Rwandan Women Research Articles

NGOs Income Generation Services and Rural Women Empowerment in Rwanda: A Case of Care International in Huye District, Isaro Programme

The main intention of this research was to analyze the role of NGOs income generating service and empowerment of rural women in Rwanda with a case of care international in Huye district, the Isaro program. The investigator used the interview guide, questionnaire and observation to collect information from the primary respondents and the field in general. Bouchard Formula was used to draw 97 respondents from target population of 2015 people (5 employees of Isaro Programme and 2010 rural women) including 5 respondents who are employees of Isaro Programme and 92 respondents who are direct beneficiaries of Isaro Programme applied both simple random and census as sampling techniques. The collected information was analyzed using multiple linear regression and correlation analysis by use of SPSS 21.0 version. The findings showed that 83 (85.6%) of respondents strongly agreed that the Isaro programme offers capacity building through training, 84 (86.6%) of respondents strongly agreed that Isaro program offers access to credit, 85 (87.6%) of respondents that the Isaro programme has group saving scheme as a service offered to rural women, 84 (86.6%) of respondents strongly agreed that Isaro programme offers mutuelle de santé as a service to rural women,

Premenopausal Breast Cancer Risk Factors and Associations with Molecular Subtypes: A Case-Control Study.

Background Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women's cancer-related deaths and morbidity worldwide. In Rwanda, BC incidence is increasing with an unacceptably high mortality rate in premenopausal women. Objectives The purpose was to identify modifiable BC risk factors and assess associations between common breast cancer risks factors and molecular subtypes in premenopausal women in Rwanda. Methods This was a case-control study. Premenopausal women with histological confirmation of BC and frequency-matched for age controls were recruited. A preestablished questionnaire was administered to both cases and controls for sociodemographics, BC probable risk factors, and clinical and pathological characteristics. BC was classified into luminal A, luminal B, HER2-type, basal-like (triple negative), and unclassified molecular subtypes by immunohistochemistry (IHC). Odds ratio (OR) and 95% confidence interval (CI) were estimated using multivariate logistic regression analysis. Results 340 participants were recruited into the study (170 cases vs. 170 controls). The median age was 39 years. The majority of cases presented at advanced stages of the disease (51.2% in stages III and IV) and had invasive ductal carcinoma (98.2%). 60.6% had subtypes of poor prognosis (HER2 enriched 14.7%, triple negative 12.9%, and unclassified 32.9%). Alcohol intake (AOR = 3.73, 95%CI 2.19 − 6.32, p < 0.001), obesity/overweight in adolescence or early adulthood (AOR = 10.86, 95%CI 4.82 − 24.4, p < 0.001), history of primary infertility (AOR = 33.8, 95%CI 3.5 − 321.5, p = 0.002), nulliparity (AOR = 3.75, 95%CI 1.61 − 8.75, p = 0.002), and a history of benign breast disease (AOR = 6.06, 95%CI 1.19 − 30.73, p = 0.03) were associated with the occurrence of premenopausal breast cancer. There was no significant difference between risk factor stratification per molecular subtype. Conclusion Several reproductive, environmental, and lifestyle risk factors have been identified to be associated with premenopausal BC. Among them, alcohol intake and obesity/overweight during adolescence/early adulthood can be modified. Interventions targeting alcohol consumption and obesity/overweight in adolescents and young adults may decrease the incidence of premenopausal breast cancer.

Entrepreneurial feminism in Kigali

Entrepreneurship has been attributed to a masculine career in many economies. Rwanda was no exception to the discrimination of women in entrepreneurship. Due to gender, stereotype, and patriarchy, Rwandan women were not free in deciding to participate in entrepreneurial feminism. Some women became liberalists to break the glass ceiling to launch entrepreneurial feminism. They faced constraints that included a lack of entrepreneurship skills, market opportunity, and fear of failure. This article aimed to explore how gender affects new entrepreneurial feminism creation in Kigali. A quantitative approach used to collect survey data from 409 women-owned SMEs in Kigali were selected purposively. The findings indicated that most women-owned SMEs in Kigali started a necessary business due to unemployment. In contrast, those who needed time to care for their family while generating income launched the opportunity business. (64.3%) accepted permission from partners to start a business. While (24.9%) broke the glass ceiling. A lack of entrepreneurship skills was the major constraint they faced.

