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Kabakambira JD, Kong JM. Optimizing Type 2 Diabetes Management in a Medically Complex Patient: A Case Report of a Patient with Type 2 Diabetes and HIV. Diabetes Metab Syndr Obes 2023; 16:2401-2406. [PMID: 37588513 PMCID: PMC10426454 DOI: 10.2147/dmso.s415949] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023] Open
Abstract
Background The prevalence of diabetes is rapidly escalating, with projections indicating that 783 million individuals aged 20-79 years worldwide will be affected by diabetes. This rise is concurrent with a persistent prevalence of HIV in developing nations, while conventional risk factors such as sedentary lifestyle and unhealthy diet may account for this trend, HIV and its treatment have emerged as potential contributing factors. Achieving optimal diabetes control in patients with HIV necessitates a profound understanding of the intricate interplay between the two diseases and their respective treatments. Case Report We present a case involving a patient with long standing type 2 diabetes, coexisting HIV infection and hypertension. Despite receiving high doses of insulin, as advised by most diabetes guidelines, the patient's diabetes remained poorly controlled. In lieu of strictly adhering to guidelines, our primary focus was to conduct a comprehensive reevaluation of the patient's medications, prioritizing the development of streamlined and safe treatment regimens for all three of her medical conditions. Employing this strategy, we observed swift improvement in blood glucose levels, leading to successful diabetes control within one year. Conclusion This case underscores the importance of individualizing diabetes management in patients with multiple comorbidities. It highlights the significance of reassessing treatment approaches beyond standard guidelines, with a focus on tailoring therapy to suit the unique needs and complexities of each patient's medical profile. Such personalized interventions hold promise for achieving optimal diabetes control in individuals with diverse comorbidities.
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Affiliation(s)
| | - Jason M Kong
- Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
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Nishimwe A, Ruranga C, Musanabaganwa C, Mugeni R, Semakula M, Nzabanita J, Kabano I, Uwimana A, Utumatwishima JN, Kabakambira JD, Uwineza A, Halvorsen L, Descamps F, Houghtaling J, Burke B, Bahati O, Bizimana C, Jansen S, Twizere C, Nkurikiyeyezu K, Birungi F, Nsanzimana S, Twagirumukiza M. Leveraging artificial intelligence and data science techniques in harmonizing, sharing, accessing and analyzing SARS-COV-2/COVID-19 data in Rwanda (LAISDAR Project): study design and rationale. BMC Med Inform Decis Mak 2022; 22:214. [PMID: 35962355 PMCID: PMC9372951 DOI: 10.1186/s12911-022-01965-9] [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: 03/04/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Since the outbreak of COVID-19 pandemic in Rwanda, a vast amount of SARS-COV-2/COVID-19-related data have been collected including COVID-19 testing and hospital routine care data. Unfortunately, those data are fragmented in silos with different data structures or formats and cannot be used to improve understanding of the disease, monitor its progress, and generate evidence to guide prevention measures. The objective of this project is to leverage the artificial intelligence (AI) and data science techniques in harmonizing datasets to support Rwandan government needs in monitoring and predicting the COVID-19 burden, including the hospital admissions and overall infection rates. Methods The project will gather the existing data including hospital electronic health records (EHRs), the COVID-19 testing data and will link with longitudinal data from community surveys. The open-source tools from Observational Health Data Sciences and Informatics (OHDSI) will be used to harmonize hospital EHRs through the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The project will also leverage other OHDSI tools for data analytics and network integration, as well as R Studio and Python. The network will include up to 15 health facilities in Rwanda, whose EHR data will be harmonized to OMOP CDM. Expected results This study will yield a technical infrastructure where the 15 participating hospitals and health centres will have EHR data in OMOP CDM format on a local Mac Mini (“data node”), together with a set of OHDSI open-source tools. A central server, or portal, will contain a data catalogue of participating sites, as well as the OHDSI tools that are used to define and manage distributed studies. The central server will also integrate the information from the national Covid-19 registry, as well as the results of the community surveys. The ultimate project outcome is the dynamic prediction modelling for COVID-19 pandemic in Rwanda. Discussion The project is the first on the African continent leveraging AI and implementation of an OMOP CDM based federated data network for data harmonization. Such infrastructure is scalable for other pandemics monitoring, outcomes predictions, and tailored response planning.
