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Hunjan I, Umulisa A, Parati G, Bianchetti MG, Milani GP, Muvunyi B, Ntaganda E, Radovanovic D, Stroppa C, Suter P, Muggli F. Blood pressure screening in Mata Sector, a rural area of Rwanda. J Hum Hypertens 2024:10.1038/s41371-024-00912-7. [PMID: 38658710 DOI: 10.1038/s41371-024-00912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
In rural sub-Saharan Africa, knowledge of non-communicable diseases such as high blood pressure (BP) is rather limited. This report provides information about a BP screening in Mata Sector, a rural region in Southern Province of Rwanda. Community-based, house-to-house screening was performed between February and July 2020 on more than 7000 inhabitants. The screening was conducted by a local team composed by 20 community health care workers, five community health care supervisors, and one nurse with hypertension surveillance training. BP and heart rate were recorded after 5 min of resting, using a validated automated oscillometric OMRON M6 IT-HEM-7322-E monitor with Intelli Wrap Cuff (HEM-FL31-E) technology. The mean of the second and third value was retained. BP was normal (<140/90 mm Hg) in 6340 (88%) and elevated in 863 (12%) participants with 95% of unawareness. Grade 1 (140-159/90-99 mm Hg) hypertensive BP readings were detected in 697 (81%), grade 2 (160-179/100-109 mm Hg) in 134 (16%), and grade 3 (≥180/≥110 mm Hg) in 32 (3.7%) individuals. The prevalence of hypertensive readings was significantly age-dependent. Additionally, a slightly greater proportion of participants with high BP (14% versus 11%) had a body mass index (BMI) ≥ 25.0 kg/m2. Also resting heart rate was higher in individuals with high BP (82 versus 77 beats/min). Although individuals identified with occasionally elevated BP values need further confirmatory measurements to establish the diagnosis of hypertension, these data suggest that high BP represents a noteworthy and preventable reason of concern within sub-Saharan Africa.
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Affiliation(s)
- Isabella Hunjan
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alice Umulisa
- Health Care Centre of Nyamyumba, District of Nyaruguru, Nyamyumba, Rwanda
| | - Gianfranco Parati
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy.
| | - Mario G Bianchetti
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Bienvenu Muvunyi
- Medical Specialized Services, King Faisal Hospital, Kigali, Rwanda
| | - Evariste Ntaganda
- Cardiovascular diseases Unit, Non-communicable diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Dragana Radovanovic
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Clara Stroppa
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Paolo Suter
- Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Franco Muggli
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Niyibizi JB, Ntawuyirushintege S, Nganabashaka JP, Umwali G, Tumusiime D, Ntaganda E, Rulisa S, Bavuma CM. Community Health Worker-Led Cardiovascular Disease Risk Screening and Referral for Care and Further Management in Rural and Urban Communities in Rwanda. Int J Environ Res Public Health 2023; 20:ijerph20095641. [PMID: 37174161 PMCID: PMC10178163 DOI: 10.3390/ijerph20095641] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
Cardiovascular disease (CVD) is a global health issue. Low- and middle-income countries (LMICs) are facing early CVD-related morbidity. Early diagnosis and treatment are an effective strategy to tackle CVD. The aim of this study was to assess the ability of community health workers (CHWs) to screen and identify persons with high risks of CVD in the communities, using a body mass index (BMI)-based CVD risk assessment tool, and to refer them to the health facility for care and follow-up. This was an action research study conducted in rural and urban communities, conveniently sampled in Rwanda. Five villages were randomly selected from each community, and one CHW per each selected village was identified and trained to conduct CVD risk screening using a BMI-based CVD risk screening tool. Each CHW was assigned to screen 100 fellow community members (CMs) for CVD risk and to refer those with CVD risk scores ≥10 (either moderate or high CVD risk) to a health facility for care and further management. Descriptive statistics with Pearson's chi-square test were used to assess any differences between rural and urban study participants vis-à-vis the key studied variables. Spearman's rank coefficient and Cohen's Kappa coefficient were mainly used to compare the CVD risk scoring from the CHWs with the CVD risk scoring from the nurses. Community members aged 35 to 74 years were included in the study. The participation rates were 99.6% and 99.4% in rural and urban communities, respectively, with female predominance (57.8% vs. 55.3% for rural and urban, p-value: 0.426). Of the participants screened, 7.4% had a high CVD risk (≥20%), with predominance in the rural community compared to the urban community (8.0% vs. 6.8%, p-value: 0.111). Furthermore, the prevalence of moderate or high CVD risk (≥10%) was higher in the rural community than in the urban community (26.7% vs. 21.1%, p-value: 0.111). There was a strong positive correlation between CHW-based CVD risk scoring and nurse-based CVD risk scoring in both rural and urban communities, 0.6215 (p-value < 0.001) vs. 0.7308 (p-value = 0.005). In regard to CVD risk characterization, the observed agreement to both the CHW-generated 10-year CVD risk assessment and the nurse-generated 10-year CVD risk assessment was characterized as "fair" in both rural and urban areas at 41.6% with the kappa statistic of 0.3275 (p-value < 001) and 43.2% with kappa statistic of 0.3229 (p-value =0.057), respectively. In Rwanda, CHWs can screen their fellow CMs for CVD risk and link those with high CVD risk to the healthcare facility for care and follow-up. CHWs could contribute to the prevention of CVDs through early diagnosis and early treatment at the bottom of the health system.
