Hospital In Rwanda Research Articles

Assessing the waiting time for emergency orthopedic surgery for open fractures – A 6-month review of records at one of the largest referral public hospitals in Rwanda

INTRODUCTION: The delay in surgical intervention for open fractures can have severe negative consequences. However, the delay for patients with open fractures presenting at Centre Hospitalier Universitaire de Kigali (CHUK), one of the largest public hospitals in Kigali, Rwanda, had not been studied. This study assessed the waiting time for surgery and compared it against the 6-hour (ideal time) and 24-hours (acceptable time) standards.METHODS: A review of the postoperative register and patients’ records was conducted. All medical charts of open fracture cases between April and September 2018 were audited. A surgical case was considered significantly delayed if the time interval from patient arrival at the emergency room to the operation theater was longer than 24 hours. The demographics, acuity level, insurance status and work shifts, were assessed using bi- and multivariate analysis.RESULTS: A total of 115 open fracture case files were audited. From arrival at the emergency room to surgery, the median time was 41 hours (IQR 21, 93). Only 3 (2.6%) were operated within 6 hours and 38 (33%) within 6 to 24 hours. The main factor contributing to the delay was obtaining orthopedic consultation note and documenting the decision to operate (median 10 hours, IQR 4 to 17). Meanwhile, the designated emergency theater was not utilized for a total of 18 hours per day, especially during night shifts.CONCLUSION: There was a significant delay in obtaining emergency orthopedic consultation and, thus, the timing of the surgical treatment. Examining the patient flow system in orthopedic surgical care delivery is needed in order to maximize theater utilization at this urban university hospital.

Effect of Delay of Care for Patients with Craniomaxillofacial Trauma in Rwanda.

ObjectivesCraniomaxillofacial (CMF) trauma represents a significant proportion of global surgical disease burden, disproportionally affecting low- and middle-income countries where care is often delayed. We investigated risk factors for delays to care for patients with CMF trauma presenting to the highest-volume trauma hospital in Rwanda and the impact on complication rates.Study DesignThis prospective cohort study comprised all patients with CMF trauma presenting to the University Teaching Hospital of Kigali, Rwanda, between June 1 and October 1, 2020.SettingUrban referral center in resource-limited setting.MethodsEpidemiologic data were collected, and logistic regression analysis was undertaken to explore risk factors for delays in care and complications.ResultsFifty-four patients (94.4% men) met criteria for inclusion. The mean age was 30 years. A majority of patients presented from a rural setting (n = 34, 63%); the most common cause of trauma was motor vehicle accident (n = 18, 33%); and the most common injury was mandibular fracture (n = 28, 35%). An overall 78% of patients had delayed treatment of the fracture after arrival to the hospital, and 81% of these patients experienced a complication (n = 34, P = .03). Delay in treatment was associated with 4-times greater likelihood of complication (odds ratio, 4.25 [95% CI, 1.08-16.70]; P = .038).ConclusionDelay in treatment of CMF traumatic injuries correlates with higher rates of complications. Delays most commonly resulted from a lack of surgeon and/or operating room availability or were related to transfers from rural districts. Expansion of the CMF trauma surgical workforce, increased operative capacity, and coordinated transfer care efforts may improve trauma care.

Performance of the Universal Vital Assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: A retrospective external validation study.

BackgroundWe previously derived a Universal Vital Assessment (UVA) score to better risk-stratify hospitalized patients in sub-Saharan Africa, including those with infection. Here, we aimed to externally validate the performance of the UVA score using previously collected data from patients hospitalized with acute infection in Rwanda.MethodsWe performed a secondary analysis of data collected from adults ≥18 years with acute infection admitted to Gitwe District Hospital in Rwanda from 2016 until 2017. We calculated the UVA score from the time of admission and at 72 hours after admission. We also calculated quick sepsis-related organ failure assessment (qSOFA) and modified early warning scores (MEWS). We calculated amalgamated qSOFA scores by inserting UVA cut-offs into the qSOFA score, and modified UVA scores by removing the HIV criterion. The performance of each score determined by the area under the receiver operator characteristic curve (AUC) was the primary outcome measure.ResultsWe included 573 hospitalized adult patients with acute infection of whom 40 (7%) died in-hospital. The admission AUCs (95% confidence interval [CI]) for the prediction of mortality by the scores were: UVA, 0.77 (0.68–0.85); modified UVA, 0.77 (0.68–0.85); qSOFA, 0.66 (0.56–0.75), amalgamated qSOFA, 0.71 (0.61–0.80); and MEWS, 0.74 (0.64, 0.83). The positive predictive values (95% CI) of the scores at commonly used cut-offs were: UVA >4, 0.35 (0.15–0.59); modified UVA >4, 0.35 (0.15–0.59); qSOFA >1, 0.14 (0.07–0.24); amalgamated qSOFA >1, 0.44 (0.20–0.70); and MEWS >5, 0.14 (0.08–0.22). The 72 hour (N = 236) AUC (95% CI) for the prediction of mortality by UVA was 0.59 (0.43–0.74). The Chi-Square test for linear trend did not identify an association between mortality and delta UVA score at 72 hours (p = 0.82).ConclusionsThe admission UVA score and amalgamated qSOFA score had good predictive ability for mortality in adult patients admitted to hospital with acute infection in Rwanda. The UVA score could be used to assist with triage decisions and clinical interventions, for baseline risk stratification in clinical studies, and in a clinical definition of sepsis in Africa.

