Rwandan Women Research Articles

Intersectionalities of formality of marital status and women’s risk and protective factors for intimate partner violence in Rwanda

abstractIndashyikirwa is an intimate partner violence (IPV) prevention programme being implemented by CARE International Rwanda, Rwanda Women’s Network and Rwanda Men’s Resource Centre in Rwanda. One critical aspect of the programme is a 5-month curriculum to promote equitable, violence-free relationships among formally and informally married heterosexual couples. This article complements existing evidence in Rwanda around how formality of marital status influences women’s access to rights, social status, risk and protective factors for IPV, and highlights barriers to formalising marriage – primarily lack of financial means and gendered inequalities. It draws on research of Indashyikirwa, including interviews with 15 male and 15 female partners of formally and informally married couples, 9 community leaders, 3 women’s space facilitators, 9 staff members, 12 community activists and 24 focus groups with community members. Interviews and focus groups were conducted in Kinyarwanda, transcribed and translated into English, and analysed thematically. The findings indicate poor legal protection and related limited institutional responses for informally married women who experience IPV. An intersectional lens supports recommendations to address such inequalities, including raising awareness among women in informal marriages about strategies to ensure rights for themselves and their children, and to legally acknowledge informal unions after a certain period of cohabitation.

Self-reported pregnancy-related health problems and self-rated health status in Rwandan women postpartum: a population-based cross-sectional study.

BackgroundSelf-rated health status (SRH) can be used as a predictor of morbidity and mortality. Postpartum self-rated health has been used to estimate maternal morbidity and postpartum problems. Reproductive history factors are associated with poor self-rated health postpartum. This study investigated prevalence of self-reported health problems during first, second, and third trimesters of pregnancy, delivery, and postpartum. In addition, this study investigated SRH in Rwandan women up to 13 months from partus.MethodsThis population-based, cross-sectional study collected data in 2014 using structured interviews (N = 921). Univariable analysis was used to identify variables that were associated with poor self-rated health status (poor-SRH). Logistic regression analyses were performed to identify factors associated with poor-SRH at one day, one week, and one month postpartum and at the time of the interview.ResultsMean time between latest delivery and the time of interview was 7.1 months. Prevalence of anaemia, hypertension, diabetes mellitus during pregnancy, and severe bleeding during pregnancy and labour were 15.0, 4.9, 2.4, and 3.7 %, respectively. The prevalence of poor-SRH was 32.2 % at one day postpartum, 7.8 % at one month, and 11.7 % at time of the interview. Hypertension during pregnancy and significant postpartum haemorrhage were associated with poor-SRH at one day and one week postpartum. Severe bleeding during pregnancy and labour were associated with poor-SRH at one week and one month postpartum. Infection and anaemia during pregnancy were associated with poor-SRH at one month postpartum and at the time of interview. The Kaplan-Meier curves illustrate restitution of health for most women during the study period.ConclusionsThis population-based study reports a high prevalence of poor SRH status among Rwandan women in the early postpartum period. Identified factors associated with poor-SRH were severe bleeding, hypertension, infection, and anaemia during pregnancy and postpartum haemorrhage. These factors may be prevented or reduced by providing more frequent and specific attention during pregnancy and by providing timely measures that address complications during delivery, including adequate postpartum care.

Overweight or obesity prevalence, trends and risk factors among women in Rwanda: A cross-sectional study using the Rwanda Demographic and Health Surveys, 2000–2010

