Population In Rwanda Research Articles

HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross-sectional study.

IntroductionGiven intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali.MethodsMSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade.ResultsA total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection.Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed.ConclusionsThese data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.

Neonatal Outcomes from Mothers with Hypertension Disorders of Pregnancy: A Retrospective Study at a Referral Hospital in Rwanda

Background&#x0D; Globally, maternal hypertensive disorders in pregnancy significantly increase both maternal and perinatal morbidity and mortality. Maternal hypertension affects 14 percent of pregnancies. Eearly detection and management are critical for improving the health outcomes of both mother and neonate.&#x0D; Objective&#x0D; To assess the association between maternal hypertension disorders in pregnancy and immediate neonatal outcomes at a University Teaching Hospital in Rwanda.&#x0D; Methods&#x0D; A retrospective study of maternal files with hypertension disorders was conducted from January 1, 2016, to March 31, 2019. A census sample of 114 records and pretested checklist was used to collect data. Descriptive statistics were used to analyze associations between maternal factors and immediate neonatal outcomes.&#x0D; Results&#x0D; Neonatal outcomes included low birth weight (75.4%), prematurity (59.6%), admission to neonatal intensive care unit (50.4%), intrauterine growth restriction (32.4%), and neonatal death (22.8%). Nearly two-thirds (62%) of mothers had preeclampsia. Significant associations with immediate neonatal outcomes included gestational age, medical history, delivery mode, maternal referral status, preterm birth, prematurity, and abortion.&#x0D; Conclusion&#x0D; Maternal hypertensive disorders were significantly associated with adverse neonatal outcomes in our study population in Rwanda. Improving early detection, health education, and management of hypertensive disorders in pregnancy is critical to reduce maternal and neonatal morbidity and mortality.&#x0D; Rwanda J Med Health Sci 2020;3(2):193-203

Prevalence and sociodemographic determinants of dyspepsia in the general population of Rwanda

IntroductionDyspepsia accounts for a significant burden of worldwide disease, but there is a relative paucity of data from the sub-Saharan African setting. We undertook to describe the burden, risk factors...

HIV self-testing in Rwanda: awareness and acceptability among male clinic attendees in Kigali, Rwanda: A cross-sectional survey

BackgroundThe Rwandan Ministry of Health recently (in February 2017) recommended the use of HIV self-testing (HIVST) as an additional strategy for hard-to-reach populations such as men. However, the level of awareness and acceptability of this testing strategy among this population in Rwanda is not known. The main objective of this study is to assess the level of awareness and acceptability of HIVST among male clinic attendees in Kigali, Rwanda. MethodsA cross-sectional survey was employed to systematically sample and interview 579 male health-facility attendees over a seven-week period. We employed a pretested interviewer questionnaire to collect data. The chi-square test was used to determine associations between explanatory variables. Univariate binary logistic regression analysis was carried out to obtain preliminary insight into the unconditional association of each independent variable and dependent variables (awareness and acceptability). Multiple logistic regression was employed to determine explanatory variables associated with awareness or acceptability status while adjusting for other study variables. All statistical analyses were performed using Stata version 11.2. ResultsOf the 579 men interviewed, only 21% were aware of HIVST, while 74% found it acceptable. Logistic regression analysis identified the following as factors significantly (p < 0.05) associated with HIVST awareness: having paid or received money for sex in the past month, health-seeking behavior, HIVST knowledge, HIVST attitude, and HIV risk perception. Factors associated with HIVST acceptability include the following: health-seeking behavior, HIVST knowledge, HIVST attitude, and condom use after taking drugs and alcohol. ConclusionThe findings reveal low awareness and high acceptability of HIVST among men in Rwanda. Our findings accentuate the need to promote awareness of HIVST as an important intervention for improving the uptake of HIV testing among men, a traditionally hard-to-reach population in Rwanda.