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Affiliation(s)
- Jean Berchmans Niyibizi
- College of Medicine and Health Sciences, University of Rwanda, Kigali 4285, Rwanda
- Global Public Health, Karolinska Institute, 171 77 Stockholm, Sweden
| | | | | | - Ghislaine Umwali
- College of Medicine and Health Sciences, University of Rwanda, Kigali 4285, Rwanda
| | - David Tumusiime
- College of Medicine and Health Sciences, University of Rwanda, Kigali 4285, Rwanda
| | - Evariste Ntaganda
- Non-Communicable Diseases Division, Rwanda Biomedical Center, Kigali 7162, Rwanda
| | - Stephen Rulisa
- College of Medicine and Health Sciences, University of Rwanda, Kigali 4285, Rwanda
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Niyibizi JB, Okop KJ, Nganabashaka JP, Umwali G, Rulisa S, Ntawuyirushintege S, Tumusiime D, Nyandwi A, Ntaganda E, Delobelle P, Levitt N, Bavuma CM. Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: a qualitative study. BMC Public Health 2022; 22:920. [PMID: 35534821 PMCID: PMC9088034 DOI: 10.1186/s12889-022-13330-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background In Rwanda, cardiovascular diseases (CVDs) are the third leading cause of death, and hence constitute an important public health issue. Worldwide, most CVDs are due to lifestyle and preventable risk factors. Prevention interventions are based on risk factors for CVD risk, yet the outcome of such interventions might be limited by the lack of awareness or misconception of CVD risk. This study aimed to explore how rural and urban population groups in Rwanda perceive CVD risk and tailor communication strategies for estimated total cardiovascular risk. Methods An exploratory qualitative study design was applied using focus group discussions to collect data from rural and urban community dwellers. In total, 65 community members took part in this study. Thematic analysis with Atlas ti 7.5.18 was used and the main findings for each theme were reported as a narrative summary. Results Participants thought that CVD risk is due to either financial stress, psychosocial stress, substance abuse, noise pollution, unhealthy diets, diabetes or overworking. Participants did not understand CVD risk presented in a quantitative format, but preferred qualitative formats or colours to represent low, moderate and high CVD risk through in-person communication. Participants preferred to be screened for CVD risk by community health workers using mobile health technology. Conclusion Rural and urban community members in Rwanda are aware of what could potentially put them at CVD risk in their respective local communities. Community health workers are preferred by local communities for CVD risk screening. Quantitative formats to present the total CVD risk appear inappropriate to the Rwandan population and qualitative formats are therefore advisable. Thus, operational research on the use of qualitative formats to communicate CVD risk is recommended to improve decision-making on CVD risk communication in the context of Rwanda. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13330-6.