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Affiliation(s)
- Aurore Nishimwe
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Charles Ruranga
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
| | | | - Regine Mugeni
- Rwamagana Provincial Hospital, East province, Rwamagana, Rwanda
| | | | - Joseph Nzabanita
- College of Science and Technology, University of Rwanda, Kigali, Rwanda
| | - Ignace Kabano
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
| | - Annie Uwimana
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
| | | | | | - Annette Uwineza
- The University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | | | | | | | | | - Odile Bahati
- Regional Alliance of Sustainable Development, Kigali, Rwanda
| | | | - Stefan Jansen
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Celestin Twizere
- Center of Excellence in Biomedical Engineering and eHealth, University of Rwanda, Kigali, Rwanda
| | - Kizito Nkurikiyeyezu
- Center of Excellence in Biomedical Engineering and eHealth, University of Rwanda, Kigali, Rwanda
| | - Francine Birungi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Marc Twagirumukiza
- 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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Kateera F, Shumbusho F, Manirambona L, Kabihizi J, Murangwa A, Serumondo J, Makuza JD, Nsanzimana S, Muvunyi CM, Kabakambira JD, Sylvain H, Camus G, Grant PM, Gupta N. Safety and efficacy of sofosbuvir-velpatasvir to treat chronic hepatitis C virus infection in treatment-naive patients in Rwanda (SHARED-3): a single-arm trial. Lancet Gastroenterol Hepatol 2022; 7:533-541. [DOI: 10.1016/s2468-1253(21)00398-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 02/07/2023]
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Musengamana V, Adejumo O, Banamwana G, Mukagendaneza MJ, Twahirwa TS, Munyaneza E, Kabakambira JD. Workplace violence experience among nurses at a selected University Teaching Hospital in Rwanda. Pan Afr Med J 2022; 41:64. [PMID: 35371373 PMCID: PMC8933447 DOI: 10.11604/pamj.2022.41.64.30865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/03/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction workplace violence is a global problem in the health sector, especially in the hospitals affecting healthcare works´ job satisfaction and performance. Workplace violence (WPV) is present in different forms associated with various factors and the nurses are the most affected. This study aimed to explore WPV among nurses working at a selected University Teaching Hospital in Rwanda. Methods the research approach used was the quantitative descriptive cross-sectional design. The stratified random sampling was used to recruit 195 participants among 379 nurses. The data were collected using a structured, validated, and self-administered questionnaire that was adapted from the International Labor Organization, International Council of nurses, the World Health Organization, and Public Services International. Descriptive statistics were used for analyzing frequencies and percentages. The Chi-square test was used for evaluating the association between variables. Results the findings revealed that (58.5%, n=114) of nurses have experienced some types of WPV in the twelve months preceding the study, among them (44.6%, n=108) of nurses were verbally abused. The nurses providing emergency care, the nurses working in the emergency department, and nurses working with vulnerable patients like HIV/AIDS patients were associated with WPV Chi-square (1, n=195), P=<0.001). The psychological problems have been found to be the first consequences of WPV. Conclusion based on the study findings, it was concluded that the hospital management needs to be aware of WPV, develop and implement appropriate policies and strategies. These will strengthen nurses´ concentration towards them and will result in service delivery improvement.
