Tsion Yohannes

This article discusses the University of Global Health Equity (UGHE)’s use of a Gender Equity and Diversity Inclusion Audit as a tool to mainstream gender and minority groups’ inclusion. The internal audit analysed gender and minority groups’ inclusiveness, sensitivity, and/or awareness in institutional programmes, projects, plans, practices, and policies and identified the gaps within. This article gives an overview on why and how UGHE (Rwanda) created a single tool for an internal audit covering both gender equity and minority inclusion, implemented by its Center for Gender Equity (CGE) with the participation of students, staff, and faculty from both its Butaro campus and Kigali headquarters in Rwanda. The tool is based on a four-part methodology that includes a desk review of official university documents, self-assessment questionnaires for employees and students, in-depth interviews, and consultative meetings with selected staff and UGHE leaders. The data collected through this robust audit allowed for the identification of gaps in the mainstreaming of gender and minority inclusion—the main ones are briefly discussed in the article, and this will guide the design of UGHE’s strategy to correct these. The gender mainstreaming strategy’s ultimate objective is advancing institutional equity.

Background Teenage pregnancies remain a pressing issue in Sub-Saharan Africa, including Rwanda. Adolescent girlsand young women (AGYW) continue to face a myriad of challenges in accessing sexual reproductive health (SRH)services. This study examines the accessibility and utilization of SRH services provided to AGYW in youth corners inRwamagana district, Rwanda. It seeks to explore challenges and opportunities for accessing SRH services in youthcorners.Methods Utilising a descriptive qualitative research design, the study included 8 in-depth focus group discussionsand 4 key informant interviews. Stratified sampling methodology was utilised to increase the representativeness ofthe AGYW and 71 AGYW participated in the study. The feminist standpoint theory aided in focusing on marginalisedvoices, analysing power structures and contextualising experiences of AGYW in Rwamagana. The socio-ecologicalmodel was used to analyse data using thematic analysis.Results The findings reveal various SRH services accessed by AGYW in youth corners, including family planning,services regarding sexually transmitted infections (STIs) and menstrual hygiene management. Barriers to serviceutilisation included limited knowledge about the available services, distance to health facility, unavailability ofsome services, AGYW being viewed as a prostitute when one is seen with condoms, norms that discourage opendiscussions about sexual health, and stigma surrounding the use of contraceptives. This was further worsened by thegender norms which create additional hurdles for AGYW, as they navigate societal expectations and restrictions thatare not equally imposed on their male counterparts. The inconsistent availability of services coupled with diverseoperating schedules also posed a challenge to accessing services. Most AGYW expressed trust in the healthcareproviders’ ability to maintain confidentiality, given their training and professional obligations. This sense of trust actedas a motivating factor for AGYW to be more open and forthcoming in utilising the available SRH services.Conclusion Addressing the identified challenges faced by AGYW in accessing SRH services in youth corners will helpto promote their well-being and bodily autonomy.

Teen mothers are more susceptible to the negative consequences of pregnancy, due to system-wide and socio-cultural barriers to accessing needed services, posing higher pregnancy complications and health risks to the babies and mothers. Understanding their lived experience can inform context-specific health programs and interventions that address their needs and improve the health outcomes. Twenty-three women who had delivered her first child before the age of 18 years were interviewed using semi-structured interview guide. The transcripts were coded, categorized and summarized into four major themes: 1) Many pregnant teen girls were disadvantaged by the system from accessing the healthcare services, 2) Although being judged, many found the health care services positive and important, 3) Faced financial difficulty in accessing health services, despite most medical services are covered by community based health insurance, 4) Health care services focuses mostly on the medical health of pregnancy, the social and psychological needs were mostly not available. The study highlighted the gap in providing mental health services, financial support to the teen mothers as part of a comprehensive health services. Some of them consulted health services for the first time with and did not return for follow up if perceived the services was bad. More sensitive and targeted materials and ANC services can be offered to this unique group of clients. More acceptance training to the health care providers and the public is needed. For health facilities, there is a need to also check their psychological wellbeing when seeking ANC services. Online or mobile phone-based mental health interventions may provide some solutions to the issue. Government should re-evaluate the health insurance system to avoid unintentional exclusion of this group of population. Policy to facilitate men to take responsibilities on teen pregnancy issue is needed.