The effect of a decision-support mHealth application on maternal and neonatal outcomes in two district hospitals in Rwanda: pre \u2013 post intervention study

BackgroundGlobally, mobile health (mHealth) applications are known for their potential to improve healthcare providers’ access to relevant and reliable health information. Besides, electronic decision support tools, such as the Safe Delivery mHealth Application (SDA), may help to reduce clinical errors and to ensure quality care at the point of service delivery. The current study investigated the use of the SDA and its relationship to basic emergency obstetric and newborn care (BEmONC) outcomes for the most frequent complications in Rwanda; post-partum haemorrhage (PPH) and newborn asphyxia.MethodsThe study adopted a pre–post intervention design. A pre-intervention record review of BEmONC outcomes: Apgar score and PPH progressions, was conducted for 6 months’ period (February 2019 - July 2019). The intervention took place in two district hospitals in Rwanda and entails the implementation of the SDA for 6 months (October 2019- March 2020), and included 54 nurses and midwives using the SDA to manage PPH and neonatal resuscitation. Six months’ post-SDA intervention, the effect of the SDA on BEmONC outcomes was evaluated. The study included 327 participants (114 cases of PPH and 213 cases of neonatal complications). The analysis compared the outcome variables between the baseline and the endline data. Fisher’s exact test was used to compare the proportions and test between-group differences and significance level set at p < 0.05.ResultsUnstable newborn outcomes following neonatal resuscitation were recorded in 62% newborns cases at baseline and 28% newborns cases at endline, P-value = 0.000. Unstable maternal outcomes following PPH management were recorded in 19% maternal cases at baseline and 6% maternal cases at endline, P-value = 0.048. There was a significant association between the SDA intervention and newborns’ and maternal’ outcomes following neonatal resuscitation and PPH management, 6 months after baseline.ConclusionThe use of the SDA supported nurses and midwives in the management of PPH and neonatal resuscitation which may have contributed to improved maternal and neonatal outcomes during 6 months of the SDA intervention. The findings of this study are promising as they contribute to a broader knowledge about the effectiveness of SDA in low and middle income hospital settings.

Comparison of Abdominopelvic CT Diagnoses at Academic Teaching Hospitals in Rwanda and the United States

Purpose: The purpose of this study was to compare the disease processes encountered on abdominal and pelvic CT examinations at academic teaching hospitals in Rwanda and the United States and to highlight how these differences may impact a global radiology collaboration. Materials and Methods: In this retrospective study, we included 130 patients (mean 59 +/-17 years, range 20-91, F:M 74:56) who underwent abdominal/pelvic CT examinations between April 1st-12th, 2019. CT examinations were prospectively encountered in clinical work at the Centre Hospitalier Universitaire de Kigali or University Teaching Hospital of Kigali (CHUK) in Kigali, Rwanda, where the radiology report impression, patient age, gender, study indication, CT protocol, and clinical diagnosis were recorded when available. Abdominal/pelvic CT examinations at the Massachusetts General Hospital (MGH) in Boston, Massachusetts, United States were then retrospectively reviewed for the same information. Patient age and gender were compared using Student’s t-test and Chi-square statistic. Frequency of formal recommendations in radiology reports, available comparison of CT examinations, presence of known diagnoses, and intravenous and oral contrast media use were compared using Fisher’s exact test. Diagnostic categories were qualitatively compared. Results: A wide variety of pathology was encountered by abdominal/pelvic CT at both sites of imaging, with qualitative differences observed in cancer types, infectious agents, and how imaging guides care. Patients in Rwanda were older (p=0.0017), more likely to receive intravenous (p &lt; 0.05) and positive oral contrast (p &lt; 0.05) media and less likely to receive a formal recommendation in their radiology report (p &lt; 0.05). Patients in the United States were more likely to have an available prior abdominal/pelvic CT (p &lt; 0.05), to present for follow-up of a known diagnosis (p &lt; 0.05), and to receive a formal recommendation in their radiology report (p &lt; 0.05). Conclusion: Participation in global radiology collaborations is beneficial for radiologists by broadening exposure to pathologies and practice different from their own institution and region.

