Prof. Rex Wong

BackgroundNeonatal Care Units (NCUs) provide special care to sick and small newborns and help reduce neonatal mortality. For parents, having a hospitalized newborn can be a traumatic experience. In sub-Saharan Africa, there is limited literature about the parents’ experience in NCUs.ObjectiveOur study aimed to explore the experience of parents in the NCU of a rural district hospital in Rwanda.MethodsA qualitative study was conducted with parents whose newborns were hospitalized in the Ruli District Hospital NCU from September 2018 to January 2019. Interviews were conducted using a semi-structured guide in the participants’ homes by trained data collectors. Data were transcribed, translated, and then coded using a structured code book. All data were organized using Dedoose software for analysis.ResultsTwenty-one interviews were conducted primarily with mothers (90.5%, n = 19) among newborns who were most often discharged home alive (90.5%, n = 19). Four themes emerged from the interviews. These were the parental adaptation to having a sick neonate in NCU, adaptation to the NCU environment, interaction with people (healthcare providers and fellow parents) in the NCU, and financial stressors.ConclusionThe admission of a newborn to the NCU is a source of stress for parents and caregivers in rural Rwanda, however, there were several positive aspects which helped mothers adapt to the NCU. The experience in the NCU can be improved when healthcare providers communicate and explain the newborn’s status to the parents and actively involve them in the care of their newborn. Expanding the NCU access for families, encouraging peer support, and ensuring financial accessibility for neonatal care services could contribute to improved experiences for parents and families in general.

Background Healthcare facilities in Ethiopia are responsible for collecting samples for testing and treating COVID-19 patients, providing COVID-19 information to staff, establishment of response teams, and provision of adequate personal protective equipment (PPE). Working at the frontlines against the pandemic, health care providers’ level of knowledge about COVID-19, attitude towards their work, and confidence in the preparedness of their facilities are essential factors in mounting a successful response. Objectives This study investigated the knowledge level of HCP in Ethiopia on this novel coronavirus, and their perspectives on whether their workplaces have sufficient preparedness to handle this disease. Methods A self-administered online survey was conducted. Results The knowledge related to COVID-19 among HCPs was high, with an overall average of 91.5%. The majority of our respondents were supportive to the government’s measures to minimize disease transmission, but most of them were also frustrated by how COVID affected their day to day lives. The majority of them were worried about contracting COVID at work and transmitting the infection to their families. Most respondents did not feel safe going to work (P<0.001). Apart from providing adequate information on COVID-19, most workplaces did not have sufficient PPE (P<000.1) and medical supplies (P<0.001). Close to 50% of respondents agreed and disagreed that their workplaces had clear protocols for handling COVID-19 (P = 0.144). Those who handled known COVID patients were more likely to agree their workplaces had clear protocols (OR = 2.69, P<0.001). Conclusion Improving supplies of PPEs and establishing a clear communicating protocol in handling COVID patients are highly recommended.

Purpose This paper aims to assess the knowledge, perceptions and mental health impact of COVID-19 among students in Rwanda. Design/methodology/approach This paper is a cross-sectional online survey questionnaire. Findings The mean knowledge score among the 375 respondents was 75.14% (SD ± 19.1), with 195 (55.1%) of the respondents scoring below 80%. Students who believed that COVID-19 education was sufficient were more likely to have lower knowledge levels (OR = 1.84, 95% CI = 1.15; 2.94). While most respondents were aware of their vulnerability to the virus, they did not see themselves at risk of becoming infected. The percentage of respondents reported to have some form of mental health issues was 49.7%. The three most important factors in influencing mental health were age, history of mental health issues, and the way news was reported. Education quality was less affected for those who received online schooling (OR = 0.55, 95% CI = 0.33, 0.94). Practical implications Education about COVID-19 should be strengthened by capitalizing on existing online and offline learning platforms to frequently update new or changing information. Originality/value This paper was the first study assessing the knowledge, perception and mental health impact of COVID-19 among Rwanda students.

The COVID-19 pandemic has resulted in many schools rapidly rolled out online learning due to school closure or lockdown. This study assessed the online learning experience of 193 students in different universities of Rwanda during COVID-19. The reported main advantages of online learning revolved around the comfortability and self-responsibility in their studies. However, internet access and stability remained the biggest challenges. Respondents reported online learning not stimulating, lacked interactions with other students and with instructors, and they were distracted easily and had difficulty to maintain their discipline. Many students indicated they prefer in-person classes over online learning. Investment to provide students stable internet access and to training instructors to design more interactive and engaging online learning materials according to best practices could improve the students’ online experience. The use of blended online and in-person classroom learning to maximize students learning experiences and outcomes should be explored.