INTRODUCTION: This protocol outlines the establishment and implementation of a Human Development and Demographic Surveillance System (HD2SS) in Butaro, Rwanda. The HD2SS will facilitate prospective, continuous monitoring of the population, tracking vital statistics, social events, and key health and demographic indicators in a defined population. The system will enable accurate and validated assessment of the impact of health and related population-level interventions, supporting evidence-based decision-making and data-driven improvements in healthcare and socioeconomic outcomes at a population level. METHODS: The HD2SS will be implemented in the Butaro sector, home to 38,013 individuals across 68 villages. The Butaro sector was purposively selected due to the existence of the University of Global Health Equity and Partners In Health-supported Butaro healthcare delivery. Data, including location, demographic, socioeconomic, and health-related variables, will be collected using the annual household census and stored using the Survey Solutions system for real-time electronic data capture, ensuring data quality, security, and confidentiality. Data analysis will enable the identification of emerging trends, the development of interventions, and the evaluation of related policies and programs. CONCLUSION: The HD2SS will provide currently limited but much-needed data to inform improvements in public health programming and socioeconomic development and strengthen local health research capacity. Regular dissemination of findings will ensure stakeholders, including local health authorities and development partners, are informed and able to use the results to improve health and social development outcomes in Rwanda.

Objective As populations age, multimorbidity and frailty have emerged as major health challenges. While their associations with disability and mortality are well documented, their impact on quality of life (QoL) in sub-Saharan Africa remains underexplored. We examined the associations between frailty, multimorbidity and QoL among older adults in Rwanda. Design A cross-sectional population-based study. Multimorbidity was defined as having two or more chronic conditions, including hypertension, diabetes, heart disease and mental health conditions. Frailty scores were derived using the Fried phenotype, and QoL was measured using the European Health Instrument Survey-Quality of Life index (scaled 0%–100%). Sequential linear regression models were used to examine independent associations. Setting Rural and urban settings of Rwanda. Participant We analysed data from 4369 adults (≥40 years). Results The mean QoL score was 48.2% (±15.6). Frailty and multimorbidity prevalence were 14.5% (95% CI 13.5 to 15.6) and 55.2% (95% CI 53.7 to 56.6), respectively, while 55.0% (95% CI 53.3 to 56.3) were classified as prefrail. Frailty and multimorbidity are independently associated with poorer QoL. Compared with robust individuals, prefrail and frail individuals experienced a 3.66 (95% CI −4.63 to –2.70) and 7.30 (95% CI −8.76 to –5.83) percentage point reduction in QoL, respectively. Multimorbidity was associated with a 4.66% (95% CI −5.54 to –3.79) point decrease in QoL. Impairments in activities of daily living partly mediated these associations. Conclusions Frailty and multimorbidity showed a strong negative association with QoL, with frailty having a stronger effect. These findings underscore the need for age-responsive healthcare strategies, including frailty screening and integrated chronic care, to enhance QoL among older adults in Rwanda.

Abstract Background While Sub-Saharan Africa contains nearly one third of the global burden of disease, it only contains 3.5% of the healthcare workforce. Furthermore, female medical doctors are underrepresented across the continent. Studies show that increasing gender representation in medicine not only bridges this gap but may have a positive impact on patient care. This study explores the support systems influencing female students to pursue medical school in Rwanda, aiming to recommend ways to increase female participation through support systems. Methods This is an exploratory, interpretive study employing qualitative methods. The study was conducted at thirteen secondary schools within two provinces and three universities in Rwanda that offer a medical degree program. Participants were divided into focus groups, including female and male secondary students in science and non-science combinations; teachers of secondary students; female and male students enrolled in medical school; and parents of secondary students in science and non-science combinations. Private and public, mixed and girls-only secondary schools that met the criteria were selected in each province, and all universities offering a medical degree. Participants were selected via random stratified sampling. Thirty-four semi-structured focus group discussions were conducted (28 secondary-level and 6 university-level) and 16 interviews. Data was coded inductively, with common themes identified. Results Four main themes were identified as support systems that can either serve as facilitators or barriers to pursuing an MBBS, including teacher support, parental or familial support, financial or institutional policy support, and having access to female mentors or role models. Conclusion Social support systems are enablers encouraging female students to join medical school. Integrating social support systems in schools and the community has the potential to increase female applicants to medical school in Rwanda.