Rwandan Women in Higher Education: Progress, Successes, and Challenges

In nearly three decades since Rwanda’s genocide and civil war, its education sector has undergone reconstruction to an unprecedented degree within higher education. While greater numbers of girls are attending university, and more women are becoming university faculty members, their status in educational leadership roles remains unclear. This qualitative investigation sought to present insight into four women who serve as professors and executive leaders within the higher education system by examining their progress, successes, and challenges. Four of the many insights that have emerged include women’s smaller acceptance rate into higher education as undergraduates; the country’s lack of Ph.D. programs, thereby requiring women to leave the country in order to obtain the terminal degree; disproportionate service expectations placed on women academics as compared to men that affect scholarly output; and society’s expectation for women’s responsibilities as wives and mothers regardless of career responsibilities or status. To remedy these findings, further investigation can shed light on the reasons for low acceptance of women into the university; may lead to development of a strategic plan to address the lack of opportunities for students to enter graduate level education leading to the Ph.D.; and may address broader national policies that support women academics such as attention to child care and mentoring for promotion.

Towards stronger antenatal care: Understanding predictors of late presentation to antenatal services and implications for obstetric risk management in Rwanda.

Early antenatal care (ANC) reduces maternal and neonatal morbidity and mortality through identification of pregnancy-related complications, yet 44% of Rwandan women present to ANC after 16 weeks gestational age (GA). The objective of this study was to identify factors associated with delayed initiation of ANC and describe differences in the obstetric risks identified at the first ANC visit (ANC-1) between women presenting early and late to care. This secondary data analysis included 10,231 women presenting for ANC-1 across 18 health centers in Rwanda (May 2017-December 2018). Multivariable logistic regression models were constructed using backwards elimination to identify predictors of presentation to ANC at ≥16 and ≥24 weeks GA. Logistic regression was used to examine differences in obstetric risk factors identified at ANC-1 between women presenting before and after 16- and 24-weeks GA. Sixty-one percent of women presented to ANC at ≥16 weeks and 24.7% at ≥24 weeks GA, with a mean (SD) GA at presentation of 18.9 (6.9) weeks. Younger age (16 weeks: OR = 1.36, 95% CI: 1.06, 1.75; 24 weeks: OR = 1.33, 95% CI: 0.95, 1.85), higher parity (16 weeks: 1-4 births, OR = 1.55, 95% CI: 1.39, 1.72; five or more births, OR = 2.57, 95% CI: 2.17, 3.04; 24 weeks: 1-4 births, OR = 1.93, 95% CI: 1.78, 2.09; five or more births, OR = 3.20, 95% CI: 2.66, 3.85), lower educational attainment (16 weeks: primary, OR = 0.75, 95% CI: 0.65, 0.86; secondary, OR = 0.60, 95% CI: 0.47,0.76; university, OR = 0.48, 95% CI: 0.33, 0.70; 24 weeks: primary, OR = 0.64, 95% CI: 0.53, 0.77; secondary, OR = 0.43, 95% CI: 0.29, 0.63; university, OR = 0.12, 95% CI: 0.04, 0.32) and contributing to household income (16 weeks: OR = 1.78, 95% CI: 1.40, 2.25; 24 weeks: OR = 1.91, 95% CI: 1.42, 2.55) were associated with delayed ANC-1 (≥16 and ≥24 weeks GA). History of a spontaneous abortion (16 weeks: OR = 0.74, 95% CI: 0.66, 0.84; 24 weeks: OR = 0.70, 95% CI: 0.58, 0.84), pregnancy testing (16 weeks: OR = 0.48, 95% CI: 0.33, 0.71; 24 weeks: OR = 0.41, 95% CI: 0.27, 0.61; 24 weeks) and residing in the same district (16 weeks: OR = 1.55, 95% CI: 1.08, 2.22; 24 weeks: OR = 1.73, 95% CI: 1.04, 2.87) or catchment area (16 weeks: OR = 1.53, 95% CI: 1.05, 2.23; 24 weeks: OR = 1.84, 95% CI: 1.28, 2.66; 24 weeks) as the health facility were protective against delayed ANC-1. Women with a prior preterm (OR, 0.71, 95% CI, 0.53, 0.95) or low birthweight delivery (OR, 0.72, 95% CI, 0.55, 0.95) were less likely to initiate ANC after 16 weeks. Women with no obstetric history were more likely to present after 16 weeks GA (OR, 1.18, 95% CI, 1.06, 1.32). This study identified multiple predictors of delayed ANC-1. Focusing existing Community Health Worker outreach efforts on the populations at greatest risk of delaying care and expanding access to home pregnancy testing may improve early care attendance. While women presenting late to care were less likely to present without an identified obstetric risk factor, lower than expected rates were identified in the study population overall. Health centers may benefit from provider training and standardized screening protocols to improve identification of obstetric risk factors at ANC-1.