Objectives: Obesity has been a growing concern worldwide and in sub-Saharan Africa in particular. The objective of this study was to explore the prevalence of and secular trends in the rate of being overweight/obese in Rwandan women and the associated socio-demographic risk factors. Design: The study involved a secondary analysis of data from the Rwanda Demographic and Health Surveys (RDHSs) conducted in 2000, 2005 and 2010. These are countrywide, cross-sectional household studies conducted every five years. A stratified cluster sampling technique was used. Setting: A total of 10,421 women in 2000, 11,539 in 2005 and 12,540 in 2010 participated in the population based household surveys in Rwanda. Primary outcome measure: Participants whose body mass indexes were ≥25 kg/m2 were considered to be overweight/obese. Results: The prevalence of woman being overweight/obese increased from 13% in 2000 to 16.5% in 2010. The highest prevalence rates in 2010 were found in Kigali city (35%) and other urban areas (31.5%). Women with higher levels of education and from wealthier households were more likely to be overweight/obese. Using multivariable logistic regression analysis in the full model, the area of residence, wealth, religion and the number of household members were found to be significantly associated with being overweight/obese. In the adjusted model only the first three of these were still associated with a significantly increased risk. Conclusion: Being overweight/obese is becoming more common in Rwandan women, especially in those living in urban areas who are wealthy. Being overweight/obese is also associated with being Protestant. The reasons for this association are likely to be complex and require further study. Health awareness campaigns should recognise the importance of over-nutrition, as well as under nutrition, and should promote healthy diets and the importance of physical activity. Keywords: overweight, obesity, women, Rwanda

Trauma experienced in the genocide period in Rwanda, its mental health effects and barriers to care 17 years later: a study among men and women in Rwanda, 20-35 years of age

Trauma experienced in the genocide period in Rwanda, its mental health effects and barriers to care 17 years later: a study among men and women in Rwanda, 20-35 years of age

Bone quality assessed using quantitative ultrasound at the distal radius does not differ in antiretroviral therapy-naïve HIV-positive and HIV-negative Rwandan women.

The incidence of fractures appears to be increased in HIV-infected individuals. We assessed bone quality using quantitative ultrasound (QUS) in HIV-infected and uninfected Rwandan women. A Sunlight Omnisense 7000 QUS was used to measure the speed of ultrasound (SOS) at the distal radius in 646 antiretroviral therapy (ART)-naïve HIV-infected women and 211 HIV-uninfected women. The Z-scores for SOS were based on data for women of the same age from the manufacturer's reference material. The mean CD4 cell count was 285 (± 166) cells/μL in the HIV-positive women. SOS Z-scores adjusted and unadjusted for body mass index did not differ between the groups. SOS did not differ by CD4 count (< 200 vs. ≥ 200 cells/μL: 4016 (± 117) vs. 4028 (± 107) m/s, respectively; p=0.19. In HIV-positive ART-naïve Rwandan women with advanced HIV disease, bone quality at the distal radius was similar to that in HIV-negative controls.

Consuming Iron Biofortified Beans Increases Iron Status in Rwandan Women after 128 Days in a Randomized Controlled Feeding Trial

Background: Food-based strategies to reduce nutritional iron deficiency have not been universally successful. Biofortification has the potential to become a sustainable, inexpensive, and effective solution.Objective: This randomized controlled trial was conducted to determine the efficacy of iron-biofortified beans (Fe-Beans) to improve iron status in Rwandan women.Methods: A total of 195 women (aged 18–27 y) with serum ferritin <20 μg/L were randomly assigned to receive either Fe-Beans, with 86 mg Fe/kg, or standard unfortified beans (Control-Beans), with 50 mg Fe/kg, 2 times/d for 128 d in Huye, Rwanda. Iron status was assessed by hemoglobin, serum ferritin, soluble transferrin receptor (sTfR), and body iron (BI); inflammation was assessed by serum C-reactive protein (CRP) and serum α1-acid glycoprotein (AGP). Anthropometric measurements were performed at baseline and at end line. Random weekly serial sampling was used to collect blood during the middle 8 wk of the feeding trial. Mixed-effects regression analysis with repeated measurements was used to evaluate the effect of Fe-Beans compared with Control-Beans on iron biomarkers throughout the course of the study.Results: At baseline, 86% of subjects were iron-deficient (serum ferritin <15 μg/L) and 37% were anemic (hemoglobin <120 g/L). Both groups consumed an average of 336 g wet beans/d. The Fe-Beans group consumed 14.5 ± 1.6 mg Fe/d from biofortified beans, whereas the Control-Beans group consumed 8.6 ± 0.8 mg Fe/d from standard beans (P < 0.05). Repeated-measures analyses showed significant time-by-treatment interactions for hemoglobin, log serum ferritin, and BI (P < 0.05). The Fe-Beans group had significantly greater increases in hemoglobin (3.8 g/L), log serum ferritin (0.1 log μg/L), and BI (0.5 mg/kg) than did controls after 128 d. For every 1 g Fe consumed from beans over the 128 study days, there was a significant 4.2-g/L increase in hemoglobin (P < 0.05).Conclusion: The consumption of iron-biofortified beans significantly improved iron status in Rwandan women. This trial was registered at clinicaltrials.gov as NCT01594359.

