Georges Bucyibaruta

Open tibia fractures, particularly from high-energy trauma, are often infected, making treatment difficult. Honey, with its antibacterial characteristics, has been recommended as an alternative to standard wound dressings. This study compares the efficacy of honey dressings versus standard dressings in reducing microorganism presence in open tibia fractures. This a randomized, open-label, parallel-group experiment study done at the University Teaching Hospital of Kigali, Rwanda. Honey or regular saline dressings were randomly assigned to 98 Gustilo IIIA open tibia fracture patients. Days one and five wound assessments, bacterial cultures, and antibiotic sensitivities. Microorganism decrease was the main outcome, while wound size, infection rates, pain, and other wound characteristics were supplementary metrics. Statistical analysis was conducted with STATA 23 and a significance level of p<0.05. On Day one, there were no significant differences between the two groups in terms of microorganism presence or wound characteristics. However, by Day five, Honey dressing group showed a significant reduction in bacterial presence compared to the control group, with 82% of the honey-treated wounds showing no bacterial growth versus 62.5% in the control group. Honey dressings were particularly effective in reducing Staphylococcus aureus and Pseudomonas spp. infections. Antibiotic sensitivity patterns were similar between groups, although Honey-treated wounds exhibited slightly increased sensitivity to chloramphenicol combinations. In conclusion, Honey dressings reduced antibiotic-resistant microorganisms in open tibia fractures better than standard dressings on day five. These data suggest that Honey may be a feasible alternative to traditional wound care for open fractures, especially in resource-limited settings. These findings should be confirmed by larger sample sizes and longer follow-ups.

Introduction: The WHO Surgical Safety Checklist (WHO SSC) is a low-cost, high-impact tool shown to improve surgical outcomes and enhance safety culture, particularly in low- and middle-income countries (LMICs). Despite its effectiveness, adherence remains inconsistent across resource-constrained settings. This study evaluated WHO SSC availability and compliance in Rwandan and Malawian hospitals, identifying systemic and behavioural factors influencing implementation. Methods: A prospective observational study and cross-sectional staff survey were conducted in 28 referral and district hospitals in Rwanda and Malawi. Surgical cases were selected using stratified random sampling, and checklist adherence was assessed via structured observation across the three checklist phases. Theatre staff completed questionnaires on checklist familiarity, training, and team dynamics. Statistical analysis included descriptive methods and generalised linear models to identify predictors of checklist availability and use. Results: Of 602 surgical procedures observed, checklist availability was significantly higher in referral hospitals (62%) than in district hospitals (30%), and in elective (56%) versus emergency surgeries (38%). Availability was lower in Rwanda (31%) compared to Malawi (69%) (p < 0.01), yet Rwandan hospitals demonstrated superior adherence across all phases: Sign-In (estimate = 29.4, p < 0.01), Time-Out (15.8, p < 0.01), and Sign-Out (15.2, p < 0.01). Team presence during Time-Out increased checklist use eleven-fold (OR: 11.8, 95% CI: 6.56–21.33). Familiarity with the checklist and 5–10 years of experience also improved compliance. Discussion: Despite broad awareness, checklist use in LMICs remains inconsistent due to logistical barriers and workforce dynamics. Targeted training, increased checklist availability, and digital tools may strengthen implementation and enhance surgical safety in under-resourced settings.