Variations and Determinants of Anemia among Reproductive Age Women in Five Sub-Saharan Africa Countries.

Background The Ghana Demographic and Health Survey 2014 report indicates that anemia among women in their reproductive age in the country stood at 42 percent, making it a severe public health problem according to the World Health Organization (WHO) classification. WHO Global Observatory data indicates that some sub-Saharan African countries have been able to reduce the prevalence of anemia among women of reproductive age compared to Ghana in 2016. To inform policy decisions, data from the Demographic and Health Surveys 2014–2018 were analyzed to determine the disparities in the prevalence of anemia and related factors among women of reproductive age in Ghana, Ethiopia, Uganda, Tanzania, and Rwanda. Methods This research utilized data from the Demographic and Health Surveys 2014, 2016, 2014-2015, 2015-2016, and 2016 from Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively. Respondents were women aged between 15 and 49 years. Hemoglobin levels were measured by HemoCue hemoglobin meter. 45,299 women data were extracted from the five countries with 4,644, 14,923, 6,680, 13,064, and 5,988 from Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively. Association between anemia and selected predictive variables was assessed using Pearson's chi-square test statistic. Poisson regression with robust standard errors was used to estimate the prevalence rate ratios of developing anemia. The deviance goodness of fit test was employed to test the fit of the Poisson model to the data set. Results There was a statistically significant difference in prevalence of 1,962 (42.3%), 3,527 (23.6%), 1,284 (19.3%), 5,857 (44.8%), and 1,898 (31.7%) for Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively, χ2 = 2,181.86 and p value < 0.001. Parity, pregnancy status, and contraceptives significantly increased the prevalence rate ratio of a woman developing anemia. Women in Ethiopia with a parity of six or more were 58% more likely to develop anemia than those with parity of zero. Tanzanian women who were pregnant had a 14% increased rate ratio of developing anemia. Factors that significantly decreased anemia in this study were wealth index, women's age, and women's highest level of education. Women who were in the higher education category in Ethiopia were 57% less likely to develop anemia. Ugandan women in the richest category of the wealth index were 28% less likely to develop anemia. Rwandan women in the middle category of the wealth index were 20% less likely to develop anemia. Women who were within the 45-49 age category in Ethiopia were 48% less likely to develop anemia. Conclusion The individual country governments should encourage the implementation of increasing female enrollment in higher education. Women in their reproductive age should be encouraged to use modern contraceptives to reduce their anemia prevalence.

Abstract 99: A Tablet-Based Electronic Medical Record System to Improve Cancer Early Detection and Linkage to Care at Health Facilities In Rwanda

