Jeanine Condo

This session looks at how longstanding patterns in research culture influence who is recognised, rewarded, and visible in global knowledge production. Gendered gaps continue to appear in authorship, citation patterns, career progression, and access to funding. These differences often reflect broader structural factors, including how research careers are organised, how credit is assigned, and how care responsibilities shape the time and continuity researchers can dedicate to their work. By bringing together researchers and representatives from funding bodies, the session explores how these dynamics emerge in practice and how systems can evolve to better support equitable research environments.

Low birth weight (LBW) is a significant public health concern, particularly in developing countries, because it is associated with increased neonatal and i

Introduction: Inadequate minimum meal frequency (MMF) contributes to malnutrition among infants and young children, increasing the risk of stunting, micronutrient deficiencies, impaired cognitive development and higher morbidity and mortality. In Rwanda, limited data exist on the prevalence and determinants of meeting MMF among children aged 6–23 months. This study aimed to determine the prevalence and determinants of meeting MMF in this population. Methods: A cross-sectional study was conducted using secondary data from the 2019–2020 Rwanda Demographic and Health Survey, comprising 1203 children aged 6–23 months. The main outcome was meeting MMF, defined according to WHO guidelines as receiving the minimum recommended number of meals per day, based on age and breastfeeding status. Bivariate analysis using χ² tests and binary logistic regression was conducted to determine the determinants of meeting MMF. Variables with a p<0.05 were included in a multivariable logistic regression model. Results: The prevalence of meeting MMF was 46.1%. Four factors were independently associated with meeting MMF. Children from the poorest households had 70% lower odds of meeting MMF (adjusted OR (AOR)=0.298, 95% CI 0.124 to 0.717). Children whose mothers earned less than their husbands had 53% lower odds of meeting MMF (AOR=0.466, 95% CI 0.235 to 0.924). Children who experienced recent diarrhoeal illness had 57% lower odds of meeting MMF (AOR=0.434, 95% CI 0.267 to 0.706). Additionally, lack of postnatal care visits was associated with 45% lower odds of meeting MMF (AOR=0.551, 95% CI 0.328 to 0.926, p=0.024). Conclusions: The study revealed that less than half (46.1%) of the Rwandan children aged 6–23 months met the MMF requirement. Key factors negatively associated included household poverty, maternal income inequality, recent diarrhoeal diseases and lack of postnatal care visits. These findings underscore the need for integrated socioeconomic and healthcare interventions.

Background: Digital health innovations address health care accessibility challenges in low- and middle-income countries. Babyl, Rwanda’s largest telemedicine platform, reached 450 of 510 health facilities and enrolled 2 million patients before halting in September 2023 for system redesign. Limited research has explored implementation experiences and user perspectives that influenced its sustainability. Objective: This study aims to explore user experiences and implementation lessons from Babyl’s digital health platform, examining drivers that supported or hindered adoption and scale-up. This qualitative study uniquely examines the lived experiences of diverse stakeholders, active users, lapsed users, nonusers, health care providers, and Babyl agents to understand implementation challenges that contributed to the platform’s halt. Methods: A qualitative, cross-sectional study used 20 focus group discussions (FGDs) and 32 key informant interviews (KIIs) across 12 health centers in ten districts with diverse utilization rates, geographic locations, and Babyl agent availability. FGDs captured collective community perspectives while KIIs provided in-depth individual experiences, enabling data triangulation. FGDs included active users, lapsed users, registered nonusers, and eligible nonregistrants. KIIs involved health center heads, health care providers, and Babyl agents. Data were analyzed using thematic analysis following Braun and Clarke’s framework. Data saturation was achieved when no new themes emerged from the last 3 FGDs and 5 KIIs. All transcripts were validated through member checking with a subset of participants, and intercoder reliability was established with a Cohen kappa of 0.82 across 2 independent coders. Results: Five themes emerged: (1) knowledge and perceptions of digital health, (2) enablers and barriers to utilization, (3) experience and satisfaction, (4) benefits, and (5) improvement suggestions. Participants held positive perceptions of digital health for improving access and reducing wait times. Key enablers included qualified providers, convenience, privacy, and Babyl agents. Major barriers included negative perceptions of remote care quality, service delays, limited digital literacy, device access challenges, and inadequate health facility integration. Users reported high satisfaction with consultations but experienced process confusion. Patient and provider perspectives diverged: patients emphasized convenience, while providers expressed concerns about diagnostic limitations without physical examination. Digital literacy and smartphone access were pronounced barriers among rural and older participants. Recommendations included community mobilization, universal agent deployment, expanded coverage, and sustainable financing. Conclusions: Multiple implementation challenges at individual, community, health system, and policy levels contributed to Babyl’s discontinuation. Critical lessons include the importance of genuine health system integration, sustainable financing, stakeholder engagement, and gradual scaling. Findings provide insights for Rwanda’s health sector digitalization and other African nations investing in telemedicine platforms.

