Lawrence Rugema

Background: Point-of-care (POC) diagnostics could improve timely diagnosis of skin neglected tropical diseases (skin NTDs) in settings with limited access to laboratory services. However, evidence on their diagnostic performance, operational feasibility and readiness for decentralized implementation remains fragmented. Methods: We systematically searched PubMed, Web of Science, Google Scholar, and grey literature sources for studies evaluating POC diagnostic technologies for skin NTDs. Diagnostic performance, evidence maturity and operational characteristics were synthesized narratively because of heterogeneity across technologies, populations, reference standards, and reported outcomes. Diagnostic-accuracy studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Results: A short summary of the article’s main findings. Conclusions: POC diagnostics for skin NTDs show promising technological development but uneven evidence of maturity. Molecular technologies have generally progressed further in analytical development than in clinical and field validation, while simpler rapid tests have greater field experience but variable performance. Future research should prioritize prospective clinical and implementation-focused evaluation of complete diagnostic workflows in representative endemic settings.

Between 2010 and 2014, approximately 25 million unsafe abortions were performed annually across the globe. Africa alone accounted for 29% of all unsafe abortions, and 62% of the related deaths. Women living in poverty, especially adolescents, lack information about where and how to access safe abortion services. They often lack adequate insight to make informed decisions. The purpose of this study was to explore the empowered perspectives of women leaders in Rwanda about the recent policy change for safe abortion. The study identifies women leaders’ perceived barriers and their attitudes about resulting consequences toward safe abortion. In this qualitative study, seven focus group discussions and eight key informant interviews were performed in October 2019. A total of 51 women leaders participated, their age ranging from 38 to 60 years. Participants were drawn from three districts, namely Gasabo, Kicukiro, and Nyarugenge. For variability of data, participants came from parliament, government ministries, government parastatals, and civil society organizations. All interviews were conducted in Kinyarwanda and later translated into English. Data were analyzed using qualitative content analysis. The emerging theme Strong barriers and numerous consequences of safe abortion illustrates how women leaders perceive barriers to safe abortion and its related consequences in Rwanda. The theme is divided into two categories: (1) Perceived barriers of safe abortion and (2) Consequences of providing safe abortion. The sub-categories for the first category are Reluctance to fully support safe abortion due to perceived unjustified abortions”, Abortion-related stigma, Abortion is against cultural and religious beliefs, Emotional attachment to the unborn and Lack of awareness of abortion. The sub-categories for the second category are Perceived physiological trauma, Cause for barrenness/infertility, Increase in services abuse by adolescents/women, Increase of workload for healthcare providers, “Increase in sexual activities and STIs, and Abortion-related physiological trauma. The subject of safe abortion evokes mixed reactions among participants, and is entangled with unsafe abortion in most cases. Participants stress that the word ‘abortion’ disturbs, regardless of whether it relates to being safe or unsafe. Participants believe the word ‘abortion’ outweighs the word ‘safe’. Societal expectations play a major role in the decision-making process of any adolescent or a family member faced with a pregnant adolescent regardless of the existing safe abortion law. Community mobilization and sensitization are crucial if safe abortion in accordance with abortion law is to be embraced. Messages that reinforce safe abortion as acceptable and address stigma, fears of trauma, and barrenness should be developed to educate adolescents, parents, and women leaders about safe abortion, to mitigate unsafe abortion-related complications.

Stunted linear growth continues to be a public health problem that overwhelms the entire world and, particularly, developing countries. Despite several interventions designed and implemented to reduce stunting, the rate of 33.1% is still high for the proposed target of 19% in 2024. This study investigated the prevalence and associated factors of stunting among children aged 6–23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother–child dyads (two individuals from one home) living in low-income families in five districts with a high prevalence of stunting. Descriptive statistics were used to determine the prevalence of stunting. In addition, we used bivariate analysis and a multivariate logistic regression model to measure the strength of the association between childhood stunting and exposure variables. The prevalence of stunting was 34.1%. Children from households without a vegetable garden (AOR = 2.165, p-value < 0.01), children aged 19–23 months (AOR = 4.410, p-value = 0.01), and children aged 13–18 months (AOR = 2.788, p-value = 0.08) showed increased likelihood of stunting. On the other hand, children whose mothers were not exposed to physical violence (AOR = 0.145, p-value < 0.001), those whose fathers were working (AOR = 0.036, p-value = 0.001), those whose parents were both working (AOR = 0.208, p-value = 0.029), and children whose mothers demonstrated good hand washing practice (AOR = 0.181, p-value < 0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of handwashing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight child stunting.

