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PubMed1997

[Rwanda, a retrospective to aid rendered following the 1994 genocide].

Some 700,000 Tutsi were killed in Rwanda in 1994, and 1.2 million Hutu fled to neighbouring countries. The United Nations and the non-governmental organizations recently issued a document assessing the aid given. Several matters could have been better. Security in the camps, for instance, was a crucial problem and relief workers and armed forces were unprepared for the involuntary cooperation. Also, estimates of numbers of refugees were inadequate and such estimates were manipulated for political purposes. Relief organizations resorted too quickly to import of goods that were available locally, thereby making the aid unnecessarily expensive. The refugees themselves were involved too little in establishing relief priorities. Life of the original population round the camps was disrupted, a fact that received hardly any attention.

Disasters↗

PubMed1998

Psychological intervention with military personnel in Rwanda.

The Canadian Forces have deployed on humanitarian, peacekeeping, and peacemaking operations frequently throughout the 1990s. The circumstances that many Canadian soldiers have found themselves in while deployed have been grim. They have been witness to countless unspeakable acts and carry the burden of their experiences with them. As a result of their operational deployment, many soldiers develop stress reactions that interfere with their daily social functioning. This article reviews the psychological support provided to Canadian soldiers deployed to Rwanda in 1994. The primary intervention known as "debriefing" is also elaborated upon.

Canada↗

PubMed2006

A randomised trial to assess the safety and efficacy of artemether-lumefantrine (Coartem) for the treatment of uncomplicated Plasmodium falciparum malaria in Rwanda.

Coartem is a fixed-dose combination of artemether-lumefantrine that, given in six doses, provides effective treatment for children with uncomplicated Plasmodium falciparum infection in areas with highly endemic and multidrug-resistant malaria. In Rwanda since 2001, amodiaquine+sulfadoxine-pyrimethamine (AQ+SP) has been the first-line treatment, but resistance to this combination has rapidly emerged and spread. Coartem was considered as a possible alternative, and a randomised, open-label, clinical trial to test its safety, tolerability and efficacy was carried out in 2004-2005. Five hundred children aged 12-59 months with uncomplicated P. falciparum malaria were randomly allocated to AQ+SP or Coartem. Patients were followed up until day 28 after treatment. Adverse events and clinical and parasitological outcomes were recorded. Adequate clinical and parasitological response (ACPR) was significantly higher in children treated with Coartem than in those treated with AQ+SP: the PCR-adjusted 28-day ACPR was 96.68% for Coartem and 79.35% for AQ+SP. Both treatments rapidly cleared parasitaemia and fever, although parasite clearance was significantly faster in children treated with Coartem. Mean packed cell volume increased in all patients, with no significant differences between treatments. Coartem proved to be more efficacious than AQ+SP, with a good safety and tolerability profile.

Amodiaquine↗

PubMed1998

Incompatibility of Protopolystoma xenopodis (Monogenea: Polystomatidae) with an octoploid Xenopus species from southern Rwanda.

Protopolystoma xenopodis is an oviparous monogenean occurring as an adult in the urinary bladder of the clawed toad Xenopus laevis. Oncomiracidia invade the host's kidneys where juveniles develop, subsequently migrating to the definitive site. In central Africa, the tetraploid X. laevis occurs in sympatry with octoploid congeners, including Xenopus wittei, believed to be the hybrid derivatives of X. laevis- and Xenopus fraseri-like parental lineages. Twenty laboratory-raised, naive specimens of an X. wittei-like species from southern Rwanda were each exposed to 30 embryonated P. xenopodis eggs (at 20 degrees C) and screened for parasite egg production until 9 months post-exposure. These toads failed to support the development of gravid parasites (comparable experimental procedures produce at least 35% prevalence of patent infection in the natural host X. laevis). Further X. wittei aff. (n = 26) and X. laevis (n = 17) were exposed to P. xenopodis oncomiracidia and dissected at variable times post-exposure: larvae were able to invade the kidneys of X. wittei aff. and began feeding and morphological development. Severe mortality of juveniles occurred in both natural and unnatural hosts between invasion and 39 days post-exposure. However, while small numbers of parasites persisted in X. laevis, no stages were found in X. wittei aff. beyond 39 days. Present data demonstrate the incompatibility of P. xenopodis with X. wittei aff. and are consistent with a hypothesis that specificity in Protopolystoma-Xenopus systems is determined primarily by the ability of juveniles to complete development in the host's kidneys.

Animals↗

PubMed1999

Maternal humoral factors associated with perinatal human immunodeficiency virus type-1 transmission in a cohort from Kigali, Rwanda, 1988-1994.

