis.ResultsOf the 600 respondents, 35.1% reported IPV in the last 12 months. HIV+ pregnant women had higher rates of all forms of IVP violence than HIV- pregnant women: pulling hair (44.3% vs. 20.3%), slapping (32.0% vs. 15.3%), kicking with fists (36.3% vs. 19.7%), throwing to the ground and kicking with feet (23.3% vs. 12.7%), and burning with hot liquid (4.1% vs. 3.5%). HIV positive participants were more than twice likely to report physical IPV than those who were HIV negative (OR = 2.38; 95% CI [1.59, 3.57]). Other factors positively associated with physical IPV included sexual abuse before the age of 14 years (OR = 2.69; 95% CI [1.69, 4.29]), having an alcohol drinking male partner (OR = 4.10; 95% CI [2.48, 6.77] for occasional drinkers and OR = 3.37; 95% CI [2.05, 5.54] for heavy drinkers), and having a male partner with other sexual partners (OR = 1.53; 95% CI [1.15, 2.20]. Education was negatively associated with lifetime IPV.ConclusionWe have reported on prevalence of IPV violence among pregnant women attending antenatal care in Rwanda, Central Africa. We advocate that screening for IPV be an integral part of HIV and AIDS care, as well as routine antenatal care. Services for battered women should also be made available.

What is the preferred place of care at the end of life for HIV/AIDS patients in countries affected by civil war and genocide: the case of Rwanda?

The main aim of palliative care is to improve the quality of life of people facing threatening diseases by allowing them a dignified death. Therefore, it is crucial to take into account the user's preference of where to be taken care of during the terminal phase of illness. Palliative care in Rwanda is at an early phase of development; therefore, effective planning and implementation that considers the user's view on where to be taken care of is important. This study investigated where HIV/AIDS patients wanted to be cared for in the terminal phase of illness. The results form part of a larger study on met and unmet palliative care needs of people living with HIV/AIDS in selected areas in Rwanda.