Abstract Purpose: For a cancer early detection program to improve cancer outcomes, patients with abnormal initial tests must be linked to timely diagnosis and care. We describe the development and early implementation of a tablet-based electronic medical record (EMR) at rural Rwandan health care facilities to facilitate clinical documentation and tracking of patients participating in a cervical cancer screening and breast cancer early detection program. Methods: To develop the EMR tool, a multi-institutional team was established consisting of software developers and health informatics implementers from Rwanda Biomedical Centre, Partners In Health, and the Clinton Health Access Initiative. We utilized the open-source software OpenMRS linked with an android mobile app, mUzima, used on tablets offline at rural health centers. Data are synchronized to a national OpenMRS server. In four workshops, clinicians and project leaders from Rwanda's Women's Cancer Early Detection initiative identified key clinical variables and workflows to track and link patients to care. Quality assessment of data from June-November 2020 is underway to identify gaps. Results: Twenty-two informatics trainers trained 269 clinicians at 81 health facilities from June- November 2020, enabling the tablet-based tool to be routinely utilized in the cancer early detection program in 4 districts. From June-November 2020, OpenMRS data show 13,783 patients were evaluated for cervical cancer screening and 3,608 had breast evaluation. Early implementation challenges included form completion burden for clinicians and insufficient validation rules limiting data quality. Additionally, clinical reports have not been finalized, requiring manual tracking of missed visits. Informatics, programmatic, and clinical partners discussed strategies to resolve challenges at a weeklong workshop in December 2020. Conclusion: Building an informatics system to facilitate cancer early detection in rural low-resource health facilities is feasible but requires continuous adaptation, training and multidisciplinary cross-institutional collaboration. Further evaluation will investigate the tool's impact on timely patient care. Citation Format: Eric Kagabo, Todd Anderson, Nadine Karema, Jean-Marie Vianney Dusengimana, Marc Hagenimana, Francois Uwinkindi, Jean Paul Balinda, Placide Habinshuti, Joshua Byiringiro, Nang'andu Chyizuka, Lydia Pace. A Tablet-Based Electronic Medical Record System to Improve Cancer Early Detection and Linkage to Care at Health Facilities In Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 99.

Function and disability status among women with fistula using WHODAS2.0: A descriptive study from Rwanda and Democratic Republic of Congo.

To assess function and disability among women in Rwanda and Democratic Republic of Congo living with fistula and identify characteristics associated with higher disability scores. Women presenting for fistula care were recruited. Eligible participants underwent a physical examination to classify fistula type and completed the WHO Disability Assessment Schedule 2.0 questionnaire to ascertain the impact of fistula on function across six domains: cognition, mobility, self-care, getting along, life activities, and participation. Disability scores were calculated (where 0=no disability and 100=complete disability). Participants were grouped according to no, low, or high disability status; results were examined to determine the domains most affected. Among 69 participants, fistula type included: vesicovaginal (59.4%), ureterovaginal (14.5%), total absence of proximal urethra (11.6%), and rectovaginal (14.5%). Median disability score was 43.0/100 (interquartile range 26.0-67.0); 83% exhibited high disability status. Life activities and participation in society domains were most affected. Women with rectovaginal fistula reported the lowest scores, and those with total absence of proximal urethra reported the highest scores. WHO Disability Assessment Schedule 2.0 represents a simple, robust measure of global disability status, aligns with research efforts to estimate maternal disability, and may inform health needs and resource allocation for this population. In this study, disability was common, varied by fistula type, and affected physical, mental, and social domains.

High mortality rate of obstetric critically ill women in Rwanda and its predictability

BackgroundReasons for admission to intensive care units (ICUs) for obstetric patients vary from one setting to another. Outcomes from ICU and prediction models are not well explored in Rwanda owing to lack of appropriate scores. This study aimed to assess reasons for admission and accuracy of prediction models for mortality of obstetric patients admitted to ICUs of two public tertiary hospitals in Rwanda.MethodsWe prospectively collected data from all obstetric patients admitted to the ICUs of the two public tertiary hospitals in Rwanda from March 2017 to February 2018 to identify reasons for admission, demographic and clinical characteristics, outcome including death and its predictability by both the Modified Early Obstetric Warning Score (MEOWS) and quick Sequential Organ Failure Assessment (qSOFA). We analysed the accuracy of mortality prediction models by MEOWS or qSOFA by using logistic regression adjusting for factors associated with mortality. Area under the Receiver Operating characteristic (AUROC) curves is used to show the predicting capacity for each individual tool.ResultsObstetric patients (n = 94) represented 12.8 % of all 747 ICU admissions which is 1.8 % of all 4.999 admitted women for pregnancy or labor. Sepsis (n = 30; 31.9 %) and obstetric haemorrhage (n = 24; 25.5 %) were the two commonest reasons for ICU admission. Overall ICU mortality for obstetric patients was 54.3 % (n = 51) with average length of stay of 6.6 ± 7.525 days. MEOWS score was an independent predictor of mortality (adjusted (a)OR 1.25; 95 % CI 1.07–1.46) and so was qSOFA score (aOR 2.81; 95 % CI 1.25–6.30) with an adjusted AUROC of 0.773 (95 % CI 0.67–0.88) and 0.764 (95 % CI 0.65–0.87), indicating fair accuracy for ICU mortality prediction in these settings of both MEOWS and qSOFA scores.ConclusionsSepsis and obstetric haemorrhage were the commonest reasons for obstetric admissions to ICU in Rwanda. MEOWS and qSOFA scores could accurately predict ICU mortality of obstetric patients in resource-limited settings, but larger studies are needed before a recommendation for their use in routine practice in similar settings.

