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Alayande BT, Forbes CW, Iradakunda J, Majyambere JP, Hey MT, Powell BL, Perl J, McCall N, Paul T, Ingabire JA, Shimelash N, Mutabazi E, Kimto EO, Danladi GM, Tubasiime R, Rickard J, Karekezi C, Makiriro G, Bigirimana SP, Harelimana JG, ElSayed A, Ndibanje AJ, Mpirimbanyi C, Masimbi O, Ndayishimiye M, Ntabana F, Haonga BT, Anderson GA, Byringyiro JC, Ntirenganya F, Riviello RR, Bekele A. Determining Critical Topics for Undergraduate Surgical Education in Rwanda: Results of a Modified Delphi Process and a Consensus Conference. Cureus 2023; 15:e43625. [PMID: 37600431 PMCID: PMC10433784 DOI: 10.7759/cureus.43625] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Developing a contextually appropriate curriculum is critical to train physicians who can address surgical challenges in sub-Saharan Africa. An innovative modified Delphi process was used to identify contextually optimized curricular content to meet sub-Saharan Africa and Rwanda's surgical needs. Methods Participants were surgeons from East, Central, Southern, and West Africa and general practitioners with surgical experience. Delphi participants excluded or prioritized surgical topic areas generated from extensive grey and formal literature review. Surgical educators first screened and condensed identified topics. Round 1 screened and prioritized identified topics, with a 75% consensus cut-off based on the content validity index and a prioritization score. Topics that reached consensus were screened again in round 2 and re-prioritized, following controlled feedback. Frequencies for aggregate prioritization scores, experts in agreement, item-level content validity index, universal agreement and scale-level content validity index based on the average method (S-CVI/Ave) using proportion relevance, and intra-class correlation (ICC) (based on a mean-rating, consistency, two-way mixed-effects model) were performed. We also used arithmetic mean values and modal frequency. Cronbach's Alpha was also calculated to ascertain reliability. Results were validated through a multi-institution consensus conference attended by Rwanda-based surgical specialists, general practitioners, medical students, surgical educators, and surgical association representatives using an inclusive, participatory, collaborative, agreement-seeking, and cooperative, a priori consensus decision-making model. Results Two-hundred and sixty-seven broad surgical content areas were identified through the initial round and presented to experts. In round 2, a total of 247 (92%) content areas reached 75% consensus among 31 experts. Topics that did not achieve consensus consisted broadly of small intestinal malignancies, rare hepatobiliary pathologies, and transplantation. In the final round, 99.6% of content areas reached 75% consensus among 31 experts. The highest prioritization was on wound healing, fluid and electrolyte management, and appendicitis, followed by metabolic response, infection, preoperative preparation, antibiotics, small bowel obstruction and perforation, breast infection, acute urinary retention, testicular torsion, hemorrhoids, and surgical ethics. Overall, the consistency and average agreement between panel experts was strong. ICC was 0.856 (95% CI: 0.83-0.87). Cronbach's Alpha for round 2 was very strong (0.985, 95% CI: 0.976-0.991) and higher than round 1, demonstrating strong reliability. All 246 topics from round 4 were verbally accepted by 40 participants in open forum discussions during the consensus conference. Conclusions A modified Delphi process and consensus were able to identify essential topics to be included within a highly contextualized, locally driven surgical clerkship curriculum delivered in rural Rwanda. Other contexts can use similar processes to develop relevant curricula.
