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PubMed1994

Maternal human immunodeficiency virus 1 infection and intrauterine growth: a prospective cohort study in Butare, Rwanda.

A prospective cohort study of 318 human immunodeficiency virus 1 (HIV-1)-infected and 309 seronegative pregnant women was carried out in Butare, Rwanda. Birth weight was significantly lower among singleton infants born alive to HIV-1-infected mothers compared with those born alive to seronegative mothers (2706 g vs. 2825 g; P = 0.002). Crown-to-heel length, head circumference, chest circumference and placental weight were also reduced. Maternal HIV-1 infection was significantly associated with intrauterine growth retardation but not with preterm birth. Differences in the body mass index and weight/head ratio suggest that the adverse impact on live born infants may have been most severe towards the end of pregnancy, resulting in a lean infant with a relatively large head. The higher frequency of intrauterine growth retardation could not be explained by potential confounding factors such as maternal cigarette smoking, history of sexually transmitted diseases or sociodemographic characteristics. The neonatal physical examination did not reveal any differences in clinical signs or symptoms within 48 hours of birth except for the presence of conjunctivitis which was more common among infants of HIV-1-infected mothers. The perinatal and neonatal mortality rates were not significantly affected by maternal HIV-1 status.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Growth of human immunodeficiency type 1-infected and uninfected children: a prospective cohort study in Kigali, Rwanda, 1988 to 1993.

OBJECTIVE: To compare the anthropometric characteristics of children with and without HIV-1 infection. METHODS: In a prospective cohort study of 218 children born to HIV-1 seropositive mothers and 218 children born to HIV-1 seronegative mothers in Kigali, Rwanda, 3 groups were compared: infected children (n = 46); uninfected children born to seropositive mothers (n = 140); and uninfected children born to seronegative mothers (n = 207). Weight, height and head circumference were measured at birth, every 3 months during the first year of life and every 6 months thereafter. The weight-for-age, height-for-age, weight-for-height and head circumference-for-age mean z scores were calculated. RESULTS: The weight-for-age, height-for-age and head circumference-for-age mean z scores were lower among HIV-infected children than among uninfected ones at each time period. The reduction in the weight-for-age mean z score was the greatest between 12 and 36 months. The reduction in the height-for-age mean z score of HIV-infected children was persistently below 2 SD after 9 months of age. On the other hand the weight-for-height mean z score was not consistently lower in HIV-infected children when compared with uninfected ones. The anthropometric characteristics of uninfected children born to seropositive mothers were similar to those of children born to seronegative mothers. CONCLUSIONS: In this study HIV-infected children were more frequently stunted (low height-for-age) than uninfected ones. Wasting (low weight-for-height) was not common among HIV-infected children.

Adult↗
PubMedDate not supplied

The etiology of genital ulceration in Rwanda.

The etiology of genital ulcer disease was determined in 210 consecutive patients (110 men and 100 women) who presented at a clinic in Kigali, Rwanda, because of genital ulcers. When mixed infections are included, syphilis (21%), chancroid (24%), and genital herpes (17%) were about equally frequent in men. Lymphogranuloma venereum with ulceration was found in 11% of patients. Syphilis (40%) was the most common diagnosis in women; genital herpes (20%), lymphogranuloma venereum with ulceration (19%) and chancroid (12%) also were frequent diagnoses. Microscopic examination for treponemes after silver-impregnation staining had a poor sensitivity and specificity for the diagnosis of primary syphilis. Overall, 59% of the patients (43% of the men and 77% of the women) had IgG antibodies to the human immunodeficiency virus.

Adolescent↗
PubMed2001

Antimicrobial susceptibilities of Neisseria gonorrhoeae in Kigali, Rwanda, and trends of resistance between 1986 and 2000.

