Background In Rwanda, maternal community health workers (M-CHWs) are involved in the country’s ov... more Background In Rwanda, maternal community health workers (M-CHWs) are involved in the country’s overall health system. In maternal health, their role includes the provision of preventive and promotional health services at the community level. They provide services such as health education on maternal health wellbeing, advice and information on access and timely utilization of health facilities for prenatal, delivery and postpartum care. The contribution of M-CHWs in the health sector combined with other government initiatives led the country to achieving the fifth Millennium Development Goal (MDG) - target 5A- that aimed to improve maternal health through the reduction of maternal mortality ratio by 75% between 1990 and 2015). The objective of this study was to explore M-CHWs’ perceptions and experiences on access and provision of maternal health services. Methods We used a case study methodology, a qualitative research approach to explore M-CHWs’ experiences and perceptions on acces...
Background Stunting affects more than 161 million children under five years of age worldwide. Rwa... more Background Stunting affects more than 161 million children under five years of age worldwide. Rwanda has a high prevalence of stunted children under five years of age (~38%) according to the 2014-2015 Rwanda Demographic and Health Survey. Objectives The aim of this study is to compare the prevalence rates of stunting in Rwanda using the Rwanda Demographic and Health Survey data of 2005, 2010 and 2014-2015. Methods The three Rwanda Demographic and Health Survey cross-sectional studies into consideration were conducted in 2005, 2010 and in 2014-2015. Stunting prevalence rates from those surveys were compared using Pearson's chi-squared tests and Marascuilo procedure using STATA (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.). Results The Pearson's chi-squared tests and Marascuilo procedure used in this research confirmed a significant difference between the reported three RDHS stunting prevalence rates. The trends in the stunting p...
Background Increasing men’s involvement in their pregnant partners’ wellness has been reported as... more Background Increasing men’s involvement in their pregnant partners’ wellness has been reported as one of the ways to improve access to and utilization of maternal health services, including birth preparedness and complication readiness. Men can play meaningful roles in the support systems that pregnant women need to achieve better maternal health outcomes. In Rwanda, the roles that men take vary, resulting in diverse expectations and responsibilities to support the health of women during this critical time. In this study, we aimed to examine the views, perspectives, and experiences of women on men’s involvement in maternal health and how this impacts access and utilization of maternal health services. Methods We conducted 21 interviews with pregnant and recently-pregnant women to gain an understanding of their views on men’s involvement in facilitating their partners’ health during pregnancy. Interviews were conducted across five Rwandan districts in both rural and urban settings of...
Access to health care is essential to achieving the best health outcomes. In this chapter, I high... more Access to health care is essential to achieving the best health outcomes. In this chapter, I highlight the structural, geographical, social-cultural and economic factors that act as facilitators or barriers to accessing maternal health services at the community level in Rwanda. Using five dimensions of access to health care (availability, accessibility, accommodation, affordability and acceptability), I qualitatively explore community dynamics pertaining to women’s access to community maternal health services in both rural and urban settings. I also examine the role of volunteer community health workers, who are elected by their own communities to provide maternal health services to women, and link communities to the formal health care system.
Objectives Training healthcare professionals in emergency maternal healthcare is a critical compo... more Objectives Training healthcare professionals in emergency maternal healthcare is a critical component of improving overall maternal health in developing countries like Rwanda. This paper explored the challenges that healthcare professionals who participated in a Continuing Professional Development (CPD) program on Advanced Life Support in Obstetrics® (ALSO) face in putting the learned knowledge and skills into practice in hospitals of Rwanda. Methods This study used a mixed methods approach to understand the challenges/barriers to applying new knowledge and skills in the hospitals of Rwanda. We conducted thirteen purposive in-depth interviews with ALSO® trainees (nurses, midwives and physicians) complemented with a cross-sectional survey on staff turnover in eight of the nine hospitals in the Eastern province of Rwanda. Results Our study found that trainees do not get enough opportunity to apply the new knowledge and skills in their hospitals and expand to health centers. In part because they are frequently rotating to different departments of the hospital and are not getting the opportunity to train their colleagues to share the learned knowledge and skills. The lack of refresher trainings/mentorship and the high personnel turnover were also reported as a barrier to applying new knowledge and skills. Reasons for staff turnover included pursuing further studies, a better opportunity (job/remuneration), low morale, and family related motives including joining a spouse or better schools for children. Conclusions for Practice Expanding and formalizing CPD training to all the healthcare professionals involved in providing maternal care services would improve the provision of emergency maternal healthcare in Rwanda. Keywords Maternal healthcare · Healthcare professionals · Continuing Professional Development · Advanced Life Support in Obstetrics® Significance Healthcare professionals in Rwanda are encouraged to participate in CPD programs to remain updated in their profession. Research shows CPD impact on improving the quality of healthcare, confidence and inter-professionalism among healthcare professionals. However, little is known about the challenges faced by Rwandan healthcare professionals to applying the knowledge/skills learned through CPD programs. This study reveals that the implementation of ALSO® CPD in Rwandan hospitals was hindered by staff rotations and turnover, lack of refresher training and mentor-ship, and limited opportunities to train colleagues. A more formalized system from which trainees and health institutions could benefit from ALSO® CPD is imperative.
