Costs Associated With Surgical Infections at a Tertiary Referral Hospital in Rwanda.

INTRODUCTION: In low-income and middle-income countries, there is a high demand for surgical care, although many individuals lack access due to its affordability, availability, and accessibility. Costs are an important metric in healthcare and can influence healthcare access and outcomes. The aim of this study was to determine the financial impact of infections in acute care surgery patients and factors associated with inability to pay the hospital bill at a Rwandan referral hospital. MATERIALS AND METHODS: This was a prospective observational study of acute care surgery patients at a tertiary referral hospital in Rwanda with infections. Data were collected on demographics, clinical features, hospital charges, and expenses. Factors associated with inability to pay the hospital bill were analyzed using Chi-squared and Wilcoxon rank sum tests. RESULTS: Over 14 mo, 191 acute care surgery patients with infections were enrolled. Most (n = 174, 91%) patients had health insurance. Median total hospital charges were 414.24 United States Dollars (interquartile range [IQR]: 268.20, 797.48) and median patient charges were 41.53 USD (IQR: 17.15, 103.09). At discharge, 53 (28%) patients were unable to pay their hospital bill. On a univariate analysis actors associated with inability to pay the bill included transportation via ambulance, occupation as a farmer, diagnosis, complications, surgical site infection, and length of hospital stay. On a multivariable analysis, intestinal obstruction (adjusted odds ratio 4.56, 95% confidence interval 1.16, 17.95, P value 0.030) and length of hospital stay more than 7 d (adjusted odds ratio 2.95, 95% confidence interval 1.04, 8.34, P value 0.042) were associated with inability to pay the final hospital bill. CONCLUSIONS: Although there is broad availability of health insurance in Rwanda, hospital charges and other expenses remain a financial burden for many patients seeking surgical care. Further innovative efforts are needed to mitigate expenses and minimize financial risk.

Short-term Outcomes of Gastric Cancer at University Teaching Hospital of Kigali (CHUK), Rwanda.

PURPOSE: Gastric cancer is endemic in the so-called stomach cancer region comprising Rwanda, Burundi, South Western Uganda, and eastern Kivu province of Democratic Republic of Congo, but its outcomes in that region are under investigated. The purpose of this study was to describe the short-term outcomes (in-hospital mortality rate, length of hospital stay, 3-, 6-, 12-, and 24-month survival rates) in patients treated for gastric cancer in Rwanda. METHODS: We retrospectively reviewed the data collected from records of patients who consulted Kigali University Teaching Hospital (CHUK) over a period of 10 years from September 2007 to August 2016. We followed patients before and after discharge for survival data. Baseline demographic data studied using descriptive statistics, whereas Kaplan-Meier model and univariate Cox regression were used for survival analysis. RESULTS: Among 199 patients enrolled in this study, 92 (46%) were males and 107 (54%) females. The age was ranging between 24 and 93 years with a mean age of 55.4. The mean symptom duration was 15 months. Many patients had advanced disease, 62.3% with distant metastases on presentation. Treatment with curative intent was offered for only 19.9% of patients. The in-hospital mortality rate was 13.3%. The 3-, 6-, 12-, and 24-month survival rate was 52%, 40.5%, 28%, and 23.4%, respectively. The overall survival rate was 7 months. CONCLUSION: Rwanda records a high number of delayed consultations and advanced disease at the time of presentation in patients with gastric cancer. This cancer is associated with poor outcomes as evidenced by high hospital mortality rates and short post discharge survival.

Community- and Hospital-Acquired Infections in Surgical patients at a Tertiary Referral Hospital in Rwanda.

BACKGROUND: Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasing in globally. The aim of this study was to compare community-acquired infections (CAIs) and hospital-acquired infections (HAIs) and determine the rate of third-generation cephalosporin resistance and ESBL-PE at a tertiary referral hospital in Rwanda. METHODS: This was a cross-sectional study of Rwandan acute care surgery patients with infection. Samples were processed for culture and susceptibility patterns using Kirby-Bauer disk diffusion method. Third-generation cephalosporin resistance and ESBL-PE were compared in patients with CAI versus HAI. RESULTS: Over 14 months, 220 samples were collected from 191 patients: 116 (62%) patients had CAI, 59 (32%) had HAI, and 12 (6%) had both CAI and HAI. Most (n = 178, 94%) patients were started on antibiotics with third-generation cephalosporins (ceftriaxone n = 109, 57%; cefotaxime n = 52, 27%) and metronidazole (n = 155, 81%) commonly given. Commonly isolated organisms included Escherichia coli (n = 62, 42%), Staphylococcus aureus (n = 27, 18%), and Klebsiella spp. (n = 22, 15%). Overall, 67 of 113 isolates tested had resistance to third-generation cephalosporins, with higher resistance seen in HAI compared with CAI (74% vs 46%, p value = 0.002). Overall, 47 of 89 (53%) isolates were ESBL-PE with higher rates in HAI compared with CAI (73% vs 38%, p value = 0.001). CONCLUSIONS: There is broad and prolonged use of third-generation cephalosporins despite high resistance rates. ESBL-PE are high in Rwandan surgical patients with higher rates in HAI compared with CAIs. Infection prevention practices and antibiotic stewardship are critical to reduce infection rates with resistant organisms in a low-resource setting.