MGHD 2023

Introduction: Safe drinking water is crucial for human health. But scarcity and disparities in access pose global challenges. Developing countries, particularly rural areas, have significant difficulties in accessibility of safe drinking water. The Sustainable Development Goals (SDGs) 6.1 calls for universal access to drinking water. Drinking water in households can be contaminated by different factors such as poor hygiene and sanitation practices. Monitoring the quality of drinking water in households can contribute to the well-being of people especially those living in rural areas like Butaro. Methods: A quantitative cross-sectional study on the assessment of drinking water quality in storage containers was conducted in Butaro sector, Rwanda. The study area was 3 cells (Mubuga, Muhotora, Rusumo) surrounding Urugezi Marshland. Random sampling was used to obtain 270 household representatives. A survey questionnaire was used to collect data related to factors that can affect drinking water quality in households and drinking water samples were collected from households drinking water storage containers. Collected water samples were tested for pH, turbidity, and microbiological contamination including Total coliforms, fecal coliforms, and E.coli. . Laboratory results were analyzed by comparing them to the national drinking water standard set by Rwanda Standard Board (RSB). Result: Males comprised 37% while females accounted for 63%, with the most prevalent age group being 30 to 44 years at 33.3% and the highest proportion of participants having a primary school education level at 54.8%. Regarding physical parameters analyzed 56.7% of water samples were within the acceptable range of pH and the majority of the tested samples 96.3% had an acceptable range of turbidity. However microbiological tests showed that 57.4 % of water samples were contaminated with total coliforms. Fecal coliforms were found in 35.9% of water samples and E.coli was found in only 2.22% of tested water samples. The comparison to the standard showed that 21.9% of water samples were safe for drinking as those samples meet the standard regarding measured parameters. The bivariate analysis done showed an association of drinking water quality with age group, education level, village, source of water, consistency of water supply in public standpipe, water treatment, and frequency of toilet cleaning. The Multivariate analysis showed the association of water quality with age with an odds ratio (OR) of 3.381. Protected springs and surface water also showed significant associations with a lower odds ratio of having unsafe water compared to using public standpipes. For protected springs the odd ratio (OR) was 0.260 while the surface water odds ratio was 0.243. Conclusion: The study revealed that the majority of drinking water stored in containers did not meet national quality standards in Rwanda. Factors such as age, education, village, water source, and hygiene practices were associated with water quality. To address this issue, collaborative efforts are needed to implement One Health WASH interventions, particularly in rural areas, to improve the quality of drinking water in storage containers. Regular monitoring is essential to ensure the safety and prevent contamination of stored drinking water.

Background: Teenage pregnancies pose a significant challenge in Sub-Saharan Africa, including Rwanda, where a high percentage of adolescent girls become mothers each year. Despite the implementation of laws and policies to promote Adolescent Sexual Reproductive Health (ASRH) and the establishment of youth corners in health centers, there are gaps in accessing and utilizing SRH services by Adolescent Girls and Young Women (AGYW). Knowledge levels on HIV and SRH have declined among young women, leading to risky behaviors and inadequate access to timely services. This lack of knowledge contributes to the burden of disease among adolescents, including unplanned pregnancies, unsafe abortions, and STIs, including HIV. This study aimed to assess the acceptability and utilization of youth corners by AGYW in Rwamagana District. Methods: The study employed a descriptive qualitative research design, which involved conducting in-depth focus group discussions with Adolescent Girls and Young Women (AGYW). Additionally, key informant interviews were conducted with the focal person responsible for overseeing the youth corners. Furthermore, observational checklists were utilized to gather data in the selected youth corners located in Rwamagana District. Results: A total of 8 Focus groups discussions (FGDs) and 4 Key Informant Interviews (KIIs) were conducted. The results highlighted the various SRH services that AGYW are utilizing in the youth corners, factors affecting acceptability and utilization and possible solutions to avert the situation. 