Search Results (396)

Background: The burden of bacterial bloodstream infections (BSIs) is rapidly increasing in Africa including Rwanda. Methods: This is a retrospective study that investigates the diversity, distribution, and antimicrobial susceptibility profiles of BSI bacteria in three tertiary referral hospitals in Rwanda between 2020 and 2022. Results: A total of 1532 blood culture tests were performed for visiting patients. Overall, the proportions of Gram-negative and Gram-positive bacteria were 48.2% and 51.8, respectively. Staphylococcus aureus was the predominant species accounting for 25% of all Gram-positive BSI species, and Klebsiella species represented 41% of all Gram-negative BSI species. Antimicrobial susceptibility testing revealed that Amikacin exhibited the highest activity against Enterobacter spp., Serratia spp., and Escherichia coli in >92% of cases and Klebsiella spp. in 75.7%. Meropenem and Imipenem were highly efficacious to Salmonella spp. (100% susceptibility), Enterobacter spp. (96.2% and 91.7%, respectively), and Escherichia coli (94.7% and 95.5%, respectively). The susceptibility of Enterococcus spp., S. aureus, and Streptococcus spp. to Vancomycin was 100%, 99.5%, and 97.1%, respectively. Klebsiella spp. was highly sensitive to Colistin (98.7%), Polymyxin B (85.6%), Imipenem (84.9%), and Meropenem (78.5%). Conclusions: We recommend strengthening the implementation of integrated transdisciplinary and multisectoral One Health including AMR stewardship for the surveillance, prevention, and control of AMR in Rwanda. Full article

Background: Antimicrobial resistance (AMR) is a global problem that results in high morbidity and mortality, particularly in low- and middle-income countries. Inappropriate use of antimicrobials is a major driver of AMR. This study aimed to evaluate the rate and quality of antimicrobial prescription and use at the University Teaching Hospital of Kigali (CHUK), a tertiary-referral teaching hospital. Methodology: A point prevalence survey (PPS) of antimicrobial prescription was conducted using the Global PPS tool, including a healthcare-acquired infection (HAI) module. Results: On the day of the PPS, 39.3% (145/369) of inpatients were prescribed at least one antimicrobial. Out of the 259 prescribed antimicrobials, 232 (89.6%) were antibacterials, of which 151 (65.1%) belonged to the watch group of the WHO AWaRe classification. The top three antibiotics prescribed were cefotaxime (87; 37.5%), parenteral metronidazole (31; 13.4%), and meropenem (23; 9.9%). Stop or review dates for the prescribed antimicrobials were documented in 27/259 prescriptions (10.4%). Surgical prophylaxis (SP) was prescribed for longer than one day in 83.3% of 61 patients. Samples for culture were sent for 27.1% (63/232) of all the patients prescribed antibiotics. Conclusion: This PPS demonstrates multiple indicators of the poor use of antimicrobials, including the high prevalence usage of watch antibiotics and prolonged surgical prophylaxis and other poor-quality indicators. Thus, there is an urgent need for intervention to improve antimicrobial stewardship. Full article

HIV-1 subtypes have distinct geographical distributions, with subtypes A, C, and D and inter-subtype recombinants circulating in sub-Saharan Africa. Historically, individuals living with subtype A viruses exhibit slower CD4 decline and progression to AIDS diagnosis. Despite this, there are few authentic infectious molecular clones (IMCs) of subtype A or AC recombinant transmitted founder (TF) viruses with which to investigate viral impacts on pathogenesis. In this study, we constructed 16 authentic subtype A1 and 4 A1C recombinant IMCs from the IAVI Rwandan Protocol C acute infection cohort and characterized these viruses phenotypically. The virus replicative capacity (RC) scores varied over 50-fold, but the natural substitution of non-consensus amino acids in the p17(MA) domain of Gag was generally linked to higher RC levels. Sensitivity to a panel of broadly neutralizing antibodies (bNAbs) showed that all but one TF was sensitive to N6, which targets the CD4 binding site, while bNAbs PG16 and PGT 128 had a similar level of potency but reduced breadth against our panel of viruses. In contrast, bNAb 10E8V4 revealed high breadth but much lower potency. This panel of well-characterized, authentic subtype A and AC recombinant IMCs provides a resource for studies on the role of the virus subtype in HIV-1 transmission, pathogenesis, and vaccine design. Full article