Determinants of the persistence of malaria in Rwanda

BackgroundMalaria has a considerable impact on the health of the populations of developing countries; indeed, the entire population of Rwanda is at risk of contracting the disease. Although various interventions to control malaria have been implemented in Rwanda, the incidence of malaria has increased since 2012. There is an interest in understanding factors driving its persistence in Rwanda. This study aims at evaluating the effect of socio-economic and environmental factors, seasonality and the use of insecticide-treated mosquito nets (ITNs) on malaria persistence in Rwanda.MethodsThis study analysed data from the 2014–2015 Rwanda Demographic and Health Survey of 11,202 household’s members composed of children under the age of 5 and women aged between 15 and 49. Bivariate analysis was performed between the outcome and each covariate including wealth, altitude, education level, place of residence, and use of ITNs generating percentages. Chi square test was performed to compare malaria negatives and positives on each covariate. Significant variables were subjected to logistic regression analysis to evaluate factors that are significantly associated with malaria at P < 0.05. The analysis was performed in R x64 3.6 and QGIS3.6 was used to map geographical distribution of malaria cases.ResultsThe lowest wealth category was associated with the incidence of malaria [AOR] = 1.54, 95% CI (1.78–2.03). Having a place of residence < 1700 m above sea level (asl) and non-use of ITNs were significantly associated with the incidence of malaria (adjusted odds ratio [AOR] = 2.93, 95% confidence interval [95% CI] 1.94–4.42 and [AOR] = 1.29, 95% C.I (1.03–1.60), respectively). Season and type of residence were not significantly associated with malaria prevalence while women had lower risk of contracting malaria than children.ConclusionIncreased malaria prevalence was associated with lower income, non-compliance with bed-net usage and living below 1700 m of altitude. In addition to current malaria control strategies, potential interventions in individuals with lower income and areas at low altitudes should be taken into consideration when formulating malaria-control strategies, Also use of ITNs to control the spread of malaria should be emphasized.

Key technology development needs and applicability analysis of renewable energy hybrid technologies in off-grid areas for the Rwanda power sector

Until recently, the Rwanda power sector increased rapidly to double the 2010 installed capacity. The energy consumption in Rwanda experienced a steady rise correspondingly with the population and modern socio-economic life. Consequently, Rwanda household access to electricity increased to 53% by September 2019. Not only does 47% of Rwanda's population lack electricity access, there are persistent power failures and the grid is also unstable. Using renewable energy hybrid technologies in off-grid areas might be a solution to this problem. However, the high cost of renewable energy hybrid systems has led to its slow adoption in many developing countries. Hence, it is important to find the most appropriate hybrid combinations that reduce energy cost and access electricity generation that maximizes the available renewable energy resources. This paper examines some new technology development needs related to the power sector in Rwanda. Secondly, four different 100% renewable energy hybrid systems were designed and simulated to support rural and remote areas considering an average load demand of 158.1 kWh/day with a peak load of 18 kW. The hybrid systems simulation and optimization were obtained using HOMER (hybrid optimization model for electric renewables) software. The input data were obtained from National Aeronautics and Space Administration (NASA) for solar and wind resources, and hydro resources were from real-time field data for selected study site. The simulation results indicate hydro/solar/battery hybrid is the most cost-effective and environmentally viable alternative for off-grid rural electrification because of low net present cost (NPC) and least greenhouse gas emissions. The proposed hybrid combination could apply to other rural areas in the region and elsewhere in the world especially where climate conditions are similar.