4 themes were used to depict the views of AGYW on acceptability and utilization of SRH services in youth corners and these are: 1. SRH service provision in youth corner; 2. Inter and intra-personal factors that affect SRH acceptability and utilization; 3. Obstacles in provision of SRH and 4. Improving access to SRH for AGYW. The results reveal that lack of knowledge on SRH, religion, culture, distance, and lack of trained healthcare providers on the provision of youth friendly SRH services continue to hinder acceptability and utilization of SRH services in youth corners. Conclusion: The research successfully identified the range of SRH services provided to AGYW in the youth corners of Rwamagana over the past 12 months, which include include contraceptives, emergency contraceptives, pregnancy tests, HIV and STI testing and screening, ASRH information, post-GBV services, and counseling. The study findings emphasize the need to improve the provision of sexual and reproductive health (SRH) services and the existing legal framework to better meet the needs of Adolescent Girls and Young Women (AGYW). Integrating the experiences and recommendations of AGYW into the development of SRH interventions is crucial for creating responsive and effective services. Through assessing the acceptability and utilization of these services by AGYW in Rwamagana district, the study also identified that AGYW face barriers such as limited knowledge, interpersonal and institutional factors, financial burdens, and distance to the youth corners. By addressing these challenges and capitalizing on the opportunities, policymakers and stakeholders can enhance the accessibility, acceptability, and utilization of SRH services for AGYW in the district, promoting their overall well-being and upholding their rights to comprehensive SRH care.

Background: Volcanoes National Park (VNP) in Rwanda is a diverse ecosystem that encompasses various habitats and is home to endangered species such as gorillas and golden monkeys. The study aimed to assess the knowledge and implementation of Water, Sanitation, and Hygiene (WASH) practices among field staff members at VNP, emphasizing the importance of One Health principles for maintaining a sustainable and balanced ecosystem. Additionally, the compliance of the infrastructure at patrol posts within the park was evaluated to ensure a safe and healthy environment for both park personnel and wildlife. Methods: The research utilized a survey questionnaire to gather demographic, descriptive, and infrastructure data, as well as assess participants' WASH knowledge and implementation levels. Additionally, direct observations were carried out using an adapted WASH-FIT checklist to evaluate infrastructure compliance at patrol posts. Data analysis involved various statistical methods, including descriptive statistics, chi-square tests, Fisher's exact tests, Cramer's V tests, bivariate logistic regression, Wilcoxon signed-rank tests, and Spearman's rho correlation, all performed using SPSS. Results: A survey of 233 participants revealed variations in knowledge levels among professional categories, with guides scoring the highest knowledge level (Median=94.7%). However, implementation of WASH practices was comparatively lower than knowledge level for all professions. A significant positive association was found between knowledge and implementation, with higher knowledge levels generally associated with better WASH practices. The WASH-FIT checklist identified deficiencies in water, sanitation, and hygiene facilities at patrol posts. Discussion and Conclusion: The study findings underscore the association between profession and education level with WASH knowledge, aligning with existing research. Poor WASH infrastructure was identified as a contributing factor to subpar implementation, as inadequate facilities hinder staff from ensuring proper WASH practices. Therefore, it is crucial to integrate One Health principles into VNP's WASH practices to maintain a balanced ecosystem and prevent disease transmission. Targeted interventions are imperative, encompassing improved infrastructure, hygiene promotion, WASH training and increasing awareness among park personnel regarding WASH practices and its interconnectedness with human and animal health. Collaboration among park management, researchers, and local communities is vital for successful implementation. Taking a holistic approach to health and well-being is key to fostering positive and sustainable changes in WASH practices at VNP.

