Determinants of Syphilis and Trichomonas Infections among Women Attending Selected Health Facilities in Kigali, Rwanda

Background: Syphilis and Trichomonas are among more than 30 known Sexually Transmitted Infections (STIs). They make part of the four (4) most prevalent treatable STIs globally, together with Chlamydia and gonorrhea. They are associated with lifelong health problems, especially among women and their babies, including but not limited to exacerbation of HIV acquisition risks, preterm labor, birth defects, and deaths. This study was conducted to determine the prevalence and determinants of Syphilis and Trichomonas infections among women attending selected Health Facilities (HFs) in Kigali, Rwanda. Methods: This study was a cross-sectional survey that collected data from 174 women who attended eight (8) HFs in Kigali, Rwanda from October 7 to December 6, 2019, for Outpatient Diagnosis (OPD) services. The HFs were purposefully selected while women participants were recruited using a systematic random sampling strategy. Vaginal swabs were microscopically examined for the presence of Trichomonas vaginalis and Syphilis was diagnosed using FaStep Syphilis Rapid tests to detect IgG and IgM specific to Treponema pallidum. The questionnaire captured information on the socio-demographic characteristics and sexual behaviors of the participants. Fisher exact test, Phi, and logistic regression were the main statistical analysis of the study. Results: This study recruited 174 women; aged between 17 and 49 years old, with a mean age of 29 years. The findings show that 12% (21 out of 174) of the women had either Syphilis (9.8%) or Trichomonas (2.3%), but none had both. Syphilis infections significantly affected women living in slums (40%, p=0.001), with a history of STI before (15.2%, p=0.028), not always using a condom (14.9%, p=0.014), and self-reporting to have had one lifetime sex partner (23.5%, p= 0.002). Living in slums, not always using a condom, and self-report of one lifetime sex partner uniquely increase the risks of getting syphilis up to 6.305, 5.53, and 5.81 times compared to their counterparts who are not, respectively. Trichomonas infection was significantly high (p <0.01) among women in economic category one (18.2%, p=0.029), self-reporting to lack transport (13.6%, p <0.001) and health cover (12.5%, p <0.001) as barriers of not attending a health facility while they are sick. Lacking transport means and health cover uniquely exacerbate the risks of Trichomonas infection up to 36.7 and 22.32 times, respectively. Conclusion: This study concludes that Syphilis and trichomonas infections are still major public health problems among women attending health facilities in Kigali, Rwanda. Therefore, there is still a need to enhance health promotion programs to improve healthcare-seeking behaviors and empower women to negotiate safe sexual activities.

Home Education for Children with Newly Diagnosed Type-1 Diabetes-Exploring Needs and Experiences among Participants of Home Education Visits

Objective: Type 1-diabetes is increasing among younger age groups and type 1-diabetes has a major impact on daily life of both the children and their families. The aim of the current study was to explore a family and network centered intervention to children with newly diagnosed type-1 diabetes. Home education visits performed by health care professionals were evaluated using focus group interviews. Method: We conducted five focus group interviews with 21 home education attendants and two individual interviews with health care professionals. Employing inductive content analysis. Results: Families of children who have newly been diagnosed with type 1-diabetes struggle to comply with diabetes care and, thus, leaving the children to the care of others is a major concern. Lack of knowledge among members of family and social network, adhere to an anxiety of doing something wrong in relation to diabetes care. Home education visits educate the wider family and social network about diabetes care. Focus group participants and health professionals describe that the education visits constitute a major support for parents in the task of instructing family and social network members. Additionally, family and social network members report that they feel more confident to contribute more to the care of the child with type 1-diabetes. Conclusion: Existing prejudices and lack of knowledge leads to stress and worry among the social network of children with type-1 diabetes. Home education improves knowledge and feeling of confidence concerning diabetes care among family and social network, with the potential to strengthen and maintain close social relations.

Factors Associated with Men Engagement in HIV Continuum of Care in Rwanda: A Cross Sectional Study to Identify Gaps to be Closed Towards HIV Epidemic Control in Rwanda

Despite the global achievements to control HIV epidemic and end AIDS by 2030, there is still a discrepancy in accessing HIV services. Men are among the population that are lagging behind when it comes to consuming available services to mitigate the impact of HIV/AIDS. We conducted this study to determine the level of Rwandan men engagement in HIV services delivery. We used cross- sectional design to analyze data from a Population- based HIV impact assessment, a household-based survey conducted in Rwanda from October 2018 to March 2019. Cascade from awareness of the HIV status, linkage to ART and Viral load suppression were analyzed. Logistic regression analysis was conducted to establish relationship between independent variables and outcomes. Data cleaning and analysis was conducted using SAS 9.4. 13. A total of 821 males aged 15 to 64 years participated in the survey, 302 (2.1%) of them tested positive, 92.2% (95% CI: 89.2-95.2) reported tested once for HIV. Overall, 78.2% (95% CI: 72.4-84) reported to be aware of their status and on ART. 70.5% (95% CI: 63.8-77.2) reported to have suppressed viral load. Married or living together with a partner showed to be 7 times more likely to be on ART vs single or never married (OR: 7.42, 95% CI: (1.75;31.38), P <0.01). Odds of viral load suppression increases with age, and those aged above 55 years showed to be more suppressing their virus (OR: 3.94, (95% CI: 0.92-16.9), P=0.07). Findings from this study revealed the gaps to be closed to include all population in maximizing HIV service delivery.

COVID-19 Home Based Management in Poor Resources Settings: A Case of Rwanda

COVID-19 is an infectious disease and can be transmitted from humans to humans through infected air droplets during coughing and sneezing or though contact with contaminated hands or surfaces. By March 01st 2021, World Health Organization (WHO) reported 113,820,168 confirmed cases globally, among them 2,851,062 are from the continent of Africa. Rwanda reported 18,850 confirmed cases, and 261 deaths. Healthcare systems have been burdened by the huge number of COVID-19 cases. Home-Based Care (HBC) was introduced as an alternative option to control the pandemic specifically in poor resource countries. Since December 2020, the number of COVID-19 case and death continued to rise in Rwanda. To handle this issue, the government of Rwanda started promoting the home-based care for asymptomatic people or patients with mild symptoms and they would be followed up by trained Community Health Workers (CHW). The increased number of positive cases is attributed to inadequate compliance to COVID-19 Infectious Prevention and Control (IPC) measures, low socio-economic status, inability to self-isolate due to having small and shared living rooms, food insecurity, lack of familiarity to disinfection procedures for home sanitation, inadequate access to water, weak policy regulating HBC, insufficient PPEs for CHWs, CHW fear of getting infected through HBC, low level of community awareness and perception, comorbidities, poor communication during follow up of HBC patients. Overall, we concluded that HBC has been very crucial in management of COVID-19 as it relieved the burden on health facilities, but more improvement on HBC is needed to be properly applicable in poor resource settings.