The Nyabarongo river catchment in Rwanda has experienced significant changes in its land use and land cover (LULC) in recent decades, with profound implications for non-point source pollution. However, there are limited studies on non-point pollution caused by nutrient loss associated with land use and land cover changes in the catchment. This study investigates the spatiotemporal impacts of these changes on water quality considering nitrogen and phosphorus within the catchment from 2000 to 2020 and 2030 as a projection. The SWAT model was used in analysis of hydrological simulations, while the CA–Markov model was used for the future projection of LULC in 2030. The results revealed (1) the important changes in LULC in the study area, where a decrease in forestland was observed with a considerable increase in built-up land, grassland, and cropland; (2) that the R² and NSE of the TN and TP in the runoff simulation in the catchment were all above 0.70, showing good applicability during calibration and validation periods; (3) that from 2000 to 2020 and looking to the projection in 2030, the simulated monthly average TN and TP levels have progressively increased from 15.36 to 145.71 kg/ha, 2.46 to 15.47 kg/ha, 67.2 to 158.8 kg/ha, and 9.3 to 17.43 kg/ha, respectively; and (4) that the most polluted land use types are agriculture and urban areas, due to increases in human activities as a consequence of population growth in the catchment. Understanding the patterns and drivers of these changes is critical for developing effective policies and practices for sustainable land management and protection of water resources. Full article

The Africa Centers for Disease Control and Prevention declared mpox a Public Health Emergency of Continental Security (PHECS) in Africa. African public health systems have moved to mobilize a response against a backdrop of inherent significant challenges. With this commentary, we discuss how lessons from past public health emergencies, particularly COVID-19 and Ebola outbreaks, have prepared the region for improved disease surveillance, rapid response strategies, and effective public health communication and how these lessons can be applied to the mpox response, emphasizing the importance of strong healthcare infrastructure, effective data sharing, community engagement, targeted interventions, and robust contact tracing. Additionally, addressing misinformation and building public trust are crucial for controlling the spread of any disease. By leveraging these strategies, African countries can enhance their response to mpox. This includes improving diagnostic capabilities, strengthening cross-border collaborations, and prioritizing vaccination campaigns where needed. Ultimately, by applying the hard-earned lessons from the COVID-19 pandemic and Ebola outbreak, the East Africa region can better address the challenges posed by mpox and safeguard public health. Full article

Rwanda, in eastern tropical Africa, is a small, densely populated country where climatic disasters are often the cause of considerable damage and deaths. Landslides are among the most frequent hazards, linked to the country’s peculiar configuration including high relief with steep slopes, humid tropical climate with heavy rainfall, intense deforestation over the past 60 years, and extensive use of the soil for agriculture. The Karongi region, in the west-central part of the country, was affected by an exceptional cluster of more than 700 landslides during a single night (6–7 May 2018) over an area of 100 km². We analyse the causes of this spectacular event based on field geological and geomorphology investigation and CHIRPS and ERA5-Land climate data. We demonstrate that (1) the notably steep slopes favoured soil instability; (2) the layered soil and especially the gravelly, porous C horizon allowed water storage and served as a detachment level for the landslides; (3) relatively low intensity, almost continuous rainfall over the previous two months lead to soil water-logging; and (4) acoustic waves from thunder or mechanical shaking by strong wind destabilized the water-logged soil through thixotropy triggering the landslides. This analysis should serve as a guide for forecasting landslide-triggering conditions in Rwanda. Full article

