Profie and Economic Impact of Motorcycle Injuries Treated at a University Referral Hospital in Kigali; Rwanda

Background: Motorcycle injuries constitute a major public health problem in developing countries; leading to significant disability and straining healthcare resources. We aim to present the basic epidemiology of motorcycle injuries presenting to an urban referral hospital in Rwanda and to evaluate patient outcomes and associated costs arising from injuries sustained on motorcycles. Methods: We conducted a retrospective cross-sectional study of motorcycle injury patients presenting to Kigali Teaching University Hospital from January-December; 2011. Patients were identified through review of ward registers and trauma registries and stratified into 3 groups based upon length of stay. A representative sample of 269 patients was randomly selected from each group for financial analysis. Data were collected from patient medical; police; and financial records as well as patient interviews. Cost analysis was based upon the standard road accident cost conceptual framework. Data were collected using Epi data 3.1; Excel and analyzed using SPSS 16. Results: A total of 269 motorcycle accident files were examined. Males were more affected than females with sex ratio F:M;1:6.72.Youths were more involved in motorcycle accident (53.2) than other age group(16-30 years) .The majority of Motorcycles victims were motorcyclists; (30.86); businessmen (20.45) and students (11.53). Motorcycle-vehicle (41.61) was the fist cause of motorcycle injuries then motorcycle-pedestrian (30.86). Helmet use was 92.75. Head injuries and fractures were the predominant diagnoses (82.15). About 46.7 had pre-hospital care. The mean hospital stay was 15.43 days; and 38.3 spent more than 15 days in hospitalization. Permanent disability was confirmed in 11.5 (n=31); and mortality was 10.4 (n=28). The total economic cost was estimated at US$1;236;207.31 with 39.40 (US$487;030.30) due to loss of labor and 21.76 due to direct medical costs (US$269;000.84). Conclusions: Motorcycle injuries create a substantial disability and cost burden in Kigali; Rwanda. Prevention and early treatment should be promoted to decrease the morbidity and financial burden

Rotavirus Gastroenteritis Surveillance and Prevalence Assessment among Under Five Children in Rwanda

Rotavirus remains the most common cause of severe childhood diarrhea worldwide and of diarrheal mortality in developing countries. Despite the efforts made by the government of Rwanda and the stakeholders to reduce children mortality; the prevalence of rotavirus among under five children in Rwanda remains to be determined. We conducted a hospital-based cross-sectional study that aimed at determining the prevalence of rotavirus infection in under fie children presenting with gastroenteritis in eight hospitals in Rwanda. From June 2013 and August 2014 we collected and tested stool samples for the presence ofrotavirus using an enzyme immunoassay and a Real Time-Polymerase Chain Reaction for genotyping. In 969 stool samples; 232 (23.94 and 5.1) while the lowest one was observed in March (0.00). Muhima Hospital had the highest prevalence (33.33) whereas Kabgayi and Rwamagana Hospitals had the lowest (15.62 and 18.18; respectively). Male children were more affected than females (25.8 versus 21.5). We found that the prevalence was higher (31.10) in children aged between 12 and 24 months than in other age groups. For genotyping; G9 [P8] was the most prevalent genotype as G9 prevalence was 54.6 whereas [P8] prevalence was 73.9.In conclusion; the prevalence of rotavirus gastroenteritis was high among children aged less than 5 years; and it was different according to age groups and among different hospitals

Sputum concentration improves diagnosis of pulmonary tuberculosis cases in children at a tertiary care institution in Rwanda

Introduction: A great concern exists about the emergence of antibiotic resistant organisms. The goal of this study is to delineate antibiotic sensitivity patterns at King Faisal Hospital. Methods: A three years study; from Jan 2009 to Dec 2011 was conducted in the Microbiology unit; department of Laboratory; King Faisal hospital; Rwanda. All the specimens and antibiotic sensitivity were processed according to the standard guidelines. Microorganisms and their sensitivity data were reviewed and compiled by using hospital information system. Results: Over the 3-year period; several Enterobacteriaceae pathogens declined in susceptibility to various antimicrobial agents. A total of 2153 Enterobacteriaceae were isolated. Most common isolate was Escherichia coli check for this species in other resources (1413) followed by Klebsiella check for this species in other resources species (550); Enterobacter check for this species in other resources species (110); Proteus check for this species in other resources species (165); Citrobacter check for this species in other resources Species (79); Shigella check for this species in other resources species (110) and other species. Most notable were the decreased sensitivities to cefuroxime: E. coli (84 to 72); Klebsiella (78 to 33); Enterobacter (50 to 41) Proteus(67 to 59) and Shigella to ciprofloxacin (100 to 96). And also decreased sensitivities to Imipenem: E. coli (100 to 98) and Klebsiella species (100 to 94). Conclusion: These decreased antibiotic sensitivities reflect increased bacterial selection pressure as a result of widespread antibiotic use. A combined approach involving infection-control specialists; infectious disease physicians; and hospital administrators is necessary to address this increasingly difficult problem

Patterns of Injury at Two University Teaching Hospitals in Rwanda: Baseline Injury Epidemiology Using the Rwanda Injury Registry

Introduction: Globally; more worldwide deaths in 2010 could be attributed to injuries than the total number of deaths from infection with AIDS; tuberculosis; and malaria combined; with a disproportionate number of these deaths occurring in low- and middle-income countries. Yet; worldwide research and plans for prevention of injuries are far below other world health problems; especially in developing countries. Methods: A 31-item; 2-page registry form was adapted from regional trauma registries for use in Rwanda to collect data at the two main university referral hospitals in Kigali and Butare. Beginning in 2011; registrars recorded demographics; pre-hospital care; initial physiology; early interventions; and disposition of injured patients who met our selection criteria. Inpatient 30-day discharge status; mortality; and complications were abstracted from patient charts; ward reports and operating room logs. Descriptive analysis was used to evaluate patterns of injury and basic injury epidemiology at the two study hospitals from August 1; 2011-January 31; 2013. Results: A total of 3599 patients were registered from August 1; 2011 to January 31; 2013. Patients were predominantly male; and road traffic crashes were the leading cause of injury overall; contributing to a greater proportion of injuries in the more urban capital than the smaller city of Butare. The majority of patients were admitted to the hospital. All variables evaluated except for the percentage of injuries acquired via a penetrating mechanism showed statistically signifiant differences at an alpha signifiance level of 0.05; illustrating that the trauma population presenting at the two hospitals may be quite different. Conclusion: The Rwanda Injury Registry indicates a high burden of road traffic injuries in a predominantly working age male population over an eighteen-month period. This information can be useful in expanding injury surveillance programs and hopefully implementing population-based prevention programs

Clinical and Genetic Diagnosis of Multiple Osteochondromas in Rwandan Patients

Multiple Osteochondromas (MO) or hereditary multiple exostoses (HME) is an autosomal dominant skeletal disorder mainly characterized by multiple osteochondromas predominantly located at the growth plates of long bones. MO is a genetically heterogeneous disorder and results from mutations in EXT1 and EXT2 genes located on chromosome 8q23-q24 and 11p11-p12. We hereby report a case of a 23-year-old girl who presented characteristic clinical and radiological features of MO. The same clinical signs were observed in her relatives. The p.Arg340Cys mutation in the EXT1 gene was found in the proband confirming the clinical diagnosis. A surgical management was carried out in all affected bones which consisted of excision of the bigger and pain full osteochondromas. The patient was informed of her problem and genetic counseling was offered to the family's members