OBJECTIVES: to study different parameters of humoral immunity responses in the serum of 39 human immunodeficiency virus type-1 infected pregnant women from Kigali, (Rwanda) in correlation with perinatal transmission. METHODS: this study was done between 1988 and 1994. Thirty nine HIV-1 infected women, 18 transmitting (T) and 21 non-transmitting (NT) mothers, have been chosen based on the quantity of sera available for analysis. Maternal data were collected at the time of delivery or during the preceding month. Quantification of viral load was performed by the signal amplification bDNA assay. Specific reactivity of antibody was tested against recombinant p24 protein and five different synthetic peptides from gp120 and gp41 based on HIV LAI-strain sequences. Neutralization assays were performed against laboratory (RII strain of the HIV-1 C subtype) and primary strains (two NSI and one SI of the HIV-1 A subtype). Antibody Dependent Cellular Cytotoxicity assay was performed with CEM.NK(R) cells against a laboratory HIV-1 strain. RESULTS: absence of correlation regarding maternal viral load, or viral subtype and vertical transmission was observed. By contrast, the CD4/CD8 ratio was significantly higher in non-transmitting mothers compared to transmitting mothers. Moreover, high anti-p24 antibody avidity was correlated with a lower risk of perinatal transmission. Furthermore, transmission risk appeared significantly higher with reactivity of serum samples to linear epitopes of gp41 (amino acids 566-582, 578-594), whereas risk appeared lower with reactivity to the immunodominant domain of gp41 (amino acids 597-609). No significant difference was observed in titres of antibody neutralizing primary isolates (two NSI (non syncitium inducer) and one SI (syncitium inducer) of the HIV-1 A subtype) and laboratory strain (RII strain, of the HIV-1 C subtype) between transmitting and non-transmitting mother's sera. In addition, titres of Antibody Dependent Cellular Cytotoxicity were similar in transmitting versus non-transmitting mothers. However, high Antibody Dependent Cellular Cytotoxicity titres were correlated with a good clinical status of children. CONCLUSIONS: three parameters such as high CD4/CD8 ratio, high anti-p24 antibody avidity and high reactivity against the immunodominant epitope of gp41 have been shown to be correlated with no perinatal transmission. High Antibody Dependent Cellular Cytotoxicity titres appeared to be linked to a good clinical status of children after birth. One parameter, reactivity against two linear epitopes of gp41, appeared to be correlated with vertical transmission.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Simple DNA extraction method for dried blood spots and comparison of two PCR assays for diagnosis of vertical human immunodeficiency virus type 1 transmission in Rwanda.

Dried blood spots (DBS) on filter paper facilitate the collection, transport, and storage of blood samples for laboratory use. A rapid and simple DNA extraction procedure from DBS was developed and evaluated for the diagnosis of human immunodeficiency virus type 1 (HIV-1) infection in children by an in-house nested-PCR assay on three genome regions and by the Amplicor HIV-1 DNA prototype assay version 1.5 (Roche Molecular Systems). A total of 150 samples from children born to HIV-1-infected mothers were collected in Kigali, Rwanda, in parallel as DBS and as peripheral blood mononuclear cell (PBMC) pellets. The results obtained on DBS by the two PCR assays were compared to the results of nested PCR on PBMCs. Of 150 PBMC samples, 10 were positive, 117 were negative, and 23 were indeterminate for HIV-1 infection. In DNA extracted from filter papers and amplified by using the in-house nested PCR, 9 of these 10 positive samples (90%) were found to be positive, and 1 was found to be indeterminate (only the pol region could be amplified). All of the negative samples and all of the 23 indeterminate samples tested negative for HIV-1 infection. When we used the Amplicor DNA test on DBS, all of the 10 PBMC-positive samples were found to be positive and all of the 23 indeterminate samples were found to be negative. Of the PBMC-negative samples, 115 were found to be negative and 2 were found to be indeterminate. We conclude that this simple rapid DNA extraction method on DBS in combination with both detection methods gave a reliable molecular diagnosis of HIV-1 infection in children born to HIV-infected mothers.

Acquired Immunodeficiency Syndrome↗

PubMed1979

Peptic ulcer in Rwanda, Africa: influence of geography and dietary habits.

There are areas of Africa with an extremely high incidence of peptic ulcer disease, while most of Africa has a low incidence of ulcer disease. The reason for this variation is unknown. Thirty-three patients with peptic ulcer disease in Rwanda, Africa, were studied in an attempt to determine why they had ulcer disease. High basal acid studies (mean of 10.3 mq per hour) were found in the patients with duodenal peptic ulcers. The males predominated over the females and the Batutsi predominated over the Bahutu in having much more peptic ulcer disease. The male population and patients with ulcers had the custom of eating only one large meal per day. There is a definite correlation between the incidence of peptic ulcers among certain tribes and going for long periods without eating.

Adolescent↗

PubMed1976

Treatment of gonorrhoea with a combination of probenecid and procaine penicillin in Rwanda.

Treatment of acute gonorrhoea with 1 g of probenecid orally followed after 1 h by 4.8 M-units of procaine penicillin intramuscularly yielded a 97.4% cure in men. The cure rate of 81.8% in women is not so satisfactory but the fact that the patients, mostly prostitutes, were chronically infected must be considered. The incidence of post-gonococcal urethritis in men was 34%. Disc sensitivity of neisseria gonorrhoea showed a similar pattern of mostly resistant strains for streptomycin, as in Uganda and Kenya. Ninety-four per cent of strains are sensitive to penicillin but these results must be confirmed by the more reliable dilution method. It is concluded that the treatment schedule studied, eventually simplified by the administration of probenecid and injections of penicillin simultaneously, can be recommended as a standard treatment for gonorrhoea in Rwanda.

Acute Disease↗

PubMed1989