Assessing The Prevalence of Intestinal Stomas Among Major Abdominal Surgery Patients and Exploring the Lived Experience of Long-Term Ostomates in Rwanda: A Mixed Methods Study

Introduction:Intestinal stoma formation is a critical but often under documented surgical intervention in Rwanda, typically performed to manage bowel obstruction, be it benign or malignant, perforation, or trauma. Despite its clinical significance, little is known about the national prevalence of stoma formation or the lived experiences of individuals adapting to long-term stoma use.

Objectives: This study aimed to (1) estimate the prevalence of intestinal stomas among abdominal surgery patients in Rwanda in 2024, (2) describe the demographic and clinical characteristics among abdominal surgery patients in Rwanda in 2024, (3) assess the association between selected demographic and clinical characteristics and the likelihood of stoma formation among abdominal surgery patients in Rwanda in 2024, and 4) explore the medical, social, psychological, and economic challenges experienced by individuals with long-term stomas.

Methods: A mixed-methods design was employed. Quantitative data were retrospectively extracted from 509 abdominal surgical theater registries across referral and level two teaching hospitals (L2TH) and analyzed using chi-square and Fisher’s exact tests, where appropriate in SPSS. Qualitative data were collected through semi-structured interviews with 11 individuals living with long-term stomas and analyzed thematically using Dedoose.

Results: Of the 509 patients that underwent major abdominal surgery, the prevalence of stoma formation was 12%. Stomas were significantly associated with age, hospital type, and etiology (all p<0.05). No significant association was found with sex (p=0.834). Qualitative findings indicated that living with a stoma involved persistent physical, emotional, and social challenges, compounded by supply shortages, financial barriers, and limited institutional support. Participants also described acceptance, spirituality, and social support as key coping mechanisms that fostered adaptation.

Conclusion: Stoma formation in Rwanda was more prevalent among older adults and patients with malignancy, with notable differences across hospital types. Beyond clinical determinants, the lived experience of individuals with stomas was shaped by ongoing material, psychosocial and structural constraints. Strengthening stoma care supply chains, improving patient support systems, and integrating psychosocial care are essential to enhance long-term wellbeing and quality of life for ostomates

Keywords: Intestinal stoma, colorectal cancer, lived experience, Rwanda, stoma care, mixed methods