搜索结果：Rwanda journal of medicine and health sciences

Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.

Effective coverage (EC) has emerged as a better measure of service coverage, in the past decades, compared to the simple crude coverage measures. It represents the proportion of a population in need of a service that successfully receives it with sufficient quality to achieve the intended health benefits. Nevertheless, EC in maternal and newborn health (MNH) services are significantly variable across and within countries. Therefore, this study aimed to identify the societal and health system factors that can explain why some countries are having higher EC of MNH services than others in Sub-Saharan Africa (SSA). A mixed-method case study design was employed with inclusion of document review. Effective coverage rates were estimated using countries demographic and health survey (DHS) datasets. Two countries were then selected for each MNH service domain from each performance category, high, medium, and low, for further analysis of explanatory factors. Data sources included DHS and health facility survey summary reports, the Global Health Expenditure Database, and TheGlobalEconomy.com. We found huge variation in EC of MNH services across countries in SSA. The scores range from 7% in Ethiopia to 64% in Liberia for 4+ ANC visits, 9% in Ethiopia and Nigeria to 81% in Rwanda for institutional delivery, 3% in Ethiopia to 77% in Gambia for PNC mothers, and 1% in Ethiopia to 68% in South Africa for PNC newborns. These discrepancies are highly likely influenced by multilevel health system and societal factors. High-performing countries in EC of MNH services have higher service availability and readiness scores than medium- and low-performing ones. For instance, Ghana and Liberia scored 83% and 84%, respectively, for tracer indicators of ANC service availability, compared to 43% in Ethiopia and 64% in Malawi. Similar pattern is observed between the selected countries EC estimates of MNH services and their health service specific readiness index scores. In addition, they also have favourable societal factors including high proportion of women attending primary and/or more school levels, better mass media and internet access, and relatively lower political instability indexes. Low-performing countries like Ethiopia and Nigeria had complex futures including having low health service availability and readiness scores and unfavourable societal factors including in women's education, and internet and mass media access. Furthermore, the two countries had weakest average political stability index that hinders the utilization and delivery of MNH services. The findings revealed that better health service availability and readiness, strong healthcare financing, favourable societal factors and having a relatively stable political index are critical in determining countries performance in EC of MNH services. Therefore, countries, particularly low performers in EC of MNH services need to learn from positive outliers in improving EC of MNH services. Strengthening existing health facilities with better staffing, training, and resources is crucial beyond merely expanding new ones.

BACKGROUND: Clinical laboratories are vital in healthcare, influencing medical decisions. As the field moves toward precision medicine and digital tools, laboratories must innovate with automation and data analytics to provide accurate, timely insights for diagnosis and treatment. Future success depends on investing in technology, training, and system integration. This study assessed Rwandan clinical referral laboratory’s readiness to adopt innovative technologies, gathering views from physicians and clinical laboratory professionals, and highlighted challenges and key factors impacting their adoption in meeting healthcare expectations. METHODS: A qualitative design was used, collecting data from three sources: (1) observations, (2) key informant interviews (KIIs) with laboratory professionals, and (3) a survey of physicians on laboratory services. Data from the three sources were initially coded separately and merged to generate subthemes using an inductive reflexive thematic approach (Braun & Clarke). Subthemes across datasets were aligned and refined into two final themes. RESULTS: Two themes were generated: (1) Repackaging and reshaping laboratories for quality and future readiness. In this theme key challenges described to affect laboratory services in Rwanda included inadequate infrastructure, shortages of specialised personnel, and difficulties in retention of staff. (2) Reflecting and addressing healthcare expectations. In this theme participants described key challenges to include interruption of services due to stock-outs, equipment breakdown, delays in test results, and the unavailability of certain diagnostic tests. These obstacles hinder the readiness of laboratories to adopt advanced technologies and meet healthcare expectations. CONCLUSION: To optimize clinical laboratory services in Rwanda, key areas such as infrastructure, specialised professionals, equipment maintenance, and supply chain management need to be strengthened. Insights from multidisciplinary workforce that include laboratory specialists are essential to reshape services, enabling effective integration of advanced technologies and meeting evolving healthcare demands.