Dietary Practices and Metabolic Syndrome in the Young Adult Population of Rwanda

Dietary Practices and Metabolic Syndrome in the Young Adult Population of Rwanda

Prevalence of hepatitis B surface antigen (HBsAg) positivity and its associated factors in Rwanda

BackgroundThe epidemiology of hepatitis B virus (HBV) infection in the general population in Rwanda is not well known. This study examined the prevalence of HBV surface antigen (HBsAg) positivity and associated risk factors among people aged 25 years and over in an organized national screening campaign.MethodsThis is a cross-sectional study using data from a nationwide HBV screening campaign organized by the Rwanda Biomedical Centre from March to October 2018. This campaign targeted individuals aged > 25 years old from 24 of 30 districts of Rwanda. Sensitization was done through multimedia announcements, community health workers and local church leaders. During the campaign, a structured interview was administered by trained healthcare workers to collect information on socio-demographic, clinical and behavioral characteristics of participants; HBV screening was performed with HBsAg using enzyme-linked immunosorbent assays (ELISA) testing. Bivariate and multivariate logistic regressions were used to assess factors associated with HBsAg positivity in the screened participants.ResultsA total of 327,360 individuals were screened during the campaign. Overall 12,865(3.9%) were HBsAg positive. The highest prevalence (4.2%) was found in the 35–44-year-old group, but the difference from other groups was not significant (Odds Ratio [OR = 1.057, 95% Confidence Interval(CI) (0.904–1.235)]. Being male [OR = 1.348, 95% CI (1.30,1.40)]; being single [OR = 1.092, 95% CI (1.10–1.16)] compared to married; a previous positive TB screening test [OR = 2.352, 95% CI (1.63–3.39)]; history of surgical operation [OR = 1.082, 95% CI (1.00,1.17)]; exposure to traditional operational practices and scarification [OR = 1.187, 95% CI (1.13, 1.24)]; and having a person in the family with viral hepatitis [OR = 1.367, 95% CI (1.21, 1.53)] were significantly associated with HBV infection.ConclusionsThese data provide the first national estimate of the prevalence of HBsAg seropositivity and its associated factors in Rwanda. The study identified people with the highest risk of HBV infection who should be the priority of future prevention efforts in Rwanda and in similar settings.

REVIEW ON WATER RESOURCES MANAGEMENT AND KEY THREATS IN RWANDA, EAST AFRICA

Water is important for human health, industry, agriculture and ensuring the integrity and sustainability of the ecosystem. The water resources are the top affected by climate variability and population growth. The current population of Rwanda is about 12 million heading to about 25 million in 2050 under the changing climate, where since 1970 temperature rose by 1.4°C and is predicted that in 2050 to be about 2.5°C with severe effects on water resources in Rwanda. Thereby, this study reviewed the status and causes of water quality problems and suggested appropriate options to undertake for sustainable water resources access, employ and management in Rwanda. It was noticed that among others, the key threats to water quality in Rwanda, include not limited to climate change causing rainfall patterns which generated flooding, landslides and periodic droughts, which loaded pollutants into water. In addition, water quality is jeopardized by the rapid population growth, agrochemicals, industrialization, urbanization, soil steepness and land mismanagement. Accordingly, the reviewed water quality indicate that the water quality pollution likelihood is increasing over time. These facts reveal that the water quality soon or late will be highly polluted and calls for further adaptation and management measures.

Shifting through the forest: home range, movement patterns, and diet of the eastern chimpanzee (Pan troglodytes schweinfurthii) in Nyungwe National Park, Rwanda.

