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PubMedDate not supplied

Occupational health and gorilla conservation in Rwanda.

The design and implementation of an employee health program for people who work with mountain gorillas in Rwanda is described. This program aims to improve worker health and to reduce human-to-gorilla transmission of infectious disease. The program covered approximately 111 workers, generally healthy men and women 25-45 years old, including essentially all people in Rwanda who have regular contact with gorillas. Initial assessment included a questionnaire, medical examination, and local tests. U.S. laboratory facilities were utilized to confirm some results and for serologic testing for zoonotic (simian) viruses. Initial interventions included STD/HIV prevention health education, tetanus immunization, and anthelminthic treatment. Local physicians continue to provide health services, including follow-up testing and treatment. Mountain Gorilla Veterinary Project (MGVP) veterinarians assist in planning and implementing continuing program components in collaboration with local health authorities and the other employing organizations.

Adult↗
PubMedDate not supplied

[Seroepidemiology of toxoplasmosis in 2 communities of Rwanda (Central Africa)].

We collected dry blood specimens from two rural areas in Rwanda, that were tested for antibodies to Toxoplasma gondii through the Direct Agglutination technique. 50% of the adults in both communities had antibodies to T. gondii. The Ngenda (NGD) population apparently acquired antibodies at a later stage of its life (only 12% were positive at 14 years of age). The Nyarutovu (NVU) population already showed a 31% positivity at the same age. We would like to point out the pathogenic role played by toxoplasmosis during pregnancy and the need of new studies about the epidemiology of the disease as well as the transmission mechanism in Rwanda.

Adolescent↗
PubMed1997

Health care in post-war Rwanda: re-establishing a national hospital using a mentor approach.

OBJECTIVES: To describe the rehabilitation of a large referral hospital amid the civil war in Rwanda, and to discuss the effectiveness of a mentor approach in re-establishing the facility's administrative structure. DESIGN: A mentor administrative design was used to re-establish the hospital personnel structure. This approach linked Rwandan health workers with foreign medical consultants. Formal interviews to evaluate the acceptance and effectiveness of the mentor administration model were conducted with foreign and Rwandan administrative staff. Six month retrospective review of hospital demographics (August 1994-January 1995) was compared to 1993 pre-war data (January-December, 1993). SETTING: The Central Hospital of Kigali, a 600 bed facility in Rwanda, East Africa. PARTICIPANTS: Rwandan and foreign administrators, non-government relief organizations (NGOs), United Nations Military forces, and patients presenting to the Central Hospital. RESULTS: The hospital became fully functional in August of 1994. Both foreign and Rwandan administrators surveyed stated that the mentor program was effective but the hospital would ultimately require external financial support for sustainability. A total of 38,042 patients were treated at the hospital during the six month study period. Compared to 1993 pre-war data, there was a substantial increase in both the overall patient volume and the number of traumatic injuries. Despite this, the case fatality ratio during the post-war period was significantly lower. CONCLUSIONS: A mentor approach was utilized to re-establish the administrative structure of the Central Hospital of Kigali. The facility was able to successfully function despite a larger patient volume compared to the pre-war period. This collaborative effort between NGOs and Rwandan personnel resulted in the development of a sustainable administrative and medical program. The use of a mentor administration may serve as a model for future rehabilitative efforts abroad.

Attitude of Health Personnel↗
PubMedDate not supplied

[The prepayment scheme in Rwanda (II): membership and use of services by beneficiaries].

In Rwanda, the Ministry of Health is rebuilding the health sector destroyed during the genocide while trying to guarantee the financial accessibility of the population to the services through the setting up of a prepayment scheme. Membership remains low in the three pilot districts where the prepayment scheme was introduced four years before (15,6%). In two of these districts, the curative consultation and maternity utilisation has increased appreciably. The members of the prepayment scheme make greater use of the services than the rest of the population. There is a significantly higher prepayment scheme membership among households with a relatively high income and those with a large family (more than 5 family members). Overall, non-members of the prepayment scheme spend more on health services than members do. There are indications that developing the prepayment scheme would be very useful for the people in Rwanda if specific strategies geared to the poor were set up.

Eligibility Determination↗
PubMed2006

Performance-based financing and changing the district health system: experience from Rwanda.