Community health workers (CHWs) have been instrumental in the delivery of primary healthcare (PHC) services in Rwanda since 1995, with their responsibilities expanding from basic health promotion to integrated community case management. This study explored the evolution, contributions, challenges and policy implications of Rwanda CHW programme over the past three decades. A qualitative descriptive study was conducted across 15 districts in Rwanda, using in-depth interviews with 46 purposively selected CHWs and key informants. Data were analysed thematically using Braun and Clarke's framework, supported by NVivo software. The majority of CHWs were female (65.2%) and had completed primary education (71.7%). CHWs exhibited extended knowledge on PHC services delivery, including maternal and child health, family planning, diagnosis and treatment of malaria, management of tuberculosis (TB), nutrition, non-communicable diseases and outbreak response. Lived experience from the pioneers of CHWs revealed how community-based health services were gradually embraced and highlighted CHW's significant contribution to managing HIV and TB. Key enablers of CHW effectiveness revealed by the study included supportive local leadership, community trust, positive community feedback, performance-based financing and participation in local development cooperatives. The study also highlighted the digitalisation of reporting tools and continuous advanced trainings as essential strategic recommendations to strengthening CHWs' service delivery. CHWs have significantly contributed to the transformation of Rwanda's health system and remain key to advancing universal health coverage. Continued investment in scaling up of existing digital tools and continuous trainings will be key to enhance CHWs' performances and sustain the progress in community health programmes.

Interprofessional education (IPE) is essential for preparing healthcare students to work collaboratively. However, embedding IPE in a traditionally siloed educational framework can be a challenging process as its integration requires a shift in teaching strategies and creation of collaborative learning environments, allowing practical and meaningful interactions between students. The study explored the experiences and perceptions of students regarding the implementation and effectiveness of IPE at the University of Rwanda, College of Medicine and Health Sciences. We used qualitative descriptive exploratory design. Data were collected through focus group discussions among 31 students. Thematic analysis was conducted on the transcripts from students' narratives, organized using NVIVO version 15. Four overarching themes emerged from the analysis: (1) experiences of IPE in clinical settings, (2) perceived benefits of IPE, (3) structural challenges to implement IPE at UR-CMHS, and (4) proposed strategies to enhance IPE at UR-CMHS. IPE has the potential to enhance communication, reduce medical errors, and improve patient care. However, barriers such as hierarchies, workload issues, and lack of shared training hinder its effectiveness. Implementing institutional support and a dedicated IPE module at the CMHS-UR could foster a collaborative learning environment and better prepare graduates for team-based healthcare.

Evidence suggests that clinical mentorship enhances the competence and professional development of nurses and midwives, thereby improving patient outcomes. However, there is limited knowledge of their experience with mentorship programs in Rwanda and similar resource-limited contexts. This study aimed to explore the benefits and challenges faced by nurse and midwife mentees in a clinical mentorship program in Rwanda. The study aimed to understand the specific benefits and challenges mentees experienced in the Training, Support, and Access Model (TSAM) mentorship program. An interpretive phenomenological design was used to conduct 28 in-depth interviews with nurse and midwife mentees in selected health facilities in Rwanda. Audio recordings were transcribed and translated into English, and NVivo software was used to organize the data and conduct thematic analysis based on Crist and Tanner's framework.The analysis revealed three primary themes: 1) developing professional competencies, highlighting new knowledge acquisition and enhanced clinical skills, 2) perceptions of the mentorship process, which included mentorship insights and improvement suggestions, and 3) experiences of support, challenges, and coping strategies. The findings substantiate the critical role of mentorship in enhancing professional competencies and advancing clinical practice. The insights gained on support mechanisms, challenges encountered, and effective coping strategies underscore mentorship as a dynamic tool for fostering professional development and resilience among nurses and midwives. This study articulates the multifaceted nature of clinical mentorship in nursing and midwifery.