Ten-year trends of syphilis in sero-surveillance of pregnant women in Rwanda and correlates of syphilis-HIV co-infection.

Syphilis can be transmitted by pregnant women to their children and is a public health problem in Africa. A cross-sectional survey was conducted in 24 antenatal clinics from 2002 to 2003 and increased to 30 sites from 2005 to 2011. Participants were tested for syphilis and HIV. Multi-variate logistic regression was performed to identify risks associated with syphilis and its co-infection with HIV. Results showed that syphilis decreased from 3.8% in 2002 to 2.0% in 2011. Syphilis in the HIV-infected participants increased from 6.0% in 2002 to 10.8% in 2011, but decreased from 3.7% to 1.7% in the HIV-negative participants. In 2011, syphilis in urban participants was 2.7% and 1.4% in rural ones. HIV-infected participants screened positive for syphilis more frequently in both rural (aOR = 3.64 [95% CI: 1.56%-8.51%]) and urban areas (aOR = 7.26 [95% CI: 5.04%-10.46%]). Older participants (25-49 years) residing in urban areas (aOR = 0.43[95% CI: 0.32%-0.58%]) and women with secondary or high education (aOR = 0.35[95% CI: 0.20%-0.62%]) were less likely to screen positive for syphilis. HIV-syphilis co-infection was more likely in women residing in urban areas (aOR = 8.32[95% CI: 3.54%-19.56%]), but less likely in women with secondary/high education (aOR = 0.11[95% CI: 0.01%-0.77%]). In conclusion, syphilis increased in HIV-positive pregnant women, but decreased in HIV-negative women. Positive HIV status and young age were associated risks for syphilis. HIV-syphilis co-infection was associated with a lower level of education and urban residence.

Gender Inequality Prevents Abused Women from Seeking Care Despite Protection Given in Gender-Based Violence Legislation: A Qualitative Study from Rwanda.

ObjectiveDespite its burden on a person’s life, Intimate Partner Violence (IPV) is known to be poorly recognised and managed in most countries and communities. This study aimed to explore health care professionals’ experiences of the health care seeking processes of women exposed to intimate partner violence in Rwanda.MethodsSix focus group discussions were conducted in three district hospitals and three mental health units in Rwanda. A sample of 43 health care professionals with various professions and length of work experience, who regularly took care of patients subjected to IPV, was selected for focus group discussions. The analysis was performed using qualitative content analysis.ResultsThe theme “Gendered norms and values defeat the violence legislation in women’s health care seeking when women are abused” expressed the health care professionals’ experiences of the double-faced situation which women exposed to IPV met in their help seeking process. Positive initiatives to protect women were identified, but the potential for abused women to seek help and support was reduced because of poverty, gender inequality with prevailing strong norms of male superiority, and the tendency to keep abuse as a private family matter.ConclusionLegislative measures have been instituted to protect women from abuse. Still many Rwandan women do not benefit from these efforts. The role of the health care services needs to be reinforced as an important and available resource for help and support for abused women but further legislative changes are also needed. Initiatives to further improve gender equality, and institutionalised collaboration between different sectors in society would contribute to protecting women from IPV.

