Knowledge, Barriers and Motivators to Cervical Cancer Screening in Rwanda: A Qualitative Study.

Background: Cervical cancer is a global public health problem with marked geographical disparity. High morbidity and mortality rates in developing countries are associated with low screening rates. In 2020, in Rwanda, 3.7 million women aged 15-59 years were at risk of developing cervical cancer, the most commonly diagnosed female cancer in Rwanda. Despite Rwanda being the first African country to vaccinate against human papilloma virus with a three-dose regimen vaccination coverage of nearly 93% in the target population of girls aged <15 years, and having established cervical cancer screening program, recent studies have found low screening rates. Our study sought to determine knowledge, motivators and barriers of cervical cancer screening. Methods: We conducted a qualitative descriptive study; using focus group interview in an urban health facility (Muhima district hospital) and a rural health center (Nyagasambu health center) offering cervical screening services in Rwanda. Participants were women seeking these services and other women attending the health facility for any reason, and female staff working in these facilities. Interviews were recorded and transcribed, and data were analyzed using content analysis. Results: Thirty women participated in focus group interview, with an average age of 39 years. Many of women showed knowledge about cervical cancer existence and prevention methods. However, fear for pain, lack of knowledge about screening, how and where the screening was done, and concern for privacy were recurring subthemes. Some participants also mentioned lack of health insurance as a barrier for cervical cancer screening. Conclusion: Barriers to uptake cervical cancer screening services in Rwanda are related to poor information about cervical cancer and the importance of screening as well as non-adherence to medical insurance. Population sensitization through campaign and community outreach activities could have a positive impact on increasing the usage of cervical cancer screening in Rwanda.

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.

Use of Student-Generated Multiple Choice Questions to Enhance Team-Based Learning of Anatomy at the University of Rwanda.

INTRODUCTION: Teaching of human anatomy has undergone significant changes in the past three decades. At the University of Rwanda, anatomy is being taught using team-based learning (TBL). While student-generated multiple choice questions (MCQs) stimulate deeper thinking on a given topic, their impact on anatomy learning is not known. This study aimed to find out the impact of student-generated MCQs on the current anatomy teaching method at the University of Rwanda. METHODS: In this comparative interventional study, two similar chapters on anatomy were selected; one was taught using TBL while for the other one, in addition to TBL, students were encouraged to set MCQs while studying. Pre- and post-test scores were analyzed using SPSS 23 and the Student's t-test was used to compare the mean scores obtained. RESULTS: Thirty-one medical students were recruited. Pre-test mean scores were 25.10 and 25.19 out of 50 for chapters 1 and 2, respectively. Although the students' post-test scores improved after teaching for each chapter, the improvement was much greater for chapter 2 than for chapter 1, with mean scores of 39.97 and 32.45 out of 50, respectively (P<0.05). Despite such improvement, almost half of the students found that setting MCQs was not easy. CONCLUSION: This study found that student-generated MCQs can be used as a simple and cost-effective tool to enhance TBL of anatomy.