We assessed the prevalence and correlates of stunting among children aged 6-23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother-child dyads living in poor households from five districts with a high prevalence of stunting. We used descriptive statistics to determine the prevalence of stunting, bivariate analysis, and a multivariate logistic re-gression model to measure the strength of the Association between childhood stunting and exposure variables. Stunting was at 34.1%. Children aged 19-23 months (AOR = 4.410, 95% CI: [1.911-10.173], p-value=0.01), children aged 13-18 months (AOR=2.788, 95% CI: [1.302-5.968], p-value=0.08), children from households that do not have a vegetable garden (AOR=2.165, 95% CI: [1.201-3.905], p-value<0.01) were more likely to be stunted. On the other hand, children whose mothers were not exposed to physical violence (AOR= 0.145, 95% CI: [0.074-0.287], p-value<0.001), children whose fathers were working (AOR=0.036, 95% CI: [0.005-0.242], p-value=0.001), children whose both parents were working (AOR=0.208, 95% CI: [0.051-0.851], p-value=0.029) and children whose mothers had good hand-washing practice (AOR=0.181, 95% CI: [0.091-0.362], p-value<0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of hand-washing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight stunting.

Background: Between 2010 and 2014, approximately 25 million unsafe abortions were performed annually across the globe. Africa alone accounted for 29% of all unsafe abortions, and 62% of the related deaths. Women living in poverty, especially adolescents, lack information about where and how to access safe abortion services. They often do not have the power to make informed decisions on the subject. The purpose of this study is to explore the barriers and consequences of safe abortion as perceived by women leaders in Rwanda. Method: In this qualitative study, seven focus group discussions and seven key informant interviews were performed in October 2019. A total of 51 women leaders participated, their age ranging from 38 to 60 years. Participants were drawn from three districts, namely Gasabo, Kicukiro, and Nyarugenge. For variability of data, participants came from parliament, government ministries, government parastatals, and civil society organizations. All interviews were conducted in Kinyarwanda and later translated into English. Data were analyzed using qualitative content analysis. Results: The emerging theme “strong barriers and numerous consequences of safe abortion” illustrates how women leaders perceive barriers to safe abortion and its related consequences in Rwanda. The theme is divided into two categories: 1) “Perceived barriers of safe abortion” and 2) “Consequences of providing safe abortion”. The sub-categories for the first category are “Reluctance to fully support safe abortion due to perceived unjustified abortions”, “Abortion-related stigma, “Abortion is against cultural and religious beliefs”, and “Emotional attachment to the unborn”. The sub-categories for the second category are “Perceived physiological trauma”, “cause for barrenness/infertility”, “increase in services abuse by adolescents/women”, “increase of workload for healthcare providers”, “increase in sexual activities and STIs”, and “Abortion-related physiological trauma”. Conclusion: The subject of safe abortion evokes mixed reactions among participants, and is entangled with unsafe abortion in most cases. Participants stress that the word ‘abortion’ disturbs, regardless of whether it relates to being safe or unsafe. Participants believe the word ‘abortion’ outweighs the word ‘safe’. Societal expectations play a major role in the decision-making process of any adolescent or a family member faced with a pregnant adolescent regardless of the existing safe abortion law. Community mobilization and sensitization are crucial if safe abortion in accordance with abortion law is to be embraced. Messages that reinforce safe abortion as acceptable and address stigma, fears of trauma, and barrenness should be developed to educate adolescents, parents, and women leaders about safe abortion, to mitigate unsafe abortion-related complications.