Context specific realities and experiences of nurses and midwives in basic emergency obstetric and newborn care services in two district hospitals in Rwanda: a qualitative study

BackgroundIn low and middle-income countries, nurses and midwives are the frontline healthcare workers in obstetric care. Insights into experiences of these healthcare workers in managing obstetric emergencies are critical for improving the quality of care. This article presents such insights, from the nurses and midwives working in Rwandan district hospitals, who reflected on their experiences of managing the most common birth-related complications; postpartum hemorrhage (PPH) and newborn asphyxia. Rwanda has made remarkable progress in obstetric care. However, challenges remain in the provision of high-quality basic emergency obstetric and newborn care (BEmONC). This study is a qualitative part of a broader research project about implementation of an mLearning and mHealth decision support tool in BEmONC services in Rwanda.MethodsIn this exploratory qualitative aspect of the research, four focus group discussions (FGDs) with 26 nurses and midwives from two district hospitals in Rwanda were conducted. Each FGD was made up of two parts. The first part focused on the participants’ reflections on the research results (from the previous study), while the second part explored their experiences of delivering obstetric care services. The research results included: survey results reflecting their knowledge and skills of PPH management and of neonatal resuscitation (NR); and findings from a six-month record review of PPH management and NR outcomes, from the district hospitals under study. Data were analyzed using hybrid thematic analysis.ResultsThe analysis revealed three main themes: (1) reflections to the baseline research results, (2) self-reflection on the current practices, and (3) contextual factors influencing the delivery of BEmONC services. Nurses and midwives felt that the presented findings were a true reflection of the reality and offered diverse explanations for the results. The participants’ narratives of lived experiences of providing BEmONC services are also presented.ConclusionThe insights of nurses and midwives regarding the management of birth-related complications revealed multi-faceted factors that influence the quality of their obstetric care. Even though the study was focused on PPH management and NR, the resulting recommendations to improve quality of care could benefit the broader field of maternal and child health, particularly in low and middle-income countries.

Workplace violence experience among nurses at a selected university teaching hospital in Rwanda.

Introductionworkplace violence is a global problem in the health sector, especially in the hospitals affecting healthcare works´ job satisfaction and performance. Workplace violence (WPV) is present in different forms associated with various factors and the nurses are the most affected. This study aimed to explore WPV among nurses working at a selected University Teaching Hospital in Rwanda.Methodsthe research approach used was the quantitative descriptive cross-sectional design. The stratified random sampling was used to recruit 195 participants among 379 nurses. The data were collected using a structured, validated, and self-administered questionnaire that was adapted from the International Labor Organization, International Council of nurses, the World Health Organization, and Public Services International. Descriptive statistics were used for analyzing frequencies and percentages. The Chi-square test was used for evaluating the association between variables.Resultsthe findings revealed that (58.5%, n=114) of nurses have experienced some types of WPV in the twelve months preceding the study, among them (44.6%, n=108) of nurses were verbally abused. The nurses providing emergency care, the nurses working in the emergency department, and nurses working with vulnerable patients like HIV/AIDS patients were associated with WPV Chi-square (1, n=195), P=<0.001). The psychological problems have been found to be the first consequences of WPV.Conclusionbased on the study findings, it was concluded that the hospital management needs to be aware of WPV, develop and implement appropriate policies and strategies. These will strengthen nurses´ concentration towards them and will result in service delivery improvement.