Background: Digital health interventions, such as electronic immunization registries (eIRs) and electronic logistic management information systems (eLMIS), have the potential to significantly improve immunization data management and vaccine logistics in low- and middle-income countries (LMICs). Despite their growing adoption, there is limited evidence of the financial and economic costs associated with their implementation compared to traditional paper-based systems. Objectives: We aimed to measure the costs of implementing eIR and eLMIS systems in LMICs and to estimate their economic costs as compared to the previous paper-based registries. Methods: The study was conducted across four countries—Guinea, Honduras, Rwanda, and Tanzania—which implemented the tools in 2018, 2012, 2019, and 2014, respectively. A combination of primary and secondary data sources was used for the analysis. Retrospective cost data regarding the design, development, and implementation of the tools were directly obtained from implementers and National Immunization Program offices in all countries. Primary survey data were collected to gauge the operational expenses of immunization information systems, both with and without electronic tools, using an activity-based costing approach in 275 facilities. The annual cost of the immunization information system at the national level was then extrapolated and compared to national spending on immunization as a measure of affordability. Costs were reported in 2023 international dollars (I$) Results: The total costs of designing, developing, and deploying eIR, eLMIS, or both were I$ 2.2, 6.4, 6.8, and 44.3 million in Guinea, Honduras, Rwanda, and Tanzania, respectively. Design costs were greatly affected by the degree of customization of the tool, whereas rollout costs were mostly driven by the costs of purchasing hardware and training health workers. Overall, the implementation of the electronic systems was associated with higher costs in Honduras (I$626 per facility, 95% CI 516-821) and Rwanda (I$399, 95% CI I$108-I$691), a cost reduction in Tanzania (−I$2539, 95% CI −I$4290 to −I$789) and no significant cost difference in Guinea. The percentage weight of the cost of managing data with the electronic systems over the total national immunization budgets was estimated at 0.7%, 7.7%, 3.3%, and 4.8% for Guinea, Honduras, Rwanda, and Tanzania, respectively. Conclusions: Digital health interventions such as eIR and eLMIS can potentially reduce costs and improve the efficiency of immunization data management and vaccine logistics in LMICs. However, the extent of cost savings depends on how effectively these digital systems replace traditional paper-based methods and the extent of their use in decision-making, especially at the facility level. Careful planning and investment are essential to unlocking the full economic potential of digital health in LMICs.

Introduction: Rwanda has initiated recency testing alongside existing HIV testing services of provider-initiated testing, partner notification services (PNSs), and of prevention of mother-to-child HIV transmission. We aimed to determine characteristics of the newly diagnosed population using a nationwide cohort. Methods: We included all newly diagnosed patients with HIV aged 15 and above who consented to recency testing and assessed patient- and health center–related predictors of recent HIV infection using multivariable logistic regression models. Results: We obtained data from 485 of 565 health facilities in Rwanda that introduced PNS and recency testing alongside preexisting testing services. From October 2018 to February 2024, 8940 individuals consented to HIV recency testing. Among them, 537 (6.0%) were recently infected. The odds of detecting a recent HIV infection increased by 1% for each month of experience in PNS. Patient-related factors associated with recent infections included female sex, younger age (15–24 years), residing in southern or northern provinces compared with the western province, and self-reported sex with a known HIV-infected person or unprotected sex outside of a relationship in the last 12 months. Conclusions: Only 6% of newly diagnosed HIV infections were characterized as recent. Public health interventions targeting younger females may assist in reducing new infections in this group.

Marburg virus disease (MVD) is a highly fatal hemorrhagic fever with fatality rates between 33 and 88% in sub-Saharan Africa. Rwanda reported its first MVD outbreak on September 27, 2024. This study assessed Rwanda's response to its first MVD outbreak, focusing on identifying critical success factors and areas for improvement during the initial 10 days after outbreak declaration. This observational study analyzed publicly available data from daily screenings and outbreak reports provided by the Rwanda Ministry of Health and Rwanda Biomedical Center between September 27 and October 7, 2024. The study examined confirmed cases, deaths, testing rates, and recoveries, including healthcare response measures. Data was collected from checkpoints and passenger screening at entry points, with information aggregated into Rwanda's Health System. By October 7, 2024, Rwanda reported 56 confirmed MVD cases, including 12 deaths and 8 recoveries. Daily screening began on October 3rd, and by October 7th, 2387 individuals were tested, with a positivity rate of 2.3%. Healthcare workers accounted for over 70% of confirmed cases. No new deaths were reported from October 4 (day 7) until October 7th (day 10), though the first 2-3 days after outbreak declaration were critical, with 6 deaths occurring during this period. Rwanda's response included increased testing, early detection, intensive care management, experimental therapeutics (monoclonal antibodies and remdesivir), and comprehensive contact tracing. Analysis of the first 10 days of Rwanda's MVD outbreak provides valuable insights into effective outbreak response, highlighting the importance of early interventions, healthcare worker protection, enhanced testing, and international collaboration. Early detection and intensive management of cases, including advanced critical care and strong laboratory infrastructure, are essential to reduce early mortality. These findings emphasize the need to strengthen healthcare systems by establishing rapid preparedness and response mechanisms before outbreaks occur and fostering international partnerships to enhance outbreak management and control.