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Affiliation(s)
- Jean Berchmans Niyibizi
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda.
| | - Kufre Joseph Okop
- Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jean Pierre Nganabashaka
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda
| | - Ghislaine Umwali
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda
| | - Stephen Rulisa
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda.,Kigali University Teaching Hospital, Kigali, Rwanda
| | - Seleman Ntawuyirushintege
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda
| | - David Tumusiime
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda
| | | | | | - Peter Delobelle
- Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, Cape Town, South Africa.,Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Naomi Levitt
- Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Charlotte M Bavuma
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda.,Kigali University Teaching Hospital, Kigali, Rwanda
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Ntaganda E, Mugeni R, Harerimana E, Ngoga G, Dusabeyezu S, Uwinkindi F, Utumatwishima JN, Mutimura E, Davila-Roman VG, Schechtman K, Nishimwe A, Twizeyimana L, Brown AL, Cade WT, Bushaku M, de Las Fuentes L, Reeds D, Twagirumukiza M. High rates of undiagnosed and uncontrolled hypertension upon a screening campaign in rural Rwanda: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:197. [PMID: 35473501 PMCID: PMC9044706 DOI: 10.1186/s12872-022-02606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hypertension remains the major risk factor for cardiovascular diseases (CVDs) worldwide with a prevalence and mortality in low- and middle-income countries (LMICs) among the highest. The early detection of hypertension risk factors is a crucial pillar for CVD prevention. Design and method This cross-sectional study included 4284 subjects, mean age 46 ± 16SD, 56.4% females and mean BMI 26.6 ± 3.7 SD. Data were collected through a screening campaign in rural area of Kirehe District, Eastern of Rwanda, with the objective to characterize and examine the prevalence of elevated blood pressure (BP) and other CVD risk factors. An adapted tool from the World Health Organization STEPwise Approach was used for data collection. Elevated BP was defined as ≥ 140/90 mm/Hg and elevated blood glucose as blood glucose ≥ 100 mg/dL after a 6-h fast. Results Of the sampled population, 21.2% (n = 910) had an elevated BP at screening; BP was elevated among individuals not previously known to have HTN in 18.7% (n = 752). Among individuals with a prior diagnosis of HTN, 62.2% (n = 158 of 254) BP was uncontrolled. Age, weight, smoking, alcohol history and waist circumference were associated with BP in both univariate analyses and multivariate analysis.
Conclusion High rates of elevated BP identified through a health screening campaign in this Rwandan district were surprising given the rural characteristics of the district and relatively low population age. These data highlight the need to implement an adequate strategy for the prevention, diagnosis, and control of HTN that includes rural areas of Rwanda as part of a multicomponent strategy for CVD prevention.
Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02606-9.
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Affiliation(s)
- Evariste Ntaganda
- Rwanda Biomedical Center (RBC), Rwanda Ministry of Health, Kigali, Rwanda
| | - Regine Mugeni
- Rwamagana Provincial Hospital, Rwamagana, Eastern Province, Rwanda.
| | | | - Gedeon Ngoga
- Partners in Health (PIH)/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | - Francois Uwinkindi
- Rwanda Biomedical Center (RBC), Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Eugene Mutimura
- National Council for Science and Technology (NCST), Kigali, Rwanda
| | - Victor G Davila-Roman
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kenneth Schechtman
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Aurore Nishimwe
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda.,School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Angela L Brown
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - W Todd Cade
- Duke University School of Medicine, Durham, NC, 27710, USA
| | - Marcus Bushaku
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda
| | - Lisa de Las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Dominic Reeds
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Marc Twagirumukiza
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Niyibizi JB, Nganabashaka JP, Ntawuyirushintege S, Tumusiime D, Umwali G, Rulisa S, Nyandwi A, Okop KJ, Ntaganda E, Sell K, Levitt N, Jessani NS, Bavuma CM. Using Citizen Science Within an Integrated Knowledge Translation (IKT) Approach to Explore Cardiovascular Disease Risk Perception in Rwanda. Front Trop Dis 2021. [DOI: 10.3389/fitd.2021.752357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundCollaborative approaches to generating knowledge between knowledge users (KUs) and researchers as a means of enhancing evidence-informed decision making have been gaining ground over the last few years. The principal study targeted rural and urban communities within the catchment areas of Cyanika health centre (Burera district, Northern Province) and Kacyiru health centre (Gasabo district, in City of Kigali), respectively to understand perceptions and preferences of communication with respect to cardiovascular disease (CVD) risk in Rwanda. This paper describes the integration of citizen science within an integrated knowledge translation (IKT) approach for this study.MethodsThe citizen science approach included deliberate, selective and targeted engagement of KUs at various steps throughout the study. It incorporated national and district levels stakeholders, primary health care stakeholders, local community leaders and influencers, and local community members (selected and trained to be termed citizen scientists) in the process of implementation. Data for this paper included minutes, reports and notes from meetings and workshops which were perused to report the immediate outcomes and challenges of citizen science within an IKT approach for a study such as described for Rwanda.ResultsAs a result of a deliberate IKT strategy, key national stakeholders attended and contributed to all phases of citizen science implementation. Project-based and relationship-based immediate outcomes were documented. In line with local community health issues reported by the citizen scientists, the local community stakeholders pledged home grown solutions. These included enhancement of compliance to implement the “kitchen garden per household” policy, teaching local residents on preparation of healthy diet from locally available food items, organizing collective physical activity, fighting against locally made substandard beverages and teaching local residents on CVD (risk factors). As an indicator of the probable uptake of research evidence, district officials appreciated citizen scientists’ work and decided to consider presented results in their next fiscal year action plan.ConclusionCitizen science proved to be an important strategy for research co-production in Rwanda. While this strategy falls within the remit of a larger IKT approach it focuses on the role and ownership of research by local community residents. This study demonstrated that to improve the relevance and impact of research in local community a deliberate IKT approach that incorporates citizen science can be invaluable.
