Predictors of surgical complications following gynecologic cancer surgery in a low income country: experience from two tertiary hospitals in rwanda

Acute pancreatitis management and outcome at tertiary hospitals in Rwanda: A prospective multicenter study.

Although timely surgery is essential for improving general health and psychosocial outcomes, delays in cleft surgery remain common in low- and middle-income countries, including Rwanda, where little is known about the underlying causes. This study aimed to explore the factors influencing delays in cleft surgery in Rwanda using the four-delay framework. A phenomenological qualitative study was conducted between April and July 2024. We conducted 29 in-depth interviews with 15 caregivers of children with orofacial clefts and 14 healthcare providers involved in cleft care. Transcripts were analysed thematically using an inductive-deductive hybrid approach in MAXQDA (V.24), guided by the four-delay framework while allowing themes to emerge from the data. This qualitative study was conducted across six Operation Smile-supported hospitals in Rwanda. Operation Smile is a non-governmental organisation providing cleft care in several low- and middle-income countries, including Rwanda. Among these facilities, one is a tertiary-level hospital located in Kigali city, while the others are secondary-level hospitals distributed across all provinces of the country. Participants were purposively selected and comprised caregivers of children who underwent cleft surgery at Operation Smile-supported hospitals between 2023 and 2024, as well as healthcare providers with a minimum of 6 months' experience delivering cleft care at these facilities. Six major themes and 15 subthemes emerged. Limited caregiver awareness, cultural beliefs and inconsistent knowledge of clefts among healthcare providers influenced delays in seeking care. Reaching care was impeded by long distances, poor road infrastructure and inadequate transportation options. Receiving care was delayed by patient-related factors such as poor nutritional status of children and systemic issues, including shortages of specialised cleft care workforce (such as plastic surgeons, oral and maxillofacial surgeons, anaesthesiologists, etc) and surgical infrastructure. Remaining in care was affected by the absence of multidisciplinary follow-up services. Despite these barriers, caregivers appreciated the support services provided by Operation Smile, including nutrition, transportation and coverage of surgery costs. Cleft surgery delays in Rwanda are driven by multifactorial barriers across all stages of care. Strengthening early identification, public awareness, health provider training and post-operative support systems is essential to reducing delays and improving outcomes. Findings support the need for integrated cleft care within national surgical plans and broader health system strengthening efforts, and encourage the social and psychological support to affected children and caregivers.

ObjectiveThe objective of the study was to determine the prevalence of elevated PSA levels (> 4.0 ng/mL) and examine sociodemographic and modifiable lifestyle risk factors associated with PSA elevation among asymptomatic Rwandan men aged ≥ 40 years.Material and MethodsA cross-sectional study was conducted at Kabutare District Hospital in Rwanda between March and April 2025, enrolling 136 asymptomatic male participants aged ≥ 40 years. Lifestyle and anthropometric data were collected via structured interviews. Serum total PSA was measured using the enzyme linked immunosorbent assay (Fortress BXE0851A kit). Elevated PSA was defined as > 4.0 ng/mL. Statistical analyses included descriptive statistics and Chi-square/Fisher’s exact tests for bivariate associations.ResultsElevated PSA was observed in 14% of participants. Chi-square analysis revealed significant associations between elevated PSA and BMI category (p < 0.001), smoking status (p < 0.001), alcohol use (p < 0.001), sexual activity frequency (p = 0.018), and occupation (p < 0.001).ConclusionElevated PSA prevalence among asymptomatic Rwandan men mirrors global patterns observed in Black populations. Associations with underweight status, occupational exposure, and alcohol use suggest multifactorial influences. These findings highlight the need for targeted screening strategies and community-level interventions to promote early prostate cancer detection in Rwanda.

