Dr. Janna Schurer

Abstract In 2018, rural residents of northern Rwanda raised water, sanitation, and hygiene (WASH) access and availability as a community concern; however, no baseline information was available to prioritize communities for intervention. This study aimed to assess WASH for people and animals in four cells in Butaro Sector and to identify the cell with the lowest WASH access. This cross-sectional, quantitative study utilized telephone surveys to collect data. Households were randomly selected, and 539 male and female heads-of-household agreed to participate. Overall, 56.8% of households reported access to safe drinking water, but this differed significantly by cell (p < 0.001). Approximately half (54.2%) of respondents walked 30 min or longer to fetch water, travelling one or more times per day. Nearly all (98.5%) households reported the presence of sanitation infrastructure, most often a pit latrine. Across cells, animals experienced poorer access to clean water and sanitation than people. One cell, Gatsibo, reported the poorest overall access to WASH services. Multi-sector collaboration among public health, water authorities, and local leaders is needed to reduce travel times for fetching water and to ensure that all residents can access sufficient safe water to meet the health and hygiene needs of people and animals.

Background Podoconiosis is a neglected tropical disease commonly found in volcanic regions, where soil is rich in silica. It usually manifests as bilateral lower limb edema. The majority of people affected by podoconiosis are farmers who do not wear shoes. The condition was recently documented in all 30 districts in Rwanda but knowledge, attitudes and practices (KAP) of Rwandan health professionals and environmental officers towards podoconiosis are unknown. Methodology/Findings The objective of this study was to assess the knowledge, attitudes and practices (KAP) of Rwandan health providers and environmental officers towards podoconiosis in order to improve patient healthcare experiences and health outcomes, and to reduce stigma against affected individuals. To achieve this goal, we administered a KAP assessment to physicians (N = 13), nurses/midwives (N = 59), community health workers (N = 226), and environmental officers (N = 38) in the third highest podoconiosis prevalence district in Rwanda (Musanze). All 336 respondents had heard of podoconiosis, but 147 (44%) respondents correctly identified soil as the only direct cause of podoconiosis. The awareness of signs and symptoms and risk groups was lower than any other category (31.5% and 47.5%, respectively). The overall attitude toward podoconiosis was positive (86.1%), with CHWs least likely to harbor negative beliefs against podoconiosis patients. One particular area where most respondents (76%) expressed negative attitude was that they saw people with podoconiosis as a threat to their own health and their family’s health. Prescription of antibiotics and use of ointments/soap to manage wounds was low (5% and 32.2%, respectively), in part due to supply shortages at health facilities. Conclusions This study identified clear gaps in health provider knowledge and practices that affect patient care for those with podoconiosis. Improved access to essential medicines at health facilities and podoconiosis-focused training sessions for practicing health providers are necessary to minimize the burden and stigma of affected individuals.

Background: Podoconiosis is a preventable, progressive, and non-infectious form of elephantiasis that can contribute to significant disability and economic burden when not treated early. Nurses play a critical role in early detection and response in rural Africa, but it is unclear if they receive adequate training on podoconiosis. We aimed to characterize podoconiosis instruction at all government accredited, post-secondary nursing institutions in three African countries.MethodsData for this cross-sectional study was collected through a quantitative survey with several open-answer questions. Through a rigorous online search, we identified all post-secondary institutions in Kenya, Rwanda and Uganda accredited to teach human nursing. A total of 289 accredited programs, including 85 certificate, 56 degree and 148 diploma programs were invited to participate. Respondents completed surveys online or by telephone. Measures focused on podoconiosis knowledge, perceptions of quality/quantity of podoconiosis instruction, and barriers to sufficient podoconiosis education.ResultsWe obtained information about 212 curricula across 149 nursing institutions in the three countries (participation rate: 73.4%). Podoconiosis coverage was limited across programs (certificate—24.1%; diploma—55.6%; degree—30.3%). Most respondents felt that the quality and quantity of instruction were insufficient (60.6%, 62.9%), respectively. Exclusion from government curricula, low priority and faculty lack of knowledge were commonly reported barriers to podoconiosis inclusion.ConclusionsThis study demonstrated clear gaps in podoconiosis training for nurses across the three countries and highlights a serious challenge in eliminating podoconiosis as a public health problem. Interventions to improve nurses’ knowledge could include the development and free distribution of podoconiosis teaching materials, designed for integration into pre-existing courses.