Populations of the endangered eastern chimpanzee (Pan troglodytes schweinfurthii) are declining throughout their range. Although Nyungwe National Park (NNP) harbors the largest remaining eastern chimpanzee population in Rwanda, we know little about their space use and dietary patterns. We studied home range, movement, and diet of two communities of chimpanzees in NNP using daily tracking data (6:00 am to 6:00 pm) collected from 2000 to 2015. One community, Mayebe, resided in the forest center, and the other community, Cyamudongo, inhabited a forest fragment located about 10 km from the main forest. Home range estimated with the 95% kernel density estimation (KDE) method was 21 km2 for the Mayebe community and 4 km2 for the Cyamudongo community. Chimpanzee home range sizes were smaller during the dry versus wet season and varied monthly throughout the year. The Mayebe community had an average hourly step length of 75 ± SE 5 m with a daily movement range of 987 ± SE 71 m, while the Cyamudongo community had a shorter hourly step length of 52 ± SE 3 m with a daily movement range of 651 ± SE 71 m. Both chimpanzee communities fed primarily on Ficus spp. Other important dietary items included fruits of Symphonia globulifera, Syzygium guineense, and Chrysophyllum gorungosanum for the Mayebe community and Trilepisium madagascariense for the Cyamudongo community. Food choice varied monthly and seasonally for each chimpanzee community. Our study provides the first estimates of home range size and movement parameters for chimpanzees in Rwanda and documents their food habits and seasonal variations therein. We also identified the 50% core home range for each chimpanzee community and suggest this area as the focus of management actions. These results could help park management reduce threats to chimpanzees and other sympatric species by improving the efficiency of ranger patrols.

Population need for primary eye care in Rwanda: A national survey.

BackgroundUniversal access to Primary Eye Care (PEC) is a key global initiative to reduce and prevent avoidable causes of visual impairment (VI). PEC can address minor eye conditions, simple forms of uncorrected refractive error (URE) and create a referral pathway for specialist eye care, thus offering a potential solution to a lack of eye health specialists in low-income countries. However, there is little information on the population need for PEC, including prevalence of URE in all ages in Sub-Saharan Africa.MethodsA national survey was conducted of people aged 7 and over in Rwanda in September-December 2016. Participants were selected through two-stage probability proportional to size sampling and compact segment sampling. VI (visual acuity<6/12) was assessed using Portable Eye Examination Kit (PEEK); URE was detected using a pinhole and presbyopia using local near vision test. We also used validated questionnaires to collect socio-demographic and minor eye symptoms information. Prevalence estimates for VI, URE and need for PEC (URE, presbyopia with good distance vision, need for referrals and minor eye conditions) were age and sex standardized to the Rwandan population. Associations between age, sex, socio-economic status and the key outcomes were examined using logistic regression.Results4618 participants were examined and interviewed out of 5361 enumerated (86% response rate). The adjusted population prevalence of VI was 3.7% (95%CI = 3.0–4.5%), URE was 2.2% (95%CI = 1.7–2.8%) and overall need for PEC was 34.0% (95%CI = 31.8–36.4%). Women and older people were more likely to need PEC and require a referral.ConclusionsNearly a third of the population in Rwanda has the potential to benefit from PEC, with greater need identified in older people and women. Universal access to PEC can address unmet eye health needs and public health planning needs to ensure equitable access to older people and women.

Association between glutathione peroxidase 1 codon 198 variant and the occurrence of breast cancer in Rwanda.

BackgroundGlutathione peroxidase 1 gene (GPX1) is one of the antioxidant enzyme that remove the reactive oxygen species in a continuous process. Since the identification of a well‐characterized functional polymorphism named p.Pro198Leu (rs1050450 C>T) in GPX1 gene, abundant studies have evaluated the association between p.Pro198Leu polymorphism and tumor risk in diverse population. But, the available results related to breast cancer are conflicting and absent in Africa. The present case–control study was planned to assess the presence of GPX1 Pro198Leu polymorphism in Rwanda population to determine whether it is associated with the risk of developing breast cancer.MethodsGenomic DNA from peripheral blood leukocytes of 41 patients with breast cancer and 42 healthy controls were enrolled and genotyped GPX1 Pro198Leu polymorphism by PCR amplification and DNA sequencing.ResultsNo significant difference in the frequencies of Pro/Pro (49%) and Pro/Leu (51%) genotypes in cancer cases and in controls (50% each) were found. The allelic frequencies of Pro and Leu were 74% versus 26% and 75% versus 25% in breast cancer cases and controls respectively. No association was observed in allele frequencies of Pro and Leu, and familial history. Only an overall association of GPX1 Pro198Leu with grade of cancer (Pro/Leu vs. Pro/Pro: p = .0200) was detected.ConclusionThe result of this study suggested that GPX1 Pro198Leu polymorphism could not be a risk factor for breast cancer in Rwanda. However, large‐scale studies on the effect of this polymorphism on the factors disturbing the redox homeostasis are needed for conclusive understanding.