By 2030, an estimated 80% of the world's older population (aged ≥60 years) will reside in low- and middle-income countries (LMICs). Ageing well in these regions requires addressing complex financial, health, and social care needs through evidence-based policy and practice. However, data collection in LMICs remains limited and often unrepresentative, as seen in Brazil, where nearly 70% of geriatrics and gerontology publications (2014–2019) originated from the south or southeast regions. Recognizing the diverse needs of ageing populations, it is crucial to prioritize locally informed research and targeted interventions. Urgent action is needed to expand research efforts, inform policy development, and strengthen systems that address the medical and psychosocial challenges faced by older individuals in LMICs.

Background: Preterm birth affects 13.4 million cases globally, presenting significant health and socioeconomic challenges. Addressing preterm birth's underlying risk factors and causes, such as Preterm Premature Rupture of Membranes (PPROM) and Cervical Insufficiency (CI), is important. Although these conditions are manageable, they still contribute to a high rate of preterm birth, especially in developing countries like Rwanda, where limited resources alter effective management. This study sought to explore skilled birth attendants' (SBAs') lived experience in the management of PPROM and CI as risk factors for preterm birth in Rwanda. Materials and Methods: A qualitative study using a phenomenological approach was conducted in five health facilities in Rwanda. Participants were 24 SBAs working in obstetrics and gynaecology departments and included Nurses, Midwives, General Practitioners, Obstetric/Gynaecology Residents, Obstetrician/Gynaecologists and Fetomaternal Medicine Specialists. After obtaining informed consent, 24 in-depth interviews were conducted using a semi-structured interview guide. The interviews were recorded in the participants' preferred language, either Kinyarwanda or English and transcribed verbatim. Kinyarwanda transcripts were translated into English. The transcripts were coded inductively and thematically analysed using Dedoose. Results of the study underscored the experiences of SBAs during management of PPROM and CI, including the challenges they face and the foundational anchors of the management. Results: Four themes emerged: Teamwork in action: collaborative care drives success; evidence-based practice: protocols and expertise lead CI and PPROM management; transformative impact: better practices, better outcomes; and overcoming obstacles: resource gaps and patient challenges. Conclusions/Recommendations: PPROM and CI management in Rwanda includes a blend of emotional experiences for those involved, reference to various guidelines, task-sharing and informal in-service education. Addressing resource limitations, adherence to harmonised evidence-based national protocols, formalising task-sharing, emotional support of SBA, and continuous education can benefit PPROM and CI care. Keywords: Cervical Insufficiency, Lived experiences, Preterm birth, Preterm Premature Rupture of Membranes, Skilled birth attendants

Through progressive policies, Rwanda has made significant strides in promoting girls’ education and empowerment. However, female enrollment in Bachelor of Medicine and Bachelor of Surgery (MBBS) programs remains disproportionately low. This cross-sectional study investigates the influence of gender stereotypes and girls’ self-perceptions on female engagement in MBBS programs in Rwanda. The data analyzed for this study has been used and published in BMC Medical Education in a study with a different but clearly related focus, under the title “Gender-based support systems influencing female students to pursue a bachelor of medicine, bachelor of surgery (MBBS) in Rwanda” (Neil KL, BMC Med Educ 24:641,2024). While the previous analysis focused on the presence and gaps in gender-based support systems, the current research has a new focus on gender based self-perceptions influence in girls interest in pursuing medical school training. Conducted across 13 secondary schools and 3 universities offering MBBS degrees, the study engaged 8–12 students, parents/guardians, and teachers in each focus group discussion in a total of thirty-four focus group discussions and sixteen semi-structured interviews. Twenty-eight discussions took place at the secondary school level, and six were conducted at the MBBS level. Data analysis utilized inductive coding to identify recurring themes. The study identified three overarching themes: society’s role in shaping gendered expectations about domestic and professional roles, girls’ self-perceptions regarding their ability to pursue sciences and MBBS within these norms, and internalized stereotypes affecting girls’ career aspirations. Drawing on gender schema and social cognitive theory, the research underscores how societal expectations and stereotypes shape and constrain girls’ career choices. The findings highlight the necessity of dismantling gender-based perceptions that hinder girls’ participation in scientific disciplines, including MBBS.