Upper Gastrointestinal Cancers in Rwanda: Epidemiological, Clinical and Histopathological Features in Patients Presenting to a Tertiary Referral Hospital

Background: Scant data on upper gastrointestinal cancers in Rwanda exist to guide potential prevention efforts. We evaluated the epidemiological, clinical and histopathological data among patients with gastric and esophageal tumors at a tertiary Referral Hospital in Rwanda. Methodology: We performed a retrospective review of histologically-confirmed esophageal and gastric cancers in adults age ≥ 18 yrs. old presenting to a university teaching hospital (Centre Hospitalier Universitaire de Butare) from 2014-2019. Variables included age at diagnosis, sex, clinical presentation, tumor location and histopathological type. Results: There were 149 upper gastrointestinal cancers, of which 137 (92%) were gastric and 12 (8%) were esophageal. Gastric cancer patients had a mean age at presentation of 56.9 ± 12.3 years (range 21 - 87). Presenting symptoms were epigastric pain (78.8%), weight loss (53.3%), post-prandial vomiting (52.6%), early satiety (29.9%), epigastric mass (24.8%), hematemesis (19.7%) and melena (16.8%). The location was antrum 50.3%, corpus 21.8%, fundus 8%, and cardia 8%. Tumor type was adenocarcinoma in 94.1%. Helicobacter pylori infection was present in 108 (78.8%). Esophageal cancer patients had a mean age of 54.4 ± 9.5 years (range 35 - 72). Presenting symptoms were dysphagia (100%) and weight loss (83%). The most common site was lower third esophagus (9/12), and adenocarcinoma cancer subtype accounted for 5/12 (41.6%) cases. Conclusion: Gastric adenocarcinoma was the most commonly diagnosed upper gastrointestinal cancers and was associated with a high prevalence of H. pylori infection. This study lays the foundation for future work to improve cancer outcomes in Rwanda.

Knowledge and Skills on Triage among Nurses Working in Emergency Departments in Referral Hospitals in Rwanda

BackgroundUnpredictable numbers of patients attending emergency departments highlight the need for Triage. Triage which is the prioritization of patient care based on severity of illness or injury, prognosis, and availability of resources is effective when clinicians are knowledgeable and skilled to perform it.ObjectiveTo assess knowledge and skills on triage among nurses working in emergency departments of Rwandan referral hospitals.MethodsCross-sectional analytical design was adopted. ninety-six (96) nurses working in emergency departments were selected using proportionate stratified sampling method. Each hospital was considered as a stratum. A self-administered questionnaire and observation checklist were use as instruments. Inferential and descriptive statistics were used in analysis.ResultsThe majority of participants (63.6%) demonstrated low level of triage knowledge and almost a half (47.9%) of participants had low level of triage skills. Nurses experience in emergency department, level of education and triage training were not found to significantly influence triage knowledge and skills positively (P&gt;0.05).ConclusionDeficit in triage knowledge and skills were revealed among nurses working in emergency departments in Rwanda. Accredited continuous educational training on triage should be regularly provided to enhance knowledge and skills of emergency department nurses on Triage.Rwanda J Med Health Sci 2021;4(3):398-405

Incidence and Reasons for a Surgical Cancellation at a Hospital in Rwanda

BackgroundSurgery cancellation is a challenging and costly event resulting in operating theatre inefficiency and psychological and financial problems for the patients and their families. This study aimed to find out the incidence and reasons for surgical cancellation at a Rwandan hospital.MethodsA retrospective study was conducted on 736 patients’ files obtained from theatre registry lists of surgical operations done from January to March 2017. The American Association of Perioperative Nurses (AORN) checklist for documenting cancelled surgical cases was used to establish the rate and reasons for cancellation. Data were analyzed using frequency and percentage descriptive statistics.ResultsOut of the 736 surgeries booked, 179 (24.3%) were cancelled as follows: Orthopedic and general surgeries (28.2%) respectively, gynecology and obstetrics (27.4%), urology surgeries (15.5%), maxillofacial surgeries (15.9%), ENT (15.6%) and plastic surgeries (13.3%). Time constrain/long list (19.6%), acute change in medical status (10.6%), non-turn-up of the patient (8.4%), and abnormal lab findings (7.8%) were the most prevalent reasons.ConclusionThe surgical cancellation rate at the study hospital was 24%, increasing with the number of patients booked and the type of surgical procedure. A prospective study is required to gain more insight into the reason for cancellations, mostly amenable to mitigation measures.Rwanda J Med Health Sci 2021;4(3):379-386

Medication interruptions and associated factors among nurses working in pediatric unit at a selected referral hospital in Rwanda