Remotely sensed nighttime light data have become vital for electrification mapping in data-scarce regions. However, uncertainty persists regarding the veracity of these electrification maps. This study investigates how characteristics of electrified areas influence their detectability using nighttime lights. Utilizing a dataset comprising the locations, installation date, and electricity purchase history of thousands of electric meters and transformers from utilities in Rwanda and Kenya, we present a systematic error assessment of electrification maps produced with nighttime lights. Descriptive analysis is employed to offer empirical evidence that the likelihood of successfully identifying an electrified nighttime light pixel increases as characteristics including the time since electrification, the number of meters within a pixel, and the total annual electricity purchase of meters in a pixel increase. The performance of models trained on various temporal aggregations of nighttime light data (annual, quarterly, monthly, and daily) was compared, and it was determined that aggregation at the monthly level yielded the best results. Additionally, we investigate the transferability of electrification models across locations. Our findings reveal that models trained on data from Rwanda demonstrate strong transferability to Kenya, and vice versa, as indicated by balanced accuracies differing by less than 5% when additional data from the test location are included in the training set. Also, models developed with data from the centralized grid in East Africa were found to be useful for detecting areas electrified with off-grid systems in West Africa. This research provides valuable insight into the characterization of sources of nighttime lights and their utility for mapping electrification. Full article

Composting is a common method for managing organic waste and creating nutrient-rich soil amendments. Recently, biochar, a carbon-rich material from biomass pyrolysis, has been noted for potentially improving composting. This study examines the impact of adding biochar to compost made from cow manure and kitchen waste through a controlled lab experiment. The treatments were labeled as CMX (cow manure), KWX (kitchen waste), and CMKWX (both) with X being the percentage of CM, KW, and CMKW minus that of biochar in the mixture. Key parameters such as temperature (T), pH, and electric conductivity (EC) were tracked during the composting processes, and the final composts were analyzed for total nitrogen (N), available nitrogen (AN), total phosphorus (TP), available phosphorus (AP), total potassium (TK), organic carbon (OC), calcium (Ca²⁺), magnesium (Mg²⁺), and organic matter (OM). The results showed that adding less than 10% biochar influenced composting positively. Specifically, 5% biochar amendment led to higher thermophilic temperatures (45–57 °C) and stable pH levels (6.3–8.7) compared to controls. However, biochar did not significantly enhance EC, which peaked at 1.78 dS/m in both the control and 5% biochar treatments. Nutrient analysis revealed that biochar increased Ca²⁺ (13.62 meq/g) and Mg²⁺ (5.73 meq/g) retention in CM composts (CM85 and CM100). The highest OM content was 16.84% in CM90, while the lowest was 3.81% in CM95. Higher OM negatively affected TN, with CM treatments having more OM and KW treatments having more TN. TP and TK were higher in control treatments without biochar. This study highlights the benefits of integrating biochar with organic waste for enhancing compost nutrient profiles and soil fertility. It was observed that the more diverse the compost feedstock, i.e., CMKW, the higher the nutrient content for treatments containing less than 10% biochar. Full article

During population-based HIV impact assessments (PHIAs), some participants who self-reported testing HIV-positive (PSRP) tested negative in one or more subsequent survey HIV tests. These unexpected discrepancies between their self-reported results and the survey results draw into question the validity of either the self-reported status or the test results. We analyzed PSRP with negative test results aged 15–59 years old using data collected from 2015 to 2021 in 13 countries, assessing prevalence, self-report status, survey HIV status, viral load, rapid tests and confirmatory tests, and answers to follow-up questions (such as years on treatment). Across these surveys, 19,026 participants were PSRP, and 256 (1.3%) of these were concluded to be HIV-negative after additional survey-based testing and review. PSRP determined to be HIV-negative trended higher in countries with a higher HIV prevalence, but their number was small enough that accepting self-reported HIV-positive status without testing would not have significantly affected the prevalence estimates for HIV or viral load suppression. Additionally, using more detailed information for Uganda, we examined 107 PSRP with any negative test results and found no significant correlation with years on treatment or age. Using these details, we examined support for the possible reasons for these discrepancies beyond misdiagnosis and false reporting. These findings suggest that those conducting surveys would benefit from a nuanced understanding of HIV testing among PSRP to conduct surveys ethically and produce high-quality results. Full article