Giving Voice to the Experiences of Rwandan Women With Urogenital Fistula

BackgroundUrogenital fistula is a debilitating condition that women can develop following obstructed labor. The primary objective of this study was to reveal illness narratives of Rwandan women with urogenital fistula to appreciate their unique experiences. The secondary aim was to identify common themes that emerged when women discussed their experiences living with fistula. MethodsWomen presenting for urogenital fistula repair at Kibagabaga Hospital were asked to participate in the study. Eleven participants were asked questions designed to elicit their understanding of their condition and the social and emotional consequences of their fistula. All interviews were anonymous. Transcribed interviews were examined for relative themes to categorize responses into larger domains. FindingsCommon themes were identified from the interviews on topics of what barriers existed to having a successful delivery, the socioeconomic and psychosocial consequences of developing a fistula, and each woman's understanding of her fistula. Excerpts from patients' illness narratives illustrated these themes. ConclusionsThese narratives can be used to appreciate the variations in each woman's understanding of her medical condition and the changes that occurred in her life as a result of her fistula. Through patients' narratives, physicians can improve their appreciation of cultural differences to design targeted educational and preventive interventions.

Genocide, masculinity and posttraumatic growth in Rwanda: reconstructing male identity through ndi umunyarwanda

ABSTRACTWhile the experiences of Rwandan women during and after the 1994 genocide have been studied quite extensively, little attention has been paid to the lives of men. Through an analysis of their testimonies, this article explores how Tutsi men experienced the 1994 genocide and how it has affected their identities. The analysis identifies three time periods where different versions of masculinity are expressed: the early stages of the genocide, where a predominantly warrior/military identity persisted; later stages of the genocide, during which men became aware of their vulnerability and the extent of the genocide; and the post-genocide period, in which masculinity has been rebuilt through the ideology of ndi umunyarwanda, the notion of Rwandanness or Rwandicity. Post-genocide male identity draws heavily on precolonial military values such as patriotism, dignity, unity and the importance of a strong army; however, the idealism of warriorhood has been lost. The emphasis of masculinity post-1994 appears to be on a shared culture and language and collectively working for one's country, not fighting for it. Indeed, there appears to be a complete aversion to violence of any kind, which, it is argued, is a form of posttraumatic growth. Another positive aspect of the change in male identity is the rejection of former colonial influences and their ideas in exchange for more authentic cultural expression and self-acceptance. The form of ndi umunyarwanda adopted by the men in this study is distinct from the government's version of this ideology, however, as these men reject the idea of forced apologies and reconciliation. In light of these findings, the article discusses the practical implications for those engaged in social work with survivors, and also calls for a more nuanced discussion of post-genocide Rwanda and the concept of Rwandicity.

Obstetric fistula management and predictors of successful closure among women attending a public tertiary hospital in Rwanda: a retrospective review of records.

BackgroundGlobally, 50,000–100,000 women develop obstetric fistula annually. At least 33,000 of these women live in Sub-Saharan Africa where limitations in quality obstetric care and fistula corrective repairs are prevalent. Among women with fistula seeking care at public health facilities in resource-limited settings, there is paucity of data on quality of care received. The aim of this study was to characterize obstetric fistula among Rwandan women managed at a public tertiary hospital and evaluate for predictors of successful fistula closures.MethodsA retrospective review of records for all obstetric fistula women managed at a public referral health facility between 2007 and 2013 was performed. Patient socio-demographics, obstetric characteristics and fistula repair outcomes data were reviewed. A multivariate logistic regression model was used to analyse for predictors of successful fistula repair outcomes.ResultsA total of 272 women aged between 16 to 78 years and with a mean age of 34.6 years were included. Of these, 93 (34.2 %), 48 (17.6 %), 65 (24 %) and 64 (23 %) women had vesico-vaginal fistula, recto-vaginal fistula, urethro-vaginal fistula and vesico-uteral fistula types, respectively. Successful fistula closure was achieved among 86.3 %. Women with fistula who reported being in labour for ≥3 days, having ≥1 previous fistula repair attempt, and having lived with the fistula for >1 year, had significantly lower odds of successful repair outcomes.ConclusionsAmong 272 women with obstetric fistula managed in this study, 69.5 and 26.5 % of their fistula were causally associated with obstructed labour complications and iatrogenic factors, respectively. Successful fistula closure rates of about 89 % among women of index repair attempt were achieved. Conversely, reported histories of ≥3 days in labour, ≥1 previous failed attempts at repair and a fistula duration of >1 year, were significant determinants of failed fistula closures. To effectively mitigate obstetric fistula burden in Rwanda, a comprehensive package of services including quality emergency obstetric care, increased availability of and access to quality fistula repair, active surveillance to identify community-based women with fistula and a strong political will towards effective fistula care, are recommended.