Introduction: Interruptions have been proven to cause medication administration errors in pediatric settings. Therefore, this study assessed the medication interruptions and associated factors among nurses in a pediatric unit at a selected referral hospital in Rwanda.&#x0D; Methods: A descriptive observational study was conducted among 59 nurses using a developed observational checklist. Data were entered into SPSS, version 26. Descriptive and inferential statistics were used to analyze the data. The IRB of the University of Rwanda approved the study.&#x0D; Results: Among the 414 medication administrations observed, 149 (36%) had interruptions. The main source of interruption was technical problem (14.5%) with interruption from direct care (12%) as the main reason. The factors associated with interruption occurrence were shift of the day, time of medication round, duration and phase of medication administration and nurse perception (p = 0.001), age (p=0.046), educational level (p = 0.044) and professional experience (p = 0.031).&#x0D; Conclusion: The existence of medication interruptions is evident with associated factors predominantly being demographics and technical. Therefore, the authors recommended that an in-service training program for nurses regarding medication administration errors. The hospital leadership should address the technical problems including availing the required materials for medication administration.&#x0D; &#x0D; French title: Interruptions médicamenteuses et facteurs associés chez les infirmières travaillant dans l'unité pédiatrique d'un hôpital de référence sélectionné au Rwanda&#x0D; Introduction : Il a été prouvé que les interruptions provoquent des erreurs d'administration de médicaments en milieu pédiatrique. Par conséquent, cette étude a évalué les interruptions de médication et les facteurs associés chez les infirmières d'une unité de pédiatrie d'un hôpital de référence sélectionné au Rwanda.&#x0D; Méthode de l'étude : Une étude observationnelle descriptive a été menée auprès de 59 infirmières à l'aide d'une liste de contrôle d'observation élaborée. Les données ont été saisies dans SPSS, 26. Des statistiques descriptives et inférentielles ont été utilisées pour analyser les données. L'IRB de l'Université du Rwanda a approuvé l'étude.&#x0D; Résultats de l'étude : Parmi les 414 administrations de médicaments observées, 149 (36 %) ont subi des interruptions. La principale source d'interruption était un problème technique (14,5 %) avec l'interruption des soins directs (12 %) comme principale raison. Les facteurs associés à l'occurrence d'interruption étaient décalage de la journée, heure de la tournée de médicaments, durée et phase d'administration des médicaments et perception de l'infirmière (p = 0,001), âge (p=0,046), niveau d'éducation (p = 0,044) et expérience professionnelle (p = 0,031).&#x0D; Conclusion : L'existence d'interruptions de médication est évidente avec des facteurs associés principalement démographiques et techniques. Par conséquent, les auteurs recommandent un programme de formation continue pour les infirmières concernant les erreurs d'administration de médicaments. La direction de l'hôpital devrait résoudre les problèmes techniques, notamment en mettant à disposition les matériaux requis pour l'administration des médicaments.

Diabetic Complications and Associated Factors: A 5-Year Facility-Based Retrospective Study at a Tertiary Hospital in Rwanda.

IntroductionDiabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin production, insulin action, or both. Despite advances in DM diagnosis and management, the incidence of DM-related complications remains high. This study aimed to determine patterns of common complications and associated factors among hospitalized patients in Rwanda.MethodsA cross-sectional study, with retrospective chart review, was conducted at CHUK from July to August, 2021. Charts for DM patients admitted from January 2016 to December 2020 were considered while those inaccessible at the time of data collection were excluded. Linear regression model was used to assess the relationship between dependent and independent variables with a p < 0.05 considered statistically significant.ResultsA total of 246 charts were reviewed. The median age was 56 years (IQR: 14–90). More than half of participants (n = 135; 54.9%) were females; majority from the Central region (n = 138; 56.7%). Recorded DM risk factors included alcohol intake (n = 81; 48.5%); smoking (n = 40; 24.2%), obesity (n = 43; 52.4%), and family history of DM (n = 27; 56.3%). Majority (n = 153; 84.5%) had type 2 DM and (n = 147; 69%) had known their diagnosis for at least 6 years. Hypertension (n = 124, 50.4%), acute hyperglycemic state (n = 59, 24%), nephropathy (n = 58, 23.6%), and stroke (n = 38, 15.4%) were frequently reported complications. Nearly all participants (n = 81, 95.2%) with complications had poor glycemic control. Alcohol intake, age ≥45 years, and T1DM were associated with higher odds of DM complications (aOR = 8, 95% CI = 2–32.6, p = 0.003, aOR = 6.2, 95% CI = 1.4–27.6, p = 0.016 and aOR = 14.1, 95% CI = 1.2–161.5, p = 0.034, respectively). Duration of DM (p = 0.001) was significant at bivariate analysis.ConclusionDM complications were prevalent among the studied population with poor glycemic control mainly influenced by alcohol consumption and duration of DM. Expansion of integrated DM and hypertension screening services to lower-level centers is needed to reduce the associated morbidity and mortality.