Adherence to national pediatric antibiotic prescription guideline for pneumonia treatment of children 2–59 months: a retrospective chart review at a regional hospital in Rwanda

Background: Hypertension affects more than one billion people worldwide, accounting for nearly 10 million deaths and approximately 220 million Disability-Adjusted Life Years (DALYs) in 2017. Despite its growing burden, evidence on the prevalence and associated factors of hypertension remains limited in many African countries, including Rwanda, and is not fully integrated into national health policies. This study aimed to identify factors associated with hypertension among adult patients attending selected hospitals in Rwanda. Methods: A cross-sectional study was conducted among adults aged 18–64 years attending Gisenyi District Hospital in the Western Province and Rwamagana Provincial Hospital in the Eastern Province of Rwanda. Using stratified proportionate sampling, 313 participants were recruited between August and September 2025. Data were collected using a structured questionnaire. Descriptive statistics were summarized using frequencies and percentages, while chi-square tests and multivariate logistic regression were used to identify factors associated with hypertension. Statistical significance was set at p &lt; 0.05 with 95% confidence intervals. Ethical approval was obtained, and informed consent was secured from all participants. Results: The prevalence of hypertension was 40.3%. Factors significantly associated with hypertension included older age, daily smoking, daily alcohol consumption, frequent addition of salt to food, physical inactivity, obesity (BMI ≥30.0 kg/m²), and a family history of hypertension. Adults aged ≥60 years were nearly seven times more likely to be hypertensive compared to younger adults (AOR = 6.786, 95% CI: 2.492–18.479, p = 0.002). Conclusion: Hypertension is a major public health concern among adult outpatients in the selected Rwandan hospitals. Routine blood pressure screening, health education focusing on smoking cessation, alcohol moderation, reduced salt intake, increased physical activity, weight management, and family-centered counseling are recommended. These findings provide important evidence to inform policy and strengthen hypertension prevention and control strategies in Rwanda. Key words: Prevalence, Factors, Hypertension, Adult Outpatients, Rwanda

Evaluation of diagnostic and therapeutic hysteroscopy outcomes at a tertiary hospital in Rwanda

The metabolic syndrome (MetS) is a cluster of interconnected risk factors, affecting approximately 20-30% of the adult population worldwide, with a rising burden in sub-Saharan Africa, including Rwanda. Hospital workers, a critical component of the healthcare system, are at risk of developing MetS due to occupational stress, sedentary lifestyle, and poor dietary habits. This study aimed to determine the prevalence of MetS and its associated risk factors among hospital workers at a provincial hospital in Rwanda. A cross-sectional study was conducted among healthcare workers aged 35-65 years at a provincial hospital in Rwanda. Data were collected using the World Health Organization (WHO) STEPwise tool and MetS was defined according to NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel III) criteria. Statistical analyses were performed using Stata 15, with significance set at p < 0.05. The overall prevalence of MetS was 37.9%, significantly higher in females (48.7%) than males (7.7%, p < 0.001). Low High-Density Lipoprotein-C (HDL-C) was the most prevalent MetS component (60.8%), especially among females. Abdominal obesity was also significantly higher in females. Multiple logistic regression analysis identified increasing Body Mass Index (BMI) (adjusted odds ratio [aOR]: 1.25; 95% confidence interval [CI]: 1.09-1.44; p = 0.001) and age (aOR: 1.13; 95% CI: 1.03-1.23; p = 0.010) were identified as independent predictors of Metabolic Syndrome (MetS). Metabolic syndrome is common among hospital workers in Rwanda, particularly among women. Higher BMI and older age are key predictors, highlighting the need for targeted workplace interventions to reduce modifiable risk factors and improve metabolic health in this population.

