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PubMedDate not supplied

Airborne field hospital in disaster area: lessons from Armenia (1988) and Rwanda (1994).

The outcome of survivors within disaster areas largely depends upon the quick reallocation and operation of logistic and medical support systems. Enthusiastic media equipped with advanced communication systems, reveal mass human suffering in real time. But, the response period required for the organization of rescue systems is much slower and is most frustrating. In this article, we present our experience in quick deployment and operation of airborne field hospitals gained following the earthquake disaster in Armenia in 1988 and the civil war in Rwanda in 1994. Deployment of improvised, volunteer-based, military field hospitals was feasible within 24 hours after the decision was made. A multi-disciplinary structure enabled an effective, flexible mode of operation and reduced the dependency on mericulous, time-consuming assessments of requirements prior to deployment. These missions are a paradigm for the successful incorporation and integration within the capabilities of military infrastructure of volunteer professionals drafted from civil medical facilities. Such field hospitals could provide backup for primary care medical systems in disaster areas and substitute or take some pressure off of local hospitals, particularly when evacuation systems are insufficient.

Aircraft↗
PubMed1999

Capillaria hepatica (Nematoda) infections in human-habituated mountain gorillas (Gorilla gorilla beringei) of the Parc National de Volcans, Rwanda.

Habituation to humans of free-ranging populations of endangered mountain gorillas (Gorilla gorilla beringei) raised concern of anthropozoonotic transmission of parasitic helminths and protozoans. Examinations of liver tissue of 19 gorillas found dead in the Parc National de Volcans, Rwanda, revealed 10 cases of hepatic nematodiasis due to Capillaria hepatica. Identifiable C. hepatica eggs were present in the liver of 4 gorillas (3 juveniles, 1 adult), and nematode cross-sections were found in 1 juvenile gorilla. Six other adult gorillas had areas of periportal and subcapsular fibrosis with calcified eggs. Histologically, the lesions surrounded by the areas of mild inflammatory reaction were characterized by subcapsular, periportal foci of fibrosis in which were embedded numerous C. hepatica eggs. Control of hepatic capillariasis in the remaining populations of mountain gorillas should be focused on eradication or control of populations of rodent pests (i.e., mice and rats) that sustain the reservoir of C. hepatica in habitats shared by gorillas and humans.

Animals↗
PubMed1975

Serological evidence for syphilis in different population groups in Rwanda.

The prevalence of serological syphilis, based on qualitative VDRL slide test was studied in different population groups in Rwanda. A positive VDRL was found in 0.7% of female students of a social school, in 2.2% of male and female premarital consultants, in 3.2% of prenatal consultants, in 6.5% of soldiers, and in 27.9% of prostitutes. As the first groups were not exposed to venereal disease, VDRL reactivity due to biological false positive reaction or to yaws antecedents is estimated at 0.5 to 2%. Accordingly, VDRL reactivity due to syphilis is estimated at 1 to 2% in prenatal consultants, 5 to 6% in soldiers and 25 to 26% in prostitutes. It is concluded that syphilis is not yet an important public health problem except in certain promiscuous population groups in towns, as soldiers, migrant workers and prostitutes.

Adolescent↗
PubMed2002

Primary health care in complex humanitarian emergencies: Rwanda and Kosovo experiences and their implications for public health training.

In a complex humanitarian emergency, a catastrophic breakdown of political, economic, and social systems, often accompanied by violence, contributes to a long-lasting dependency of the affected communities on external service. Relief systems, such as the Emergency Response Units of the International Federation of Red Cross and Red Crescent Societies, have served as a sound foundation for fieldwork in humanitarian emergencies. The experience in emergencies gained in Rwanda in 1994 and Kosovo in 1999 clearly points to the need for individual adjustments of therapeutic standards to preexisting morbidity and health care levels within the affected population. In complex emergencies, public health activities have been shown to promote peace, prevent violence, and reconcile enemies. A truly democratic and multi-professional approach in all public health training for domestic or foreign service serves as good pattern for fieldwork. Beyond the technical and scientific skills required in the profession, political, ethical, and communicative competencies are critical in humanitarian assistance. Because of the manifold imperatives of further public health education for emergency assistance, a humanitarian assistance competence training center should be established. Competence training centers focus on the core competencies required to meet future needs, are client-oriented, connect regional and international networks, rely on their own system of quality control, and maintain a cooperative management of knowledge. Public health focusing on complex humanitarian emergencies will have to act in prevention not only of diseases and impairments but also of political tension and hatred.

Altruism↗
PubMed2002

[Management of a giant ameloblastoma at the Butare University Hospital Center (Rwanda)].

The management of ameloblastoma is nowadays well codified, requiring surgical treatment. If clinical and radiological aspects could evocate diagnosis, only histological analysis proves it, and permits to differ ameloblastoma from other facial bone tumors. Due to difficulties in Rwanda to obtain preoperative X ray computed tomography, the diagnosis and the management are first based on the clinic features.

Adult↗
PubMed2001

Intensive care nursing in Rwanda, 1994-1995.

