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Kigali, Rwanda

Ngendahayo E.,King Faisal Specialist Hospital And Research Center | Bonane A.,UTH of Kigali | Gasana G.A.,Rwanda Military Hospital | Ssebuufu R.,UTH of Butare | And 2 more authors.
Rwanda Medical Journal | Year: 2013

Results: Knowledge of the disease’s burden and risk factors will surely influence education programs about penile hygiene, will reinforce the benefit of childhood circumcision and may influence decision makers to consider also male vaccination against HPV.Background: Cancer of the penis is rare in developed countries, but it may represent 20-30% of all cancers diagnosed in men in the developing world. In Rwanda, a recent four year retrospective patients’ charts review at University Teaching Hospital of Kigali revealed that 31 patients presented with invasive squamous cell carcinoma of the penis. About ninety per cent of them underwent penile amputation. An overall substandard data record and management was observed. The aim of this research project is to determine the clinical presentation and staging, the risk factors, the histology types, the quality of life and the postoperative 2-year outcome of penile cancer among Rwandans.Methodology: This is a multicenter prospective analytical case series study involving all male patients presenting at three University Teaching Hospitals in Kigali (CHUK, RMH, and KFH) and the University Teaching Hospital of Butare (CHUB) with penile cancer. It is a 4-year period study, including a 2-year post-treatment follow up. Patient’s characteristics, clinical presentation and presumed risk factors of the disease will be recorded. The management using standardized guidelines, the quality of life and the outcome variables will be recorded on a standardized questionnaire. A multivariate analysis will be used to determine whether phimosis, HPV infection, smoking, chronic inflammatory conditions, lack of childhood circumcision and lack of regular subpreputial hygiene are predictors of penile cancer. © 2014 Bioline International. All rights reserved. Source

Skelton T.,University of Toronto | Nshimyumuremyi I.,University of Rwanda | Mukwesi C.,Rwanda Military Hospital | Whynot S.,Dalhousie University | And 2 more authors.
Anesthesia and Analgesia | Year: 2016

Background: Safe anesthesia care is challenging in developing countries where there are shortages of personnel, drugs, equipment, and training. Anesthetists' Non-technical Skills (ANTS) - task management, team working, situation awareness, and decision making - are difficult to practice well in this context. Cesarean delivery is the most common surgical procedure in inf-Saharan Africa. This pilot study investigates whether a low-cost simulation model, with good psychological fidelity, can be used effectively to teach ANTS during cesarean delivery in Rwanda. Methods: Study participants were anesthesia providers working in a tertiary referral hospital in Rwanda. Baseline observations were conducted for 20 anesthesia providers during cesarean delivery using the established ANTS framework. After the first observation set was complete, participants were randomly assigned to either simulation intervention or control groups. The simulation intervention group underwent ANTS training using low-cost high psychological fidelity simulation with debriefing. No training was offered to the control group. Postintervention observations were then conducted in the same manner as the baseline observations. RESULTS: The primary outcome was the overall ANTS score (maximum, 16). The median (range) ANTS score of the simulation group was 13.5 (11-16). The ANTS score of the control group was 8 (8-9), with a statistically significant difference (P =.002). Simulation participants showed statistically significant improvement in infcategories and in the overall ANTS score compared with ANTS score before simulation exposure. CONCLUSIONS: Rwandan anesthesia providers show improvement in ANTS practice during cesarean delivery after 1 teaching session using a low-cost high psychological fidelity simulation model with debriefing. © 2016 International Anesthesia Research Society. Source

Bitwayiki R.,University Teaching Hospital | Bitwayiki R.,College of Medicine and Health Sciences, University of Rwanda | Orikiiriza J.T.,Rwanda Military Hospital | Orikiiriza J.T.,Makerere University | And 8 more authors.
South African Medical Journal | Year: 2015