Background Men who have sex with men (MSM) and transgender women (TGW) are disproportionately affected by HIV worldwide and in Rwanda. Additionally, MSM and TGW living with HIV are subjected to intersecting stigmatization of their sexual orientation, gender identity, and HIV status. Interventions have been put in place to avail HIV services to everyone including these vulnerable populations in Rwanda. However, the stigma against people living with HIV, MSM, and TGW and their overlap impedes the efforts. Therefore, the purpose of this study was to explore the effect of intersectional stigma on the use of HIV services among MSM and TGW living with HIV in Kigali, Rwanda. Methods This is a qualitative phenomenological study. In-depth interviews were conducted with MSM and TGW living with HIV to explore their lived experiences of intersectional stigma and the use of HIV services. Results Seventeen in-depth interviews (nine MSM and eight TGW) were conducted in total. The findings yielded four themes that highlighted how intersectional stigma affects the use of HIV services among MSM and TGW living with HIV. Those themes are: 1. Internalized, anticipated, and experienced stigma negatively affects mental health and consequently the use of HIV services, 2. Social and employment discrimination exacerbate financial difficulties and negatively affect HIV services use, 3. Experienced stigma from healthcare providers contributes to mistrust and fear of disclosure leading to inadequate use of HIV services, 4. Resilience, social support, inclusive healthcare provision, and positive health outcomes have a positive effect on HIV services use. The results revealed the mechanisms through which the HIV services use are affected by multiple intersecting stigmas and therefore emphasize areas to address in HIV care engagement for MSM and TGW living with HIV. Conclusion The findings of this study highlight how intersectional stigma contributes to economic and mental health challenges among these populations which further exacerbates the barriers to accessing and utilizing HIV services effectively. Therefore, the findings recognize the unique experiences of these communities and emphasize the need for inclusive approaches to reduce stigma and its effect on health-seeking behaviors. By amplifying the voices of these communities, we contributed to the efforts toward achieving inclusive and equitable HIV services for all.

Background Access to safe and legal abortion services is crucial for women's reproductive health and rights. The perception and attitude of healthcare providers play a significant role in the provision of abortion care. However, there is limited research on healthcare providers' perception and attitude following the revision of the abortion law in Rwanda in 2018. Understanding their perceptions and attitudes is essential for improving the quality and accessibility of abortion services. Methods This descriptive phenomenological qualitative research study was conducted in Kirehe District Hospital, Rwanda. Nineteen In-depth interviews were conducted with healthcare providers working in the gynecology and obstetrics ward. Thematic analysis using Dedoose was conducted to identify key themes and sub-themes related to healthcare providers' perceptions and attitudes towards the revised abortion law. Results Nineteen healthcare providers participated in the interviews. The study findings brought to light the significant influence of personal beliefs and interpersonal relationships among these providers, as well as their interactions with the community in shaping their perception and attitude towards the safe abortion law. These factors impacted their perception and attitude towards the law, subsequently affecting the implementation of the safe abortion law within the health facility. Conclusion The study sheds light on the diverse perceptions and attitudes of healthcare providers towards the revised safe abortion law. Factors such as personal beliefs, religious considerations, and interpretations of women's rights influence their stance on the law and its implementation. These findings highlight the importance of addressing these varying perspectives to ensure effective service delivery.

Background: Healthcare is a fundamental human right which, unfortunately, not everyone enjoys equitably. Several governmental and non-governmental organizations, like PIH, run social protection programs to address this challenge to empower the most disadvantaged communities, especially those in low-resource settings. POSER is a socioeconomic empowerment program implemented by PIH in Rwanda that aims to break the cycle of poverty, and poor health outcomes and addresses the social determinants of health through targeted support to selected vulnerable populations. The studies assessing the POSER program in Rwanda are limited, and none have explored the opinions of the beneficiaries. Purpose: This study was conducted to explore beneficiaries’ perspectives on POSER’s impact on their access to healthcare and solicit their recommendations for improvement on the program implementation. Methods: This study implemented a qualitative phenomenological study design. Focus Group Discussions and In-Depth Interviews were conducted to collect data from POSER beneficiaries in Burera district. Results: 43 beneficiaries were interviewed in seven FGDs and fourteen IDIs. Our results showed three themes: (1) POSER improved beneficiaries’ access to healthcare; (2) Beneficiaries still face limitations in accessing healthcare services; and (3) Beneficiaries wish for POSER to upscale the support to meet their needs. These themes reflect beneficiaries’ perceptions of the program on their access to healthcare and forward key points for improvement. Conclusion: This study brought out the varying perspectives of beneficiaries of the POSER program, especially concerning their healthcare access because of the program’s implementation. Beneficiaries' access to healthcare has been significantly improved by the POSER support leading to improvements in health outcomes. Despite these impacts beneficiaries still face challenges and highlighted points for improvement.