BACKGROUND: Plasmid-mediated and chromosomal-mediated resistance of Neisseria gonorrhoeae to penicillin, tetracycline, thiamphenicol, and trimethoprim-sulfamethoxazole has spread dramatically in Africa. Monitoring of antimicrobial susceptibility is a key element in the control of sexually transmitted diseases. GOAL: To document antimicrobial susceptibilities of gonococci isolated during the past 15 years in Kigali, Rwanda. STUDY DESIGN: Minimal inhibitory concentrations of recently collected gonococcal isolates of eight antimicrobials were determined. The results were compared with data collected for isolates obtained since 1986. RESULTS: In 1986, 35% of the gonococcal isolates were penicillinase-producing N gonorrhoeae. Tetracycline-resistant N gonorrhoeae appeared in 1989. The prevalence of penicillinase-producing N gonorrhoeae and tetracycline-resistant N gonorrhoeae increased significantly to 70.5% and 89.2%, respectively. Chromosomal resistance to penicillin, tetracycline, and thiamphenicol increased temporarily, then decreased significantly. Chromosomal resistance to trimethoprim-sulfamethoxazole appeared in 1988 and increased to 21.6%. All the isolates were susceptible to ceftriaxone, ciprofloxacin, spectinomycin, and kanamycin. CONCLUSIONS: This study illustrated the rapidly increasing frequencies of penicillinase-producing N gonorrhoeae and tetracycline-resistant N gonorrhoeae. Chromosomal resistance to thiamphenicol and trimethoprim-sulfamethoxazole excludes these drugs as alternative treatment. Programs for antimicrobial susceptibility surveillance of N gonorrhoeae should urgently be established in Africa.

Drug Resistance, Microbial↗
PubMed1995

Diagnostic utility of immune-complex-dissociated p24 antigen detection in perinatally acquired HIV-1 infection in Rwanda.

We evaluated the diagnostic utility and prognostic value of immune-complex-dissociated (ICD) HIV-1 p24 antigen detection in a prospective cohort study of perinatally acquired HIV-1 infection in Butare, Rwanda. HIV-1 p24 antigen was measured after acid dissociation in plasma samples collected at 6 weeks and 3 months of age from 36 HIV-1 infected and 80 uninfected children born to HIV-1 infected women. Among children with persistent HIV-1 antibody after 12 months of age, 26.7% of samples tested ICD HIV-1 p24 antigen positive. Among children who died between 3 and 12 months of age but were classified as HIV-1 infected, 17.6% tested p24 antigen positive at 6 weeks of age and 33.3% at 3 months of age. Female infants were more likely to test p24 antigen positive than male infants (p = 0.046). The specificity of the assay was 96.8%. Cumulative probabilities of child survival to 36 months of age were computed by HIV-1 status of the child and early p24 antigenemia. The mean survival time was 7 months for HIV-1 infected children with a high (> 50 pg/ml) p24 antigen concentration versus 20 months for children with p24 antigen concentrations between 10 and 50 pg/ml (p = 0.02). Cumulative probabilities of survival to 36 months of age were 0% among HIV-1 infected children with at least one positive p24 antigen test, 44% among confirmed HIV-1 infected children who were p24 antigen-negative at both 6 weeks and 3 months of age, and 95% among seroreverting children (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS Serodiagnosis↗
PubMed2002

Voluntary counseling and testing for HIV among pregnant women presenting in labor in Kigali, Rwanda.

This study investigated factors related to acceptability of voluntary counseling and testing (VCT) for HIV among pregnant women presenting in labor in Kigali, Rwanda, in an era of free and effective antiretroviral drugs for prevention of perinatal transmission of HIV. A pilot-tested questionnaire was administered to study participants to solicit information regarding their intentions to accept or refuse VCT and treatment of HIV infection during labor and delivery if confirmed infected. Two factors correlated significantly with the acceptance rate. The strongest predictive factor for acceptability of HIV testing was the profession of the male partner. Women whose partners had skilled and well-paid jobs were about four times more likely to accept HIV testing than were women whose partners were unemployed (adjusted odds ratio, 3.5; confidence interval, 1.16-10.85). The other factor significantly associated with the acceptance rate was maternal age. The likelihood of acceptance of HIV testing was about three times higher among women 35 years or older than among younger mothers (adjusted odds ratio, 3.1; confidence interval, 1.01-9.4). For every 5-year increment in maternal age, the odds of acceptance of HIV testing increased by a factor of 1.20. Using this important finding, we constructed an acceptance rate probability curve that could serve as a useful tool to evaluate the efficacy of future interventions aimed at improving the acceptability rate of HIV testing among pregnant women at the study site.