Financial Inclusion in Rwanda: an Analysis of Role Played by Commercial Banks

The purpose of this research is to analyze the role played by commercial banks on financial inclusion in Rwanda. Rwanda which is seen as a model of fast development in Africa has set a target of 90% financial inclusion by the year 2020. This target was almost achieved in 2016 where 89% were financially included but only 26% have accounts with commercial banks. This study reveals that all the three dimensions of financial inclusion i.e. access, penetration and usage of commercial banks have increased from 2004 to 2016. This research found that almost 40% of respondents have accounts in the commercial bank. The rest of respondents have accounts either in microfinance institutions or in SACCOs. The findings show again that 67.7% of people who took loans, took them from commercial banks. Although commercial banks play a great role, there is a long way to go for Rwanda to be formally included because only 26% have an account in commercial banks according to Finscope Survey 2016. On this matter, the government of Rwanda should put more efforts to computerize MFIs and SACCOs as they serve 65% of the population in Rwanda. The government of Rwanda should set policies that support microfinance and SACCOs for them to offer better services at the standards of commercial banks as this would help in having a big number of citizens formally included and it may contribute to its economic growth.

Towards Affordable Low Cost Housing: Strategies of Low Cost Housing Development for the Low Income Population in Rwanda

The issue of affordable housing remains to be interested to the researchers all-over the world. Like elsewhere, in Rwanda the modern technology is being used in housing building towards more affordable house low cost.

193 Impact of Implementation of Emergency Medicine Training on Emergency Department Mortality in Kigali, Rwanda: An Interrupted Time-Series Quasi-Experimental Design

Although emergency medicine (EM) training programs have recently been introduced in low- and middle-income countries (LMICs), no data exists on their effects on patient-centered outcomes in resource-limited settings. This study evaluated the impact of EM training on emergency department (ED) mortality among patients treated at the University Teaching Hospital of Kigali (UTH-K) ED. The study was conducted at UTH-K, the primary public referral hospital in Rwanda. An EM post-graduate diploma program was begun at UTH-K in October 2013 and full EM residency training program was begun in September 2015. Prior to initiation of these training programs, care was provided exclusively by general practice physicians (GPs); since initiation, ED care has been provided through mutually exclusive shifts allocated between GPs and EM resident (EMR) trainees who have oversight by board certified emergency physicians. All patients presenting to the ED during the nine-month period prior to initiation of the EM training (Jan.-Sept., 2013) and nine-months following the start of the EM residency program (Sept. 2015-June 2016) were eligible for inclusion. Study personnel abstracted data from a random sample of hospital records using a structured collection instrument. Prevalence and risk differences (RD) of all cause ED mortality were compared for cases treated before and after EM training initiation and based on provider type (GPs or EMRs). Secular trends were assessed and magnitudes of effects were quantified using odds ratios (OR) with 95% confidence intervals (CI). Multivariate models were adjusted a priori for age, type and severity of illness. From the 35,491 encounters during the study period, 2,580 cases were randomly sampled. There were 1,480 cases prior to training initiation and 1,100 after. The median age was 32 years (inter-quartile range (IQR): 22, 49) with a male predominance (59.9%). Medical patients comprised 54.0% of cases and injuries account for 46.0%. Median ED length of stay (LOS) was 1 day (IQR: 0, 3). The majority of cases were admitted (55.4%). Compared to the pre-implementation period, post implementation cases were more likely to be admitted (p<0.001). Pre-implementation mortality prevalence was 6.8% (95% CI: 5.4, 8.2%); post-implementation prevalence was 1.2% (95% CI: 0.5, 1.9%). In multivariate regression, as compared to ED cases treated prior to the initiation of the EM training program, those treated after were less likely to suffer ED mortality (aOR=0.14, 95% CI: 0.07, 0.30; p<0.001). In assessment by provider type, ED mortality among cases treated by GPs was 6.6% (95% CI: 5.5, 7.6%) and 1.3% (95% CI: 1.6, 2.4%) for those treated by EMRs. In regression analysis, compared to cases treated by GPs those treated by EM trainees were significantly less likely to experience ED mortality (aOR=0.08, 95% CI: 0.01, 0.55; p=0.011). No differences in secular trends in mortality were identified based on shift type either prior to (RD: 0.5%, 95% CI: -0.4, 4.6%; p=0.79) or after training initiation (RD: 0.9%, 95% CI: -0.8, 2.6%; p=0.35). ED mortality was significantly reduced with implementation of EM training in the studied population in Rwanda. Although limited by design aspects, these results demonstrate the benefit on an objective patient-centered outcome of EM training in a LMIC, and supports further research and investment in EM training in resource-limited settings.

