College of Medicine and Health Sciences

Effect of Integrated Nutrition Intervention Package on Maternal Nutritional Status and Birth Weight in Rwanda.

2023-11-01T13:02:12Z

Effect of Integrated Nutrition Intervention Package on Maternal Nutritional Status and Birth Weight in Rwanda. Fissehaye, Michael Habtu In Rwanda, low birth weight (LBW), which is caused by maternal undernutrition, is a public health concern. Five Districts have adopted the Gikuriro Program, which consists of an integrated ‘nutrition-sensitive’ and ‘nutrition-specific’ intervention. However, there is no information on the effect of such intervention on maternal nutritional status and birth weight. Therefore, the study had three main objectives: ‘to determine the effect of integrated nutrition-specific and nutrition sensitive intervention package on maternal undernutrition among pregnant women’; ‘to assess the effectiveness of an integrated maternal nutrition intervention package on birth weight’; and ‘to explore the effect and challenges of an integrated nutrition intervention package utilization among pregnant women and lactating mothers’. A quasi-experimental design was employed for the first and second objectives. A total of 552 and 545 pregnant women for intervention and control group were recruited respectively. The highest percentage were aged 25-29years (27.3%), married (46.1%) and attended primary school (62.6%). More than half (56.1%) of babies were females and the average birth weight was 3,106.84grams. When compared to the control group, maternal undernutrition was significantly lower in the intervention group (4.7% vs 18.2%; p<0.001). After adjusting for relevant confounders, the intervention group's risk of maternal undernutrition was 77.0% lower [AOR = 0.23; 95%CI = 0.15 – 0.36]. For the second objective, the intervention has increased the average birth weight by 219grams (p<0.001) and decreased LBW by 66.99% (p<0.001). The intervention group showed a decreased risk of LBW (AOR = 0.23; 95%CI = 0.12 - 0.43). For the third objective, qualitative research was conducted among 25 community health officers and 27 nutritionists for key informant interviews (KIIs), as well as 40 pregnant women and 40 lactating mothers in 10 focus group discussion (FGDs). Among implementers and beneficiaries, the view of the intervention was improved nutrition knowledge and skills, enhanced attitude toward a balanced diet, perceived improved nutrition, and financial independence. However, some of the main challenges identified were lack of awareness of the Gikuriro Program, undesirable attitude towards nutrition, economic constraints, lack of husband support, and time constraints. Thus, to establish causation and provide information for the possible national scale-up of this intervention, more research using randomization approach is recommended. Besides, other upcoming nutrition intervention projects should consider the challenges highlighted in this study for optimal nutrition intervention implementation and utilization. Doctor in Philosophy, PhD

Effect of Integrated Nutrition Intervention Package on Maternal Nutritional Status and Birth Weight in Rwanda.

2023-11-01T12:27:04Z

Effect of Depo Medroxyprogesterone Acetate (Dmpa) Injectable Contraceptive On Cardiometabolic Risk Profile Among Women of Reproductive Age in Kigali, Rwanda