A multi-platform metabolomics approach identifies highly specific biomarkers of bacterial diversity in the vagina of pregnant and non-pregnant women.

Bacterial vaginosis (BV) increases transmission of HIV, enhances the risk of preterm labour, and is associated with malodour. Clinical diagnosis often relies on microscopy, which may not reflect the microbiota composition accurately. We use an untargeted metabolomics approach, whereby we normalize the weight of samples prior to analysis, to obtained precise measurements of metabolites in vaginal fluid. We identify biomarkers for BV with high sensitivity and specificity (AUC = 0.99) in a cohort of 131 pregnant and non-pregnant Rwandan women, and demonstrate that the vaginal metabolome is strongly associated with bacterial diversity. Metabolites associated with high diversity and clinical BV include 2-hydroxyisovalerate and γ-hydroxybutyrate (GHB), but not succinate, which is produced by both Lactobacillus crispatus and BV-associated anaerobes in vitro. Biomarkers associated with high diversity and clinical BV are independent of pregnancy status, and were validated in a blinded replication cohort from Tanzania (n = 45), where we predicted clinical BV with 91% accuracy. Correlations between the metabolome and microbiota identified Gardnerella vaginalis as a putative producer of GHB, and we demonstrate production by this species in vitro. This work illustrates how changes in community structure alter the chemical composition of the vagina, and identifies highly specific biomarkers for a common condition.

Studies of Cream Seeded Carioca Beans (Phaseolus vulgaris L.) from a Rwandan Efficacy Trial: In Vitro and In Vivo Screening Tools Reflect Human Studies and Predict Beneficial Results from Iron Biofortified Beans.

Iron (Fe) deficiency is a highly prevalent micronutrient insufficiency predominantly caused by a lack of bioavailable Fe from the diet. The consumption of beans as a major food crop in some populations suffering from Fe deficiency is relatively high. Therefore, our objective was to determine whether a biofortified variety of cream seeded carioca bean (Phaseolus vulgaris L.) could provide more bioavailable-Fe than a standard variety using in-vivo (broiler chicken, Gallus gallus) and in-vitro (Caco-2 cell) models. Studies were conducted under conditions designed to mimic the actual human feeding protocol. Two carioca-beans, a standard (G4825; 58μg Fe/g) and a biofortified (SMC; 106μg Fe/g), were utilized. Diets were formulated to meet the nutrient requirements of Gallus gallus except for Fe (33.7 and 48.7μg Fe/g, standard and biofortified diets, respectively). In-vitro observations indicated that more bioavailable-Fe was present in the biofortified beans and diet (P<0.05). In-vivo, improvements in Fe-status were observed in the biofortified bean treatment, as indicated by the increased total-body-Hemoglobin-Fe, and hepatic Fe-concentration (P<0.05). Also, DMT-1 mRNA-expression was increased in the standard bean treatment (P<0.05), indicating an upregulation of absorption to compensate for less bioavailable-Fe. These results demonstrate that the biofortified beans provided more bioavailable Fe; however, the in vitro results revealed that ferritin formation values were relatively low. Such observations are indicative of the presence of high levels of polyphenols and phytate that inhibit Fe absorption. Indeed, we identified higher levels of phytate and quercetin 3–glucoside in the Fe biofortified bean variety. Our results indicate that the biofortified bean line was able to moderately improve Fe-status, and that concurrent increase in the concentration of phytate and polyphenols in beans may limit the benefit of increased Fe-concentration. Therefore, specific targeting of such compounds during the breeding process may yield improved dietary Fe-bioavailability. Our findings are in agreement with the human efficacy trial that demonstrated that the biofortified carioca beans improved the Fe-status of Rwandan women. We suggest the utilization of these in vitro and in vivo screening tools to guide studies aimed to develop and evaluate biofortified staple food crops. This approach has the potential to more effectively utilize research funds and provides a means to monitor the nutritional quality of the Fe-biofortified crops once released to farmers.