BackgroundHypoglycemia is a common yet underrecognized complication in patients with type 2 diabetes mellitus (T2DM), often linked with increased cardiovascular (CV) morbidity and mortality. Despite its clinical importance, there is a limited data on the association between hypoglycemia, CV events, and mortality among T2DM patients in Rwanda. This study investigated the occurrence of hypoglycemia and its association with CV diseases, morbidity, and mortality in T2DM patients attending two university teaching hospitals in Rwanda.MethodsA retrospective study was conducted using secondary data from 267 T2DM patients attending Kigali University Teaching Hospital (CHUK) and Butare University Teaching Hospital between 2015 and 2020. Socio-demographic and clinical data, including anti-diabetic medications, hypoglycemia episodes, CV events, and comorbidities, were extracted from medical records and analyzed using Python. Binary regression was used to determine significant predictors of hypoglycemia.ResultsHypoglycemia occurred in 112 (41.9%) patients during their hospitalization or hospital admissions. The use of insulin was significantly associated with hypoglycemia (OR = 1.590, CI: 1.100–2.290, p = 0.010). The mean age of patients who experienced hypoglycemia is 54.2 (±12.1) years. Hypoglycemia occurrence was higher in males (59.8%) group compared to females (40.2%) (p = 0.007). Cardiovascular conditions were common (73.8%), with hypertension being the most prevalent (85.4%). Insulin was the most frequently used anti-diabetic therapy (42.3%). A significant association was found between hypoglycemia and subsequent CV complications. Management of hypoglycemia predominantly involved the use of 50% dextrose solution.ConclusionHypoglycemia is a frequent and clinically significant occurrence among T2DM patients in Rwanda, particularly associated with insulin therapy and CV comorbidities. Enhanced clinical monitoring and individualized treatment regimens are essential to mitigate hypoglycemia-related complications and reduce mortality. It is important to conduct a larger studies to support the evidence based findings and address the current methodological constraints.

INTRODUCTION: Despite the high demand for pain relief during labor, access to labor analgesia remains limited in low-resource settings due to different challenges such as shortage of staff, inadequate equipment and supplies, insufficient training, high cost, and lack of local protocols. This project aimed to evaluate the feasibility of implementing a labor analgesia program at a major teaching hospital in Rwanda. METHODS: This was a quality improvement project testing the implementation of the first labor analgesia program at the University Teaching Hospital of Kigali from August 2019 till July 2023. Descriptive statistics in Microsoft Excel (2010) were used for analysis. RESULTS: 153 women underwent labour analgesia during our evaluation period. All women had adequate pain control (100%). Most women underwent epidural 136 (88.9%), followed by combined spinal epidural 13 (8.5%), and single-shot spinal anesthesia 4 (2.6%). Most labour analgesia procedures were conducted by anesthesiologists with residents 98 (64%) or anesthesiologists alone 45 (29.4%). Most women had spontaneous vaginal delivery 102 (67%), however, 51 women had cesarian section (CS) mainly due to non-reassuring fetal heart rate (FHR) 30 (58.9%) and labor arrest 10 (19.6%). Most of them had no maternal or neonatal event 44 (86%). No post-dural puncture headache, infection, or epidural hematoma was recorded. CONCLUSION: The results of this quality improvement project suggest that labour analgesia is feasible in low-resource settings and highlight essential areas for improvement, such as staffing and availability of equipment. This project provides valuable lessons for other anesthesiologists and hospitals in similar settings aiming to establish labor analgesia programs. More investments are needed in order to sustain and expand the labour analgesia program for women in low-resource settings.

Background Inconsistent use of antibiotics can lead to antimicrobial resistance (AMR) and pose a significant public health threat. The purpose of this study was to assess adherence to the national pediatric treatment guideline for antibiotic prescription for pneumonia among healthcare providers at a teaching hospital in Rwanda. Methodology A cross-sectional study was conducted by auditing the clinical records of children aged 2-59 months who were admitted with pneumonia from January 2022 to January 2024. Data on the severity of pneumonia, prescribed medications, and adherence to the treatment protocol were extracted and analyzed. Findings Out of the 308 records analyzed, only 14% were following the national guidelines in staging. While 71% of those correctly staged were prescribed the medications aligned with the guideline, none adhered to the complete regimen (in terms of route, dose, frequency, and duration). Once the medications were ordered, 97% were administered to patients as prescribed. Conclusion The study concluded that adherence to treatment guidelines remains suboptimal, with discrepancies in staging accuracy and treatment regimen implementation. This study highlighted the need for targeted interventions, including improved training, monitoring systems, and antibiotic stewardship programs, to optimize antibiotic prescribing practices, combat AMR, and improve health outcomes in pediatric populations, especially in low-resource settings.