2023-11-01T08:48:57Z

Effect of Depo Medroxyprogesterone Acetate (Dmpa) Injectable Contraceptive On Cardiometabolic Risk Profile Among Women of Reproductive Age in Kigali, Rwanda KANTARAMA, Evelyne Background Depo medroxyprogesterone acetate (DMPA) injectable contraceptive is a reversible and effective hormonal contraceptive method many women in East Africa use. However, various studies suggest it might increase cardiometabolic disease risk due to its influence on cardiometabolic risk factors and call for a thorough evaluation of its effects on cardiometabolic risk profile to design proper prevention strategies. There is a need for further research to fully characterize the effects and make an informed decision on establishing measures for regular follow-up with users. This study responds to that need and explores the impact of DMPA use on lipid profile, waist circumference, blood pressure, glycated haemoglobin, and inflammatory markers among women of reproductive age in Rwanda. Three main objectives guided the study: (i) to explore the prevalence of central obesity and its association with other cardiometabolic risk factors in women of reproductive age in Kigali, Rwanda; (ii) to evaluate the effects of DMPA on lipid profile, waist circumference, blood pressure, glycated haemoglobin, and inflammatory markers among women of reproductive age in Kigali, Rwanda; and (iii) to analyse changes in cardiometabolic risk markers among abdominally obese women of reproductive age in Kigali, Rwanda during the use of DMPA. Methods The study used a cross-sectional design to explore the prevalence of central obesity and its correlates (objective 1). It also used a prospective cohort design to evaluate the effects of DMPA on cardiometabolic risk profile among the users (objective 2) and a pre-post design to analyse the changes in cardiometabolic risk markers among abdominally obese women. The target population was women of reproductive age in Kigali city. To explore the prevalence of central obesity and its correlates, we conveniently selected 138 participants and analysed data by chi-square and logistic regression analyses. To evaluate the effects of DMPA on cardiometabolic risk profile, we randomly selected 45 DMPA users and 45 non-hormonal methods users and analysed data by the Manny Whitney test. To assess the changes in cardiometabolic risk markers among abdominally obese women during DMPA use, we selected a sample of 65 participants and analysed data using Wilcoxon signed-rank test. Results The thesis report is presented as a compilation of three complementary manuscripts, each responding to one of the objectives earlier described. Study 1: The first study explored the prevalence of central obesity and its correlates using a cross-sectional design. Results indicate that the prevalence of central obesity was 48.5% and was significantly associated with age (OR=3.25, 95% CI: 1.11-9.47), alcohol use (OR=5.57, 95% CI: 1.91-16.20), meat consumption (OR=4.33, 95% CI: 1.49-12.59), hypertriglyceridemia (OR= 4.12, 1.01-14.76), and elevated diastolic blood pressure (OR=4.87, 95% CI: 1.47-16.13). Study 2: The second study evaluates the effects of DMPA on cardiometabolic risk profiles among the users using a prospective design. Results indicate that DMPA users experienced a significant increase in waist circumference, TG, LDL, TC, hs-CRP, and glycated haemoglobin at twelve months of follow-up. In contrast, they experienced a significantly lower HDL than controls (p= <0.05). However, the study did not indicate a significant difference in blood pressure changes between DMPA users and the control group (p> 0.05). Study 3: The third study analysed the changes in cardiometabolic risk markers among abdominally obese women during the use of DMPA. Results indicate that after twelve months, all cardiometabolic risk markers showed significant changes; there was a gradual decrease in HDL and an increase in TG, LDL, TC, hs-CRP, waist circumference, SBP, DBP, and glycated haemoglobin (p= <0.05). Conclusions The prevalence of central obesity was relatively high among women of reproductive age, and it was associated with older age, elevated diastolic blood pressure, high triglycerides levels, and meat and alcohol consumption. The study recommends an intensive awareness of health risks associated with central obesity and its associated factors to address the rising risk of cardiovascular diseases in this population. DMPA induces alteration in the cardiometabolic risk profile, where this alteration worsens when the user is abdominally obese. Considering the cardiometabolic health of individual users before initiating the method and providing a follow up to the users of increased risk sounds essential PhD Thesis

Implementing Stroke Unit Care in Selected Hospitals in Rwanda

2022-09-17T10:28:36Z

Implementing Stroke Unit Care in Selected Hospitals in Rwanda Gerard, Urimubenshi, Background: The burden of stroke in low-and middle-income countries (LMICs) has risen sharply in recent years and the rate of increase is set to accelerate due to socio-demographic and lifestyle changes related to the industrialization and a rise in many modifiable vascular disease risk factors. Aims: The first aim was to establish, for countries like Rwanda, how much stroke is a major problem. The second aim was to explore whether the existing stroke services were well prepared. The third aim was to develop and implement a relevant service improvement in Rwanda. Methods: First, I conducted systematic reviews of the literature on the epidemiology and impact of stroke, and the available stroke services in Africa. Second, I conducted a systematic review of the literature and analyzed the INTERSTROKE study data to identify the stroke key performance indicators (KPIs) that have been described in stroke care and assessed their association with patient outcomes. Finally, I selected the stroke unit care KPIs relevant to Rwandan and other LMIC settings, and used several strategies including site champions, provision of educational materials, feedback on usual care, training hospital staff on stroke KPIs, consensus discussions on service improvement by local staff, and discussions with the hospital directors to promote the implementation of the selected KPIs in two hospitals in Rwanda. Results: Stroke was found to be common and important in Africa. However, the provision of stroke care was below the recommended standards. After adjustment for case mix and stroke onset-hospital arrival interval, I found a consistent trend of associations between my implementation intervention and improved delivery of stroke KPIs and patient outcomes. Conclusion: Several common KPIs of stroke unit care can be implemented in hospitals in Rwanda. However, there are some major challenges that need to be addressed for optimal implementation of stroke unit care.