English

Breed improvement and conservation are optimally achieved when the available genetic resources are characterised and strategies developed to achieve the goals. This study aimed at investigating the management practices, performance and morphological features of the indigenous cattle ecotypes in Rwanda on 250 cattle farming households. A total of 20 measurements taken on 305 female and 45 male cattle were: body length (BL), height at withers (HW), leg height (LH), heart girth (HG), body weight (BW), tail length (TL), dewlap length (DL), dewlap width (DW), rump width (RW), ear length (EL), muzzle circumference (MC), horn length (HL), distance between horns (HS), hump length (HuL), hump width (HuW), navel depth (ND), udder length (UL), udder depth (UD), teat length (TL), and body condition score (BCS). Morphometric data was analysed by ecotype for each sex and age category since there were non-significant differences in geographical location. Results show that Rwanda has five types of indigenous cattle namely: Inyambo, Inkuku, Inkoromaijo, Inkungu and Bashi. The livestock system mostly used was extensive and household income was mainly from livestock. For Inyambo cattle, the popular ecotype, age at sexual maturity was 27.44±1.04 months for males and 28.76±1.02 months for female cows. Age at first calving was 33.8±0.83 months whereas calving interval was 13.60±0.45 months. Lactation length was found to be 6.84±0.29 months. The mean daily milk was 3.58±0.19 litres and the pre weaning calf survivability was 90±6.5%. Positive and high correlations were observed between BW, HG, HW, HuL, BL and HL. Indigenous cattle population of Rwanda are not homogenous by their morphological features and other productive traits, and therefore conservation will have to target the different ecotypes and this should be done with direct engagement of their keepers. Key words: Ankole, indigenous cattle, Inyambo, phenotypes, reproductive performance.

Faecal contamination of household drinking water in Rwanda: A national cross-sectional study

Unsafe drinking water is a leading cause of morbidity and mortality, especially among young children in low-income settings. We conducted a national survey in Rwanda to determine the level of faecal contamination of household drinking water and risk factors associated therewith. Drinking water samples were collected from a nationally representative sample of 870 households and assessed for thermotolerant coliforms (TTC), a World Health Organization (WHO)-approved indicator of faecal contamination. Potential household and community-level determinants of household drinking water quality derived from household surveys, the 2012 Rwanda Population and Housing Census, and a precipitation dataset were assessed using multivariate logistic regression. Widespread faecal contamination was present, and only 24.9% (95% CI 20.9–29.4%, n=217) of household samples met WHO Guidelines of having no detectable TTC contamination, while 42.5% (95% CI 38.0–47.1%, n=361) of samples had >100TTC/100mL and considered high risk. Sub-national differences were observed, with poorer water quality in rural areas and Eastern province. In multivariate analyses, there was evidence for an association between detectable contamination and increased open waste disposal in a sector, lower elevation, and water sources other than piped to household or rainwater/bottled. Risk factors for intermediate/high risk contamination (>10TTC/100mL) included low population density, increased open waste disposal, lower elevation, water sources other than piped to household or rainwater/bottled, and occurrence of an extreme rain event the previous day. Modelling suggests non-household-based risk factors are determinants of water quality in this setting, and these results suggest a substantial proportion of Rwanda's population are exposed to faecal contamination through drinking water.