Purpose:Mortality associated with EA/TEF has declined in HICs with advances in multidisciplinary care. However, it remains as high as 80% in LMICs. This study examines the current clinical outcomes of neonates with EA/TEF at a tertiary-level hospital in Rwanda following the implementation of care by fellowship-trained pediatric surgeons.Methods:A retrospective cohort study of neonates with EA/TEF from January 2015 to December 2023. Patient data were collected from medical logbooks for all patients who received surgical treatment at Centre Hospitalier Universitaire de Kigali, Rwanda. Univariable logistic regression was used to identify factors associated with higher 30-day mortality.Results:56 patients were included. All infants were born at term and, on average, arrived 7 days after birth (6.98 ±5.18). Type C was the most common anomaly (68%). Mortality data were only available for 82.1% of patients. Of this subset, the 30-day mortality was 52.2%. Increased odds of mortality were associated with the presence of any congenital anomaly (p <0.05) and specifically a cardiac congenital anomaly (p<0.05).Conclusion:This study provides insights into infants with EA/TEF after implementing specialized surgical care, which has helped reduce mortality compared to other LMICs. Targeted quality improvement initiatives for infants with additional associated congenital anomalies could further improve outcomes.

BackgroundThe burden of advanced cancer is rising in Africa. Cancer care involves complex conversations between providers, patients, and families. International guidelines recommend communication skills training for all cancer care providers, and patient-provider communication and training needs are strongly influenced by culture. As oncology and palliative care capacity expand in African settings such as Rwanda, participatory research is needed to culturally adapt communication skills training to best fit local contexts.MethodsGuided by the Cultural Adaptation Process model, this study aimed to set the stage for adaptation and implementation of serious illness communication skills training in the Rwandan context. We conducted focus group discussions with interdisciplinary cancer care providers at Butaro Hospital in Rwanda to understand their communication training priorities and describe pertinent contextual factors. The focus groups were audio-recorded, transcribed, and analyzed using the framework method of thematic analysis.ResultsA total of 17 cancer care providers participated in one of three focus groups, including six physicians, seven nurses, two psychologists, and two social workers. Participants identified delivering bad news and responding to emotion as the most challenging aspects of clinical communication and the highest priorities for training. They expressed concerns about the psychological toll of difficult conversations on providers, advocating for future trainings to include burnout mitigation strategies. Participants described several key contextual factors that should inform adaptations of communication training for Rwandan cancer care. These include barriers common to low-resource settings as well as several local assets: interdisciplinary collaboration, dedicated clinical psychologists, group counseling sessions, peer support among patients, and strong community networks. Several findings will be directly applied to the design of an initial pilot communication training in Rwanda. Areas requiring further investigation and opportunities to broaden the scope of communication interventions beyond patient-provider encounters were identified.ConclusionsThis study sets the stage for adapted communication skills training in Rwanda that is guided by the priorities and recommendations of local cancer care providers. Several pertinent cultural and structural factors were identified that are common across diverse African settings. Therefore, our training adaptations, as well as the methodology used for adaptation, have the potential for widespread reach.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12904-025-01879-z.