Antenatal care (ANC) is essential for improving maternal and neonatal health outcomes, yet adherence to ANC services remains a challenge in many low-income settings, including Rwanda. Understanding nurses and midwives' perspectives on factors influencing ANC adherence is crucial for developing targeted interventions to enhance service utilization and maternal health outcomes. This study employed a qualitative descriptive design to explore the perspectives of nurses and midwives on ANC adherence in Rwanda. Fifteen in-depth interviews (IDIs) were conducted using a semi-structured interview guide in Kinyarwanda. The interviews were verbatim transcribed and then translated into English. Atlas.ti 7 software was used to organise the data and then thematically analysed. The perspectives of nurses and midwives were summarised in four themes. Participants mentioned facilitators of ANC engagement with ANC services such as community education, structural motivators, availability of diagnostic infrastructure like ultrasound, and nurses and midwives training and mentorship. The barriers to women's ANC adherence noted by participants are cultural beliefs and community misconceptions, stigma and secrecy surrounding unintended pregnancies, cost-related delays in ANC seeking, gender dynamics and relationships. Nurses and midwives also highlighted health care system constraints, such as staffing shortages and infrastructure and equipment limitations. Recommended interventions to enhance ANC adherence included community engagement and support, increased staff and resources, and digitalization of records. Nurses and midwives play a critical role in shaping ANC adherence through service delivery and patient education. Their consistent engagement and ability to build trust with pregnant women make them key influencers in promoting timely and sustained ANC attendance. Addressing systemic challenges, strengthening community-based support, and enhancing policy implementation are essential strategies for improving ANC adherence in Rwanda. These findings provide valuable insights for policymakers and healthcare stakeholders to develop targeted interventions aimed at increasing ANC adherence and improving maternal and neonatal health outcomes.

Globally, medicine management initially relied on paper-based logistics information systems, which were associated with delayed reporting, poor data quality, weak forecasting, and limited supply chain visibility, resulting in medicine stockouts and expiries. Many countries transitioned to electronic systems to address these challenges. Rwanda introduced an electronic logistics management information system in 2014; however, medicine stockouts and expiries have persisted. This study explored users' perceptions of the benefits and barriers of the electronic logistics management information system in managing medicine stockouts and expiries at Rwanda Medical Supply. A qualitative descriptive study was conducted at the central and Kigali regional warehouses of Rwanda Medical Supply. Twenty-two staff involved in inventory management, order processing, data management, and quantification were purposively selected. Data were collected through semi-structured interviews and a focus group discussion, and data were analyzed using inductive thematic analysis. Participants reported improved stock monitoring, data visibility, and order management, supporting the reduction of stockouts and expiries as benefits of using electronic logistic information system. However, inaccurate data, limited interoperability, inadequate training, and absence of alerts reduced system effectiveness. The electronic system improved stock visibility and supported timely ordering, but limited user skills and poor interoperability constrained accurate forecasting and decision-making, contributing to medicine expiries and supply interruptions.

An estimated 2.78 million work-related deaths and 374 million non-fatal injuries occur at workstations annually. Developing Countries place a low priority on safety, and many companies still operate without even the most basic health and safety procedures. Therefore, this research aimed to determine the level of compliance with occupational safety and health standards and their associated factors among roofing factory workers in Rwanda. A descriptive cross-sectional design was used. The study utilised a simple probability sampling technique with a sample size of 202 participants from the roofing industry. A structured questionnaire was utilized to gather primary data. The compliance level was the outcome variable. Univariate, Bivariate, and Multivariable analyses were conducted using SPSS version 25. Analysis revealed that the compliance level was high (64%); the major challenge faced with occupational safety and health standards was lack of training (44.5%); the predicting factors to OSH compliance were age (36-45 years) (AOR=3.12, P-value=0.008, CI-1.35-7.21), being married (AOR=2.15, P-value=0.047, CI=1.01-4.58), and workers level of experience (16 years and above) (AOR=4.12, P-value=0.001, CI=1.76-9.64); these were statistically significant at P<0.05. Absence of training, age, marital status, and workers' level of experience influenced occupational safety and health compliance. Thus, refresher and constant training on compliance with occupational safety and health standards should be effectively and continuously carried out.