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Affiliation(s)
- Barnabas T Alayande
- General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Global Health and Population, Harvard School of Public Health, Boston, USA
| | - Callum W Forbes
- Anesthesiology, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Jules Iradakunda
- School of Medicine, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Jean Paul Majyambere
- General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Surgery, Butaro District Hospital, Kigali, RWA
| | - Matthew T Hey
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Brittany L Powell
- Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
| | - Juliana Perl
- Biodesign, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Natalie McCall
- Division of Clinical Medicine, University of Global Health Equity, Kigali, RWA
| | - Tomlin Paul
- Educational Development and Quality Center, University of Global Health Equity, Kigali, RWA
| | - Jc Allen Ingabire
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | - Natnael Shimelash
- Biodesign, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Emmanuel Mutabazi
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | | | | | | | | | - Claire Karekezi
- Surgery, Neurosurgery Unit, Rwanda Military Hospital, Kigali, RWA
| | - Gabriel Makiriro
- Division of Clinical Medicine, University of Global Health Equity, Kigali, RWA
| | - Simon Pierre Bigirimana
- School of Medicine, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - James G Harelimana
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | | | | | | | - Ornella Masimbi
- Simulation, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | | | - Frederick Ntabana
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | - Billy Thomson Haonga
- Orthopaedic Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Geoffrey A Anderson
- Trauma, Burns, and Critical Care, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
| | - Jean Claude Byringyiro
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
- Orthopedics, University Teaching Hospital of Kigali, Kigali, RWA
| | - Faustin Ntirenganya
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
- Surgery, University Teaching Hospital of Kigali, Kigali, RWA
- NIHR Research Hub on Global Surgery, University of Rwanda, Kigali, RWA
| | - Robert R Riviello
- Trauma, Burns, and Critical Care, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Kigali, RWA
| | - Abebe Bekele
- Cardiothoracic Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
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Bahizi S, Mugeni R, Banhart D, Mukankuranga C, Makiriro G, Kirk C, Lotfy N, Flinkenflogel M, Cubaka VK. Glycemic control among patients with type 2 diabetes in a low resource setting in Rwanda: a prospective cohort study. Pan Afr Med J 2022; 43:74. [PMID: 36590994 PMCID: PMC9789783 DOI: 10.11604/pamj.2022.43.74.35639] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction diabetes is a leading cause of death, disability, and high healthcare costs, especially among patients with poor glycemic control. Providing decentralized diabetes care to patients in low-income countries remains a major challenge. We aimed to assess hemoglobin A1C (HbA1c) level of patients enrolled in primary-level non-communicable disease clinics of Rwamagana, Rwanda, and identify predictors associated with a) change in HbA1c level over a 6-month period or b) achieving HbA1c <7%. We also explored whether living in a community with a home-based care practitioner was associated with HbA1c-related outcomes. Methods we conducted structured interviews and HbA1c testing among patients with type 2 diabetes at baseline and after six months. Multivariable linear regression and multivariable logistic regression were used. Results hundred and thirty (130) participants enrolled at baseline, and 123 patients remained in the study after six months. At baseline, 26% of patients had HbA1c <7%. After 6-months, 37% of patients had HbA1c <7%. Factors correlated with the greatest improvements in HbA1c were having HbA1c >9% at baseline, while factors associated with having HbA1c <7% after six months included older age and having HbA1c <7% at baseline. We did not find significant associations between home-based care practitioners and improvement in HbA1c level or achieving HbA1c <7. Conclusion the number of patients with well-controlled glycemia improved over time during this study but was still low overall. Care provided by home-based care practitioners was not associated with six-month HbA1c outcomes. Enhanced care is needed to achieve glycemia control in primary healthcare settings.
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Affiliation(s)
- Sadallah Bahizi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,,Rwamagana Provincial Hospital, Rwanda Ministry of Health, Kigali, Rwanda,,Corresponding author: Sadallah Bahizi, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Regine Mugeni
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,,Rwamagana Provincial Hospital, Rwanda Ministry of Health, Kigali, Rwanda
| | - Dale Banhart
- Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda,,Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, USA
| | | | - Gabriel Makiriro
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,,Rwamagana Provincial Hospital, Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Nesma Lotfy
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Maaike Flinkenflogel
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,,KIT Royal Tropical Institute, Amsterdam, Netherlands
| | - Vincent Kalumire Cubaka
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,,Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
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