Occurrence of Helicobacter Pylori in Specimens of Chronic Gastritis and Gastric Adenocarcinoma Patients: A Retrospective Study at University Teaching Hospital, Kigali, Rwanda.

Introduction:Helicobacter pylori (H. pylori) infection is the major cause of gastroduodenal diseases in populations of different ages. We conducted aretrospective studyusing archived tissue samples to determine the prevalence of H. pylori infection among patients diagnosed with gastritis and gastric adenocarcinoma by histopathology cases in one hospital in Rwanda.Materials and methods:Cases of chronic gastritis and gastric adenocarcinoma histologically diagnosed in a tertiary hospital in Rwanda over the period of 2016-2018 were studied for the presence of H. pylori using immunohistochemistry. Diagnosis of positive cases considered immunoreactivity as well as bacterial morphology, including spiral, rod-shaped, angulated and coccoid forms.Results:Three hundred and seven cases were included in this study; chronic gastritis and gastric adenocarcinoma representing 39% and 61%, respectively. The overall frequency of H. pylori infection was 77.5% (80% among chronic gastritis cases versus 76% among gastric adenocarcinoma cases). Prevalence of H. pylori infection in chronic gastritis and adenocarcinoma did not significantly associate with age and sex.Conclusion:The prevalence of H. pylori was high among chronic gastritis and gastric adenocarcinoma cases in Rwanda. Pathologists should investigate the presence of H. pylori in gastric biopsies. Our data shows immunohistochemistry method is feasible and adequate to facilitate detection of H. pylori, which may guide timely treatment.

Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda - a validation and inter-rater reliability study.

There is a substantial burden of respiratory disease in infants in the sub-Saharan Africa region. Many health care providers (HCPs) that initially receive infants with respiratory distress may not be adequately skilled to differentiate between mild, moderate and severe respiratory symptoms, which may contribute to poor management and outcome. Therefore, respiratory severity scores have the potential to contributing to address this gap. to field-test the use of two existing standardized bronchiolitis severity scores (LIBSS and ReSViNET) in a population of Rwandan infants (1-12 months) presenting with respiratory illnesses to urban, tertiary, pediatric hospitals and to assess the severity of respiratory distress in these infants and the treatments used. A cross-sectional, validation study, was conducted in four tertiary hospitals in Rwanda. Infants presenting with difficulty in breathing were included. The LIBSS and ReSViNET scores were independently employed by nurses and residents to assess the severity of disease in each infant. 100 infants were recruited with a mean age of seven months. Infants presented with pneumonia (n = 51), bronchiolitis (n = 36) and other infectious respiratory illnesses (n = 13). Thirty-three infants had severe disease and survival was 94% using nurse applied LIBSS. Regarding inter-rater reliability, the intra-class correlation coefficient (ICC) for LIBSS and ReSViNET between nurses and residents was 0.985 (95% CI: 0.98-0.99) and 0.980 (0.97-0.99). The convergent validity (Pearson's correlation) between LIBSS and ReSViNET for nurses and residents was R = 0.836 (p<0.001) and R = 0.815 (p<0.001). The area under the Receiver Operator Curve (aROC) for admission to PICU or HDU was 0.956 (CI: 0.92-0.99, p<0.001) and 0.880 (CI: 0.80-0.96, p<0.001) for nurse completed LIBSS and ReSViNET respectively. LIBSS and ReSViNET were designed for infants with bronchiolitis in resource-rich settings. Both LIBSS and ReSViNET demonstrated good reliability and validity results, in this cohort of patients presenting to tertiary level hospitals. This early data demonstrate that these two scores have the potential to be used in conjunction with clinical reasoning to identify infants at increased risk of clinical deterioration and allow timely admission, treatment escalation and therefore support resource allocation in Rwanda.

Comparison of Outcomes of Emergency Laparotomies Performed During Daytime Versus Nights and Weekends in Rwandan University Teaching Hospitals.