BACKGROUND: The Joint United Nations Programme on HIV/AIDS has set ambitious targets to improve diagnosis and treatment rates, aiming for 95% of people living with HIV to know their status and 95% of those diagnosed to be on sustained antiretroviral treatment, and 95% of those on treatment to achieve viral suppression. However, challenges persist, especially concerning the HIV Viral Load (VL)/Early Infant Diagnosis (EID) testing coverage and commodity availability, leading to stock-outs and delays in testing processes. This study assessed the factors influencing commodity availability and testing platform performance in public health facilities. METHODS: A mixed methods study design was employed, integrating both quantitative and qualitative data collection methods concurrently. Primary and secondary data were collected using a structured data abstraction form applied to stock cards, stock books, and Point-of-Care (POC) data systems to obtain HIV VL and EID POC consumption data for the financial year 2023/2024 (July 2023&#x2013;June 2024). The study covered all 22 public health facilities in the Masaka region providing HIV VL and EID POC testing services. In-depth interviews, guided by an interview guide, were conducted with healthcare workers to capture factors affecting HIV EID/VL POC testing commodities and platform performance. STATA 15.0 was used for quantitative data analysis, while thematic analysis was used for qualitative data. RESULTS: The average stock-out duration per month was 9 days for VL POC cartridges and 8 days for EID POC cartridges. Most of the facilities 13/22 (59%) experienced EID cartridge stock-outs for fewer than 5 days per month, while 6/22 (27%) faced stock-outs exceeding 10 days. Similarly, 13/22 59% of facilities had VL POC cartridge shortages for fewer than 5 days, whereas 7/22 (32%) experienced stock-outs for more than 10 days. Stock availability was significantly associated with increased detection of HIV positivity. Qualitative interviews indicated that stock-outs were often driven by supply chain delays, funding constraints, and challenges in forecasting and procurement. One laboratory manager noted: &#x201c;Sometimes we wait weeks for cartridges to be supplied, which affects our ability to test on schedule.&#x201d; The mean equipment utilization rate was 47%, with only 4/22 (18%) of facilities achieving optimal utilization. Factors significantly influencing POC platform performance included device type (aOR&#x2009;=&#x2009;3.3; 95% CI: 1.06&#x2013;9.96; p&#x2009;=&#x2009;0.039), positivity rate (aOR&#x2009;=&#x2009;12; 95% CI: 1.56&#x2013;92.3; p-value&#x2009;=&#x2009;0.017), sample error rate (aOR&#x2009;=&#x2009;5; 95% CI: 1.45&#x2013;17.27; p&#x2009;=&#x2009;0.01), and frequent result uploads to national systems (aOR&#x2009;=&#x2009;3.8; 95% CI: 1.24&#x2013;11.29; p&#x2009;=&#x2009;0.019). Qualitative findings reinforced these results: staff cited equipment downtime, cartridge shortages, and limited training as barriers to optimal utilization. A respondent explained: &#x201c;We sometimes have machines but not enough trained staff to run them efficiently, or they break down and repairs take time.&#x201d; CONCLUSIONS: The findings highlight persistent supply chain inefficiencies, with some facilities experiencing prolonged stock-outs. Low platform utilization was driven by equipment downtime, cartridge shortages, and inadequate staff training. Key challenges included supply chain delays, funding constraints, infrastructure gaps, and staffing shortages. Strengthening forecasting, procurement, distribution, and staff training alongside better coordination and infrastructure investment will be crucial for improving POC testing services and enhancing early HIV diagnosis.

