Factors Affecting Immediate Use of Contraception Among Women Hospitalised for Abortion in Two Public Hospitals in Kigali, Rwanda: A Cross Sectional Study.

Background: The 2019-20 Rwanda demographic health survey revealed an overall use of modern contraceptives of 58% but participants were not likely to use family planning in the postpartum period. Three quarters of participants intended to use contraception only after they had resumed menses and not breastfeeding. This study intended to measure post-abortion contraception uptake and to evaluate factors affecting immediate post abortion contraception uptake among patients consulting two public hospitals in Kigali, Rwanda. Methods: This is an observational cross-sectional study of women admitted for abortion in 2 hospitals' obstetric units in Kigali; the University Teaching Hospital of Kigali (CHUK) and Muhima District Hospital (MH) from November 2019 to April 2020. Admission registry was accessed daily to determine abortion admissions. After informed consent, participants underwent a standardised interview prior to their discharge from respective hospital. Results: There were 252 participants over 6 months; 88.5% were counselled for post-abortion contraception and 52% desired contraception prior to hospital discharge. Upon discharge, 70.2% of the study participants who wished immediate post abortion contraception received it before discharge and 29.8% had no contraception despite having expressed interest for immediate post abortion contraception. Being married and involving husband in choosing post-abortion contraception were significantly associated with use of post-abortion contraception. Conclusion: Post-abortion contraception uptake in 2 large public hospitals in Kigali remains low. Being married and involving husband in choosing post-abortion contraception are positive factors associated with post-abortion contraception uptake while choosing a permanent contraception is associated with not receiving any contraception at the time of discharge from hospital. There is a need to consider prescribing an alternative interim methods of contraception to women desiring permanent sterilisation.

Rare but Fatal Subdural Hematoma Following Spinal Anesthesia: A Case Report of Unrecognized Untreated Postdural Puncture Headache in a Low-Resource Country Setting.

Dural puncture following neuraxial anesthesia can cause persistent cerebrospinal fluid leakage. A 35-year-old, 39-week gestation healthy parturient underwent cesarean delivery under spinal anesthesia. Spinal anesthesia was performed using a 25-gauge Quincke needle. Despite the occurrence of postoperative positional headache and neck pain, she was discharged home. Two weeks following discharge, she developed seizures and deteriorating level of consciousness. Brain computerized tomography scan revealed massive left subdural hematoma. She died 3 days later. We discuss awareness of neuraxial complication among maternity staff, effective follow-up, and available management strategy in low-resource settings. Persistent headache following neuraxial anesthesia should be investigated.

Increased Rwandan Access to Obstetrician-Gynecologists Through a U.S.-Rwanda Academic Training Partnership.

OBJECTIVE: To evaluate the first 5 years of the Human Resources for Health Rwanda program from the program onset in the July 2012-2016 academic years, and its effects on access to care through examination of: 1) the number of trained obstetrician-gynecologists (ob-gyns) who graduated from the University of Rwanda and the University of Rwanda-Human Resources for Health program and 2) a geospatial analysis of pregnant women's access to Rwandan public hospitals with trained ob-gyns. METHODS: We used GPS coordinates in this cross-sectional study to identify public (government) hospitals with ob-gyns in 2011 (before initiation of the program) compared with 2016 (year 5 of the program). We compared access to care for the years 2011 and 2016 through geocoding the proportion of pregnant women within 10 and 25 km from these hospitals and compared the travel time to these hospitals in the two time periods. We used a World Pop dataset of Rwandan pregnancies from 2015, ArcGIS for spatial operations, R for statistical analysis, zonal statistics for circular distances, and friction surface for travel time analysis. RESULTS: The number of ob-gyns in public hospitals increased from 14 to 49 nationally. Before the program, 18 residents graduated over a 7-year period (two residents per year); 33 graduated by year 5 (six residents per year). Rwandan faculty increased by 45%. In 2011, most providers were in the capital city. Between 2011 and 2016, the proportion of pregnant women living 10 km from an ob-gyn-staffed public hospital increased from 13.0% to 31.6%; within 25 km increased from 28.4% to 82.9%. Travel time analysis from 2011 to 2016 showed 49.1% of Rwandan women within 1 hour of a hospital and 85.6% within 2 hours. In 2016, this coverage increased to 87.5% and 98.3%, respectively. CONCLUSION: In 5 years, the Human Resources for Health Rwanda program improved the number of residency graduates in obstetrics and gynecology and nationwide access to these providers. The program reduced rural-urban disparities in access to ob-gyns.