Dr.Jean Paul Ndayizeye

In Burundi, the north-western region continues to grapple with the lowest level of antenatal care (ANC) attendance rate which is constantly about half the national average of 49% ANC4 coverage. Despite a dearth of empirical evidence to understand the determinants of this suboptimal attendance of ANC, widespread evidence informs that women forget scheduled ANC appointments. We designed and tested a digital intervention that uses a reminder model aimed at increasing the number of women who attend at least 4 ANC visits in this region. We enrolled a cohort of 132 pregnant women who were followed until childbirth using a single arm pre- and post-test design. The digital model builds on the collaboration between midwives or nurses, community health workers (CHWs), and pregnant women who are centrally connected through regular automated communications generated by the cPanel of the digital intervention. In addition to ANC attendances, we nested a cross-sectional survey to understand mothers’ perceptions and acceptability of the digital intervention using the acceptability framework by Sekhon et al. (2017). Descriptive analyses were performed to observe the trend in ANC attendance and logistic regressions fitted to seize determinants affecting mothers’ acceptability of the intervention. Of 132 enrolled pregnant women, 1 (0.76%) dropped out. From a baseline of 23%, nearly 73.7% of mothers attended their subsequent ANC visits after the start of the intervention. From the third month of intervention, about 80% of mothers constantly attended ANC appointments; which corresponds to greater than 200% increase from the baseline. Findings showed that 96.2% of mothers expressed satisfaction, 77.1% positively reacted to automated reminders (attitudes), 70.2% expressed willingness to participate, and 86.3% had the ability to actively participate to the intervention. Conversely, half of mothers confirmed that participation to this programme somewhat affected their time management. A key learning is that digital interventions have a lot of promise to improve pregnancy monitoring in rural settings. However, the overall user acceptability was low especially among mothers lacking personal mobile phone.

AbstractBackgroundPrevious studies focusing on high‐income countries have shown that young people often face greater barriers to accessing healthcare than older adults. However, in low‐middle income countries (LMICs), there have been a paucity of cross‐country, quantitative studies highlighting these barriers.AimThis exploratory study aims to provide a scoping review of the publicly available Demographic and Heath Survey (DHS) data with a view to form the basis for further work.Materials and methodsData on insurance coverage, agency, and access to evidence‐based family planning from 30 countries in the DHS were compared between age groups. Data on 586,250 participants 15–24 years (33% male) and 854,660 participants 25–49 years (16% male) from 30 LMICs were analyzed.ResultsSignificantly greater barriers to accessing healthcare were observed across six variables in younger population when compared to older adults across all survey questions with an average of 8.4% point difference. Also, there was wide country‐level variation: the maximum differences between age groups were 33% points; Rwanda was the only country with no age differences.DiscussionThis study highlights several possible themes for future research into improving access to healthcare for young people. These themes include more detailed evaluation of country‐specific policies to reduced barriers to healthcare for young people and further research into the causative factors that can influence healthcare utilization by young people.ConclusionOur analysis showcases increased barriers to healthcare access for young people in LMICs. We argue that they can only be improved by targeted policies and direct community engagement.

We aimed to determine whether a Case-Based Collaborative Learning (CBCL) curriculum, developed from the clinical experience of U.S.-based clinicians in collaboration with Rwandan medical faculty, is acceptable, feasible to implement, and effective as a virtual educational tool for medical students in a resource-limited, global health setting. In this CBCL distance learning education, students were actively engaged and understood the case material and asked probing and insightful questions. Course evaluations showed that 106 of the 120 total student responses (88.3%) said that the difficulty level was “about right”, while only 11/120 (9.2%) said it was “too easy” and 3/120 (2.5%) said it was “too hard” providing evidence that even though the cases were largely based on clinical encounters at an American academic medical center, they are understandable, and at the appropriate level of difficulty for Rwanda-based medical students. Qualitative analysis from student comments found the CBCL method most helpful for students to develop diagnostic frameworks, and the practice of clinical reasoning using CBCL was engaging and interactive. This method of a virtual, international CBCL approach, was feasible, effective, and acceptable for students. A large majority of students found the sessions to be of appropriate difficulty and engaging. From the global health and inter-cultural exchange perspective, this collaboration demonstrates feasibility and acceptability of international partnerships. Using virtual, video conferencing technology, similar future collaborations can improve capacity building in lower-resource settings. Keywords: Case-Based Collaborative Learning, Problem-Based Learning, Team-Based Learning, Clinical Reasoning, Global Health, Virtual Education, Medical Education, Diagnostic Frameworks

This study investigated the healthcare provider’s knowledge and attitudes towards induced abortion in Rwanda. A total of 152 healthcare providers from six public hospitals in Kigali city participated in this study. Questionnaires were used to record data on demographics, level of knowledge and attitudes towards abortion law then be cleaned, coded and entered into Excel sheet. Then all data were exported into SPSS version 22 for final cleaning and analysis. The study findings revealed that 54.6% were female, 56.0% were single, and 73% participants said that they attended formal training on abortion care. The study findings revealed that 23.70% healthcare providers had poor knowledge towards legal abortion law, and 57.20% had positive attitude with regards to induced abortion law. The findings revealed that religion and formal training on abortion care were among the factors which were strongly influencing attitudes of health care providers towards induced abortion where protestants were unlikely to have positive attitude with regards to induced abortion (AOR=0.277; 95% CI=0.027-0.377; P=<0.001) compared to participants belonged to catholic religion and participants who were not trained were unlikely to have positive attitude with regards to induced abortion (AOR=0.696; 95% CI=0.056-0.721; P=0.048) compared to trained respondents. It concludes that marital status, category of caregiver, religion, formal training on abortion and level of knowledge were the main risk factors of level of attitude towards induced abortion. More training about induced abortion are highly needed among health care providers to increase related knowledge as well as to eliminate negative attitude towards induced abortion.