BACKGROUND: The 2013 World Health Organization (WHO) guidelines for cervical pre-cancer screening recommended screening women aged 30&#x2013;49 and women living with HIV (WLHIV) starting at age 25. However, the impact of the guidelines and the age to start screening on screening uptake has not been studied. METHODS: We used a regression discontinuity design analysis of population-based data to assess the impact of the guidelines on the screening rates for women according to HIV status and age group in Ethiopia, Malawi, Rwanda, Tanzania, Zambia, and Zimbabwe. Although the PHIA surveys were conducted after 2014, when countries adopted the guidelines, the women were asked to report whether they had been screened for cervical pre-cancer at any point between 2008 and 2018. From the women&#x2019;s screening reports, we identified reports of being screened from 2008 to 2014 and after 2014 to 2018. These reports were random and unique. They enabled us to compare the screening rates from the period 2008 to 2014 and after 2014 to 2018 &#x2012; pre and post the intervention &#x2012; by HIV status, and before and after the age of 25&#xa0;years. We used a data-driven optimal bandwidth selection procedure to estimate the guidelines&#x2019; average treatment effect with local polynomial regression discontinuity and robust bias-corrected confidence intervals. RESULTS: We included 73,179 women: 6680 (9.1%) living with HIV, 4328 (5.9%) with unknown HIV status, and 62,171 (85.0) with a negative HIV status. Adolescent girls and young women living with HIV (AGYWLHIV) aged 15&#x2013;24 reported screening less often (102 (6.1%)) than their peers with unknown (66 (7.2%)) (P&#x2009;<&#x2009;0.001), or or older women. CONCLUSIONS: We found no evidence the 2013 WHO guidelines impacted women&#x2019;s cervical pre-cancer screening uptake. However, AGYWLHIV reported screening less often. Policymakers should lower the age to screen WLHIV from 25 to 15 to screen more AGYWLHIV. Studies are required to examine the impact of the guidelines on cervical pre-cancer screening in more countries. In 2013, the World Health Organization (WHO) recommended cervical pre-cancer screening for women aged 30&#x2013;49 and for women living with HIV (WLHIV) starting at age 25. Countries adopted the guidelines in 2014. However, no one has studied how these guidelines or the age to start screening affect screening rates.We analysed data from six countries&#x2014;Ethiopia, Malawi, Rwanda, Tanzania, Zambia, and Zimbabwe&#x2014;using a method that looks at changes before and after an intervention is introduced to evaluate how the WHO guidelines affected screening rates based on HIV status and age. We looked at whether women had ever been screened for cervical pre-cancer between 2008 and 2018 based on the reports of women. In each country, women indicated whether they were screened for cervical pre-cancer. They also stated in which year they were last screened. We compared the screening rates of women&#x2019;s reports before and after the year 2014 when the 2013 guidelines were introduced.Our study included 73,179 women, of which 6,680 were living with HIV, 4,328 had an unknown HIV status, and 62,171 were HIV-negative. We found that young women living with HIV (ages 15&#x2013;24) were much less likely to have been screened for cervical pre-cancer compared to women with unknown status, or older women. These young women may not be getting the treatment (ART) that helps protect against cervical cancer. We recommend that the WHO consider starting cervical screenings for women living with HIV at age 15 to help include more young women living with HIV in screenings.

Immunization inequities persist across Sub-Saharan Africa, with significant numbers of zero-dose and under-immunised children contributing to preventable morbidity and mortality. This narrative review critically examines the integration and effectiveness of machine learning, geospatial mapping, and microplanning strategies in identifying and reaching these vulnerable populations. The review's primary objective is to synthesise current evidence on how these innovative approaches are being applied within routine immunization systems to address persistent coverage gaps. A systematic search of peer-reviewed literature and grey sources was conducted, focusing on studies and programmatic reports from 2015 to 2025. The review analyses methodological trends, implementation experiences, and outcome data related to machine learning algorithms for risk profiling, geospatial technologies for mapping and targeting, and microplanning tools for local-level action. Data extraction and thematic synthesis were guided by the WHO framework for immunization equity. Findings demonstrate that machine learning models, utilizing demographic, health system, and mobility data, have enhanced the precision of zero-dose child identification, enabling more targeted outreach interventions. Geospatial mapping has further enabled real-time visualisation of immunization deserts and the spatial distribution of missed communities, supporting resource allocation and deployment of mobile teams. Microplanning, when integrated with digital tools and community engagement, has shown promise in translating high-level data into actionable local strategies, improving follow-up, and reducing missed vaccination opportunities. Despite these advancements, several challenges persist. Data quality and interoperability issues limit the scalability of machine learning and geospatial solutions, particularly in remote or fragile settings. Capacity gaps at the sub-national level, including technical skills and digital infrastructure, impede effective microplanning and data use. Furthermore, the sustainability of these approaches is threatened by fragmented investments and limited integration into national health information systems. Opportunities exist to strengthen the routine immunization system by standardising data collection, investing in workforce training, and fostering cross-sectoral collaboration. The review recommends prioritising the development of interoperable platforms, expanding context-specific pilot projects, and embedding evaluation mechanisms to track impact and equity outcomes. Policymakers are urged to leverage the demonstrated benefits of machine learning.