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Affiliation(s)
- Valens Musengamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali, Kigali, Rwanda
- Corresponding author: Valens Musengamana, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Oluyinka Adejumo
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gilbert Banamwana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | | | - Jean Damascene Kabakambira
- University Teaching Hospital of Kigali, Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Kabakambira JD, Shumbusho P, Mujawamariya G, Rutagengwa W, Twagirumukiza M. The Role of the Integrated District Hospital Based Non Communicable Diseases' Clinics in Cardiovascular Disease Control: Preliminary Data from Rwanda. Diabetes Metab Syndr Obes 2022; 15:2107-2115. [PMID: 35898444 PMCID: PMC9309289 DOI: 10.2147/dmso.s348031] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Noncommunicable diseases (NCDs), remain the leading cause of death worldwide and represent an emerging global health threat. In Rwanda and elsewhere, the prevalence of cardiovascular diseases is increasing. To address this global health threat, Rwanda launched integrated nurse-led NCD clinics in all the forty-five District Hospitals across the country in 2006, but no evaluation study has been conducted so far for the added value of this program. The main goal of this study was to assess the impact of NCD clinics on disease control in Rwanda. METHODS This was a retrospective ambulatory patient chart review at a rural district hospital and an urban teaching hospital; which enrolled patients with diabetes and/or hypertension who consulted in a period of 1 month with retrospective data of one year. RESULTS A total of 199 patients' electronic health records were reviewed from the University Teaching Hospital of Kigali (CHUK) (53%) and Nyamata District Hospital (47%). Among them, 31% had diabetes, 38% had hypertension and 31% had both diseases. The mean age for the total cohort was 60 years and was predominantly female at 70%. Throughout the year, about 59% patients with hypertension had blood pressure control at the district hospital as opposed to 38% at the referral hospital. The rate of diabetes control was 20% at the referral hospital, but no comparison could be established between the two health facilities as the follow up laboratory markers were not available at the district hospital. CONCLUSION There was a consistent blood pressure control at the district hospital. Diabetes control was not optimal at the referral hospital despite the presence of human resources and logistics required for diabetes care. The situation was even worse at the district hospital where the follow up markers were rarely available.
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Affiliation(s)
- Jean Damascene Kabakambira
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Correspondence: Jean Damascene Kabakambira, Department of Internal Medicine, University Teaching Hospital of Kigali, KN 4th Avenue, P.O Box 655, Kigali, Rwanda, Tel +250 788800966, Email
| | - Patrick Shumbusho
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gisele Mujawamariya
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - William Rutagengwa
- Department of Internal Medicine, Nyamata District Hospital, Bugesera, Rwanda
| | - Marc Twagirumukiza
- 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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Uwizeyimana T, Hashim HT, Kabakambira JD, Mujyarugamba JC, Dushime J, Ntacyabukura B, Ndayizeye R, Adebisi YA, Lucero-Prisno DE. Drug supply situation in Rwanda during COVID-19: issues, efforts and challenges. J Pharm Policy Pract 2021; 14:12. [PMID: 33472702 PMCID: PMC7816054 DOI: 10.1186/s40545-021-00301-2] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 01/30/2023] Open
Abstract
COVID-19 is a threat to health systems around the world and Rwanda is not an exception. The impact of the pandemic is far-reaching and access to health commodities is not spared. Proper drug supply is critical for a robust healthcare system. It determines the extent at which the population are likely to have access to essential medicines and treatments. In Rwanda, the pharmaceutical sector heavily relies on imports. With the emergence of COVID-19 pandemic, the drug supply system was interrupted leaving many stores from small local pharmacies to the big medical stores running out of stock. The reasons were limited importation of goods from abroad, and the panic buying practice among the customers and some institutions when responding to the pandemic. Drug and medicines accessibility, availability and affordability should be the core of any drug management policy. It is with no doubt that, Rwanda has made a tremendous work to mitigate the effect of COVID-19 on the country's drug supply; however, efforts are still needed to invest in local pharmaceutical production as a way to minimize import expenses in the country. Good policy on drug importation, production and distribution should be enforced to avoid any drug shortage that may be encountered in the Rwandan drug market.
