Prevalence of human immunodeficiency virus among female sex workers and associated risk factors in Rwanda, 2019

Background Female sex workers (FSWs) are more likely to be infected by Human immunodeficiency virus (HIV) than the general population. In Sub-Saharan countries, 18% of new HIV infections is attributed to FSWs. Study objective To determine HIV prevalence and its determinants among FSWs in Rwanda. Methodology A cross-sectional biological and behavioral surveillance survey in hotspots was conducted among FSWs countrywide. HIV laboratory tests were performed. Proportions and 95% confidence interval (CI) were calculated. Multivariable logistic regression was performed to determine factors associated with HIV in FSWs. Results The survey enrolled 1,883 FSWs. Of 1,770 FSWs who consented for HIV testing, 607 were HIV positive, giving the prevalence of 34% (95%CI= 32.11-36.54). High HIV prevalence was associated with age of 25 years or more (aOR = 3.68; 95%, CI: 2.62­5.18) and more than 5 years of sexwork (aOR = 1.31; 95% CI: 1.05­1.63). HIV prevalence and having more than three dependents (aOR= 0.34; 95%CI=0.23-0.5) and completing secondary and beyond education (aOR=0.50; 95%CI=0.36-0.71) were inversely related. Conclusion HIV prevalence is still high among FSWs in Rwanda. Prevention strategies should target the old ones in five first years of sex work and the less educated.

Factors associated with severe malaria among patients under reference to district hospitals: A cross-sectional study in Rusizi District, Rwanda

Background Severe malaria is a key global public health issue, particularly in Sub-Saharan Africa, which accounts for over 80% of global malaria deaths. Rwanda has experienced about 11-fold annual increase in reported malaria cases since 2012 to 2016. Severe malaria accounted for 13,092 cases in 2015 to 17,248 cases in 2016. Objective To determine factors associated with severe malaria among patients under reference to Gihundwe and Mibilizi Hospitals. Methods A cross-sectional study that included 228 febrile patients diagnosed with malaria at Gihundwe and Mibilizi Hospitals was conducted. Data were collected from patients' files. Logistic regressions were computed to establish determinants of severe anemia. Odds ratio (OR), 95% confidence level (CI) and p-value were reported. Results The proportion of severe malaria was 64.03%. The multivariable logistic regression analysis showed that patients under five years (aOR = 8.169; 95%CI = 3.646- 18.304); being males (aOR = 2.539; 95%CI = 1.299-4.965); farmers (aOR = 2.757; 95%CI = 1.339-5.678) and limited access to health facilities (aOR = 2.740: 95%CI = 1.038-7.232) were the main factors associated with severe malaria. Conclusion Severe malaria was high with various associated factors. There is a need to strengthen malaria control and prevention interventions for young children, men and farmers. Furthermore, beside public health interventions, health facilities should be accessible to people residing in malaria endemic areas.

Factors associated with delayed rabies post-exposure prophylaxis among dog bite victims in Nyagatare District, Rwanda, 2017 to 2019

Background Rabies is an incurable zoonotic disease of public health concern. After exposure the only effective intervention is Post-Exposure Prophylaxis (PEP). Surveillance data in Rwanda shows that a high number of dog bites do not get PEP in time. Objectives Determine factors associated with delays in post-exposure prophylaxis among victims of dog bites. Methods The retrospective cross-sectional study was conducted in Nyagatare District. It targeted people bitten by dogs and who attended Nyagatare district from January 2017 to December 2019. Review of registers and interview with victims were used to collected data using excel and analyze them using STATA version 15. Odds ratio (OR) and confidence interval (CI) were reported. Results Among 412 dog bite victims, 161 (39%) delayed getting PEP. The more likely to delay in getting PEP, were people living in rural areas, AOR = 3.54, 95%CI [2.12, 5.90], and those without medical insurance, AOR = 4.40, 95%CI [1.82-10.62]. Conclusion Seeking PEP among dog bites victims is subject to delay in Nyagatare district. Local leaders should establish initiatives to support people to get medical insurance while public health officers need to prioritize sensitization for PEP for people living in rural areas.

Perceptions and attitudes of midwives on respectful maternity care during childbirth: a qualitative study in three district hospitals of Kigali city of Rwanda

Introduction: Respectful Maternity Care (RMC) is "a universal human right for every childbearing woman". In Rwanda, few studies conducted on RMC assessed how women perceive care provided during childbirth, yet little is known about providers' perspectives. We investigated the perceptions and attitudes of midwives towards the provision of RMC to complement women's viewpoints. Methods: this qualitative study used individual in-depth interviews in Kinyarwanda language. A purposive sampling method was used to reach out to twenty-eight midwives from three district hospitals in Kigali city. Transcribed interviews were translated into English and thematic content analysis was performed using Atlas Ti, version 7. The University of Rwanda College of Medicine and Health Sciences Institutional Review Board (Ref: 363/CHMS/IRB/2019) ethically approved this study before data collection. Results: the Majority of participants revealed that they have knowledge on RMC and perceive that they provide maternal health care based on women´s rights. Positive attitudes towards providing RMC were reported by midwives, however, a considerable number of participants reported the existence of abusive practices. The majority of midwives reported facing many challenges affecting their ability to provide respectful maternal care. Conclusion: midwives understand the seven rights of women and had a positive attitude towards providing RMC. However, abusive practices still exist while providing RMC with considerable challenges, including overload and lack of labour monitoring materials. The adjustment of the ratio of midwives to clients and the availability of essential materials in labour monitoring is recommended to improve the quality of healthcare received by women during childbirth.