Evidence from low-income Asian countries shows that performance-based financing (as a specific form of contracting) can improve health service delivery more successfully than traditional input financing mechanisms. We report a field experience from Rwanda demonstrating that performance-based financing is a feasible strategy in sub-Saharan Africa too. Performance-based financing requires at least one new actor, an independent well equipped fundholder organization in the district health system separating the purchasing, service delivery as well as regulatory roles of local health authorities from the technical role of contract negotiation and fund disbursement. In Rwanda, local community groups, through patient surveys, verified the performance of health facilities and monitored consumer satisfaction. A precondition for the success of performance-based financing is that authorities must respect the autonomous management of health facilities competing for public subsidies. These changes are an opportunity to redistribute roles within the health district in a more transparent and efficient fashion.

Contract Services↗
PubMed2005

HPLC analysis of generic antiretroviral drugs purchased in Rwanda.

A reversed phase HPLC method using photo diode array detection for the simultaneous quantification of lamivudine, stavudine, nevirapine, zidovudine, methyl paraben and propyl paraben in solid and liquid drug formulations was developed and validated. The separation was achieved using a Waters Symmetry C8 column, using a mobile phase gradient comprising 50 mM NaH2PO4 (pH 3.8) and acetonitrile (95:5 to 45:55, v/v) and a flow gradient (0.5 to 1.0 ml/min). The limits of detection and quantification were below 19 ng/ml and 55 ng/ml respectively. The intra- and inter-day assay precisions were within 4.4% relative standard deviations. The developed method was applied to 12 different generic antiretroviral medications, consisting of tablets, capsules and solutions, produced by two Indian manufacturers and purchased by the Central Agency of Essential Drug Procurement of Rwanda for the ESTHER project in Rwanda. The average content of the antiretroviral agent(s) compared to the labeled amount(s) was 101.4%. Methyl paraben and propyl paraben, added to solutions as preservatives, were within the FDA recommended limits.

Anti-HIV Agents↗
PubMed1991

Human immunodeficiency virus infection in urban Rwanda. Demographic and behavioral correlates in a representative sample of childbearing women.

OBJECTIVE: --To determine behavioral and demographic risk factors for human immunodeficiency virus (HIV) infection in central Africa. DESIGN: --Cross-sectional survey. SETTING: --Kigali, Rwanda. PARTICIPANTS: --A representative sample of 1458 childbearing women aged 19 to 37 years who were recruited from outpatient prenatal and pediatric clinics at the only community hospital in the city. MAIN OUTCOME MEASURE: --Antibodies to HIV assessed by enzyme immunoassay and confirmed by Western blot or indirect immunofluorescence. RESULTS: --The HIV seroprevalence was 32% overall. Infection rates were higher in women who were single, in those in steady relationships that began after 1981, and in the 33% of women reporting more than one lifetime sexual partner. Women in legal marriages or monogamous partnerships had lower rates of infection, but even low-risk women had prevalences on the order of 20%. History of venereal disease in the past 5 years, although the strongest risk factor in a multiple logistic analysis (odds ratio, 2.7; 95% confidence interval, 2.0 to 3.7), was reported by only 30% of those infected. Having a male sexual partner who drank alcohol or who had higher income were significant risk factors for HIV infection in the multivariate analysis, but use of oral contraceptives and having an uncircumcised partner were not. CONCLUSIONS: --The epidemic of the acquired immunodeficiency syndrome in Rwanda has spread beyond high-risk groups to the general population of women without known risk factors. For most of these women, a steady male partner is the source of their HIV risk and therefore a vital target for intervention efforts.

Adult↗
PubMed1991

BCG vaccination and pediatric HIV infection--Rwanda, 1988-1990.

In Africa, tuberculosis (TB) is one of the most common severe diseases associated with human immunodeficiency virus (HIV) infection. For infants in Rwanda and other countries where the risk for TB infection is high, the World Health Organization (WHO) recommends vaccination against TB at birth with bacille Calmette-Guérin (BCG) vaccine (1). This report summarizes a study of the occurrence of immune responses and adverse reactions following BCG vaccination among a cohort of infants born to HIV-seropositive and HIV-seronegative mothers in Kigali, Rwanda, where the prevalence of HIV infection among women of childbearing age is approximately 30% (2).

Female↗
PubMed1987

HIV antibodies in a remote rural area in Rwanda, Central Africa: an analysis of potential risk factors for HIV seropositivity.