Yemen's health system has faced prolonged shocks, including war, epidemics, and COVID-19, challenging both governance and resilience. This study examines how formal governance structures and institutional capacities shaped the system's ability to anticipate, absorb, adapt, learn, and transform across a decade of crisis (2014-2025). We conducted a longitudinal qualitative analysis based on interviews with health system leaders and technical actors. Using a resilience-capacity framework, we analyzed governance functions across four phases: pre-conflict period (pre-2014), conflict escalation (2015-2019), COVID-19, and the post-pandemic period. Data were thematically coded and interpreted through the sequential resilience lens of preparedness, absorption, adaptation, learning, and transformation. Participants consistently described a health system with intact formal governance structures but fragile functional capacity. Pre-2014 governance was administratively stable yet centralized and poorly prepared for shocks. During the conflict, preparedness collapsed amid fragmented authorities, and absorptive capacity relied heavily on donor-driven service delivery. COVID-19 triggered temporary improvements in coordination and emergency response, but these were largely ad hoc and poorly institutionalized. Post-pandemic, preparedness remained procedural, absorptive capacity weakened as external funding declined, adaptive measures persisted in localized and reversible forms, and transformative governance remained constrained by political instability and weak enforcement. Digital "workaround governance," including WhatsApp-based coordination, facilitated rapid decision-making but highlighted gaps in formal systems and accountability. Across phases, learning was fragmented, donor-driven, and rarely institutionalized, limiting system-wide reform. Yemen's experience demonstrates that maintaining formal governance structures does not guarantee health system resilience. Sustainable resilience requires institutionalized preparedness, domestic contingency financing, integration of adaptive innovations, and embedding learning into routine governance. Efforts to strengthen health systems in fragile and conflict-affected settings must address governance, capacity, and political economy simultaneously to move beyond reactive crisis management toward transformative change.

Few studies have explored the effectiveness of the Community-Based Approach (CBA) on the reduction of intimate partner violence (IPV) exposure and its outcomes in Rwanda. This study, therefore, aimed at assessing the effectiveness of the Community-Based Approach (CBA) for IPV victimisation and perpetration as well as its associated mental health outcomes in Rwanda. A randomised controlled trial was conducted on a sample of 32 couples, with 17 couples assigned in treatment group and 15 assigned in control group. Data analyses were computed using mixed ANOVAs to evaluate the effect of CBA over IPV occurrence and mental health outcomes. The results revealed a noticeable difference across the time points for IPV, anxiety, and depression, while the difference was not significant for PTSD. All variables showed a significant difference between groups, including IPV, anxiety, depression, and PTSD. Additionally, there was a meaningful interaction between time and group for IPV, anxiety, and depression. A similar interaction was also observed between time and sex for both anxiety and depression. Notably, both males' and females' IPV scores decreased to nearly the same level, while anxiety and depression scores declined more in females than in males. Our findings highlight substantial efficacy of CBA for victims and perpetrators of IPV in reducing IPV, anxiety and depression symptoms in Rwanda, a post-genocide country.

The adherence to hospital accreditation standards in health facilities, which are designed to ensure the delivery of safe and high-quality healthcare services, remains a challenge. Therefore, this study sought to examine the key barriers affecting the implementation of hospital accreditation standards among health professionals in Rwanda. This was a cross-sectional study in which 40 semi-structured key informant interviews were conducted from January to March 2024, in selected public hospitals. Participants aged 27-48 years were purposively recruited based on their roles and experience in hospital operations. The interviews explored the barriers affecting the effective implementation of Risk Area 3, which addresses ensuring a safe environment for staff and patients. A qualitative phenomenological approach was used to capture participants lived experiences and perceptions of the implementation process. The present study identified the barriers that deterred the implementation of IPC measures such as overwhelming workload, financial constraint, absence of training, turnover of staff, paucity of appropriate infrastructure, lack of enough coordination of IPC measure, lack of enough supervision by EHO, insufficient space for hazardous materials and other related materials. Limited resources are the key contributor to non-compliance with IPC measures. Greater investment in both physical and human resources, along with continuous professional training, is essential to enhance the implementation and compliance with hospital accreditation standards. Policymakers should actively engage multinational organisations and international development partners to provide technical assistance and support capacity-building initiatives that strengthen local efforts toward effective and sustainable accreditation implementation.

