MGHD 2023

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: 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 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: 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.

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.