008.6 The gendered influence of stigma on hiv testing behaviour: results from a population-based survey of women and men in rwanda

Objective Stigmatisation is a multifaceted process, and distinct domains of stigma may impact HIV testing behaviour differently. We examined the relationship between two stigma domains and HIV testing behaviour among Rwandan men and women who participated in a population-based survey in 2011. Methods We conducted multivariable logistic regression with data from 4,669 Rwandan women (N = 2613) and men (N = 2,056) aged 15 years and older to predict ‘ever tested for HIV’. Independent variables included sociodemographics, knowledge of and proximity to HIV, and two stigma domains, ‘drivers’ (fear of HIV infection through casual contact with PLHIV) and ‘manifestations’ (anticipated and perceived stigma, shame and discriminatory attitudes). All analyses were disaggregated by gender. Results Three quarters of women and men reported ever testing for HIV. Sociodemographic variables significantly associated with HIV testing behaviour included: age, secondary (women only) and post-secondary education (both genders), complete knowledge of HIV [women only, OR: 1.52, 95% CI: 1.20–1.96], frequent trips outside the community (men only), and proximity (personally knowing a PLHIV) [women, OR: 1.66, 95% CI: 1.22–2.25; men, OR: 1.89, 95% CI: 1.36 – 2.60]. Fear of becoming infected with HIV via contact with saliva was the only stigma variable significantly associated with testing behaviour for women [OR: 0.68, 95% CI: 0.49 – 0.94]. For men, holding a discriminatory attitude was the only stigma variable significantly associated with testing behaviour [OR: 0.63, 95% CI: 0.41–0.98]. Socioeconomic status and residence were not significantly associated with HIV testing behaviour for either gender. Conclusion These findings demonstrate that drivers and manifestations of stigma influence HIV testing behaviour differently for women and men, suggesting the need for tailored interventions, including stigma-reduction components, to increase HIV testing among both genders in Rwanda. Targeted interventions are also needed to increase testing among adolescents (15–24) and older (50+) men and women. Disclosure of interest statement Nothing to declare.

When “Bright Futures” Fade: Paradoxes of Women’s Empowerment in Rwanda

AbstractSince the 1994 genocide, Rwanda has emerged as a global model for the promotion of women in society. Today, Rwanda has progressive gender-sensitive laws, more girls than boys in primary school, and the world’s highest percentage of women in parliament. But has this national-level progress manifested in an actual improvement in the lives of ordinary Rwandan women? If not, what has prevented these rights-based empowerment efforts from taking hold? Drawing from interviews with 152 women at all levels of Rwandan society, this article illustrates the contradictory and complicated nature of women’s empowerment efforts. It identifies three paradoxes that capture how efforts to promote women can be undermined by deeply rooted social processes. First, women are granted new rights but cannot access them unless they are married, which further reinforces their dependence on men. Second, policies aim to empower women through education but have unintended consequences that create new forms of oppression. Third,...

O13.4 Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier

Introduction Vaginal microbiome (VMB) dysbiosis is associated with increased acquisition of HIV and sexually transmitted infections (STIs). Cervicovaginal inflammation and other changes to the mucosal barrier are thought to play important roles but human data are scarce. In this study, we compared the cervicovaginal proteome among women with different VMB compositions. Methods Cervicovaginal lavages of 50 Rwandan female sex workers with known VMB composition were selected for human proteome analysis using mass-spectrometry. These women were previously clustered into four VMB groups in order of increasing bacterial diversity: group 1 had a Lactobacillus crispatus-dominated VMB; group 2 a L. iners -dominated VMB; group 3 moderate dysbiosis; and group 4 severe dysbiosis. We compared relative protein abundances among these VMB groups using targeted (abundance of pre-defined mucosal barrier proteins) and untargeted (differentially abundant proteins among all human proteins identified) approaches. Results With increasing bacterial diversity, we found: mucus alterations (increasing mucin 5B and 5AC), cytoskeleton alterations (increasing actin-organising proteins; decreasing keratins and cornified envelope proteins), increasing cell death (using LDHA/B as biomarkers of cell death), altered proteolytic activity (increasing proteasome core complex proteins/proteases; decreasing antiproteases), altered antimicrobial peptide balance (increasing psoriasin, calprotectin, and histones; decreasing lysozyme and ubiquitin), increasing proinflammatory cytokines, and decreasing immunoglobulins IgG1/2. Conclusion The VMB is strongly associated with the cervicovaginal human proteome in this cohort of Rwandan women at high risk of HIV and other STIs. Although temporal relationships cannot be derived, our findings support the hypothesis that dysbiosis causes cervicovaginal inflammation and other detrimental changes to the mucosal barrier that may lead to increased HIV/STI acquisition. Disclosure of interest statement This work was funded by the Institute of Infection and Global Health of the University of Liverpool, the Aids Fonds Netherlands (project number 201102), European and Developing Countries Clinical Trials Partnership (project number CT.2005.33070.001) and the European Commission (CHAARM consortium). The authors declare no conflicts of interest.