Adult↗
PubMed2001

The earliest cases of human immunodeficiency virus type 1 group M in Congo-Kinshasa, Rwanda and Burundi and the origin of acquired immune deficiency syndrome.

The early cases of acquired immune deficiency syndrome and human immunodeficiency virus type 1 (HIV-1) infection in the 1960s and 1970s in Congo-Kinshasa (Zaire), Rwanda and Burundi are reviewed. These countries appear to be the source of the HIV-1 group M epidemic, which then spread outwards to neighbouring Tanzania and Uganda in the east, and Congo-Brazzaville in the west. Further spread to Haiti and onwards to the USA can be explained by the hundreds of single men from Haiti who participated in the UNESCO educational programme in the Congo between 1960 and 1975.

Acquired Immunodeficiency Syndrome↗
PubMed2002

The role of research institutions in seed-related disaster relief: Seeds of Hope experiences in Rwanda.

The article describes the efforts of a coalition of agricultural research centres, Seeds of Hope (SOH) in the rebuilding, of Rwanda, after the genocide and war of 1994. Research involvement in emergency relief and rehabilitation was unusual at the time and SOH had to forge its unique complementary role. Focusing on crop and variety development and conservation it: provided technical advice to relief agencies on seed procurement; used its baseline ken to assess the effects of war on seed diversity and seed security; made preparations to restore specific germplasm (which, fortunately, proved unnecessary) and spent substantial effort on rebuilding human resource capacity in research as well as basic scientific facilities. The involvement of SOH highlighted the critical, yet very different, roles for research during emergency versus rehabilitation periods and demonstrated the cost effectiveness of building in a diagnostic component--before massive seed or germplasm distributions are programmed.

Academies and Institutes↗
PubMed1983

Sinus histiocytosis with massive lymphadenopathy in Rwanda: report of eight cases with immunohistochemical and ultrastructural studies.

The clinico-pathological, immunohistochemical and ultrastructural features of eight cases of sinus histiocytosis with massive lymphadenopathy (SHML) recorded in Rwanda from 1975 to 1980 are reported. The main histopathological features were a massive enlargement of the lymph node sinuses which were filled with large histiocytes, a great number of which phagocytosed blood cells, especially lymphocytes, and an important proliferation of plasma cells in the medullary cords. The pathogenesis of this syndrome is discussed, particularly the role of immunological disorders challenged by a chronic, but non-specific, infectious state. The ultrastructural study revealed no micro-organisms and no Langerhans' granules. Immunohistochemical staining revealed two interesting features: the presence of immunoglobulins in the cytoplasm of the histiocytes indicating the presence of an immune phagocytosis and the absence of lysozyme and alpha 1-antichymotrypsin (alpha 1-AC) from the histiocytes. The significance of the latter phenomenon is still unknown.

Adult↗
PubMed2004

The quality of essential antimicrobial and antimalarial drugs marketed in Rwanda and Tanzania: influence of tropical storage conditions on in vitro dissolution.

OBJECTIVE: The quality of 33 formulations of essential antimicrobial and antimalarial drugs (amoxicillin capsules, metronidazole tablets, sulfamethoxazole/trimethoprim tablets, quinine tablets and sulphadoxine/pyrimethamine tablets) marketed in Rwanda and Tanzania was assessed and the influence of tropical storage conditions on potency and in vitro dissolution investigated. METHODS: Drug content and in vitro dissolution were determined immediately after purchase and during 6-month storage under simulated tropical conditions (75% relative humidity, 40 degrees C) using the methods described in the USP 24 monographs on the drugs concerned. RESULTS AND DISCUSSION: At the time of purchase, the drug content of all the formulations was within the limits recommended by the USP 24, but after 6-month storage, the drug content of one sulfamethoxazole/trimethoprim and one quinine formulation were found to be substandard. Immediately after purchase, four formulations (three sulfamethoxazole/trimethoprim and one sulphadoxine/pyrimethamine combination) failed the USP 24 dissolution test. Except for three metronidazole and one quinine formulations, dissolution tests performed after 6 months of storage under simulated tropical conditions showed that drug release remained within the USP 24 recommended values. CONCLUSION: In both countries, essential drug formulations met pharmacopoeial potency requirements, but some had a poor in vitro drug release profiles. Some of the formulations tested were not stable upon storage under simulated tropical conditions.