Factors Influencing Late Utilization of First Antenatal Care Services Among Pregnant Women in Rwanda

Background: Early antenatal care (ANC) attendance promotes early detection and treatment of pregnant complications. The late utilization of ANC refers to seeking ANC services after twelve weeks of pregnancy. The research aimed to examine the factors behind late ANC services utilization among pregnant women in Rwanda. Methods: This research was a cross-sectional study using quantitative approach. The study population included pregnant women seeking ANC services from seven health centers from Mugonero District Hospital. Sample size of 140 respondents was selected using a two-stage randomized cluster sampling procedure from the study population. Data were collected through structured questionnaire, coded and analyzed using SPSS. Results: The majority (62.1%) pregnant women were married, (58.6%) had more than 3 children, 57.1% attended primary education, and 92.9% were unemployed. The prevalence of late ANC utilization was 57.1%. The odds of attending ANC lately was 2.8 times higher among pregnant women with primary education compared to mothers with tertiary education (AOR = 2.8, 95% CI: [1.32 -3.90]), unemployed mothers have been found to timely attend ANC compared to employed mothers (AOR = 0.13, 95% CI: [0.06 - 1.42]). Mothers who paid themselves transport cost were most likely to late attend ANC compared to mothers who did not pay transport (AOR = 1.90, 95% CI: [1.25-2.18]). Mothers who previously received poor ANC services at health center were most likely to late attend ANC (AOR = 2.0, 95% CI: [1.82-3.16]). Conclusion: The late antenatal care attendance remains high in the study area indicating that the importance of early initiation is not yet fully understood at the community level. Therefore, an approach that involves all stakeholders should be used to address the matter at hand.

Developing and validating a risk algorithm to diagnose Neisseria gonorrhoeae and Chlamydia trachomatis in symptomatic Rwandan women

BackgroundAlgorithms that bridge the gap between syndromic sexually transmitted infection (STI) management and treatment based in realistic diagnostic options and local epidemiology are urgently needed across Africa. Our objective was to develop and validate a risk algorithm for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) diagnosis among symptomatic Rwandan women and to compare risk algorithm performance to the current Rwandan National Criteria for NG/CT diagnosis.MethodsThe risk algorithm was derived in a cohort (n = 468) comprised of symptomatic women in Kigali who sought free screening and treatment for sexually transmitted infections and vaginal dysbioses at our research site. We used logistic regression to derive a risk algorithm for prediction of NG/CT infection. Ten-fold cross-validation internally validated the risk algorithm. We applied the risk algorithm to an external validation cohort also comprised of symptomatic Rwandan women (n = 305). Measures of calibration, discrimination, and screening performance of our risk algorithm compared to the current Rwandan National Criteria are presented.ResultsThe prevalence of NG/CT in the derivation cohort was 34.6%. The risk algorithm included: age < =25, having no/primary education, not having full-time employment, using condoms only sometimes, not reporting genital itching, testing negative for vaginal candida, and testing positive for bacterial vaginosis. The model was well calibrated (Hosmer-Lemeshow p = 0.831). Higher risk scores were significantly associated with increased prevalence of NG/CT infection (p < 0.001). Using a cut-point score of > = 5, the risk algorithm had a sensitivity of 81%, specificity of 54%, positive predictive value (PPV) of 48%, and negative predictive value (NPV) of 85%. Internal and external validation showed similar predictive ability of the risk algorithm, which outperformed the Rwandan National Criteria. Applying the Rwandan National Criteria cutoff of > = 2 (the current cutoff) to our derivation cohort had a sensitivity of 26%, specificity of 89%, PPV of 55%, and NPV of 69%.ConclusionsThese data support use of a locally relevant, evidence-based risk algorithm to significantly reduce the number of untreated NG/CT cases in symptomatic Rwandan women. The risk algorithm could be a cost-effective way to target treatment to those at highest NG/CT risk. The algorithm could also aid in sexually transmitted infection risk and prevention communication between providers and clients.

