Dr. Emmanuel Ngwakongnwi

Introduction: Rehabilitation is a fundamental healthcare component focusing on enhancing and restoring functional ability and quality of life for individuals experiencing physical, mental, cognitive, social, and psychological limitations. Rehabilitation helps individuals to maintain or regain independence, reduces long-term disability and improves community integration. In Rwanda, rehabilitation services are largely inaccessible in rural primary care (PC) settings, where the majority of persons with disabilities reside. This study explores nurses’ insights on challenges and strategies to enhance rehabilitation in rural PC in Burera district, Northern Rwanda. Methods: The study used a qualitative exploratory design to understand the challenges of rehabilitation services in PC. The study involved a focus group discussion (FGD) that used a semi-structured interview guide. Ten health centers’ nurses participated in the FGD conducted at University of Global Health Equity (UGHE), Butaro campus. The inclusion criteria were a minimum of one year working in outpatient service at the health center. Additionally, three follow-up individual interviews were conducted to validate information provided during FGD. Results: The study identified challenges affecting rehabilitation services delivery and utilization, and strategies to enhance rehabilitation services at health centers. This included challenges faced by rural health centers such as limited access to rehabilitation services, inadequate resources and structural and social barriers. These challenges hinder access and utilization of rehabilitation services at health centers. Despite the challenges, nurses highlighted strategies to overcome the listed barriers, such as investment in rehabilitation services, an outreach model, and telerehabilitation, which should increase rehabilitation services at PC. Conclusions: Primary healthcare settings in rural Rwanda face multifaceted barriers in providing rehabilitation services. Strengthening service delivery requires integrating rehabilitation into PC, training rehabilitation health personnel, improving infrastructure, and adopting innovative solutions like digital rehabilitation. These efforts will enhance access, reduce disparities, and promote the social inclusion of persons with disabilities in rural communities. Keywords: Rehabilitation, Challenges, Strategies, Primary care, Nurses, Disability, Rwanda, Rural settings, Qualitative study

Objectives This study aimed to estimate the prevalence of depression and anxiety and associated risk factors among non-communicable diseases (NCD) clinic attendees in rural Rwanda. Design Cross-sectional. Setting 44 health centres in three rural districts in Rwanda. Participants Adults aged 18 years and older with a clinical diagnosis of diabetes, hypertension and/or asthma, who were attending a follow-up appointment during the study period (n=595). Outcome measures Primary outcome measures were depression (measured by Patient Health Questionnaire-9) and anxiety (measured by Generalised Anxiety Disorder-7). Explanatory measures included sociodemographic and behavioural risk factors associated with depression and anxiety. Results Of 595 participants, 265 (44.5%) had depression (95% CI: 40.5% to 48.6%) and 202 (33.9%) had anxiety (95% CI: 30.1% to 37.9%). Comorbidity of depression and anxiety was found in 137 participants (23%). Participants with no formal education had significantly higher odds of reporting depression and anxiety compared with those with primary and secondary/higher education (adjusted OR (aOR)=2.08; 95% CI=1.27 to 3.33, p=0.004, aOR=5.00; 95% CI=1.12 to 25.00, p=0.035, respectively). In addition, participants who were unemployed were more likely to report depression and anxiety (aOR=3.03; 95% CI=1.62 to 5.67, p<0.001). Similarly, participants who had trauma in the past were more likely to report depression and anxiety than those who did not experience traumatic events in the past (aOR=1.67; 95% CI=1.09 to 2.56, p=0.019). Conclusions The overall prevalence of depression and anxiety was found to be significantly high among the study participants. The risk factors that were associated with depression and anxiety included level of education, district of residence, employment status and past trauma exposure. The findings emphasise the need for integrating mental health screening into NCD care, district-specific interventions, employment support services and trauma-focused care.

Background Resource-limited countries face challenges of integrating rehabilitation services into primary healthcare. This is always hindered by many factors such as poor healthcare policy, a shortage of healthcare providers, limited knowledge among healthcare providers, and resource constraints. This study aimed to understand rehabilitation needs in primary care and explore current management practices for rehabilitation services in primary care with the goal of generating evidence to inform policies and interventions for the improvement of rehabilitation services at primary care. Methods The study used a descriptive qualitative study design. Data collection involved the focus group discussion (FGD) of ten health nurses from Burera District, each nurse had a minimum of one year of working experience in the outpatient services at health center. A semi structured interview guide was used during data collection to explore rehabilitation needs at primary care and to understand the current management practices of disability cases presented at health center. The data were analyzed thematically by the research team. Results Data analysis revealed three major themes: Nurses’ understanding and experience with rehabilitation services. Disability cases presenting at the health center and their unmeet rehabilitation needs, and Navigating the current management practices of disability cases at rural health centers. Participants stressed the need for rehabilitation services by mentioning disability cases that need rehabilitation encountered at health centers. However, rehabilitation services for such disabilities are very limited at all health centers. The current management practice showed rehabilitation services that are available at few health centers such as mental and primary eye care services. In addition, participants emphasized limited involvement of nurses in rehabilitation service delivery. Conclusion The integration of rehabilitation services in primary care is crucial to ensure rehabilitation services for all. However, this demands strategic resource distribution, to establish rehabilitation services with specialized rehabilitation professionals at all health centers. In addition, task sharing to involve nurses and community health workers in rehabilitation service delivery at primary care will increase service availability. Furthermore, implementation of community-based rehabilitation is crucial for enhancing service accessibility and utilization mainly in rural settings.