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Affiliation(s)
| | | | | | | | | | | | - Remy Ndayizeye
- Institute for Public Health Innovation, Richmond, VA, USA
| | | | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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7
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Iradukunda A, Kembabazi S, Ssewante N, Kazibwe A, Kabakambira JD. Diabetic Complications and Associated Factors: A 5-Year Facility-Based Retrospective Study at a Tertiary Hospital in Rwanda. Diabetes Metab Syndr Obes 2021; 14:4801-4810. [PMID: 34984012 PMCID: PMC8703046 DOI: 10.2147/dmso.s343974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/02/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin production, insulin action, or both. Despite advances in DM diagnosis and management, the incidence of DM-related complications remains high. This study aimed to determine patterns of common complications and associated factors among hospitalized patients in Rwanda. METHODS A cross-sectional study, with retrospective chart review, was conducted at CHUK from July to August, 2021. Charts for DM patients admitted from January 2016 to December 2020 were considered while those inaccessible at the time of data collection were excluded. Linear regression model was used to assess the relationship between dependent and independent variables with a p < 0.05 considered statistically significant. RESULTS A total of 246 charts were reviewed. The median age was 56 years (IQR: 14-90). More than half of participants (n = 135; 54.9%) were females; majority from the Central region (n = 138; 56.7%). Recorded DM risk factors included alcohol intake (n = 81; 48.5%); smoking (n = 40; 24.2%), obesity (n = 43; 52.4%), and family history of DM (n = 27; 56.3%). Majority (n = 153; 84.5%) had type 2 DM and (n = 147; 69%) had known their diagnosis for at least 6 years. Hypertension (n = 124, 50.4%), acute hyperglycemic state (n = 59, 24%), nephropathy (n = 58, 23.6%), and stroke (n = 38, 15.4%) were frequently reported complications. Nearly all participants (n = 81, 95.2%) with complications had poor glycemic control. Alcohol intake, age ≥45 years, and T1DM were associated with higher odds of DM complications (aOR = 8, 95% CI = 2-32.6, p = 0.003, aOR = 6.2, 95% CI = 1.4-27.6, p = 0.016 and aOR = 14.1, 95% CI = 1.2-161.5, p = 0.034, respectively). Duration of DM (p = 0.001) was significant at bivariate analysis. CONCLUSION DM complications were prevalent among the studied population with poor glycemic control mainly influenced by alcohol consumption and duration of DM. Expansion of integrated DM and hypertension screening services to lower-level centers is needed to reduce the associated morbidity and mortality.
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Affiliation(s)
- Angelique Iradukunda
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Correspondence: Angelique Iradukunda School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda Email
| | - Shallon Kembabazi
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Ssewante
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Kazibwe
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Wallace LJ, Nouvet E, Bortolussi R, Arthur JA, Amporfu E, Arthur E, Barimah KB, Bitouga BA, Chemusto H, Ikechebelu J, Joe-Ikechebelu N, Kondé MK, Kabakambira JD, Kalombe GK, Karanja DMS, Konje ET, Kouyate S, Limeneh G, Mulopo FM, Ndu M, Ochomo E, Francis O, Thiongane O, Seni J, Sheriff SM, Singini D. COVID-19 in sub-Saharan Africa: impacts on vulnerable populations and sustaining home-grown solutions. Can J Public Health 2020; 111:649-653. [PMID: 32845460 PMCID: PMC7448701 DOI: 10.17269/s41997-020-00399-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/08/2020] [Indexed: 01/31/2023]
Abstract
This commentary draws on sub-Saharan African health researchers’ accounts of their countries’ responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, these measures may not reach the majority of the poor. Yet, African countries’ responses to COVID-19 have also included a range of innovations, including diversification of local businesses to produce personal protective equipment, disinfectants, test kits, etc., which may expand domestic manufacturing capabilities and deepen self-reliance. African and high-income governments, donors, non-governmental organizations, and businesses should work to strengthen existing health system capacity and back African-led business. Social scientific understandings of public perceptions, their interactions with COVID-19 control measures, and studies on promising clinical interventions are needed. However, a decolonizing response to COVID-19 must include explicit and meaningful commitments to sharing the power—the authority and resources—to study and endorse solutions.
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Affiliation(s)
- Lauren J Wallace
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Accra, Greater Accra Region, Ghana.
| | - Elysée Nouvet
- School of Health Studies, Western University, London, Ontario, Canada
| | - Robert Bortolussi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joshua A Arthur
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ashanti Region, Ghana
| | - Eugenia Amporfu
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana
| | - Eric Arthur
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana
| | - Kofi Bobi Barimah
- Centre for Plant Medicine Research, Mampong Akuapem, Eastern Region, Ghana
| | | | | | - Joseph Ikechebelu
- Obstetrics & Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | | | | | | | - Gabriel Kyomba Kalombe
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Eveline Thobias Konje
- Epidemiology and Biostatistics, School of Public Health, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | - Sekou Kouyate
- Général Lansana Conté University Sonfonia, Conakry, Guinea
| | - Gojjam Limeneh
- School of Social Work and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Mary Ndu
- School of Health Studies, Western University, London, Ontario, Canada
| | - Eric Ochomo
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Oriokot Francis
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Jeremiah Seni
- Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | | | - Douglas Singini
- Limulunga District Health Office, Limulunga, Western Province, Zambia
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Nsanzabera C, Ndayisenga L, Kabakambira JD, Hagenimana F. From Preparedness to Recovery: Learning Lessons Of COVID-19 Outbreak from China. East Afr Health Res J 2020; 4:1-7. [PMID: 34308213 PMCID: PMC8279207 DOI: 10.24248/eahrj.v4i1.616] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022] Open
Abstract
At the end of December 2019, the Chinese public health authorities reported several cases of acute respiratory syndrome in Wuhan City, Hubei province, China. Chinese scientists soon identified a novel coronavirus as the main causative agent. The disease is now referred to as coronavirus disease 2019 (COVID-19), and the causative virus is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 outbreak was declared a pandemic by the World Health Organization on March 12th, 2020. COVID-19 propagates quickly and threatens the population at large; around 20% of affected populations have presented severe forms of the diseases. In China approximately ~5% cases became critical patients in need of admission to intensive-care units. The need for intensive care has led to unprecedented overcrowding in hospitals, with catastrophic situations witnessed in Italy and other countries. The highest mortality rates have been witnessed amongst the elderly with several comorbidities. In this viewpoint we draw lessons from the implementation of population containment measures, vulnerable people protection and relevant public health pillars in China. We then discuss how these lessons can or cannot be applied to other settings.