The Prevalence of Syphilis Infection and Its Associated Factors in the General Population of Rwanda: A National Household-Based Survey.

Background. The prevalence of syphilis among HIV-infected people is a public health concern, but there is limited literature to describe the true burden of syphilis in resource-limited settings. We conducted this survey in 2013 to estimate the prevalence of syphilis. Methods. A cross-sectional survey. Participants were tested for syphilis and HIV. Factors associated with syphilis infection were identified. Results. The prevalence of syphilis was 0.9% (95% CI: 0.7–1.1). This prevalence was higher in the 25–49-year-old age (1.1% [95% CI: 0.8–1.3]) than in the 15–24-year-old age (0.6% (95% CI: 0.4–0.9)). Women with lower education had a higher prevalence of syphilis (1.2% (95% CI: 0.9–1.5)) compared to others (0.4% (95% CI: 0.2–0.8)). This prevalence among HIV-infected people was six times higher: 4.8% (95% CI: 2.9–7.9) compared to HIV-negative people (0.8% (95% CI: 0.6–1.0)). The prevalence of syphilis among HIV-infected females was 5.9% (95% CI: 3.4–10.0). HIV-infected or concurrent sexual partners was associated with increased syphilis prevalence with aOR = 4.2 (95% CI: 2.5–7.2) and aOR = 4.2 (95% CI: 2.8–6.5), respectively. Conclusions. The prevalence of syphilis was significantly higher among HIV-infected patients. HIV infection and concurrent sexual partners are associated with an increased prevalence of syphilis. Preventing HIV might help in preventing syphilis.

The protective function of personal growth initiative among a genocide-affected population in Rwanda.

The aim of the current study was to investigate the extent to which individual differences in personal growth initiative (PGI) were associated with lower reports of functional impairment of daily activities among a genocide-affected population in Rwanda. PGI measures an individual's motivation to develop as a person and the extent to which he or she is active in setting goals that work toward achieving self-improvement. We found that PGI was negatively associated with functional impairment when controlling for depression, posttraumatic stress disorder, and other demographic factors. Our results suggest that PGI may constitute an important mindset for facilitating adaptive functioning in the aftermath of adversity and in the midst of psychological distress, and as such they might have practical applications for the development of intervention programs.

Estimation of the size of the female sex worker population in Rwanda using three different methods.

HIV prevalence is disproportionately high among female sex workers compared to the general population. Many African countries lack useful data on the size of female sex worker populations to inform national HIV programmes. A female sex worker size estimation exercise using three different venue-based methodologies was conducted among female sex workers in all provinces of Rwanda in August 2010. The female sex worker national population size was estimated using capture–recapture and enumeration methods, and the multiplier method was used to estimate the size of the female sex worker population in Kigali. A structured questionnaire was also used to supplement the data. The estimated number of female sex workers by the capture–recapture method was 3205 (95% confidence interval: 2998–3412). The female sex worker size was estimated at 3348 using the enumeration method. In Kigali, the female sex worker size was estimated at 2253 (95% confidence interval: 1916–2524) using the multiplier method. Nearly 80% of all female sex workers in Rwanda were found to be based in the capital, Kigali. This study provided a first-time estimate of the female sex worker population size in Rwanda using capture–recapture, enumeration, and multiplier methods. The capture–recapture and enumeration methods provided similar estimates of female sex worker in Rwanda. Combination of such size estimation methods is feasible and productive in low-resource settings and should be considered vital to inform national HIV programmes.