"…we have to think first what we are going to feed our children before we have them …": Rwandan women use family planning to provide a better life for their children.

Use of modern contraception in Rwanda has risen dramatically over a short time period. To better understand contraceptive users’ motivations for family planning services in Rwanda, 32 in-depth interviews with contraceptive users and eight focus groups with 88 family planning providers were conducted in Rwanda’s Musanze and Nyamasheke districts. Study participants noted how family planning is critical for providing a better life for children. Family planning gives mothers independence from childcare to work in order to provide for their children’s wellbeing. Family planning presented an opportunity for generational upward mobility and was perceived as a way to contribute positively to society.

Rape Appraisals: Class Mobility, Social Geography, and Sexual Morality Tales in Ghana, South Africa, and Rwanda

Interdisciplinary scholarship in violence and trauma studies suggest that a person’s interpretation of stressful events contours how the person will respond. It is through the two-part appraisal process that survivors determine how they will cope. This project utilizes an identity-based approach to demonstrate that survivors use group-based ideologies such as social class, geography, gender, sexuality, and, for some, race to appraise their accounts of violence, assess their coping strategies, and manage traumatic events. Using the cross-cultural accounts of 146 Black Ghanaian, South African, and Rwandan women rape survivors, the findings extend the appraisal approach by highlighting how survivors in this study utilized sexual morality tales to construct a variety of appraisal accounts to interpret their assaults and to justify their coping strategies. I call these appraisals opportunities, possibilities, limitations, and solidarities. These differing appraisals demonstrated that social milieu contours the psychological experience of violence and can engender both parallel and divergent interpretations across social class and cultural contexts. Last, the implications of these findings for comparative sexual assault studies, theories of traumatic coping, gender and development, and intersectionality are discussed.

Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services.

IntroductionThe longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms.MethodsRadio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men.ResultsAmong 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts.ConclusionsSyndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.

Prevalence of Periodontitis and Associated Factors among Pregnant Women: A cross sectional survey in Southern Province, Rwanda

Background &#x0D; The literature has shown the relationship between maternal periodontitis and complications associated with pregnancy. Thus, prevalence estimates and risk factor identification for periodontitis during pregnancy in Rwanda are paramount.&#x0D; Aim&#x0D; The aim of the current study was to determine the prevalence of periodontitis and identify related risk factors among pregnant women in Rwanda.&#x0D; Methods&#x0D; A cross sectional study was conducted to determine the prevalence of periodontal diseases in a convenience sample of 400 pregnant women in the Southern Province of Rwanda. A logistic regression analysis using a hierarchical approach was performed to assess the risk factors for periodontal disease. Socio demographic factors were put in the regression model first followed by a second step for other potential factors.&#x0D; Results&#x0D; The overall prevalence of periodontitis was 60.5%. Multivariable logistic regression showed that age OR=2.48 (95% CI. 1.18-5.22), education level OR=82.15 (95% CI. 8.21-822.11), socio economic status OR=2.28 (95% CI. 1.49-6.62), employment status OR=7.3 (95% CI. 1.38-38.74, and tobacco use OR=6.89 (95% CI. 1.78-60.65) were significantly associated with periodontitis.&#x0D; Conclusion&#x0D; Periodontitis appears to be a common problem among pregnant women in Rwanda. Risk factor screening could help identify pregnant women at higher risk of periodontal disease.&#x0D; Rwanda J Med Health Sci 2021;4(1):131-150

Predictors of postpartum family planning in Rwanda: the influence of male involvement and healthcare experience