The legacy of gender-based violence and HIV/AIDS in the postgenocide era: Stories from women in Rwanda

ABSTRACTDrawing on qualitative interviews with 22 Rwandan women, we describe the lived experiences of women survivors of gender-based violence (GBV) more than a decade and a half after the 1994 Genocide. We argue that the intersection between GBV and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) has long-term implications: the majority of women interviewed continue to endure trauma, stigma, social isolation, and economic hardship in the postgenocide era and are in need of expanded economic and mental health support. Our findings have implications for the importance of providing integrated psychosocial support to survivors of GBV postconflict contexts.

A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014.

ObjectiveTo systematically review current smoking prevalence among adults in sub-Saharan Africa from 2007 to May 2014 and to describe the context of tobacco control strategies in these countries.Data SourcesFive databases, Medline, Embase, Africa-wide Information, Cinahl Plus, and Global Health were searched using a systematic search strategy. There were no language restrictions.Study Selection26 included studies measured current smoking prevalence in nationally representative adult populations in sub-Saharan African countries.Data ExtractionStudy details were independently extracted using a standard datasheet. Data on tobacco control policies, taxation and trends in prices were obtained from the Implementation Database of the WHO FCTC website.ResultsStudies represented 13 countries. Current smoking prevalence varied widely ranging from 1.8% in Zambia to 25.8% in Sierra Leone. The prevalence of smoking was consistently lower in women compared to men with the widest gender difference observed in Malawi (men 25.9%, women 2.9%). Rwanda had the highest prevalence of women smokers (12.6%) and Ghana had the lowest (0.2%). Rural, urban patterns were inconsistent. Most countries have implemented demand-reduction measures including bans on advertising, and taxation rates but to different extents.ConclusionSmoking prevalence varied widely across sub-Saharan Africa, even between similar country regions, but was always higher in men. High smoking rates were observed among countries in the eastern and southern regions of Africa, mainly among men in Ethiopia, Malawi, Rwanda, and Zambia and women in Rwanda and rural Zambia. Effective action to reduce smoking across sub-Saharan Africa, particularly targeting population groups at increased risk remains a pressing public health priority.

Investigating the association between pregnancy intention and insecticide-treated bed net (ITN) use: a cross-sectional study of pregnant women in Rwanda

Aim To examine how pregnancy intention may be related to insecticide-treated bed net (ITN) use among pregnant women in Rwanda.

From Violence to Mobilization: Women, War, and Threat in Rwanda*

Theories of social movement emergence posit “threat” as an important concept in explanations of mobilization. This article uses the case of the 1994 Rwandan genocide to investigate whether threats that stem from mass violence can also have a mobilizing effect. Drawing from interviews with 152 women in Rwanda, I reveal how threatening conditions created by the genocide and civil war initiated a grassroots mobilization process among women. This mobilization featured women founding and joining community organizations, engaging in new forms of claims making toward state institutions, and eventually running for political office. Two mechanisms facilitated this process: the social appropriation of feminine values for the reconceptualization of women as legitimate political actors, and the brokerage of connections between individual women, organizations, and government institutions by foreign actors. I conclude by suggesting that this mobilization served as a necessary, but not sufficient, condition for the meteoric rise of women in Rwanda's politics.