Detection of HIV antibodies by means of an immunoenzymatic assay, an indirect immunofluorescence technique and Western blot was attempted on 375 serum samples collected in the Murunda area, a remote rural area situated in Rwanda, central Africa. Two out of 147 (1.4%) adults from a strict rural area, five out of 59 (8.5%) adults from an adjacent market place, and 49 out of 169 (30%) STD clinic attenders from the same area were HIV seropositive. In the first two groups, HIV seropositivity was associated with a history of sexually transmitted disease (STD) in the previous 2 years (P less than 0.001) and with a history of travel to a Rwandese urban centre in the previous 5 years (P less than 0.05). This study suggests that HIV seroprevalence is low in rural central Africa compared with urban centres. Risk factors for HIV seropositivity are similar in rural and urban-based adults in Rwanda, i.e. heterosexual promiscuity and STDs. Many HIV seropositive rural subjects from this study are likely to have acquired HIV infection through sexual contacts in Rwandese cities.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[3-year study of shigellosis epidemic in Rwanda, Central Africa. Problems of public health and bacteriological aspects].

Since 1979, the Lakes region (Kivu in Zaïre, Western Uganda, Rwanda, Burundi) has been stricken by a bacillary dysentery epidemic at S. dysenteriae type 1. Supposed to be extinct since the 1950s., this bacillus has revealed a very noticeable virulence as well by the number of registered cases (524/100.000 in 1983 at Ruhengeri-Rwanda) as its fast break through. Demographic density (from 400 to 600/km2) has played an important role and has facilitated the transition toward epidemicity. Systematic bacteriological exams on the spot has allowed prompt identification of the involved germ, antibiotics to be used, and resistance variations during the period under consideration. The role of a regional laboratory to monitor diarrheal diseases has been demonstrated as of prime importance to set up a fighting strategy at regional level.

Anti-Bacterial Agents↗
PubMed1985

Nutrition studies of Ugandan refugees in Sudan and Rwanda. A report on surveys using the mid-upper arm circumference method.

Nutritional surveys were undertaken in refugee camps in southern Sudan and Rwanda. Nutrition status was assessed using the mid-upper arm circumference method. A high level of malnutrition was found in the main transit camp for refugees from Uganda into southern Sudan. Nutrition status in refugee settlements was adequate in the Rwanda camps, where refugees had only been displaced for a short period of time; there was only a limited degree of malnutrition. The findings correlate with the time period of displacement of the refugees.

Arm↗
PubMed1993

Acute arthritis and human immunodeficiency virus infection in Rwanda.

OBJECTIVE: To determine the etiology of acute arthritis observed in adults and to define its relationship with human immunodeficiency virus 1 (HIV-1) infection in Kigali, capital city of Rwanda. METHODS: From September 1, 1989 until March 31, 1990 we conducted a study of all new patients admitted with acute arthritis to the outpatient and inpatient services of the Department of Internal Medicine at the Centre Hospitalier de Kigali, in Kigali, Rwanda, a city highly endemic for HIV infection. RESULTS: Thirty-six patients (27 men 9 women; mean age: 31 years, range 18-65) were included in the study. Twenty-six (72%) were HIV seropositive. Two main diagnostic categories emerged, both strongly associated with HIV infection: (1) aseptic arthritis: 16 (44.5%) patients including 12 (33.5%) patients with spondyloarthropathy of whom 10 (83%) were HIV seropositive, and 4 (11%) patients with HIV related arthritis, (2) septic arthritis: 11 (30%) patients of whom 9 (82%) were HIV seropositive, including 4 with gonococcal, 2 with staphylococcal, 1 with Salmonella B and 2 with tuberculous arthritis. CONCLUSION: In an area highly endemic for HIV, acute arthritis should be considered a possible manifestation of HIV infection and should prompt HIV testing.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Arthritis in HIV infection. A prospective study of 76 cases in Rwanda].

A 16-month prospective study of adult patients who had been suffering from arthritis for less than one year was conducted in the Internal Medicine department of the hospital of Kigali, Rwanda. Seventy-six patients were included in the study. Out of 72 patients whose sera were tested for human immunodeficiency virus (HIV), 52 were positive, this being 72.2 percent compared with the 20.7 percent figure observed in the urban population of adults in Rwanda. Two main groups arthropathies were individualized: septic arthritis (24 patients including 19 seropositive subjects) and inflammatory rheumatism with criteria of spondyloarthropathies in some of them (34 patients, 32 tested, 28 serum positive). Thus, the finding of acute arthritis in a region with high HIV infection prevalence should suggest a possible HIV infection, especially when the arthritis itself is suggestive of this diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Surgical activity at the military health service antenna during the Turquoise operation in Rwanda June-August 1994].