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Affiliation(s)
- Charles Nsanzabera
- Department of health science, School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kenya
| | - Leonard Ndayisenga
- Project Medical Referent, Abdurafi Neglected Diseases and Outbreak response Project, Amhara regional state of Ethiopia, MSF Holland, Ethiopia Mission
| | | | - Felix Hagenimana
- Department of Statistics and Actuarial Science, Jomo Kenyatta University of Agriculture and Technology, Kenya
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Kabakambira JD, Uwera G, Hategeka M, Kayitesi ML, Malu CKK, Hategeka C. Burden of post-traumatic stress disorder acute exacerbations during the commemorations of the genocide against Tutsis in Rwanda: a cross-sectional study. Pan Afr Med J 2018; 30:216. [PMID: 30574235 PMCID: PMC6294999 DOI: 10.11604/pamj.2018.30.216.15663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Following the 1994 genocide against Tutsis in Rwanda, the prevalence of post-traumatic stress disorder (PTSD) is high. In a period of seven days every year in April, Rwandans gather to mourn the victims of the genocide. During this commemoration period, survivors living with chronic PTSD experience PTSD acute exacerbations (PAE). We assessed factors associated with severe PAE during the annual commemoration period of the genocide against Tutsis in Rwanda. Methods We carried out a retrospective cross-sectional study that included people who had PAE during the commemoration week in April 2011 across Huye District in Rwanda. Our outcome measure was PAE categorized into three levels: < 15 minutes, 15-30 minutes, and > 30 minutes. Ordinal logistic regression analyses were performed to identify factors associated with severe PAE. Results We enrolled 383 people with PAE, of whom 71.8% were female and 53.5% were aged 20-45 years. All participants reported history of PAE, of which 59.8% had experienced more than two PAE during the previous commemoration periods. 33.2% had PAE that lasted > 30 minutes. History of PAE (> twice) (OR = 1.86; 95% CI = 1.27-2.75) and having lost a partner in genocide (OR = 2.19; 95% CI = 1.01-4.81) were associated with severe PAE, after adjusting for sex and age. Conclusion Our findings suggest that PAE is frequent during the commemoration periods. People who reported having more prior PAE and being widow (er) were more likely to have severe PAE. While history of PAE and bereavement status are non-modifiable factors, our findings could help identify and target these people who are at risk for severe PAE.