Emergency laparotomy is a common procedure with high morbidity and mortality. The aim of this study was to assess if the time of surgery (day versus night and weekend) affects the morbidity and mortality in a low-resource setting. A retrospective study was conducted in 2 university teaching hospitals in Rwanda. Patient characteristics, time of laparotomy, operative details and postoperative outcomes were recorded. Chi-square and Wilcoxon rank sum tests were used to determine factors and outcomes associated with time of surgery. Logistic regression was used to determine factors associated with mortality. In 309 patients, who underwent emergency laparotomy, 147 (48%) patients were operated during the daytime, 123 (40%) patients were operated during the night shift and 39 (12%) patients were operated on the weekend. Common diagnoses were intestinal obstruction (n = 141, 46%), peritonitis (n = 101, 33%) and abdominal trauma (n = 40, 13%). The overall mortality rate was 16% with 14% in patients operated during day and 17% in patients operated during night and weekends (p = 0.564). Overall, the morbidity rate was 30% with 27% in patients operated during the day compared with 32% in patients operated during night/weekends (p = 0.348). After controlling for confounding factors, there was no association between time of operation and mortality or morbidity. Morbidity and mortality associated with emergency laparotomy are high but the time of day for emergency laparotomy did not affect outcome in Rwandan referral hospitals.

Focused Cardiac Ultrasound Findings in Children Presenting With Shock to a Tertiary Care Hospital in Rwanda.

Shock remains a leading proximate cause of death in children. Children in sub-Saharan African (SSA) countries present with shock from a wide range of pathologies. Routine physiologic parameters may not reflect underlying physiology. No previous work has systematically described ultrasound findings in children with shock in an SSA country. We set out to perform focused cardiac ultrasound (FOCUS) on children with shock in Rwanda and describe the findings in this pilot study. In a prospective descriptive study, we trained pediatric residents to perform FOCUS on children presenting with shock to an urban tertiary care pediatric emergency department in Kigali, Rwanda. Images were transmitted via cellphone network and reviewed by experts. Primary outcome was expert's description of the FOCUS findings. Secondary outcomes included mortality at 48-hour, change in assessment and treatment after FOCUS, and agreement of FOCUS findings between residents and experts. Between January 2020 and April 2020, 25 subjects were enrolled by 8 residents. Eleven of 25 (44%) were newly diagnosed with acquired or congenital heart disease. The 48-hour mortality rate was higher in this group compared with those without heart disease (8 of 11 vs 1 of 14). The resident reported changing assessment and treatment based on FOCUS findings in 60% of patients (15 of 25). There was good to excellent agreements between residents and FOCUS experts on left ventricle function, pericardial effusion, and intravascular volume. In children presenting with signs and symptoms of shock in SSA, one could perform a screening FOCUS to distinguish between hypovolemic and cardiogenic shock.

Epidemiology of Patients with Head Injury at a Tertiary Hospital in Rwanda.

IntroductionTraumatic injuries disproportionately affect populations in low and middle-income countries (LMIC) where head injuries predominate. The Rwandan Ministry of Health (MOH) has dramatically improved access to emergency services by rebuilding its health infrastructure. The MOH has strengthened the nation’s acute emergency response by renovating emergency departments (ED), developing the field of emergency medicine as a specialty, and establishing a prehospital care service: Service d’Aide Medicale Urgente (SAMU). Despite the prevalence of traumatic injury in LMIC and the evolving emergency service in Rwanda, data regarding head trauma epidemiology is lacking.MethodsWe conducted this retrospective cohort study at the University Teaching Hospital of Kigali (UTH-K) and used a linked prehospital database to investigate the demographics, mechanism, and degree of acute medical interventions amongst prehospital patients with head injury.ResultsOf the 2,426 patients transported by SAMU during the study period, 1,669 were found to have traumatic injuries. Data from 945 prehospital patients were accrued, with 534 (56.5%) of these patients diagnosed with a head injury. The median age was 30 years, with most patients being male (80.3%). Motor vehicle collisions accounted for almost 78% of all head injuries. One in six head injuries were due to a pedestrian struck by a vehicle. Emergency department interventions included intubations (6.7%), intravenous fluids (2.4%), and oxygen administration (4.9%). Alcohol use was not evaluated or could not be confirmed in 81.3% of head injury cases. The median length of stay (LOS) in the ED was two days (interquartile range: 1,3). A total of 184 patients were admitted, with 13% requiring craniotomies; their median in-hospital care duration was 13 days.ConclusionIn this cohort of Rwandan trauma patients, head injury was most prevalent amongst males and pedestrians. Alcohol use was not evaluated in the majority of patients. These traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of head injury, may be beneficial in the Rwandan setting.