Background. Dyspepsia has been demonstrated worldwide to have major personal and societal impacts, but data on the burden of this disease in Africa are lacking. Objective. To document the prevalence of dyspepsia and its quality-of-life impact among healthcare workers (HCWs) at Butare University Teaching Hospital (BUTH), Rwanda. Methods. A cross-sectional survey among consenting HCWs at BUTH was conducted. Multilingual interviewers guided participants through validated questionnaires, including the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), to detect the presence and frequency of dyspeptic symptoms, and the Short-Form Nepean Dyspepsia Index (SF-NDI), to examine the impact of dyspepsia on quality of life. Results. The study included 378 enrolled HCWs, all of whom provided responses to the SF-LDQ and 356 of whom responded to the SF-NDI. The prevalence of dyspepsia in the study population was 38.9% (147/378). Of these 147 HCWs, 79 (53.7%) had very mild dyspepsia, 33 (22.4%) had mild dyspepsia, 20 (13.6%) had moderate dyspepsia and 15 (10.2%) had severe dyspepsia. Females were more likely to complain of dyspepsia than males (98/206 v. 49/172; odds ratio (OR) 2.3; 95% confidence interval (CI) 1.5 - 3.5; p<0.001). Participants with dyspepsia of at least mild severity had SF-NDI scores reflecting reduced quality of life when compared with non-dyspeptic participants (OR 17.0; 95% CI 5.0 - 57.1; p<0.001), with most marked effects on the ‘tension’ and ‘eating and drinking’ subdomains of the SF-NDI. Conclusion. The prevalence of dyspepsia among HCWs in Rwanda is high and is associated with lowered quality of life. © 2015, South African Medical Association. All rights reserved. Source

Mutimura E.,Regional Alliance for Sustainable Development | Addison D.,The New School | Anastos K.,Yeshiva University | Hoover D.,Rutgers University | And 6 more authors.
AIDS | Year: 2015

Background: Initiation of antiretroviral therapy (ART) in the advanced stages of HIV infection remains a major challenge in sub-Saharan Africa. This study was conducted to better understand barriers and enablers to timely ART initiation in Rwanda where ART coverage is high and national ART eligibility guidelines first expanded in 2007-2008. Methods: Using data on 6326 patients (≥15 years) at five Rwandan clinics, we assessed trends and correlates of CD4+ cell count at ART initiation and the proportion initiating ART with advanced HIV disease (CD4+ < 200 cells/μl or WHO stage IV) . Results: Out of 6326 patients, 4486 enrolling in HIV care initiated ART with median CD4+ cell count of 211 cells/μl [interquartile range: 131-300]. Median CD4+ cell counts at ART initiation increased from 183 cells/ml in 2007 to 293 cells/ml in 2011-2012, and the proportion with advanced HIV disease decreased from 66.2 to 29.4%. Factors associated with a higher odds of advanced HIV disease at ART initiation were male sex [adjusted odds ratios (AOR)=1.7; 95% confidence interval (CI): 1.3-2.1] and older age (AOR46-55+ vs. <25=2.3; 95% CI: 1.2-4.3). Among those initiating ART more than 1 year after enrollment in care, those who had a gap in care of 12 or more months prior to ART initiation had higher odds of advanced HIV disease (AOR=5.2; 95% CI: 1.2-21.1) . Conclusion: Marked improvements in the median CD4+ cell count at ART initiation and proportion initiating ART with advanced HIV disease were observed following the expansion of ART eligibility criteria in Rwanda. However, sex disparities in late treatment initiation persisted through 2011-2012, and appeared to be driven by later diagnosis and/or delayed linkage to care among men . © 2014 Wolters Kluwer Health. © Lippincott Williams & Wilkins. Source

Silverstein A.,Rwanda Military Hospital | Silverstein A.,Harvard University | Silverstein A.,University of Miami | Mugenzi P.,Rwanda Military Hospital | And 4 more authors.
Journal of Cancer Policy | Year: 2016

Introduction: While cancer is a leading cause of morbidity and mortality globally with an increasing burden on low- and middle-income countries (LMICs), these countries lack the appropriate funding and resources to care for cancer patients and conduct relevant research. The purpose of this study is to describe the challenges faced by a Rwandan research team looking to describe gastric cancer, the third most common cancer in terms of incidence and mortality in LMICs. We aim to use these lessons to not only highlight the need for growth in data management but also to provide suggestions on ways to achieve such improvement. Methods: A retrospective review at a single institution in Rwanda. Patient information was found and collected from eight different hospital sources for all patients diagnosed with gastric cancer or presenting with symptoms suggestive of possible gastric cancer etiology since October 2012. Results: The team identified 125 patients who were separated into 27 unique groups based on the sources in which they were found. The greatest number of sources in which any patient was found was five (n = 1). 76.0% of patients were located in the EMR (n = 95). Discussion: Challenges to obtain comprehensive patient information are prohibitive for the cancer research development needed in LMICs. In order to meet this need, documentation should be more standardized and reflect coordinated care. Through widespread implementation of institutional EMR systems, future scale up to national cancer registries that inform and reflect national cancer care plans is possible. © 2015 Elsevier Ltd. Source

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