Integrated knowledge translation (IKT) is an approach facilitating collaboration between researchers and decision-makers towards evidence-informed decision-making. Increasingly evaluated in various contexts, less is known about the implementation process of IKT, including in low- and middle-income countries. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) developed, implemented and evaluated an IKT approach across five countries. Here, we examined how the IKT approach was implemented in the African-German multi-country research consortium, investigating project-level context; implementation process, strategy, and outcomes; and exploring intervention core components. This process evaluation used a mixed-methods comparative case study design. Following a previously published protocol, the main authors of this paper surveyed and interviewed African&#xa0;CEBHA+ researchers and their partners from policy and practice in 2020/2021 and 2022/2023 and identified relevant IKT-related documents. We drew on our programme theory and implementation science frameworks to undertake qualitative content analysis of interview data and documents. Data was analysed within sites, integrated with descriptively analysed quantitative survey data, and subsequently compared across sites. We enrolled 36 researchers and 19 decision-makers and analysed 92 IKT-related documents. IKT was implemented at the five sites in Ethiopia, Malawi, Rwanda, South Africa, and Uganda. In our cross-site analysis of fidelity and adaptability of IKT, we identified three core components of the IKT approach: (i) continuous tailored engagement between researchers and decision-makers, (ii) researchers' commitment to research impact, and (iii) linking to existing KT routines. The context analysis revealed that IKT implementation was facilitated by local KT structures, pre-existing knowledge translation routines and relationships with decision-makers, senior leadership motivation, and funder support including a dedicated budget for IKT activities. Feasibility of IKT implementation was reduced by administrative challenges, overall project complexity, and conflicting priorities. This research leveraged a unique opportunity to study a systematic IKT approach implemented across sites in five African countries in the context of a large international research consortium. The findings can inform IKT design and implementation in other multi-site and multi-country projects. Particularly, the identified core components can guide adaptation and refinement of IKT in contextually diverse settings, including low- and middle- income countries.

HIV prevention and treatment supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR) have saved millions of lives. Rwanda is among the most successful countries worldwide in achieving global targets with PEPFAR support. Abrupt PEPFAR funding uncertainty raises concerns about continued HIV epidemic control. We projected the impact of the Government of Rwanda's (GoR's) capacity to offset PEPFAR funding elimination on adult HIV epidemic and care continuum outcomes over 10 years. Using an HIV policy model calibrated to Rwanda, we assessed capacity to sustain HIV services at: 50% (with no capacity by GoR to cover the PEPFAR funding gap), 75%, 90% and 100% (with full capacity by GoR to cover the gap). Scenarios involved reducing the number on antiretroviral therapy (ART), immediately discontinuing ART and proportionally decreasing HIV diagnosis, ART initiation, and care re-engagement. We projected epidemic outcomes (HIV prevalence, HIV incidence, number with HIV, new HIV infections, deaths) and care continuum outcomes (percentage diagnosed, percentage on ART among those diagnosed, percentage virally suppressed among those on ART). We calculated differences in projected outcomes for partial or no capacity versus full capacity. Secondary analyses assessed the timing of the GoR's response. Compared to full capacity at 10 years, the model projected a 13.9%-38.7% increase in HIV prevalence and 69.0%-246.7% increase in HIV incidence across coverage capacity scenarios. This translated to 29,000-64,000 additional adults with HIV and 20,000-92,000 cumulative new adult HIV infections. Cumulative projected deaths increased by 10,000-51,200. The model projected continual reductions in percentage diagnosed at 10 years; percentage virally suppressed among those on ART was similar across scenarios. Higher, and more delayed, coverage capacity had projected outcomes similar to lower, and less delayed, coverage capacity. Outcomes for gradual increases in coverage capacity were generally similar to or better than full, but delayed, coverage capacity. Even in countries like Rwanda that have achieved epidemic control, abrupt and persistent elimination of PEPFAR funding could drastically reverse critical gains. Evidence quantifying the consequences of different capacities to sustain HIV services underscores the high stakes of rapid and sufficient action.