The deployment of Australian Military personnel in support of the United Nations Aid Mission in Rwanda (UNAMIR II) in August 1994 represented the first large contingent of Australian medical personnel since the Vietnam War. A kaleidoscope of emotions filled the minds of many deploying personnel before, during and after the deployment. Yet through this turmoil, there were many valued lessons learned. For many, it was a reality check--a return to the basics of life. This article is a personal account of the experience of an intensive care nurse working in a third-world country performing first-world medicine.

Adaptation, Psychological↗
PubMed2001

Rwanda: gods and ghosts.

This paper provides a personal story. I was born in Africa and have a great empathy for its people. The perceptions I provide are through the eyes of an African born individual who has lived in Australia for many years. It is said that you can take the child out of Africa; however, you cannot take Africa out of the child. During my return to Rwanda in 1994 to 1995, I learned many lessons. Perhaps the most significant being that the Rwandan people displayed absolute stoicism and acceptance of adversity, and from the suffering they had endured, they displayed a great dignity.

Adaptation, Psychological↗
PubMedDate not supplied

[The prepayment scheme in Rwanda (I): analysis of a pilot experiment].

Rwanda has made the setting up of a prepayment scheme a priority in its health sector reform in order to make health services more financially accessible to the population. A pilot study was carried out in three districts. The yearly family subscription charge was fixed at 7.9 US dollars, which covers care delivered at Health Centre level as well as some services at the hospital. The beneficiaries and providers mention difficulties in order to mobilise the subscription charges all at a time, the insufficiency of the offer of services at the hospital and the absence of involvement of the political authorities in the process. The Ministry of Health did initiate the experiment but the choice of the privileged pilot districts prevents results from being extrapolated to the country taken as a whole with a view to a possible extension at a later stage. Given the relatively short time in which it has taken place, the population could neither understand the contingency and solidarity issues implied nor have the opportunity to feel personally involved in the system. As a conclusion, the study advocates the continuation of the experiment with a reinforcement of the coordination which should take the weak points identified into account.

Delivery of Health Care↗
PubMed1991

Economic cost of malaria in Rwanda.

Although malaria is widely recognized as a major public health problem in much of Africa, its impact on a specific national or regional economy has proved difficult to assess. This paper demonstrates the kind of analysis possible given available national aggregate statistics on epidemiology and economic indicators, the type of data most readily available. An economic model which applies the average cost of malaria per case to the known number of cases in Rwanda for 1989 estimated the total cost to be $ 2.88 per capita (in 1987 US dollars). Of this cost, $0.63 per capita represents the direct cost of treatment, including care of outpatients and hospitalized cases in both government and private facilities, as well as self-treatment. The other $ 2.25 per capita represents the indirect costs of productive time lost to malaria morbidity in adults and to care for sick children, and the cost of lifetime earnings lost through premature malaria mortality. The average output per day of the Rwandan economy was $0.83 in 1989. Thus, the per capita malaria cost equals 3.5 days of production or 1% of GDP. The average cost of each of the 1,722,271 reported malaria cases in 1989 was $11.82: $2.58 in direct and $9.24 in indirect cost. The direct cost per case is equal to 160% of the per capita budget of the Ministry of Health. Economic and epidemiological projections to 1995 yield an increase in malaria cases to over 4 million at a cost of $7.11 per capita. Direct costs are projected to rise over 200% due to increasing costs of drugs and supplies to treat increasingly drug-resistant cases. Indirect costs, which are tied to a declining economy, are projected to rise by just over 100%. By 1995, malaria is projected to cost 2.4% of the Rwandan GDP, exacerbating an already serious impact.

Costs and Cost Analysis↗
PubMed1991

Perinatal transmission of HIV-1: lack of impact of maternal HIV infection on characteristics of livebirths and on neonatal mortality in Kigali, Rwanda.

We present the baseline results of a prospective cohort study on the perinatal transmission of HIV-1 in Kigali, Rwanda. HIV-1-antibody testing was offered to all women of urban origin delivering a live newborn at the maternity ward of the Centre Hospitalier de Kigali from November 1988 to June 1989; 218 newborns of 215 HIV-positive mothers were matched to 218 newborns of 216 HIV-negative mothers. The matching criteria were maternal age and parity. No differences in socioeconomic characteristics were observed between HIV-positive and HIV-negative women. HIV-positive mothers more frequently reported a history of at least one death of a previously born child (P less than 0.01) and a history of abortion (P less than 0.001). Most of the HIV-positive women were asymptomatic, but 72.4% of them had a CD4; CD8 ratio less than 1 versus 10.1% in the HIV-negative group (P less than 0.001). The frequency of signs and symptoms was not statistically different in the two groups, except for a history of herpes zoster or chronic cough, which was more frequent among HIV-positive women. The rates of prematurity, low birth weight, congenital malformations and neonatal mortality were comparable in the two groups. However, infants of HIV-positive mothers had a mean birth weight 130 g lower than the infants of HIV-negative mothers (P less than 0.01). The impact of maternal HIV-1 infection on the infant seems limited during the neonatal period.

Abortion, Spontaneous↗
PubMedDate not supplied

[Focus of borreliosis in Gisenyi (Rwanda)].