BackgroundStrengthened efforts in postpartum family planning (PPFP) is a key priority to accelerate progress in reproductive, maternal, newborn, and child health outcomes. This secondary data analysis explores factors associated with PPFP uptake in Rwanda. The purpose of this study was to explore variables that may influence PPFP use for postpartum women in Rwanda including health facility type, respectful maternity care, locus of control, and mental health status.MethodsThis secondary analysis of data from a cluster randomized control trial used information abstracted from questionnaires administered to women (≥ 15 years of age) at two time points—one during pregnancy (baseline) and one after delivery of the baby (follow-up). The dependent variable, PPFP uptake, was evaluated against the independent variables: respectful care, locus of control, and mental health status. These data were abstracted from linked questionnaires completed from January 2017 to February 2019. The sample size provided 97% power to detect a change at a 95% significance level with a sample size of 640 at a 15% effect size. Chi-square testing was applied for the bivariate analyses. A logistic regression model using the generalized linear model function was performed; odds ratio and adjusted (by age group and education group) odds ratio with 95% confidence interval were reported.ResultsOf the 646 respondents, although 92% reported not wanting another pregnancy within the next year, 72% used PPFP. Antenatal care wait time (p = < 0.01; Adj OR (Adj 95% CI) 21–40 min: 2.35 (1.46,3.79); 41–60 min: 1.50 (0.84,2.69); 61–450 min: 5.42 (2.86,10.75) and reporting joint healthcare decision-making between the woman and her partner (male) (p = 0.04; Adj OR (Adj 95% CI) husband/partner: 0.59 (0.35,0.97); mother and partner jointly: 1.06 (0.66,1.72) were associated with PPFP uptake.ConclusionsThese results illustrate that partner (male) involvement and improved quality of maternal health services may improve PPFP utilization in Rwanda.

Type-specific persistence, clearance and incidence of high-risk HPV among screen-positive Rwandan women living with HIV

BackgroundPersistent infection with high-risk human papillomavirus (hrHPV) is a critical step in cervical carcinogenesis. We report on type-specific hrHPV persistence, clearance and incidence among screen-positive Rwandan women living with HIV (WLWH).MethodsThis was a nested analysis from a large cervical cancer screening study of ~ 5000 Rwandan WLWH. Women who tested positive for hrHPV and/or visual inspection with acetic acid were referred to colposcopy. For a subset of women (n = 298) who were ≥ 6 months delayed in receiving colposcopy, we tested their screening and colposcopy visit specimens using the AmpFire HPV genotyping assay that tests 14 hrHPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) individually.ResultsThe mean, median (interquartile range [IQR]) and range of time between the screening and colposcopy visits were 644, 650 (490–820.5) and 197–1161 days, respectively. Mean, median (IQR) and range of age at the screening visit were 38, 37 (34–43) and 30–54 years, respectively. Two-hundred eighty-three (95.0%) had CD4 count (cells per mm3) data available at baseline with mean, median (IQR) and range of 592, 513 (346–717) and 0–7290, respectively. Two-hundred thirty-five WLWH were positive for at least one hrHPV type at the screening visit, of whom 50.2% had at least one HPV type-specific infection persist; 37.2% of all HPV infections detected at the screening visit persisted. Compared to all other HPV types in aggregate, HPV16 (vs. non-HPV16 types) (47.7%, p = 0.03) and HPV33 (vs. non-HPV33 types) (56.7%, p = 0.03) were significantly more likely, and HPV39 (vs. non-HPV39 types) (6.7%, p = 0.01), HPV51 (vs. non-HPV51 types) (15.6%, p < 0.01), and HPV66 (vs. non-HPV66 types (17.9%, p = 0.04) were significantly less likely, to persist. Lower CD4 counts were associated with having any persistent hrHPV infection (ptrend = 0.04) and multiple persistent hrHPV infections (ptrend = 0.04).ConclusionThere is a significant proportion of WLWH with persistent hrHPV infection, emphasizing the need to vaccinate them against HPV prior to becoming sexually active.

Knowledge and Factors Associated with Overweight and Obesity Prevention among Women Attending Kibagabaga Hospital, Rwanda