Background: Postpartum hemorrhage (PPH) is globally the primary cause of maternal mortality and morbidity. Adherence to clinical guidelines plays a vital role in the effective management of PPH, and mentorship programs have been implemented to enhance the knowledge and skills of Health care providers (HCPs) and adherence to clinical guidelines. However, there is a need to know if they improved adherence to guidelines and maternal outcomes. This study aimed to assess the effect of a clinical mentorship program on healthcare providers' adherence to PPH clinical guidelines and maternal outcomes in the Muhima District Hospital catchment area. Methods: A quasi-experimental design was employed, comparing the same healthcare providers’ adherence to clinical guidelines before and after mentorship. Maternal outcomes were also evaluated in relation to adherence to clinical guidelines. Adherence to clinical guidelines and maternal outcomes were assessed based on standardized medical records. We used consecutive sampling, where cases were added one after another as they appeared in medical registers. Statistical analyses, including the Mann-Whitney test, bivariate (Chi-square and Fischer’s exact tests), and multivariate regression analysis, were conducted to explore the relationship between mentorship and adherence to guidelines and between adherence to guidelines and maternal outcomes. Results: 384 women who had PPH were included in the study. Adherence to clinical guidelines among healthcare providers in managing PPH was (96.4%) before and (95.8%) after the mentorship program. No significant association was found between mentorship and adherence to guidelines (p-value=0.792). However, adherence to clinical guidelines was significantly associated with favorable maternal outcomes (p-value< 0.001). Multivariate regression analysis showed much lower odds of experiencing no complications (AOR= 0.011, 95% CI: 0.002-0.073) for those whose management did not adhere to the guidelines compared to the group which showed adherence. Additionally, estimated blood loss between 500 ml and 1000 ml had higher odds (AOR= 286.777, 95% CI:31.130- 2641.895) of resulting in no complications compared to blood loss of more than 1000 ml. Conclusion: Adherence to clinical guidelines is essential to ensure high-quality care and improve maternal outcomes in PPH cases. The study confirms the effect of adherence to guidelines on maternal outcomes, highlighting the need to promote and strengthen adherence to clinical guidelines. Nonetheless, it became clear that mentorship alone cannot be considered the sole factor determining adherence, implying that other elements, like programs offered by external institutions, may have an influence. Recommendations: Future research should focus on assessing other metrics for adherence and explore barriers and facilitators to adherence in qualitative studies. Promoting adherence to clinical guidelines

Introduction: This research aims to assess the mental health needs of young people (YP) aged 15 to 24 living with HIV in Kigali. The specific objectives of this research are to assess the prevalence of MH conditions among YPL with HIV in SHCs (Selected Health Centers) Kigali, Rwanda, to examine the risk factors associated with MH conditions among YP aged 15 to 24 living with HIV in SHCs in Kigali, Rwanda, to determine MH services availability and treatment types offered at the health facility to YP aged 15 to 24 years living with HIV in SHCs in Kigali,Rwanda. Methods: The research utilized a quantitative cross-sectional design and collected data through a survey questionnaire. Participants were selected using stratified sampling techniques, resulting in a sample of 265 young people living with HIV. Pregnant and breastfeeding YP were excluded from the study. Descriptive and inferential statistics, including bivariate and multivariate analyses, were performed using the latest version of SPSS 26.0. Results: The study revealed a high prevalence of mental health conditions among the participants, with depression affecting 45.7% of YP, anxiety affecting 33.2%, and Post-Traumatic Stress Disorder (PTSD) affecting 27.9%. In relation to depression, the study found that individuals who took less than 30 minutes to reach healthcare facilities had a lower likelihood of experiencing depression (OR = 0.546, 95% CI: 0.316 to 0.942). Being bullied more than half the days was strongly associated with increased depression risk (OR = 9.527, 95% CI:1.318 to 68.839). For anxiety, individuals with primary education had a higher likelihood of experiencing anxiety (OR = 2.047, 95% CI: 0.429 to 9.767). Not engaging in sexual activity in the last three months was associated with a reduced likelihood of PTSD (OR = 0.317, 95% CI:0.144 to 0.700). Having three meals per day was significantly associated with increased PTSD risk (OR = 3.265, 95% CI: 1.481 to 2.461). Conclusion and recommendations: The study emphasizes the high prevalence of mental health conditions among young people (YP) living with HIV and highlights the need for tailored mental health services. Recommendations include integrating mental health services into existing HIV care frameworks is vital to ensure comprehensive support for YP living with HIV.