Purpose:ARMs are common congenital disorders, including LMICs, where limited neonatal and surgical care leads to worse outcomes compared to HICs. Recent efforts to improve health systems in LMICs focus on training healthcare workers. This study assesses the clinical care of infants with ARMs at the University Teaching Hospital of Kigali (CHUK), a tertiary-level hospital in Rwanda, provided by pediatric surgeons and other fellowship-trained pediatric specialists.Methods:A retrospective study of patients who presented with ARMs at CHUK, Rwanda, from January 2015 to December 2023. All patients who underwent their definitive anorectoplasty at the CHUK and had retrievable data in operative logbooks were included. Regression analysis was performed to determine predictors of 30-day mortality.Results:62 patients were included. The most common fistula type was a rectovestibular fistula (48%) in females and a rectoperineal fistula (18.9%) in males. 43.5% underwent a three-stage repair. 30-day mortality was 17.9%. Low weight (<3000g) at surgery was significantly associated with 94% higher odds of mortality.Conclusion:Although mortality was higher than that encountered in HICs, it was lower than what has generally been reported in LMICs. This could be attributed to the improved care provided by fellowship-trained pediatric specialists.

Increasing postpartum family planning using an evidence-based approach: the success of a university teaching hospital in Rwanda

Acute non-traumatic abdominal pain presenting to emergency unit of a university teaching hospital in Rwanda.

Many studies address health care provider burnout in high-income countries; however, there is little data on burnout in low-income countries. Our objectives were (1) to estimate the prevalence of burnout among perioperative health care providers and (2) to explore factors associated with burnout among perioperative health care providers in Rwandan public hospitals. A cross-sectional study using a survey was conducted among perioperative health care providers working in 22 public hospitals across Rwanda. We used a purposive sampling method to represent all regions (4 provinces and the capital Kigali) and types of public hospitals in Rwanda conducting surgery, excluding major teaching centers. We used the Maslach Burnout Inventory Human Services Survey (MBI_HSS), a validated 22-item survey including 3 dimensions of burnout: (1) emotional exhaustion (EE), (2) depersonalization (DP), and (3) personal achievement (PA). We estimated the prevalence of burnout using Wilson's method and we identified factors associated with burnout using a multivariate analysis. There were 221 responses from 402 surveys sent with a response rate of 53.7% including nurses 106 (47.9%), general practitioners 36 (16.3%), nonphysician anesthetists 33 (14.9%), midwives 25 (11.3%), and specialist surgeons and anesthesiologists 4 (1.8%). Forty-7 (21.3, 95% CI 16.1-27.3)% participants had burnout, 95 (42.9, 95 CI 36.6-49.6)% had high emotional exhaustion, 57 (25.8, 95 CI 20.5-31.9)% had low personal accomplishment, 15 (6.8, 95 CI 4.2-10.9)% had high depersonalization). Three major burnout profiles were identified among participants, including the overextended group 84 (38%), the engaged group 83 (37.6%), and the ineffective group 39 (17.6%). Among postulated predictors of burnout, only a lack of having the right equipment was strongly associated with burnout (adj-OR, 3.21; 95 CI, 1.18-8.73, P = .02). One in 5 perioperative health care providers in Rwanda report having burnout, which is consistent with previous data. This suggests that burnout is widespread across the Rwandan health care system, across different perioperative professions. The only factor that was associated with burnout was lack of access to essential equipment; however, other factors that have been identified in the literature, which are not statistically significant in this study, should not be overlooked. Addressing equipment shortages may reduce the risk of burnout among perioperative health care providers in low-resource settings, in addition to directly impacting the quality of care.

Children with clefts face a high risk of malnutrition (undernutrition) with a range of serious life-threatening challenges. The objective of this study was to estimate the prevalence of malnutrition in children with clefts in Rwanda. A retrospective cross-sectional study was conducted among children with clefts admitted at a Hospital in Rwanda between 2018 and 2022. Descriptive statistics were conducted, and WHO Z-scores were used to classify nutritional status (stunting, wasting, underweight, and overall malnutrition). Subsequently, chi-square and logistic regression analyses identified factors associated with malnutrition, with statistical significance set at P < 0.05. The prevalence of malnutrition was 54.2%. Children with combined clefts were 61.8% more malnourished. The odds of malnutrition were 1.69 times (AOR: 1.69; 95% CI: 1.14 to 2.48) more among males. Similarly, the prevalence of malnutrition was about three-fold more among children <12 months of age (AOR: 2.81; 95% CI: 1.61 to 4.87) and 2.20 times more among children of divorced parents AOR: 2.20; 95% CI: 1.26 to 3.83), and 2.50 times (AOR: 2.50; 95% CI: 1.31 to 4.78) more among children with combined clefts. Moreover, household income has a significant association with malnutrition (P=0.049). Similarly, children with cleft lips were 1.58 times (AOR: 1.58; 95% CI: 1.06 to 2.36) more likely to be malnourished than those with cleft palate. The burden of malnutrition among children with clefts was high. Early identification and appropriate feeding management are crucial to ensuring no one is left behind in the fight against malnutrition.