The military health service provided a surgery antenna during the two months of the Turquoise operation in Zaire and Rwanda. During this period, the antenna functioned as a back-up station for the French troop and the local populations subjected to various conditions: Rwanda refugees who had escaped the massacres, subjects wounded by canon shots, war wounds, surgery emergencies in the refugee population. There were 315 operations performed including 33% in children and 70% for lesions of the limbs. The activity during the mission was analyzed on the basis of strategy for surgical diagnosis and treatment under local conditions (lack of complementary examinations, limited number of personnel, disrupted families in the refugee population, no possibility for transfer, major cholera and dysentery epidemic...).

Child↗
PubMed1992

Safety and immunogenicity of high-dose Edmonston-Zagreb measles vaccine in children with HIV-1 infection. A cohort study in Kigali, Rwanda.

OBJECTIVE: To compare the reactogenicity and immunogenicity of high-dose Edmonston-Zagreb (EZ) measles vaccine in children with and without human immunodeficiency virus, type 1 (HIV-1), infection. DESIGN: Prospective cohort study. SETTING: General pediatric clinic and home visits in Kigali, the capital of Rwanda. PARTICIPANTS: Infants born to HIV-1-seropositive and -seronegative mothers were vaccinated with a 10(5.0) 50% tissue culture infective dose of EZ measles vaccine at 6 months of age. Control visits were made 10 and 14 days later to monitor local and general reactions. Measles serum antibodies were measured by an enzyme-linked immunosorbent assay technique at birth and at 6 and 9 months of age. Three groups were compared: infected children (n = 43), uninfected children born to seropositive mothers (n = 135), and uninfected children born to seronegative mothers (n = 194). RESULTS: Three hundred twenty-three children (86.8%) were available for the reactogenicity study. No statistically significant difference between the three groups was found in the occurrence of minor adverse reactions. No severe adverse reaction was observed. One hundred ninety children (51.1%) were available for the immunogenicity study. The percentage of infants negative for measles antibody at 6 months was significantly higher (P = .021) in HIV-infected children (85%) and in uninfected children born to seropositive mothers (90%) than in uninfected children born to seronegative mothers (75%). The overall seroconversion rate at 9 months was 90% (95% confidence interval, 85.7% to 94.3%), without any statistically significant difference between the three groups. CONCLUSION: High-dose EZ vaccine administered at 6 months of age is safe and highly immunogenic in both HIV-infected and uninfected children.

Antibodies, Viral↗
PubMed1981

Multivariate statistical analysis of quantitative serum protein data in populations of Rwanda.

Data on serum protein levels of four populations from Rwanda were analyzed by multivariate statistical methods to assess their utility as an anthropological tool. These populations consisted of two ethnic groups in two different environments. Seven proteins were considered in the analysis. The total concentration of proteins is intermediate between Italian levels and those of the Binga pygmies of the Republic of Central Africa (RCA). Discrimination between the populations was possible with a 25% misclassification. The major principal components can be interpreted from a medical viewpoint, and show significant differences between the populations.

Black People↗
PubMed2006

Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda.

This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out-of-pocket health spending contributed to increased poverty. The analysis uses cross-sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community-based health insurance. Results indicate that health spending had a small impact on the socio-economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user-fee paying individuals who reported significantly lower visit rates than the insured.

Cost Sharing↗
PubMed1986

Metastatic focal infections due to multiresistant Salmonella typhimurium in children: a 34 month experience in Rwanda.

Nineteen out of 139 children with severe systemic disease due to multiresistant Salmonella typhimurium observed during a 34-month period in an in-patient department in Rwanda had focal metastatic infections. More than 80% of the invasive Salmonella infections were acquired in the hospital. Focal metastatic infections occurred after longer hospital stays than bacteremia (29.1 +/- 17.4 days as against 13.5 +/- 9.0 days, p less than 0.01) and were diagnosed more time after the first sign of infection (3.28 +/- 1.41 days as against 1.86 +/- 1.10 days, p less than 0.01). Bacteremia was documented in 13 of the 17 children with focal infection from whom blood cultures were obtained. Seven of 12 had positive stool cultures. The sites of metastatic focal infection were meninges (7 cases), soft tissue (5 cases), joint or bone (4 cases), pleura (2 cases), eye (1 case). The clinical course of meningitis was fulminant and 6/7 patients died before receiving adequate antimicrobial therapy. One child with meningitis and 9 patients with focal infections at other sites were treated with cefotaxime and were cured or improved.

Child↗