Anti-Infective Agents↗
PubMed2004

Is amodiaquine failing in Rwanda? Efficacy of amodiaquine alone and combined with artesunate in children with uncomplicated malaria.

We investigated the safety and efficacy of amodiaquine alone (AQ) and combined with artesunate (AQ + AS) in 308 Rwandan children 6-59 months old with uncomplicated Plasmodium falciparum malaria attending three sentinel sites. The two treatment regimes were well tolerated and no serious adverse events were recorded. After excluding new infections, children treated with AQ + AS had fewer clinical failures at day 28 after treatment than those treated with AQ alone: OR = 0.20 [95% CI: 0.06-0.57 (P = 0.001)]. Total (parasitological and clinical) failure was also significantly less frequent in the AQ + AS group: OR = 0.34 [95% CI: 0.17-0.67 (P = 0.001)]. When adjusting for study site, the hazard ratio for treatment failure was 0.37 [95% CI: 0.20-0.68 (P = 0.001)]. Combining AQ with AS increases the efficacy of the treatment but the apparent increase of AQ resistance observed in just a 1-year period is worrying and casts doubts on the suitability of implementing AQ + AS as first-line treatment in Rwanda. Alternative treatments should be identified and tested.

Amodiaquine↗
PubMed2006

Thresholds for health insurance in Rwanda: who should pay how much?

Community-based health insurance schemes were introduced in Rwanda in 1999 and now cover 27% of the population. Due to widespread poverty, it remains unclear to what degree poorer population strata can be anticipated to pay into the system. This study investigates the extent to which the Rwandan population can financially contribute to obtain health insurance. More specifically, researchers explored the relationship between resource mobilization for the health system and the ability to provide community-based health insurance across socio-economic strata. Data from six household surveys are analysed revealing a consistent pattern: the goals of maximizing health revenue and maximizing participation in community-based health insurance are mutually exclusive. However, the upper three quartiles of the Rwandan population are able to contribute 1 US dollar per capita per year. In order to extend coverage to the poorest quartile, a corresponding subsidy for the coming years has to be considered.

Community Health Services↗
PubMed2006

Reviewing institutions of rural health centres: the Performance Initiative in Butare, Rwanda.

In many low-income countries, performance of pyramidal health systems with a public purpose is not meeting the expectations and needs of the populations they serve. A question that has not been studied and tested sufficiently is, 'What is the right package of institutional mechanisms required for organisations and individuals working in these health systems?' This paper presents the experience of the Performance Initiative, an innovative contractual approach that has reshaped the incentive structure in place in two rural districts of Rwanda. It describes the general background, the initial analysis, the institutional arrangement and the results after 3 years of operations. At this stage of the experience, it shows that 'output-based payment + greater autonomy' is a feasible and effective strategy for improving the performance of public health centres. As part of a more global package of strategies, contracting-in approaches could be an interesting option for governments, donors and non-governmental organisations in their effort to achieve some of the Millennium Development Goals.

Community Health Services↗
PubMed1996

War zone paediatrics in Rwanda.

Children are particularly vulnerable to injury and death in two types of 20th century conflicts; terrorist attack and civil war. This account describes some first-hand experiences of the aftermath of the Rwandan Civil War of 1994. Events leading to the conflict are described, eye witness accounts of child trauma during the war are recorded and the medical problems (currently ongoing) affecting children are described. Over a period of 3 months from April to June 1994, between half and one million Rwandese, a significant proportion of them women and children, were murdered in brutal hand-to-hand killing, dying from close-quarter gunshot and machete slaughter. Nearly half of the population became refugees in neighbouring countries or displaced persons in their own land. UNAMIR II, the United Nations Emergency Humanitarian Response, grew to some 7000 persons by May 1995. Medical aid was provided by emergency medical contingents from the United Kingdom, Canada and Australia, the latter through its Australian Medical Support Force, providing the definitive emergency medical infrastructure from August 1994. In the consequent post-war civil and social disruption, children suffered from burns, cholera and from motor vehicle trauma. Ongoing landmine blasts continue to affect children and adolescents especially. A new International humanitarian code to build a time-expiry device into landmines and other similar ordinance is urgently required as the post-conflict ongoing disasters in Rwanda, Afghanistan and Cambodia illustrate. Current problems affecting children include an increasing risk of HIV infection, trauma and the special humanitarian needs of thousands of orphans.