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Niyonsenga SP, Park PH, Ngoga G, Ntaganda E, Kateera F, Gupta N, Rwagasore E, Rwunganira S, Munyarugo A, Mutumbira C, Dusabayezu S, Eagan A, Boudreaux C, Noble C, Muhimpundu MA, Ndayisaba FG, Nsanzimana S, Bukhman G, Uwinkindi F. Implementation outcomes of national decentralization of integrated outpatient services for severe non-communicable diseases to district hospitals in Rwanda. Trop Med Int Health 2021; 26:953-961. [PMID: 33892521 PMCID: PMC8453822 DOI: 10.1111/tmi.13593] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Effective coverage of non-communicable disease (NCD) care in sub-Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first-level hospitals. This study describes the facility-level implementation outcomes of this strategy. METHODS In 2014, the Ministry of Health trained two nurses in each of the country's 42 first-level hospitals to implement and deliver nurse-led, integrated, outpatient NCD clinics, which focused on severe NCDs. Post-intervention evaluation occurred via repeated cross-sectional surveys, informal interviews and routinely collected clinical data over two rounds of visits in 2015 and 2017. Implementation outcomes included fidelity, feasibility and penetration. RESULTS By 2017, all NCD clinics were staffed by at least one NCD-trained nurse. Among the approximately 27 000 nationally enrolled patients, hypertension was the most common diagnosis (70%), followed by type 2 diabetes (19%), chronic respiratory disease (5%), type 1 diabetes (4%) and heart failure (2%). With the exception of warfarin and beta-blockers, national essential medicines were available at more than 70% of facilities. Clinicians adhered to clinical protocols at approximately 70% agreement with evaluators. CONCLUSION The government of Rwanda was able to scale a nurse-led outpatient NCD programme to all first-level hospitals with good fidelity, feasibility and penetration as to expand access to care for severe NCDs.