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Affiliation(s)
- Jean Damascene Kabakambira
- National Institutes of Health, Bethesda, MD, United States.,University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Gladys Uwera
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Marthe Hategeka
- School of Healthcare, Vancouver Career College, Burnaby, Canada
| | | | | | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
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11
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Kabakambira JD, Hategeka C, Page C, Ntirenganya C, Dusabejambo V, Ndoli J, Ngabonziza F, Hale D, Bayingana C, Walker T. Efficacy of Helicobacter pylori eradication regimens in Rwanda: a randomized controlled trial. BMC Gastroenterol 2018; 18:134. [PMID: 30165823 PMCID: PMC6117961 DOI: 10.1186/s12876-018-0863-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Successful H. pylori treatment requires the knowledge of local antimicrobial resistance. Data on the efficacy of H. pylori eradication regimens available in sub-Saharan Africa are scant, hence the optimal treatment is unknown. Our goals were to determine the efficacy of available regimens in Rwanda as well as evaluate the effect of treatment on health-related quality of life (HRQoL) in patients undergoing esophagogastroduodenoscopy. METHODS This is a randomized controlled trial conducted from November 2015 to October 2016 at a tertiary hospital in Rwanda. Enrollees were 299 patients (35% male, age 42 ± 16 years (mean ± SD)) who had a positive modified rapid urease test on endoscopic biopsies. After a fecal antigen test (FAT) and HRQoL assessment by the Short Form Nepean Dyspepsia Index (SF-NDI) questionnaire, patients were randomized 1:1:1:1 to either a triple therapy combining omeprazole, amoxicillin and one of clarithromycin/ciprofloxacin/metronidazole or a quadruple therapy combining omeprazole, amoxicillin, ciprofloxacin and doxycycline. All therapies were given for a duration of 10 days. The outcome measures were the persistence of positive FAT (treatment failure) 4 to 6 weeks after treatment and change in HRQoL scores. RESULTS The treatment success rate was 80% in the total population and 78% in patients with a history of prior triple therapy. Significant improvement in HRQoL in the total group (HRQoL mean scores before and after treatment respectively: 76 ± 11 and 32 ± 11, p < 0.001) and the group with functional dyspepsia (HRQoL mean scores before and after treatment respectively: 73 ± 11 and 30 ± 9, P < 0.001) was observed across all treatment groups. Using clarithromycin based triple therapy (standard of care) as a reference, the group treated with metronidazole had worse HRQoL (p = 0.012) and had a trend towards worse treatment outcome (p = 0.086) compared to the ciprofloxacin based combination therapies. CONCLUSION Clarithromycin and ciprofloxacin based combination therapies are effective and safe to use alternatively for H. pylori eradication and improve HRQoL. Among the regimens studied, metronidazole based triple therapy is likely to be clinically inferior. TRIAL REGISTRATION The clinical trial was retrospectively registered ( PACTR201804003257400 ) with the Pan African Clinical Trial Registry database, on April 6th, 2018 in South Africa.
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Affiliation(s)
| | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC Canada
| | - Cameron Page
- Department of Medicine, University Hospital of Brooklyn, New York, USA
| | | | | | - Jules Ndoli
- Butare University Teaching Hospital (CHUB), Huye, Rwanda
| | | | - DeVon Hale
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | | | - Tim Walker
- Butare University Teaching Hospital (CHUB), Huye, Rwanda
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Kabakambira JD, Niyonsenga Z, Hategeka M, Igiraneza G, Benurugo G, Lucero-Prisno Iii DE, Hategeka C. Blood pressure measurement techniques: Assessing performance in outpatient settings of a tertiary-level hospital in Rwanda. J Clin Hypertens (Greenwich) 2018; 20:1067-1072. [PMID: 29767423 DOI: 10.1111/jch.13303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/30/2018] [Revised: 03/14/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
Abstract
Cardiovascular diseases (CVD) are the leading cause of mortality globally. Hypertension is a known modifiable risk factor for CVD. Diagnosis and management of hypertension hinges upon accurate blood pressure (BP) measurement. In this study, we assessed performance to recommended guidelines for BP measurement in Rwanda. In 2017, a cross-sectional study investigating performance on 11 techniques recommended for BP measurement was undertaken across outpatient settings of 3 departments at the University Teaching Hospital of Kigali, Rwanda. Performance was checked by an inside observer. The study enrolled 164 patients. The overall mean performance on the 11 BP measurement techniques was 5.69 (±1.02) out of the 11 possible points. There was no significant difference in performance across departments (P = .28). The findings suggest that performance on currently recommended guidelines for BP measurement is not optimal. Going forward, it is important to implement interventions that will enhance performance given that diagnosis and management of hypertension depend upon accurate BP measurement.
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Affiliation(s)
- Jean Damascene Kabakambira
- National Institutes of Health, Bethesda, MD, USA.,University Teaching Hospital of Kigali, Kigali, Rwanda
| | | | - Marthe Hategeka
- School of Healthcare, Vancouver Career College, Burnaby, BC, Canada
| | - Grace Igiraneza
- Medicine, Yale Medical School, Yale University, New Haven, CT, USA
| | | | | | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
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