Background: Biosecurity is a comprehensive approach aimed at preventing the occurrence and spread of infectious diseases within livestock farms. It plays a vital role in safeguarding animal health, ensuring food safety and minimizing the transmission of diseases from animals to humans. Meanwhile, antimicrobial resistance (AMR) poses a significant threat to public health and animal medicine, as it compromises the effectiveness of antibiotics in treating infections. Certain strains of Escherichia coli (E. coli) found in dairy cattle have been identified as priority pathogens due to their potential to cause severe health issues. Currently, there is limited or no information available on the levels of biosecurity in dairy cattle farms and the prevalence of AMR in E. coli strains in Rwanda. Hence, this study aimed to assess the biosecurity levels in dairy cattle farms, determine the prevalence of AMR in E. coli and explore possible associations between biosecurity and AMR. Methods: A cross-sectional study was conducted in the Nyagatare district of the Eastern province of Rwanda between the period of May to June 2023. Biosecurity levels of 160 randomly sampled dairy cattle farms were assessed using a modified Biocheck Ughent questionnaire while standard CLSI procedures were used to identify E. coli isolates from samples collected and determine their antimicrobial susceptibility. Data collected on farmers’ demographics, farm characteristics, biosecurity levels, and antimicrobial resistance was quantitatively analyzed using SPSS Version 20. Chi-square tests and logistic regression analysis were used for tests of association between variables and the P-value set at <0.05 was considered for statistical significance. Results: The study found low biosecurity practices in dairy cattle farms, with only 1.9% practicing teat cleaning before and after milking. Only 9.4% of farmers maintained a register of animal health data. External biosecurity measures, such as quarantine and testing, were implemented by 63.1% and 63.8%, of farms respectively. However, personal protective equipment and hygienic practices for visitors and workers were significantly lacking. Out of 106 biosecurity practices assessed, results showed that biosecurity scores varied among farms, with the highest score being 50% and the lowest being 11%. Farms were observed to perform better in external biosecurity (median 34.7%) compared to internal biosecurity (median 22.8%). Overall, 51.9% of farms had fair biosecurity levels while 46.9% of them had poor biosecurity levels. Results revealed that Gender ,the Age of respondents , Training, and Education levels were not found to be significantly associated with any of the biosecurity levels. Isolates displayed varying levels of resistance to different antibiotics. Ceftazidime exhibited the highest resistance rate at 91.7%, followed by Amoxicillin at 66.7%, Trimethoprim at 25%, Tetracycline, and Ampicillin at 20.8%, Ciprofloxacin at 16.5%, and Cefepime at 12.5%. isolates showed high sensitivity to Imipenem and Gentamicin, both at 100%, followed by Cefuroxime at 95.8%, Meropenem at 91.7%, Augmentin at 87.5%, Trimethoprim, and Tetracycline at 75%, and Ampicillin at 75%. Out of the E. coli isolates with significant Multiantibiotic resistance (MAR) indexes, 63% were found in houses with poor biosecurity. Conclusion: The study highlights poor implementation of biosecurity practices and the presence of resistant E. coli phenotypes in studied dairy farms. These findings underscore the need for improved biosecurity practices in dairy cattle farms to mitigate the risk of AMR development and transmission. Enhancing biosecurity measures, such as teat cleaning, maintaining animal health records, and providing PPE for visitors and farm workers, is crucial for sustainable agriculture, the reduction of AMR prevalence, food safety, and the overall protection of public health.