Background In Rwanda, maternal community health workers (M-CHWs) are involved in the country’s ov... more Background In Rwanda, maternal community health workers (M-CHWs) are involved in the country’s overall health system. In maternal health, their role includes the provision of preventive and promotional health services at the community level. They provide services such as health education on maternal health wellbeing, advice and information on access and timely utilization of health facilities for prenatal, delivery and postpartum care. The contribution of M-CHWs in the health sector combined with other government initiatives led the country to achieving the fifth Millennium Development Goal (MDG) - target 5A- that aimed to improve maternal health through the reduction of maternal mortality ratio by 75% between 1990 and 2015). The objective of this study was to explore M-CHWs’ perceptions and experiences on access and provision of maternal health services. Methods We used a case study methodology, a qualitative research approach to explore M-CHWs’ experiences and perceptions on acces...
Background Stunting affects more than 161 million children under five years of age worldwide. Rwa... more Background Stunting affects more than 161 million children under five years of age worldwide. Rwanda has a high prevalence of stunted children under five years of age (~38%) according to the 2014-2015 Rwanda Demographic and Health Survey. Objectives The aim of this study is to compare the prevalence rates of stunting in Rwanda using the Rwanda Demographic and Health Survey data of 2005, 2010 and 2014-2015. Methods The three Rwanda Demographic and Health Survey cross-sectional studies into consideration were conducted in 2005, 2010 and in 2014-2015. Stunting prevalence rates from those surveys were compared using Pearson's chi-squared tests and Marascuilo procedure using STATA (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.). Results The Pearson's chi-squared tests and Marascuilo procedure used in this research confirmed a significant difference between the reported three RDHS stunting prevalence rates. The trends in the stunting p...
Background Increasing men’s involvement in their pregnant partners’ wellness has been reported as... more Background Increasing men’s involvement in their pregnant partners’ wellness has been reported as one of the ways to improve access to and utilization of maternal health services, including birth preparedness and complication readiness. Men can play meaningful roles in the support systems that pregnant women need to achieve better maternal health outcomes. In Rwanda, the roles that men take vary, resulting in diverse expectations and responsibilities to support the health of women during this critical time. In this study, we aimed to examine the views, perspectives, and experiences of women on men’s involvement in maternal health and how this impacts access and utilization of maternal health services. Methods We conducted 21 interviews with pregnant and recently-pregnant women to gain an understanding of their views on men’s involvement in facilitating their partners’ health during pregnancy. Interviews were conducted across five Rwandan districts in both rural and urban settings of...
Access to health care is essential to achieving the best health outcomes. In this chapter, I high... more Access to health care is essential to achieving the best health outcomes. In this chapter, I highlight the structural, geographical, social-cultural and economic factors that act as facilitators or barriers to accessing maternal health services at the community level in Rwanda. Using five dimensions of access to health care (availability, accessibility, accommodation, affordability and acceptability), I qualitatively explore community dynamics pertaining to women’s access to community maternal health services in both rural and urban settings. I also examine the role of volunteer community health workers, who are elected by their own communities to provide maternal health services to women, and link communities to the formal health care system.
Objectives Training healthcare professionals in emergency maternal healthcare is a critical compo... more Objectives Training healthcare professionals in emergency maternal healthcare is a critical component of improving overall maternal health in developing countries like Rwanda. This paper explored the challenges that healthcare professionals who participated in a Continuing Professional Development (CPD) program on Advanced Life Support in Obstetrics® (ALSO) face in putting the learned knowledge and skills into practice in hospitals of Rwanda. Methods This study used a mixed methods approach to understand the challenges/barriers to applying new knowledge and skills in the hospitals of Rwanda. We conducted thirteen purposive in-depth interviews with ALSO® trainees (nurses, midwives and physicians) complemented with a cross-sectional survey on staff turnover in eight of the nine hospitals in the Eastern province of Rwanda. Results Our study found that trainees do not get enough opportunity to apply the new knowledge and skills in their hospitals and expand to health centers. In part because they are frequently rotating to different departments of the hospital and are not getting the opportunity to train their colleagues to share the learned knowledge and skills. The lack of refresher trainings/mentorship and the high personnel turnover were also reported as a barrier to applying new knowledge and skills. Reasons for staff turnover included pursuing further studies, a better opportunity (job/remuneration), low morale, and family related motives including joining a spouse or better schools for children. Conclusions for Practice Expanding and formalizing CPD training to all the healthcare professionals involved in providing maternal care services would improve the provision of emergency maternal healthcare in Rwanda. Keywords Maternal healthcare · Healthcare professionals · Continuing Professional Development · Advanced Life Support in Obstetrics® Significance Healthcare professionals in Rwanda are encouraged to participate in CPD programs to remain updated in their profession. Research shows CPD impact on improving the quality of healthcare, confidence and inter-professionalism among healthcare professionals. However, little is known about the challenges faced by Rwandan healthcare professionals to applying the knowledge/skills learned through CPD programs. This study reveals that the implementation of ALSO® CPD in Rwandan hospitals was hindered by staff rotations and turnover, lack of refresher training and mentor-ship, and limited opportunities to train colleagues. A more formalized system from which trainees and health institutions could benefit from ALSO® CPD is imperative.
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Papers by Germaine Tuyisenge