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Affiliation(s)
| | - Paul H. Park
- Partners In HealthBostonMAUSA
- Division of Global Health EquityBrigham and Women’s HospitalBostonMAUSA
- Department of Global Health and Social MedicineProgram in Global Noncommunicable Diseases and Social ChangeHarvard Medical SchoolBostonMAUSA
| | - Gedeon Ngoga
- Partners In HealthBostonMAUSA
- Inshuti Mu BuzimaRwinkwavuRwanda
| | | | | | - Neil Gupta
- Partners In HealthBostonMAUSA
- Division of Global Health EquityBrigham and Women’s HospitalBostonMAUSA
- Department of Global Health and Social MedicineProgram in Global Noncommunicable Diseases and Social ChangeHarvard Medical SchoolBostonMAUSA
| | - Edson Rwagasore
- Rwanda Biomedical CenterRwanda Ministry of HealthKigaliRwanda
| | | | | | - Cadet Mutumbira
- Rwanda Biomedical CenterRwanda Ministry of HealthKigaliRwanda
| | | | - Arielle Eagan
- Department of Global Health and Social MedicineProgram in Global Noncommunicable Diseases and Social ChangeHarvard Medical SchoolBostonMAUSA
| | - Chantelle Boudreaux
- Department of Global Health and Social MedicineProgram in Global Noncommunicable Diseases and Social ChangeHarvard Medical SchoolBostonMAUSA
| | - Christopher Noble
- Department of Global Health and Social MedicineProgram in Global Noncommunicable Diseases and Social ChangeHarvard Medical SchoolBostonMAUSA
| | | | | | | | - Gene Bukhman
- Partners In HealthBostonMAUSA
- Division of Global Health EquityBrigham and Women’s HospitalBostonMAUSA
- Department of Global Health and Social MedicineProgram in Global Noncommunicable Diseases and Social ChangeHarvard Medical SchoolBostonMAUSA
- Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonMAUSA
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Petroze RT, Martin AN, Ntaganda E, Kyamanywa P, St‐Louis E, Rasmussen SK, Calland JF, Byiringiro JC. Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry. BJS Open 2020; 4:78-85. [PMID: 32011812 PMCID: PMC6996633 DOI: 10.1002/bjs5.50222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/29/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Child survival initiatives historically prioritized efforts to reduce child morbidity and mortality from infectious diseases and maternal conditions. Little attention has been devoted to paediatric injuries in resource-limited settings. This study aimed to evaluate the demographics and outcomes of paediatric injury in a sub-Saharan African country in an effort to improve prevention and treatment. METHODS A prospective trauma registry was established at the two university teaching campuses of the University of Rwanda to record systematically patient demographics, prehospital care, initial physiology and patient outcomes from May 2011 to July 2015. Univariable analysis was performed for demographic characteristics, injury mechanisms, geographical location and outcomes. Multivariable analysis was performed for mortality estimates. RESULTS Of 11 036 patients in the registry, 3010 (27·3 per cent) were under 18 years of age. Paediatric patients were predominantly boys (69·9 per cent) and the median age was 8 years. The mortality rate was 4·8 per cent. Falls were the most common injury (45·3 per cent), followed by road traffic accidents (30·9 per cent), burns (10·7 per cent) and blunt force/assault (7·5 per cent). Patients treated in the capital city, Kigali, had a higher incidence of head injury (7·6 per cent versus 2·0 per cent in a rural town, P < 0·001; odds ratio (OR) 4·08, 95 per cent c.i. 2·61 to 6·38) and a higher overall injury-related mortality rate (adjusted OR 3·00, 1·50 to 6·01; P = 0·019). Pedestrians had higher overall injury-related mortality compared with other road users (adjusted OR 3·26, 1·37 to 7·73; P = 0·007). CONCLUSION Paediatric injury is a significant contributor to morbidity and mortality. Delineating trauma demographics is important when planning resource utilization and capacity-building efforts to address paediatric injury in low-resource settings and identify vulnerable populations.
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Affiliation(s)
- R. T. Petroze
- Montreal Children's Hospital, Division of Paediatric General and Thoracic SurgeryMontrealQuebecCanada
- University of Florida, Division of Pediatric SurgeryGainesvilleFloridaUSA
- Department of SurgeryUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - A. N. Martin
- Department of SurgeryUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - P. Kyamanywa
- University of RwandaKigaliRwanda
- Kampala International UniversityKampalaUganda
| | - E. St‐Louis
- Montreal Children's Hospital, Division of Paediatric General and Thoracic SurgeryMontrealQuebecCanada
| | - S. K. Rasmussen
- Department of SurgeryUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - J. F. Calland
- Department of SurgeryUniversity of VirginiaCharlottesvilleVirginiaUSA
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8
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Eberly LA, Rusingiza E, Park PH, Ngoga G, Dusabeyezu S, Mutabazi F, Gahamanyi C, Ntaganda E, Kwan GF, Bukhman G. 10-Year Heart Failure Outcomes From Nurse-Driven Clinics in Rural Sub-Saharan Africa. J Am Coll Cardiol 2020; 73:977-980. [PMID: 30819366 DOI: 10.1016/j.jacc.2018.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
Abstract
Nurse-led delivery care models have the potential to address the significant burden of heart failure in sub-Saharan Africa. Starting in 2006, the Rwandan Ministry of Health, supported by Inshuti Mu Buzima (Partners In Health-Rwanda), decentralized heart failure diagnosis and care delivery in the context of advanced nurse-led integrated noncommunicable clinics at rural district hospitals. Here, the authors describe the first medium-term survival outcomes from the district level in rural sub-Saharan Africa based on their 10-year experience providing care in rural Rwanda. Kaplan-Meier methods were used to determine median time to event for: 1) composite event of known death from any cause, lost to follow-up, or transfer to estimate worst-case mortality; and 2) known death only. Five-year event-free rates were 41.7% for the composite outcome and 64.3% for known death. While death rates are encouraging, efforts to reduce loss to follow-up are needed.
