Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda.

SETTING: In 2005, in response to the increasing prevalence of rifampicin-resistant tuberculosis (RR-TB) and poor treatment outcomes, Rwanda initiated the programmatic management of RR-TB, including expanded access to systematic rifampicin drug susceptibility testing (DST) and standardised treatment.OBJECTIVE: To describe trends in diagnostic and treatment delays and estimate their effect on RR-TB mortality.DESIGN: Retrospective analysis of individual-level data including 748 (85.4%) of 876 patients diagnosed with RR-TB notified to the World Health Organization between 1 July 2005 and 31 December 2016 in Rwanda. Logistic regression was used to estimate the effect of diagnostic and therapeutic delays on RR-TB mortality.RESULTS: Between 2006 and 2016, the median diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly decreased from 30.8% in 2006 to 6.9% in 2016. Total delay in starting multidrug-resistant TB (MDR-TB) treatment of more than 100 days was associated with more than two-fold higher odds for dying. When delays were long, empirical RR-TB treatment initiation was associated with a lower mortality.CONCLUSION: The reduction of diagnostic and treatment delays reduced RR-TB mortality. We anticipate that universal testing for RR-TB, short diagnostic and therapeutic delays and effective standardised MDR-TB treatment will further decrease RR-TB mortality in Rwanda.

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

Prevalence of bacterial vaginosis in women with vaginal symptoms in South Province, Rwanda

This is a prospective study of 297 Consecutive High Vaginal Swab (HVS) specimen from patients with vaginal symptoms at the laboratory of Butare University Teaching Hospital; South Province; Rwanda. The aim of the study was to evaluate the prevalence of bacterial vaginosis and the role of some micro-organisms and laboratory indices associated with it. The age range was 16-57 years with a mean of 30.8 years. The overall prevalence of bacterial vaginosis was 17.8and the highest percentage of 52.8(28) found in the age group of 21-30 years compared with the lowest percentage of 1.9(1) in the age group less than 20 years. Almost half of patients with trichomoniasis were found to have bacterial vaginosis (P0.05). The demonstration Clue cells in wet mount was found in significantly higher numbers (90.5) in women with bacterial vaginosis (P0.001; positive predictive value 90.4) while low sensitivity and positive predictive value were seen for vaginal discharge for detecting infection with bacterial vaginosis ( p 0.05; positive predictive value 26.0). Bacterial vaginosis is common among women with vaginal symptoms in Rwanda as showed by gram stain examination. Further research into this pathology in other Rwandan women populations is needed