Background: Barriers preventing timely transportation to health facilities may impact patients’ adherence to accessing cancer diagnostic, treatment, and management services. In Rwanda where the burden of cervical and breast cancer is high with 13.9% and 14.0% incidence and 13.7% and 10.5% mortality rate respectively, economic support through transport stipend provision can help alleviate financial burdens, increase follow-up, and improve patient health outcomes (IARC, 2020b). According to Habinshuti et al. (2020) and O’Neil et al. (2019), they also found the lossto- follow-up rate of cervical and breast cancer patients in their sample population in Rwanda to be 40.1% and 14.0% respectively. The study aims to understand the respective experiences and perspectives of women beneficiaries and program personnel involved in the transport stipend provision program of Rwanda’s Bugesera District. Methods: This descriptive qualitative study used purposive sampling to select seventeen participants for in-depth interviews. Twelve women beneficiaries who received the transport stipend as part of the BIO Ventures (BVGH) for Global Health Educate, Screen, and Treat (EST) program were selected using maximum variation based on their age, distance to the health facility, number of referrals, and insurance category. Five program personnel involved in program planning and stipend provision of the same program were selected based on their period of participation. Document review of financial reports and transport database provided by BVGH were used to provide an overview of the program’s stipend eligibility criteria, distribution process, amount, reach, and cost. To enhance contextual understanding of the women beneficiaries’ experiences, two household visits were carried out, offering valuable insights into their journeys to healthcare facilities. Results: From the document review, 6730 women were screened for cervical and breast cancer between September 2021 and May 2023. An overall 7,672 $USD was allocated to the provision of transport stipend during this period with 2,762 $USD utilized as of the end of data collection period. The stipend reached 75% of the 204 women who attended follow-ups. The amount of transport stipend provided to each beneficiary varied based on their distance to the hospital. Five themes emerged from women beneficiaries’ interviews: (1) financial difficulties in accessing transportation for cancer care, (2) impact of transport stipend on access to cancer services, (3) barriers faced during transportation to cancer services, (4) challenges in the process of receiving transport stipend, and (5) recommendations to overcome transport stipend provision challenges. Five themes emerged from program personnel’s interviews: (1) impact of transportation stipend on access to cancer services, (2) challenges in the process of providing transport stipend, (3) recommendations to overcome transport stipend provision challenges, (4) recommendations for implementation of transport stipend in other settings, and (5) sustainability. Both women beneficiaries and program personnel found the transport stipend to be impactful. However, challenges remain within the provision process related to communications and delays. Insufficiency of the stipend was highlighted with recommendations to provide the same amount for all regardless of insurance and distance as well as to increase coverage to other expenses such as food, accommodation, and travel companions.