Purpose: Many medical students suffered from some levels of emotional disturbances or disorders, causing negative physical and mental health problems, affecting performance academically, professionally, and personally. This study was conducted to assess the stress among medical students in Rwanda, in order to design appropriate strategies to address or prevent any related potential negative consequences. Method: Medical students who were enrolled in the two medical schools in Rwanda completed an online survey that was developed based on the Stress in Academic Life Scale (SALS). The SALS has 27 4-point Likert scale questions assessing stress related to social support, motivation, curriculum and teaching, academic ambition, self-confidence, performance anxiety, and career. One open-ended question was also included for respondents’ comments. The SALS scores were categorized into “no to fairly”, “fairly to very” and “very to severely” stress levels. Results: A total of 137 samples responded. The overall median SAL score was 1.22, with over 54% of the respondents reported experiencing fairly to severe levels of stress. The highest stress levels were related to Curriculum and Teaching (median = 1.5), Self-confidence (median = 1.33), and Motivation (median = 1.33). The stress score was found to be negatively correlated to age (r = −0.205, P = 0.02), and the number of years in the program (r = −0.218, P = 0.01), and associated with receiving government funding (P = 0.01). Lack of financial support, lack of support from instructors, and disorganized academic activities were also reported as sources of stress. Conclusion: The results of this study suggested mild to moderate levels of stress were faced by the medical students in Rwanda. Finance plays a role, but the main stressors stemmed from the curriculum, teaching, and administrative organization. Medical schools should proactively create appropriate interventions to improve students’ physical and psychological well-being and provide mental health services in schools.

INTRODUCTION: The delay in surgical intervention for open fractures can have severe negative consequences. However, the delay for patients with open fractures presenting at Centre Hospitalier Universitaire de Kigali (CHUK), one of the largest public hospitals in Kigali, Rwanda, had not been studied. This study assessed the waiting time for surgery and compared it against the 6-hour (ideal time) and 24-hours (acceptable time) standards.METHODS: A review of the postoperative register and patients’ records was conducted. All medical charts of open fracture cases between April and September 2018 were audited. A surgical case was considered significantly delayed if the time interval from patient arrival at the emergency room to the operation theater was longer than 24 hours. The demographics, acuity level, insurance status and work shifts, were assessed using bi- and multivariate analysis.RESULTS: A total of 115 open fracture case files were audited. From arrival at the emergency room to surgery, the median time was 41 hours (IQR 21, 93). Only 3 (2.6%) were operated within 6 hours and 38 (33%) within 6 to 24 hours. The main factor contributing to the delay was obtaining orthopedic consultation note and documenting the decision to operate (median 10 hours, IQR 4 to 17). Meanwhile, the designated emergency theater was not utilized for a total of 18 hours per day, especially during night shifts.CONCLUSION: There was a significant delay in obtaining emergency orthopedic consultation and, thus, the timing of the surgical treatment. Examining the patient flow system in orthopedic surgical care delivery is needed in order to maximize theater utilization at this urban university hospital.

Objectives: The objective of this study was to examine the association of receiving care from a volunteeradministered outreach program with emergency room utilization and hospitalization among older people with chronic conditions in Hong Kong. Methods: Volunteers consisting of retired healthcare professionals, university students, and openly recruited citizens received training to provide home care services to hospital-discharged older Chinese adults aged 65+ with chronic conditions who were identified as high-risk patients of hospital admission and referred by public healthcare providers. Several home visits were made to enhance the patients’ self-care capacity. For comparison, a 4:1-propensity score matching based on age, sex, the month of discharge, length of stay for the index episode, and 14 common chronic conditions was conducted to select a comparison group from a territory-wide inpatient database. Poisson regression was used to compare emergency room utilization and the number of hospitalized days. Results: In total, 775 patients were analyzed, including 155 home care recipients and 620 extracted from the inpatient database as a matched comparison with similar baseline characteristics. Regression analysis showed that home care recipients had 21% fewer overall emergency room visits [95% confidence interval (CI): 3%–35%], 22% fewer such visits which led to hospitalization (95% CI: 1%–39%) and 22% fewer overall hospitalized days (95% CI: 16%–28%). Nevertheless, the number of hospitalized days admitted through the emergency room was 10% higher among home care recipients (95% CI: 0%–20%). Conclusions: Volunteer-administered home care might be effective in reducing emergency room visits and non-acute hospitalization, as well as early detection of acute problems warranting tertiary care. Further randomized studies are needed to substantiate this finding.