This study aimed to explore health care professionals (HCP’) perceptions about mental‐health‐seeking behaviours in men and women and its social and gender implications in Rwanda. Six focus group discussions including 43 HCPs working at mental health facilities and district hospitals in Rwanda were conducted. Data were analysed using qualitative content analysis. The emerging theme “Traditional gender role patterns and stigma are displayed in mental health care seeking, adherence to treatment and family effects” illustrated how HCPs perceived gender differences and outcomes in mental healthcare seeking. The theme was based on three categories: “Gender differences in health care seeking patterns,” “Gender roles and stigma affect adherence to counselling and treatment,” and “Gender roles exert an influence on family support” and related subcategories, with which each described various aspects contributing to the result. According to HCPs who regularly encountered people with mental health problems, neither men nor women with mental health problems could adequately benefit from the available mental health services because of the strong influence stigma and prevailing traditional gender roles had on men's and women's mental‐healthcare‐seeking behaviour. There is an urgent need for comprehensive societal interventions involving policy makers, HCPs, and the general population to diminish the stigma tied to mental illness and the traditional gender norms that negatively influence healthcare‐seeking patterns; such actions can improve the health of many citizens.

In Rwanda, many people are still mentally affected by the consequences of the genocide and yet mental health care facilities are scarce. While available literature explains the prevalence and consequences of mental disorders, there is lack of knowledge from low-income countries on health care seeking behavior due to common mental disorders. Therefore, this study sought to explore health care professionals’ acquired experiences of barriers and facilitators that people with common mental disorders face when seeking mental health care services in Rwanda. A qualitative approach was applied and data was collected from six focus group discussions (FGDs) conducted in October 2012, including a total of 43 health care professionals, men and women in different health professions. The FGDs were performed at health facilities at different care levels. Data was analyzed using manifest and latent content analysis. The emerging theme “A constant struggle to receive mental health care for mental disorders” embraced a number of barriers and few facilitators at individual, family, community and structural levels that people faced when seeking mental health care services. Identified barriers people needed to overcome were: Poverty and lack of family support, Fear of stigmatization, Poor community awareness of mental disorders, Societal beliefs in traditional healers and prayers, Scarce resources in mental health care and Gender imbalance in care seeking behavior. The few facilitators to receive mental health care were: Collaboration between authorities and organizations in mental health and having a Family with awareness of mental disorders and health insurance. From a public health perspective, this study revealed important findings of the numerous barriers and the few facilitating factors available to people seeking health for mental disorders. Having a supportive family with awareness of mental disorders who also were equipped with a health insurance was perceived as vital for successful treatment. This study highlights the need of improving availability, accessibility, acceptability and quality of mental health care at all levels in order to improve mental health care among Rwandans affected by mental disorders.

Objectives To investigate mental health effects associated with exposure to trauma in Rwanda during the 1994 genocide period, and over the lifetime, in Rwandan men and women aged 20–35 years. Setting This was a cross-sectional population-based study conducted in the southern province of Rwanda. Data was collected during December 2011 to January 2012. Participants A total population of 917 individuals were included, 440 (48%) men and 477 (52%) women aged 20–35 years. Number of households for inclusion in each village was selected proportional to the total number of households in each selected village. The response rate was 99.8%. Face-to-face interviewing was done by experienced and trained clinical psychologists, following a structured questionnaire. Results Women were slightly less exposed during the genocide period (women 35.4% and men 37.5%; p=0.537), but more women than men were exposed to traumatic episodes over their lifetime (women 83.6%, n=399; men 73.4%, n=323; pConclusions Depression, post-traumatic stress disorder, anxiety and suicidal attempts are prevalent in Rwanda, with rates twice as high in women compared with men. For women, exposure to physical and sexual abuse was independently associated with all these disorders. Early detection of gender-based violence through homes and community interventions is important.

Background