Background Smartphone applications in healthcare are becoming popular and widespread across the globe. Most of these applications screen, diagnose, and monitor health outcomes. The recent development of the OptiBP application in measuring blood pressure is a ground-breaking technology that uses smartphones already in the pockets of 3 out of 4 people across the globe (https://www.itu.int/itud/ reports/statistics/2022/11/24/ff22-mobile-phone-ownership/). The application uses photoplethysmography (PPG) to analyse pulse oximetry and report blood pressure via the fingertip (Schoettker et al., 2020). This study aimed to determine the feasibility of the OptiBP application for self-monitoring blood pressure among adults living with hypertension in Rwanda. This study employed the System Usability Scale (SUS), and the Unified Theory for Acceptance and Use of Technology (UTAUT), to determine the usability and acceptance of OptiBP in Rwanda. Methods This cross-sectional study was conducted between May 12th and June 4th, 2023. The study focused on individuals with hypertension. Participants were purposively selected from two public health facilities, namely Nyarugenge District Hospital and Nyacyonga Health Centre, located in Kigali City Province, Rwanda. The participants were provided with training on how to use the OptiBP application. They were then instructed to measure their blood pressure at least twice daily for seven consecutive days while using the application in their homes. At the end of the seven days, a structured questionnaire was administered to assess the feasibility and acceptance of the OptiBP application and analysis were performed quantitively. The questionnaire included sections covering baseline information, the System Usability Scale, the Unified Theory for Use and Acceptance of Technology. Results We enrolled 49 study participants to be involved in this study, however, 46.9% (n=23) were dropped due to incompatibility of their smartphones with the OptiBP application after attempt to calibrate their smartphones failed. The study found that 46.1% (n=12) of the participants considered the OptiBP application usable, with a SUS score of ≥68 which is the ideal SUS score for a usable application. Only length of smartphone use was found to have a significant association with SUS scores (p-value = 0.048), indicating that more prolonged smartphone use was associated with higher SUS scores and ease of use. Overall, participants expressed positive perceptions regarding the possibilities and outcomes of the OptiBP application such as ease of use, ability to use the application without help and willingness to pay a monthly subscription fee. The Net Promoter Scale (NPS) analysis, which indicates the participants' willingness to recommend the OptiBP application, shows no associations between sex, age, education, and length of smartphone use. The compliance rates for blood pressure (BP) measurements show that 46.2% of participants were compliant, while 53.8% were non-compliant. Being busy emerged as the primary factor among the various reasons cited for non-compliance. Conclusion Several challenges related to smartphone compatibility, compliance, usability, and user concerns need to be addressed for the broader implementation of the OptiBP application for self-monitoring. The findings provide valuable insights for further optimizing the OptiBP application.

Background: Gender-based violence (GBV) against women continues to be an issue across the globe and in Rwanda. The United Nations defines GBV as "any act of gender based violence that results in, or is likely to result in, physical, sexual, or psychological injury or suffering to women...whether happening in public or private life" (Kirkegaard, 2020). It is indisputable that GBV is a burden to families, healthcare system, the legal system, and communities. This study aimed to explore the community’s perspectives and understanding of GBV against women, its causes, its consequences and the community’s responses to these consequences in Nyagatare district, Rwanda. Methods: A qualitative phenomenology was carried out, which included in-depth interviews with GBV survivors along with focus group discussions (FGDs) involving healthcare providers, law enforcement officials, local leaders, and community members who do not belong to the other groups. Results: In total 32 participants (10 GBV survivors, 5 healthcare providers, 6 local leaders, 5 law enforcement officials and 6 other community members) participated in the study. Our findings highlight five themes that illustrate how the community views GBV, its causes and effects, and the community's reactions to GBV consequences: (1) traditional patriarchal beliefs and social norms disadvantaged females and contributed to GBV against them; (2) gender-based violence is not restricted to any specific form or type in the community; (3) money, substance abuse, and power often lead to gender-based violence; (4) community generally, understands the short- and long-term impacts of gender-based violence; (5) a wide range of sociocultural and structural barriers often hindered GBV survivors from seeking assistance. These findings draw attention to the lived experiences of GBV survivors, shed light on areas requiring improvement in facilitating their access to essential services, and underscore the persisting challenges embedded within the community that contribute to perpetuating a culture of violence. Conclusion: The study underscores the significance of understanding the community's perceptions of GBV in effectively addressing this prevalent and pressing issue. The findings shed light on the community's understanding of GBV, its underlying causes, and its effects in the Nyagatare district. Therefore, it is crucial that these viewpoints be taken into account when formulating national GBV strategies and initiatives to support the survivors of gender-based violence.