Background: Stunting in young children continues to be a public health concern in Rwanda. The effect of stunting in the first 1000 days of life has long-term consequences, including decreased brain development and a higher risk of developing diseases later in life. To design proper interventions, identifying the risk factors of stunting too early is paramount. The study thus aimed to identify the prevalence of stunting too early (6–23 months) and its associated risk factors. Methods: The research study analysed secondary data from the nationally conducted demographic health survey of 2019–2020, which was analysed by using bivariate analysis and multivariable logistic regression models to determine the factors associated with stunting that occurred too early. P value of <0.05, regression coefficients and their 95% CI were used to assess the level of significance as well as insights related to the strength and direction of the relationship between being stunted too early and other covariates. Results: A total of 1180 children aged 6–23 months were included in the analysis. The overall prevalence of stunting too early was 30% with a 95% CI of 27.4%–32.6%. Moreover, the prevalence of stunting was 29.0%, 20.0%, 23.0% and 35% among the 6 months, 7–8 months, 9–12 months and 13–23 months age groups, respectively. After adjusting for potential confounding variables, the following factors were independently associated with stunting too early: being male (aOR:2.3; 95% CI:1.68 to 3.00), not currently being breastfed (aOR:1.97, 95% CI:1.21 to 3.19), mothers aged 25–34 and more than 34 years (aOR:1.64; 95% CI:1.11 to 2.43) and (aOR:1.63; 95% CI:1.07 to 2.47), respectively, households with poor wealth index (aOR:2.61; 95%CI: 1.72 to 3.09), child age group of 13–23 months (aOR:2.00; 95% CI:1.14 to 5.51) and small child size at birth (aOR:2.36; 95% CI:1.42 to 3.92). Conclusions: The prevalence of stunting too early was high, and the factors significantly associated with it were the sex and age of the child, the mother’s age, low socio-economic status and small child size at birth. There is a need to address those factors through campaigns of health education, emphasis on girls’ education for their empowerment and strengthening of nutritional programme implementation.

BACKGROUND Digital health interventions, such as electronic immunization registries (eIR) and electronic Logistic Management Information Systems (eLMIS), have the potential to significantly improve immunization data management and vaccine logistics in low- and middle-income countries (LMICs). Despite their growing adoption, there is limited evidence on the financial and economic costs associated with their implementation compared to traditional paper-based systems. OBJECTIVE We aimed to measure the costs of implementing and maintaining eIR and eLMIS systems in LMICs, and to estimate the affordability of their implementation as compared to the previous paper-based registries. METHODS The study was conducted across four countries: Guinea, Honduras, Rwanda, and Tanzania. A combination of primary and secondary data sources was used for the analysis. Expenditure information regarding the design, development and implementation of the tools was directly obtained from implementers and National Immunization Program offices in all countries. Primary survey data was collected to gauge the operational expenses of immunization information systems, both with and without electronic tools using an Activity Based Costing approach. The cost of immunization information system to the national level was then extrapolated and compared to national spending on immunization as a measure for affordability. RESULTS The total costs of designing, developing and deploying eIR and/or eLMIS were I$ 1.7, 5.4, 4.7 and 33 million in Guinea, Honduras, Rwanda and Tanzania respectively. Design costs were greatly affected by the degree of customization of the tool, whereas roll out costs were mostly driven by the costs of purchasing hardware and training of health workers. Overall, the implementation of the electronic systems was associated with higher costs in Honduras (I$ 535 per facility, 95% CI 441; 702) and Rwanda (I$ 278, 95%CI 75; 482), a cost reduction in Tanzania (I$ -1,770, 95%CI -2,990; -550) and no significant cost difference in Guinea. The percentage weight of the cost of managing data with the electronic systems over the total national immunization budgets was estimated at 8.6%, 1.1%, 3.7% and 1.8% for Honduras, Rwanda, Tanzania and Guinea, respectively CONCLUSIONS Digital health interventions such as eIR and eLMIS can potentially reduce costs and improve the efficiency of immunization data management and vaccine logistics in LMICs. However, the extent of cost savings is contingent upon the degree to which these digital systems replace traditional paper-based methods. Our study suggests that the economic impact of digital health solutions greatly depends on factors such as infrastructure, implementation, and the extent to which these technologies are integrated into existing healthcare systems. Careful planning and investment are essential to realizing the full economic potential of digital health in LMICs.