Pediatric surgery is a crucial pillar of health equity but is often not prioritized in the global health agenda, especially in low-and middle-income countries. Gastroschisis (GS) is a type of structural congenital anomaly that can be treated through surgical interventions. In Rwanda, neonatal surgical care is only available in one hospital. The experience of parents of children born with gastroschisis has not been previously studied in Rwanda. The objective of this study was to explore the lived experiences of parents of children diagnosed with GS in Rwanda. A qualitative study using a semi-structured interview guide was conducted. Parents who had children with gastroschisis and were discharged alive from the hospital in Rwanda were interviewed by trained data collectors, from May to July 2021. Data were transcribed, translated, and then coded using a structured code-book. Thematic analysis was conducted with the use of Dedoose software. Sixteen parents participated in the study. Five themes emerged from the data. They were: “GS diagnosis had a significant emotional impact on the parents”, “Parents were content with the life-saving medical care provided for their children despite some dissatisfaction due to the delayed initiation of care and shortage of medications”, “GS care was accompanied by financial challenges”, “support systems were important coping mechanisms” and “the impact of GS care extended into the post-discharge period”. Having a newborn with GS was an emotional journey. The lack of pre-knowledge about the condition created a shock to the parents. Parents found support from their faith and other parents with similar experiences. The experiences with the care received were mostly positive. The overall financial burden incurred from the medical treatment and indirect costs was high and extended beyond the hospital stay. Strengthening prenatal and hospital services, providing peer, spiritual and financial support could enhance the parents’ experience.

Background: The overall HIV prevalence and incidence in Rwanda have decreased significantly in the past decade. However, opposite trends are seen among key populations (KP). The HIV prevalence among sex workers is as high as 51% and continues to rise. While the HIV prevalence among KP remains high, their adherence to treatment is low. Healthcare providers play a vital role in KP’s access and adherence to HIV treatment. This study aimed to explore the perspectives of healthcare providers on providing HIV services to key populations in Rwanda. Methods: An exploratory qualitative study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services to KP in public health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. All data were analyzed thematically using Dedoose. Results: Interviews were conducted with 18 healthcare providers. Three overarching themes emerged from the interviews: healthcare providers’ intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations and identified a lack of adherence to treatment and prevention guidelines, structural barriers, KP’s lack of trust in the healthcare system, and the discrimination and abuse KP face as challenges to effective HIV prevention and treatment. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes are essential to facilitate access to HIV services for KP.

SETTING: All public health facilities in Rwanda, East Africa.OBJECTIVE: To assess the change in the utilization of maternal and child health (MCH) services during the COVID-19 outbreak.DESIGN: This was a cross-sectional quantitative study.RESULTS: During the COVID-19 outbreak in Rwanda, the utilization of 15 MCH services in all four categories—antenatal care (ANC), deliveries, postnatal care (PNC) and vaccinations—significantly declined. The Northern and Western Provinces were affected the most, with significant decrease in respectively nine and 12 services. The Eastern Province showed no statistically significant utilization changes. Kigali was the only province with significant increase in the fourth PNC visits for babies and mothers, while the Southern Province showed significant increase in utilization of measles + rubella (MR) 1 vaccination.CONCLUSION: Access and utilization of basic MCH services were considerably affected during the COVID-19 outbreak in Rwanda. This study highlighted the need for pre-emptive measures to avoid disruptions in MCH service delivery and routine health services during outbreaks. In order for the reductions in MCH service utilization to be reversed, targeted resources and active promotion of ANC, institutional deliveries and vaccinations need to be prioritized. Further studies on long-term impact and geographical variations are needed.

The term “global health equity” has become more visible in recent years, yet we were unable to find a formal definition of the term. Our Viewpoint addresses this gap by offering a discussion of this need and proposing a definition. We define global health equity as mutually beneficial and power-balanced partnerships and processes leading to equitable human and environmental health outcomes (which we refer to as “products”) on a global scale. Equitable partnerships actively work against racism and supremacy. Such partnerships foster processes with these same dynamics; for example, sharing lead authorship responsibilities with meaningful roles for host country researchers to frame relevant questions and to provide context and interpretation for the research findings. Equitable products, such as access to technology and tailored delivery of interventions effective in the specific context, are the fruits of these partnerships and processes.