Diarrhoea continues to be a leading cause of morbidity and mortality among children under five, particularly in developing countries, including Rwanda. This study examined trends and risk factors for childhood diarrhea in Rwanda. A secondary analysis of children's records was conducted among 8,706 households in 2010, 7,261 in 2014/15, and 4,409 in 2019/20. The univariate analysis summarized the variables and described the trends in diarrhea by districts during the 2010, 2014/15, and 2019/2020 RDHS. Simple logistic regression identified associations between diarrhea and potential factors, while a multivariable model retained significant variables after addressing multicollinearity. The results were presented as adjusted odds ratios with 95% confidence intervals and p-values <0.05. The prevalence of childhood diarrhoea in Rwanda followed a U-shaped trend, falling from 12.81% in 2010 to 11.62% in 2015, and then rising to 13.65% in 2020. Factors independently associated with diarrhea included household heads less than 25 years old, households with &#x2265;4 members, not breastfeeding, less frequent radio/TV exposure, bottle feeding and unimproved toilet facilities. Interventions should focus on supporting less educated caregivers through health education, improved water, hygiene, and sanitation practices, and promotion of breastfeeding. Ensuring equitable access to clean water is also essential for reducing diarrhoea.

Cesarean section is a lifesaving obstetric intervention when medically indicated; however, its utilization remains unequal across sub-Saharan Africa (SSA). Although the World Health Organization recommends cesarean section rates of 10-15%, access remains insufficient in many low-resource settings and excessive in others. Understanding geographic patterns and drivers is essential for maternal health planning. To examine the spatial variation and determinants of cesarean section delivery across SSA. We conducted a cross-sectional analysis using Demographic and Health Survey data (2015-2024) from 201,481 weighted samples across 28 SSA countries. Spatial autocorrelation and hotspot patterns were assessed using Global Moran's I and Getis-Ord Gi* statistics. Spatial regression models, including ordinary least squares, spatial lag, spatial error, geographically weighted regression, and multiscale geographically weighted regression, were fitted. Model performance was compared using corrected Akaike Information Criterion and adjusted R2. Cesarean section delivery showed significant spatial clustering (Moran's I&#x2009;=&#x2009;0.18, z&#x2009;=&#x2009;43.3, p&#x2009;<&#x2009;0.01). Hotspot areas were identified in Uganda, Rwanda, Burundi, Kenya, Tanzania, Malawi, South Africa, Lesotho, Gabon, Ghana, and Senegal, while cold spots were observed in Ethiopia, Madagascar, Angola, Nigeria, Guinea, Cote d'Ivoire, Sierra Leone, Liberia, and Mauritania. Previous cesarean delivery, maternal age&#x2009;&#x2265;35&#x2009;years, pregnancy spacing behavior, and health insurance coverage were significant spatial predictors. Cesarean section utilization in SSA exhibits substantial geographic inequality driven by context-specific determinants. Spatially targeted maternal health policies, improved referral systems, and equitable financing mechanisms are needed to optimize access to medically indicated cesarean delivery while minimizing unnecessary procedures. Main findings: Caesarean section utilization in SSA demonstrated substantial geographic inequalities, with significant spatial clustering and regional variation influenced by previous caesarean sections, maternal age, insurance coverage, and reproductive health behaviors.Added knowledge: This study provides multicounty geospatial evidence using multiscale geographically weighted regression to identify location-specific predictors and geographic inequalities in caesarean section utilization across SSA.Global health impact for policy and action: Geographically targeted maternal health strategies are needed to improve equitable access to medically necessary caesarean section services while preventing unnecessary procedures across underserved regions of SSA.