Women in Rwanda are still suffering from overweight and obesity and health-related complications. However, little is known about overweight/obesity prevention knowledge and factors associated with overweight/obesity prevention among women. The aim of this study was to determine knowledge and factors associated with overweight and obesity prevention among women attending Kibagabaga Hospital in Rwanda. A quantitative descriptive cross-sectional design was conducted among women aged 20-45 years that was selected randomly. A structured questionnaire was used to collect data from 384 women seeking health care at the hospital during the study period. SPSS version 21 was used for data analysis; descriptive statistics was used to assess women’s knowledge related to overweight/obesity. Logistic regression was used to determine the factors associated with overweight/obesity prevention, the level of significance was set at 5%. Approval to conduct the study was obtained from the University and Hospital. The majority 35.4% of study participants were aged between 30-34 years. Women who live in urban area dominate the study (76.3%), the majority of study participants were married (60.9%). The study revealed that the 22% and 62% of women had higher level and moderate knowledge respectively. In terms of overweight/obesity prevention practices, we found that 67% mothers had adequate practices towards overweight and obesity prevention. The age of 35-39, and unemployment were found to be significantly associated with overweight/obesity prevention practices. Cost-effective health education focusing on women, physical activity and social support to reduce the socio-cultural constraints that promote overweight/obesity are necessary to combat this epidemic

Assessing the impact of group antenatal care on gestational length in Rwanda: A cluster-randomized trial

Research on group antenatal care in low- and middle-income contexts suggests high acceptability and preliminary implementation success. We studied the effect of group antenatal care on gestational age at birth among women in Rwanda, hypothesizing that participation would increase mean gestational length. For this unblinded cluster randomized trial, 36 health centers were pair-matched and randomized; half continued individual antenatal care (control), half implemented group antenatal care (intervention). Women who initiated antenatal care between May 2017 and December 2018 were invited to participate, and included in analyses if they presented before 24 weeks gestation, attended at least two visits, and their birth outcome was obtained. We used a generalized estimating equations model for analysis. In total, 4091 women in 18 control clusters and 4752 women in 18 intervention clusters were included in the analysis. On average, women attended three total antenatal care visits. Gestational length was equivalent in the intervention and control groups (39.3 weeks (SD 1.6) and 39.3 weeks (SD 1.5)). There were no significant differences between groups in secondary outcomes except that more women in control sites attended postnatal care visits (40.1% versus 29.7%, p = 0.003) and more women in intervention sites attended at least three total antenatal care visits (80.7% versus 71.7%, p = 0.003). No harms were observed. Group antenatal care did not result in a difference in gestational length between groups. This may be due to the low intervention dose. We suggest studies of both the effectiveness and costs of higher doses of group antenatal care among women at higher risk of preterm birth. We observed threats to group care due to facility staff shortages; we recommend studies in which antenatal care providers are exclusively allocated to group antenatal care during visits. ClinicalTrials.gov NCT03154177.

\u201cHe lets me go although he does not go with me.\u201d: Rwandan women\u2019s perceptions of men\u2019s roles in maternal health

BackgroundIncreasing men’s involvement in their pregnant partners’ wellness has been reported as one of the ways to improve access to and utilization of maternal health services, including birth preparedness and complication readiness. Men can play meaningful roles in the support systems that pregnant women need to achieve better maternal health outcomes. In Rwanda, the roles that men take vary, resulting in diverse expectations and responsibilities to support the health of women during this critical time. In this study, we aimed to examine the views, perspectives, and experiences of women on men’s involvement in maternal health and how this impacts access and utilization of maternal health services.MethodsWe conducted 21 interviews with pregnant and recently-pregnant women to gain an understanding of their views on men’s involvement in facilitating their partners’ health during pregnancy. Interviews were conducted across five Rwandan districts in both rural and urban settings of the country. Data analysis was guided by a thematic analysis approach. This started with independent transcript review by the investigators, after which a meeting was held to discuss emergent themes and to identify potential codes. A coding scheme was created and transcripts were coded in NVIVO™ software according to conceptual and practical topics that formed an understanding of men’s involvement in maternal care.ResultsThree key themes emerged during the analytic process that categorize the specific roles that men play in maternal health: 1) facilitating access to maternal health services, which involves assisting women with getting and or attending appointments jointly with men; 2) supporting women’s decisions, wherein men can support the decisions women make with regard to their maternal healthcare in a number of ways; and 3) evaluating information, including gathering information from multiple sources, especially from community health workers, to assist women with making informed decisions.ConclusionRwandan men take on three types of roles in supporting women’s maternal health, and their responsibilities are experienced differently by women. Interventions involving men are encouraged to increase their understanding of the implications of their involvement in maternal health without compromising women’s autonomy in decision-making and to promote positive maternal health outcomes.