Causes of Maternal Mortality in Rwanda, 2017-2019.

To assess the causes of maternal mortality at a referral hospital in Rwanda. A secondary data analysis of 217 women with recorded maternal mortality from 2017 to 2019 was conducted among 11,308 total maternal admissions. Demographics, diagnosis, management, referring hospital source, and outcomes were recorded. The mean (±SD) age of maternal death was 30.7±7.2 years (range 16-57 years). The overall maternal mortality rate was 1.99%, with yearly rates of 2.45%, 2.53%, and 1.84% in 2017, 2018, and 2019, respectively. A significant seasonal variation was noted. Sepsis was the most common cause of maternal death (50%), followed by hemorrhage (19%) and hypertensive disorders (15%). Causes of maternal deaths included preeclampsia (13%) and abortion (8%). Furthermore, 82% of all the deaths were referrals from smaller community hospitals. Maternal death due to sepsis remain a major cause of maternal deaths in Rwanda. Infection prevention and the early diagnosis and management of sepsis must be a priority in reducing maternal mortality.

Impact of structured basic life-support course on nurses' cardiopulmonary resuscitation knowledge and skills: Experience of a paediatric department in low-resource country.

IntroductionThe study aimed to assess the impact of a modified paediatric basic life support (BLS) training on paediatric nurses' knowledge and skills in the main tertiary level public hospital in Rwanda.MethodsA prospective, before-and-after educational intervention study was performed. Nurses working in the paediatric department at Centre Hospitalier Universitaire de Kigali (CHUK) were enrolled after consenting to the study. A modified BLS training was administered using didactic lectures, videos, case discussions, and simulations. Knowledge and skills were assessed before, immediately and six months after the training, using the American Heart Association (AHA) multiple-choice questions test and simulation scenarios. Ethical approval from the hospital's investigational review board was obtained before the start of the study.ResultsFifty-seven nurses working in paediatric department were included in the study, most with advanced nursing degrees. At baseline, only 3.5% scored above 80% on the knowledge test and none were able to perform high-quality one-rescuer CPR. Knowledge and high-quality one-rescuer CPR skills improved significantly immediately after the training, with 63.2% scoring above 80% and 63.2% capable of performing high-quality one-rescuer CPR (p < 0.01). Six months later, only 45.6% scored above 80% and 15.8% were capable of performing high-quality one-rescuer CPR (p < 0.01). Some skills, such as delivering breaths using bag-mask device, showed better retention.ConclusionIn the paediatric department of the main public tertiary care hospital in Rwanda, nurses' baseline knowledge and skills in providing BLS was poor but can increase with focused BLS training. Due to the decline in knowledge and skills over six months, the use of debriefing and focused trainings following resuscitation events and improved implementation of yearly departmental refresher courses are recommended.

Vitamin D Levels in Mother-Baby Pairs: A Cross-Sectional Prospective Study in a Rwandan Tertiary Hospital.

Exposure to the sunlight contributes largely to the production of vitamin D. However, vitamin D deficiency is a reality in tropical countries, despite enjoying enough sunlight, especially bearing women in their last trimester whose foetuses exclusively depend on their reserves. This work aimed at demonstrating the state of vitamin D in mother-baby pairs and associated factors in one of the University Hospitals in Rwanda. This cross-sectional prospective study was performed on mother-baby pairs at Kigali University Hospital. Mother's serum 25-hydroxyvitamin D levels were considered as outcomes compared with demographic, clinical and biological markers. Correlation analysis was conducted in order to assess the association between serum 25-hydroxyvitamin D levels for the couple mothers-babies. Approximately 38% of women and 65% of neonates had deficiency in 25-hydroxyvitamin D (<20 ng/ml). The use of a vitamin D rich diet within 24 h recall (p < 0.01) or 1 week recall (p < 0.001) before delivery was associated with appropriate vitamin D levels in mothers. Interestingly, a strong positive correlation was found between maternal and neonatal serum 25-hydroxyvitamin D levels (r = 0.760). There was a high rate of vitamin D deficiency in mothers and their babies. Babies born from women with deficiency were likely to develop low levels of vitamin D. This stresses on the need to strengthen the interventions for preventing vitamin D deficiency in the couple mothers-babies such as supplement in vitamin D before and after delivery, improving the quality of meals and regular contact with sunlight.