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Affiliation(s)
- Lauren A Eberly
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emmanuel Rusingiza
- Department of Pediatrics, Pediatric Cardiology Unit, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Paul H Park
- Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Gene F Kwan
- Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Section of Cardiology, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Eberly LA, Rusingiza E, Park PH, Ngoga G, Dusabeyezu S, Mutabazi F, Harerimana E, Mucumbitsi J, Nyembo PF, Borg R, Gahamanyi C, Mutumbira C, Ntaganda E, Rusangwa C, Kwan GF, Bukhman G. Nurse-Driven Echocardiography and Management of Heart Failure at District Hospitals in Rural Rwanda. Circ Cardiovasc Qual Outcomes 2019; 11:e004881. [PMID: 30562070 DOI: 10.1161/circoutcomes.118.004881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lauren A Eberly
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA (L.A.E., G.B.)
| | - Emmanuel Rusingiza
- Department of Pediatrics, Pediatric Cardiology Unit, Centre Hospitalier Universitaire de Kigali, Rwanda (E.R.).,Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | - Paul H Park
- Partners in Health, Boston, MA (P.H.P., G.F.K., G.B.).,Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (P.H.P., G.F.K., G.B.)
| | - Gedeon Ngoga
- Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | - Symaque Dusabeyezu
- Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | - Francis Mutabazi
- Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | - Emmanuel Harerimana
- Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | - Joseph Mucumbitsi
- Department of Paediatrics, King Faisal Hospital, Kigali, Rwanda (J.M.)
| | | | - Ryan Borg
- Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | - Cyprien Gahamanyi
- Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | - Cadet Mutumbira
- Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | | | - Christian Rusangwa
- Inshuti Mu Buzima, Rwinkwavu, Rwanda (E.R., G.N., S.D., F.M., E.H., R.B., C.G., C.M., C.R.)
| | - Gene F Kwan
- Partners in Health, Boston, MA (P.H.P., G.F.K., G.B.).,Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (P.H.P., G.F.K., G.B.).,Section of Cardiology, Department of Medicine, Boston Medical Center, MA (G.F.K.)
| | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA (L.A.E., G.B.).,Partners in Health, Boston, MA (P.H.P., G.F.K., G.B.).,Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (P.H.P., G.F.K., G.B.).,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (G.B.)
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Muhimpundu MA, Joseph KT, Husain MJ, Uwinkindi F, Ntaganda E, Rwunganira S, Habiyaremye F, Niyonsenga SP, Bagahirwa I, Robie B, Bal DG, Billick LB. Road map for leadership and management in public health: a case study on noncommunicable diseases program managers' training in Rwanda. Int J Health Promot Educ 2018; 57:82-97. [PMID: 33173440 PMCID: PMC7651004 DOI: 10.1080/14635240.2018.1552178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/21/2018] [Indexed: 06/11/2023]
Abstract
Ministries of Health (MoHs) and health organizations are compelled to work across sectors and build coalitions, strengthening health systems to abate the rise of noncommunicable diseases (NCDs). A critical element of NCD prevention and control involves significant and difficult changes in attitudes, policies and protective behavior at the population level. The population-level impact of NCD interventions depends on the strength of the health system that delivers them. In particular, low-resource settings are exploring efficiencies and linkages to existing systems or partnerships in ways that may alleviate redundancies and high delivery costs. These entail complex operational challenges, and can only be spearheaded by a competent and passionate workforce. There is a critical need to develop and strengthen the management and leadership skills of public health professionals so that they can take on the unique challenges of NCD prevention and control. An added component must include a shift from the traditional clinical approach to a community-based effort, focusing heavily on health education and community norm change. Strengthening the work-force capacity of program managers at MoHs and other implementing institutions is key to capturing, analyzing, advocating and communicating information and will, in turn, reinforce the scale-up of interventions fostering a robust health system. This paper summarizes the best practices and lessons learned from the NCD Program Managers short course conducted by the US Centers for Disease Control and Prevention (CDC) in December, 2016 in Rwanda.