As a result of the increase of relapsing fever cases in a rural area of West-Rwanda, a study of ticks collected in the houses has been performed. Ornithodoros moubata specimens were found in large amount. In patients, fever is the most frequent symptom. Serological tests performed in the surrounding area of patients with Borrelia in the blood are often positive, this confirming the ancient existence of the disease among inhabitants.

Adolescent↗
PubMedDate not supplied

Family planning in Rwanda: status and prospects.

This article analyzes the status and future prospects of family planning in Rwanda. The use of traditional contraceptive methods is examined and major constraints to modern contraceptive use are discussed, both for potential users (low demand) and family planning delivery systems (poor supply). Current contraceptive prevalence, as well as evidence of potentially higher demand, are analyzed. Contraceptive prevalence for modern methods is estimated at 3-4 percent, for 1988, of women of reproductive age who are at risk of exposure to conception. An attempt is also made to target future contraceptive prevalence rates needed to attain specific levels of fertility. Finally, the prospects for family planning as well as recommendations to increase contraceptive use are reviewed.

Adolescent↗
PubMed1989

[Kaposi's sarcoma in Rwanda: clinico-pathological and epidemiological aspects].

The clinico-pathological and epidemiological features of 119 cases of Kaposi's sarcoma diagnosed during the years 1979-1986 in the main pathology department of Rwanda are presented. Skin involvement (89%) was predominant with almost 70% of cutaneous lesions localised on the lower limbs; 11% of cases presented with extracutaneous localisations, 77% (10 cases out of 13) in the lymph nodes. Incidence rises progressively with age, and males are more affected than females with a sex ratio (m:f) of 6.4:1. The highest frequencies were observed in the western prefectures which border the province of Kivu in eastern Zaire. Histologically, three types were encountered: a mixed type (84%), a spindle cell-predominant type (12.6%) and an anaplastic type (3.4%). The factor VIII-related antigen was present in all 40 cases tested by the PAP method. Antihuman immunodeficiency virus antibodies were looked for in 18 cases: 10 cases with localised Kaposi's sarcoma, all of whom were seronegative, and 8 cases with aggressive generalised Kaposi's sarcoma, all of whom were seropositive. The results are compared with those of other authors, and the histogenesis and pathogenesis, particularly the relationship with the acquired immunodeficiency syndrome, are discussed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Clinical study of diabetes mellitus in hospital practice in Northern Rwanda (apropos of 86 case reports)].

Records of 86 patients in Ruhengeri Hospital North of Rwanda (east Africa) during nine months, revealed that diabetes was present in about 4% of all these patients. First of all, malnutrition was noted in about 9% of these diabetics. But, features of the diabetes mellitus were usually as described by Sankale as the "Cosmopolitan Diabetes".--67% of all the patients were male persons from 31 to 49 years old--Typical symptoms as: thirst, polyuria and weight loss were noted in most all patients,--Insulin requirement was noted in 65% of the patients,--Only few patients were diabetic for more than 10 years,--Neuropathy, retinopathy were usually shown,--17.5% of the patients had abnormally high blood pressure (Hypertension). Diabetes mellitus cannot be considered as a preferred share in Africa but malnutrition and obesity, at the opposite side of the nutritional spectrum, are the striking originality of this disease in developing countries.

Adult↗
PubMed1988

Serological survey of hepatitis B in northern Rwanda.

To assess the importance of perinatal transmission of hepatitis B virus and the risk of infection in different age groups in Northern Rwanda, filter paper dried blood samples from 350 subjects were examined for HBsAg and anti HBs. The study shows that vertical transmission is not very frequent in this area, and that the risk of infection increases with age. These results indicate that vaccination against hepatitis B in children could be delayed and included in the standard immunization programme.

Adult↗
PubMedDate not supplied

[Analytical study of an epidemic of bacillary dysentery in Rwanda. Epidemiologic and bacteriologic aspects].

From january 1985 to march 1985, an epidemic of bacillary dysentery stroke one of the region in north Rwanda. The area struck, only 160 km2, is densely populated (720 inhabitants/km2). Multiresistant Shigella dysenteriae n. 1 is the only responsible factor. The study of this epidemic shows that, from an endemic disease, burst out can occur in a narrow area and in a short interval of time (7 weeks). The main risk factors have been identified on individual as well as collective level. The authors demonstrate the interest of a Public Health Laboratory as technical support of an Epidemiology Monitoring Department.

Adolescent↗
PubMed1986

[Cancer in Rwanda. Study of relative frequency].

The relative frequency by age, sex and site of the malignant tumours diagnosed during the years 1982-84 in the main pathology department of Rwanda (serving approximately 80% of the population) is presented. Excluding skin, the numerically most important cancers in males were Kaposi's sarcoma (11.5%), stomach cancer (9.9%), non-Hodgkin's lymphoma (8.1%) and primary carcinoma of liver (6.6%), and in females cancers of the uterine cervix (21.4%), breast (16.8%) and stomach (6.5%). The possible sources of bias are discussed, and the results are compared with those from previous studies in this part of central Africa.

Adolescent↗