Child↗
PubMed1976

Composition of bladder stones in Rwanda.

A small area of endemic bladder stone formation occurs in Rwanda, Central Africa. The X-ray diffraction of 13 of these stones revealed that they were mainly composed of calcium oxalate monohydrate. By X-ray fluorescence the presence of considerable amounts of rubidium was demonstrated which was measured by atomic absorption spectrometry. The concentration of rubidium was about 2-5 times greater than that of zinc. Thy hypothesis that rubidium is an important lithogenic element is formulated. It might explain this endemic bladder stone formation which is exceptional for Central Africa.

Adolescent↗
PubMed1996

An account of co-ordination mechanisms for humanitarian assistance during the international response to the 1994 crisis in Rwanda.

This paper examines the co-ordination strategies developed to respond to the Great Lakes crisis following the events of April 1994. It analyses the different functions and mechanisms which sought to achieve a co-ordinated response--ranging from facilitation at one extreme to management and direction at the other. The different regimes developed to facilitate co-ordination within Rwanda and neighbouring countries, focusing on both inter-agency and inter-country co-ordination issues, are then analysed. Finally, the paper highlights the absence of mechanisms to achieve coherence between the humanitarian, political and security domains. It concludes that effective co-ordination is critical not only to achieve programme efficiency, but to ensure that the appropriate instruments and strategies to respond to complex political emergencies are in place. It proposes a radical re-shaping of international humanitarian, political and security institutions, particularly the United Nations, to improve the effectiveness of humanitarian and political responses to crises such as that in the Great Lakes.

Altruism↗
PubMed2000

Profile: restarting Rwanda's research engine.

When ethnic tensions between Rwanda's Hutus and Tutsis erupted in April 1994, one of Africa's most vibrant scientific communities suddenly vanished. Now molecular biologist Etienne Karita has returned to head the Belgian-funded National Reference Laboratory for Retroviral Infections.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Should screening of genital infections be part of antenatal care in areas of high HIV prevalence? A prospective cohort study from Kigali, Rwanda, 1992-1993. The Pregnancy and HIV (EGE) Group.

OBJECTIVE: To study the prevalence and incidence of genital infections and their association with HIV-1 infection among pregnant women in Kigali, Rwanda. SUBJECTS AND METHODS: HIV+ and HIV- pregnant women were followed prospectively during the last three months of pregnancy. At enrolment, syphilis test (RPR) on blood sample, Chlamydiae trachomatis ELISA test on cervical smear, laboratory gonococcal culture, trichomonas and candida direct examination, CD4 lymphocyte count were performed. At each monthly follow-up clinic visit until delivery, genital infections were screened in the presence of clinical signs and symptoms. RESULTS: The HIV seroprevalence rate was 34.4% (N = 1233), 384 HIV+ women and 381 HIV- women of same parity and age were enrolled. Prevalence of genital infections at enrolment was generally higher in HIV+ women than in HIV- women: syphilis, 6.3% versus 3.7% (p = 0.13); Neisseria gonorrhoea, 7.0% versus 2.4% (p = 0.005); Trichomonas vaginalis, 20.2% versus 10.9% (p = 0.0007); Chlamydia trachomatis, 3.4% versus 5.5% (p = 0.21); Candida vaginalis, 22.3% versus 20.1% (p = 0.49). Until delivery, the relative risk of acquiring genital infections was also higher in HIV+ women than in HIV- women: 1.0 for syphilis (95% CI: 0.5-2.2), 3.7 for Neisseria gonorrhoea (1.0-13.3), 2.6 for Trichomonas vaginalis (1.5-4.6) and 1.6 for Candida vaginalis (1.1-2.4). CONCLUSION: In the context of high HIV-1 seroprevalence among pregnant women, prenatal care should include at least once screening for genital infections by clinical examination with speculum and a syphilis testing in Africa.

Adolescent↗