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Affiliation(s)
| | - Kristy T. Joseph
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, USA
| | - Muhammad Jami Husain
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, USA
| | | | | | | | | | | | | | - Brian Robie
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, USA
| | - Dileep G. Bal
- University of Hawaii College of Medicine, Honolulu, USA
| | - Lauren Bartell Billick
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, USA
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11
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Eberly LA, Rusingiza E, Park PH, Ngoga G, Dusabeyezu S, Mutabazi F, Harerimana E, Mucumbitsi J, Nyembo PF, Borg R, Gahamanyi C, Mutumbira C, Ntaganda E, Rusangwa C, Kwan GF, Bukhman G. Understanding the Etiology of Heart Failure Among the Rural Poor in Sub-Saharan Africa: A 10-Year Experience From District Hospitals in Rwanda. J Card Fail 2018; 24:849-853. [PMID: 30312764 DOI: 10.1016/j.cardfail.2018.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heart failure is a significant cause of morbidity and mortality in sub-Saharan Africa. Our understanding of the heart failure burden in this region has been limited mainly to registries from urban referral centers. Starting in 2006, a nurse-driven strategy was initiated to provide echocardiography and decentralized heart failure care within noncommunicable disease (NCD) clinics in rural district hospitals in Rwanda. METHODS AND RESULTS We conducted a retrospective review of patients with cardiologist-confirmed heart failure treated at 3 district hospital NCD clinics in Rwanda from 2006 to 2017 to determine patient clinical characteristics and disease distribution. Over 10 years, 719 patients with confirmed heart failure were identified. Median age was 27 years overall, and 42 years in adults. Thirty-six percent were children (age <18 years), 68% were female, and 78% of adults were farmers. At entry, 39% were in New York Heart Association functional class III-IV. Among children, congenital heart disease (52%) and rheumatic heart disease (36%) were most common. In adults, cardiomyopathy (40%), rheumatic heart disease (27%), and hypertensive heart disease (13%) were most common. No patients were diagnosed with ischemic cardiomyopathy. CONCLUSIONS The results of the largest single-country heart failure cohort from rural sub-Saharan Africa demonstrate a persistent burden of rheumatic disease and nonischemic cardiomyopathies.
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Affiliation(s)
- Lauren A Eberly
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emmanuel Rusingiza
- Department of Pediatrics, Pediatric Cardiology Unit, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda; Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Paul H Park
- Partners in Health, Boston, Massachusetts; Program in Global Noncommunicable Diseases and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Ryan Borg
- Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | | | | | | | - Gene F Kwan
- Partners in Health, Boston, Massachusetts; Program in Global Noncommunicable Diseases and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Section of Cardiology, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Partners in Health, Boston, Massachusetts; Program in Global Noncommunicable Diseases and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Eberly L, Rusingiza E, Park P, Ngoga G, Dusabeyezu S, Mutabazi F, Harerimana E, Mucumbitsi J, Nyembo PF, Borg R, Gahamanyi C, Mutumbira C, Ntaganda E, Kwan GF, Bukhman G. HEART FAILURE AS AN ENTRY POINT FOR SEVERE CARDIOVASCULAR DISEASE IN SUB-SAHARAN AFRICA: 10-YEAR EXPERIENCE WITH NURSE-LED DIAGNOSIS AND TREATMENT AT DISTRICT HOSPITALS IN RURAL RWANDA. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31197-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nasir AA, Niyonkuru F, Nottidge TE, Adeleye AO, Ali S, Ameh EA, Bekele A, Bonet I, Derbew M, Ekenze SO, Oluwadare E, Jani PG, Labib M, Mezue WC, Mijumbi C, Zimmerman K, Baird R, Carsen S, Dreyer JS, Fairfull Smith RJ, Ferri-de-Barros F, Friedman J, Gill R, Gray A, Howe K, Bhoj I, Poenaru D, Rosen B, Yusuf AS, Abdur-Rahman LO, Ahmed BA, Panikar D, Abraham MK, Petroze RT, Groen RS, Ntaganda E, Kushner AL, Calland JF, Kyamanywa P, Ekrikpo U, Ifesanya AO, Nnabuko RE, Mazhar SB, Kotisso B, Shiferaw S, Ngonzi J, Dorman K, Byrne N, Satterthwaite L, Pittini R, Tajirian T, Kneebone R, Bello F, Desalegn D, Henok F, Dubrowsk A, Ugwumba FO, Obi UM, Ikem IC, Oginni LM, Howard A, Onyiah E, Iloabachie IC, Ohaegbulam SC, Kaggwa S, Tindimwebwa J, Mabweijano J, Lipnick M, Dubowitz G, Goetz L, Jayaraman S, Kwizera A, Ozgediz D, Matagane J, Bishop T, Guerrero A, Ganey M, Poenaru D, Park S, Simon D, Zirkle LG, Feibel RJ, Hannay JAF, Lane RHS, Cameron BH, Rambaran M, Gibson J, Howard A, Costas A, Meara JG, St-Albin M, Dyer G, Devi PR, Henshaw C, Wright J, Leah J, Spitzer RF, Caloia D, Omenge E, Chemwolo B, Zhou G, July J, Totimeh T, Mahmud R, Bernstein M, Ostrow B, Lowe J, Lawton C, Kozody LL, Coutts P, Nesbeth H, Revoredo A, Kirton R, Sibbald G, Dodge J, Giede C, Jimenez W, Cibulska P, Sinesat S, Bernardini M, McAlpine J, Finlayson S, Miller D, Elkanah O, Itsura P, Elit L. Bethune Round Table 2012: 12th Annual Conference: Filling the GapImpact of international collaboration on surgical services in a Nigerian tertiary centreSurgeons OverSeas Assessment of Surgical Needs (SOSAS) Rwanda: a useful rural health experience for medical studentsPreinternship Nigerian medical graduates lack basic musculoskeletal competencyDecompressive craniectomy: a low-cost surgical technique from a developing countryEfficacy of surgical management with manual vacuum aspiration versus medical management with misoprostol for evacuation of Lrst trimester miscarriages: a randomized trial in PakistanGaps in workforce for surgical care of children in Nigeria: increasing capacity through international partnershipsAnalyses of the gap between surgical resident and faculty surgeons concerning operating theatre teaching: report from Addis Ababa University, EthiopiaIntroduction of structured operative obstetric course at Mbarara Regional Referral Hospital with resultant reduction in maternal mortalityA training cascade for Ethiopian surgical and obstetrical care: an interprofessional, educational, leadership and skills training programUndergraduate surgery clerkship and the choice of surgery as a career: perspective from a developing countryIntramedullary nail versus external Lxation in management of open tibia fractures: experience in a developing countryThe College of Surgeons of East, Central and Southern Africa (COSECSA) Llling the gap; increasing the number of surgeonsClinical officer surgical training in Africa: COST-AfricaSecondary neuronal injuries following cervical spine trauma: audit of 68 consecutive patients admitted to neurosurgical services in Enugu, NigeriaCapacity building and workforce expansion in surgery, anesthesia and perioperative care: the GPAS model in UgandaKnowledge retention surveys: identifying the effectiveness of a road safety education program in Dar es Salaam, TanzaniaA tale of 2 fellowships: a comparative analysis of Canadian and East-African pediatric surgical trainingOutcomes of closed diaphyseal femur fractures treated with the SIGN nailManaging surgical emergencies: delivering a new course for the College of Surgeons of East Central and Southern AfricaAn evaluation of the exam for the University of Guyana Diploma in SurgeryPriority setting for health resource allocation in Brazil: a scoping literature reviewForeign aid effects on orthopedic capacity at the Hospital Saint Nicholas, HaitiReTHINK aid: international maternal health collaborationsEffect of electronic medical record implementation on patient and staff satisfaction, and chart completeness in a resource-limited antenatal clinic in KenyaImplementation of awake craniotomy in the developing world: data from China, Indonesia and AfricaRegionalization of diabetes care In Guyana, South AmericaQuantifying the burden of pediatric surgical disease due to delayed access to careImplementation of oncology surgery in Western Kenya. Can J Surg 2012. [DOI: 10.1503/cjs.016812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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