It is well known that experiences of extreme adversity strongly impact caregiving and family dynamics. In this study, we explore how caregiving is shaped by experiences of war and displacement among a community experiencing protracted, ongoing conflict and displacement, namely, Congolese Banyamulenge refugee families in Rwanda. The findings are based on six months of ethnographic team research with Banyamulenge refugee families living in semi-urban southern Rwanda. Among the caregivers, including people who arrived several years ago and others who have lived in Rwanda for over two decades, we found a strong longing for home and past cattle-herding life. We also found that caregivers emphasized the transmission of “survival tactics” as well as Banyamulenge identity and culture. We argue that these caregiving objectives and practices speak to the community’s experiences of material and existential losses in the past, as well as those anticipated in the unknown future. Second, parental caregiving efforts appear to lead to increased intergenerational dissonance, with children wishing to integrate into their host community. While this finding appears in line with much of the migration literature about intergenerational family relationships and conflict, we find that children’s orientation is not only informed by the host environment but also stems from a desire to relieve their parents’ suffering from loss and help them invest in more optimistic futures. Finally, while our findings suggest profound changes in social and cultural reproduction in the long term, we argue for caution, as ongoing changes in war dynamics in DR Congo may inform shifts in ideas on belonging among the children. The findings provide new insights for understanding how caregiving may be affected by war and displacement while effecting change in war-affected, displaced communities. Full article

Fungal infections (FIs) are spreading globally, raising a significant public health concern. However, its documentation remains sparse in Africa, particularly in Rwanda. This report provides a comprehensive review of FIs in Rwanda based on a systematic review of reports published between 1972 and 2022. The findings reveal a rich diversity of fungal pathogens, including Blastomyces, Candida, Cryptococcus, Histoplasma, Microsporum, Pneumocystis, Rhinosporidium, and Trichophyton caused human infections. Candida infections predominantly affect the vagina mucosa, while Histoplasma duboisi was linked to disseminated infections. Other pathogens, such as Blastomyces dermatitidis and Rhinosporidium seeberi, were associated with cerebellar and nasal mucosa infections, respectively. The widespread observation of soilborne fungi affecting bean crops highlights the pathogens’ threat to agricultural productivity, food security, and socioeconomic stability, as well as potential health impacts on humans, animals, and the environment. Of particular importance is that there is no information about FIs among animals in the country. Moreover, the analysis underscores significant limitations in the detection, reporting, and healthcare services related to FIs in the country, indicating gaps in diagnostic capacity and surveillance systems. This is underscored by the predominant use of traditional diagnostic techniques, including culture, cytology, and histopathology in the absence of integrating more sensitive and specific molecular tools in investigating FIs. Developing the diagnostic capacities and national surveillance systems are urgently needed to improve the health of crops, animals, and humans, as well as food security and socioeconomic stability in Rwanda. Also, it is important to indicate severe gaps in the evidence to inform policymaking, guide strategic planning, and improve healthcare and public health services, underscoring the urgent need to build national capacity in fungal diagnosis, surveillance, and research. Raising awareness among the public, scientific community, healthcare providers, and policymakers remains crucial. Furthermore, this report reveals the threats of FIs on public health and food insecurity in Rwanda. A multisectoral one health strategy is essential in research and intervention to determine and reduce the health and safety impacts of fungal pathogens on humans, animals, and the environment. Full article