End-stage renal disease (ESRD) requires hemodialysis (HD) for management. Various impacts of HD on the quality of life (QoL) of patients have been reported elsewhere, but not in Rwanda. We investigated the lived experiences of patients undergoing HD in Rwanda. This qualitative study used a phenomenological design involving interviews of 11 patients. The study population was patients undergoing dialysis in renal units at the University Teaching Hospital of Kigali (CHUK) and King Faisal Hospital (KFH), Rwanda. Purposive sampling was used to recruit patients above 18 years who could speak without experiencing any mental or auditory disorder. The data were transcribed, coded, and analyzed through the thematic analysis approach using Atlas.ti. Patients' lived experiences included physical challenges arising from discomfort and dietary restrictions; emotional challenges before, during, and after HD; psychosocial challenges encountered with peers, community, and caregivers; and health system-related challenges associated with appointment, lack of access to HD service, and logistics, among others. All the reported experiences affected their QoL during their HD treatment. Rwandan patients undergoing HD experienced various physical, emotional, psychosocial, and health system-related challenges that affect their QoL. Thus, it is important to enhance patients' education on fluid and dietary management, provide comprehensive emotional and psychological support, address logistical barriers to accessing HD services, and support caregivers through counseling and financial assistance.

Abstract Background: Palliative care is designed to offer holistic assistance to individuals living with chronic or life-threatening conditions, with the goal of easing various forms of distress. The perspectives of healthcare professionals are pivotal in shaping and delivering appropriate palliative care, especially in mental health institutions. Objectives: This research sought to explore how healthcare professionals perceive the need for palliative care among patients treated at Ndera Neuropsychiatric Teaching Hospital in Rwanda. Methods: A cross-sectional quantitative study was implemented at Ndera Neuropsychiatric Teaching Hospital, involving 112 healthcare professionals, including doctors, nurses, and other allied personnel. Participants were chosen through a stratified random sampling technique across different professional roles. Data collection was accomplished using a structured, self-completed questionnaire. Statistical analysis was performed using SPSS version 25, with findings summarized through descriptive statistics and presented in tabular format. Results: The study demonstrated a moderate to strong recognition of the necessity for palliative care (mean scores: 2.71–3.28), particularly for patients with dementia, amyotrophic lateral sclerosis, and serious psychiatric illnesses like major depression, bipolar disorder, and anxiety. While healthcare providers displayed moderately favorable attitudes toward integrating palliative care into practice (mean scores: 2.93–3.57), a notable misunderstanding between palliative and hospice care was evident, with 65% to 100% viewing hospice as a place of hopelessness. Moreover, several institutional limitations were identified, such as absent policy frameworks (reported by nearly all respondents), inadequate communication systems, limited material resources, and financial constraints. Statistically significant correlations were found between the perceived need for palliative care and both the age (p = 0.001) and work experience (p = 0.001) of respondents. Conclusions: Findings reflect a widespread acknowledgement of the importance of palliative care within the neuropsychiatric context. However, major obstacles ranging from lack of institutional support and policy guidelines to resource shortages and misconceptions continue to hinder its effective integration. Addressing these barriers is critical to advancing quality palliative care for individuals with complex neuropsychiatric conditions. Keywords: Palliative Care, Health Personnel, Mental Health Services, Hospitals, Psychiatric, Rwanda