Obstetric fistula is a childbirth complication causing abnormal openings between the urinary, bowel, and genital tracts, leading to involuntary leakage and potential long-term disability. Even after surgical repair, women continue to face psychological and social challenges that affect their social inclusion and participation. This study explored family and service provider perspectives on current support systems and identified gaps affecting women’s inclusion and participation post-fistula surgery. Building on a prior study of women who underwent obstetric fistula surgical repair, we qualitatively examined available formal and informal post-surgical supports in Ethiopia. We conducted 20 interviews with family members and service providers and analyzed them using Charmaz’s grounded theory inductive analysis approach. We identified four themes that indicated the available formal support in fistula care, the impact of formal support on women’s social participation and inclusion, the gaps in formal support systems, and post-surgery informal supports and their challenges. Both groups believed support needs for women after surgery remain unmet, highlighting the need to strengthen holistic support services to improve women’s social inclusion and participation. This study contributes to limited research on formal and informal support for women, emphasizing the need for enhanced economic, psychological, and sexual health-related support post-obstetric fistula surgery. Full article

Neyman–Scott rectangular pulse is a stochastic rainfall model with five parameters. The impacts of initial values and optimization methods on the parameter estimation of the Neyman–Scott rectangular pulse model were investigated using both the method of moments and the method of maximum likelihood. The estimates using the method of moments were influenced by the optimization method and were sensitive to the initial values and the aggregation scale of the data. Thus, by using frequentist estimation methods, we cannot guarantee the unique values as estimates. The aim of this study is to find more reliable unique values as estimates using a Bayesian approach. In this approach, parameters are estimated from the posterior distribution, and model performance is assessed by comparing observed values with fitted values. Slice sampling within the Gibbs sampler algorithm demonstrates superior convergence and model fitting, yielding unique estimates for the model parameters. The main conclusion of this study is that Bayesian estimation methods outperform other estimation methods in terms of providing reliable and stable estimates that improve rainfall generation accuracy. Full article

Increasing tenure security is essential for promoting safe and inclusive urban development and achieving Sustainable Development Goals. However, assessment of tenure security relies on conventional census and survey statistics, which often fail to capture the dimension of perceived tenure insecurity. This perceived tenure insecurity is crucial as it influences local engagement and the effectiveness of policies. In many regions, particularly in the Global South, these conventional methods lack the necessary data to adequately measure perceived tenure insecurity. This study first used household survey data to derive variations in perceived tenure insecurity and then explored the potential of Very-High Resolution (VHR) satellite imagery and spatial data to assess these variations in urban deprived areas. Focusing on the city of Kigali, Rwanda, the study collected household survey data, which were analysed using Multiple Correspondence Analysis to capture variations of perceived tenure insecurity. In addition, VHR satellite imagery and spatial datasets were analysed to characterize urban deprivation. Finally, a Random Forest regression model was used to assess the relationship between variations of perceived tenure insecurity and the spatial characteristics of urban deprived areas. The findings highlight the potential of geospatial information to estimate variations in perceived tenure insecurity within urban deprived contexts. These insights can inform evidence-based decision-making by municipalities and stakeholders in urban development initiatives. Full article

Based on social interdependence and social constructivism theories, the authors of this study examined the effects of a cooperative learning (CL) pedagogical model on the engagement and outcomes of undergraduate students in an Ethiopian university’s classrooms. We did this by using a quasi-experimental post-test control group design. The study participants included undergraduate students enrolled in the courses “Risk Management and Insurance” (n = 99) and “Foundation Engineering I” (n = 94). The control groups received regular lecture-based teaching, while the experimental group received CL instruction over two weeks in six to eight sessions. The results from the Management sample, which demonstrated that the CL intervention group reported significantly higher learning outcomes and more engagement than the control groups, are sufficient evidence for the study to validate the hypothesis. The effect sizes were moderate and ranged from 0.52 to 0.78 Cohen’s d. In the Engineering course, the results demonstrate the smallest difference between the mean scores reported by the CL group and those of the regular lecture group, with the CL group showing slightly higher student engagement and outcomes across the three categories assessed. The Engineering sample’s results, however, did not show any significant differences between the CL and control groups. This study provides evidence that course reform utilizing a CL pedagogical design could improve student engagement and learning outcomes as compared to the regular lecture-based method. By incorporating CL pedagogies, higher educators and institutions can create more engaging and effective learning environments for students. Full article