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Aidam E, Varela V, Abukari F, Torres KA, Nisingizwe MP, Yourkavitch J, Yakubu E, Abubakari A, Ibrahim R, Oot L, Beck K, Azumah S, Issahaku AH, Apoassan Jambeidu J, Abdul-Rahman L, Adu-Asare C, Uyehara M, Cashin K, Karnati R, Kirk CM. Promoting responsive care and early learning practices in Northern Ghana: results from a counselling intervention within nutrition and health services. Public Health Nutr 2024; 27:e77. [PMID: 38328894 DOI: 10.1017/s1368980024000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This study assesses change in caregiver practices after integrating responsive care and early learning (RCEL) in nutrition and health services and community platforms in northern Ghana. DESIGN We trained health facility workers and community health volunteers to deliver RCEL counselling to caregivers of children under 2 years of age through existing health facilities and community groups. We assessed changes in caregivers' RCEL practices before and after the intervention with a household questionnaire and caregiver-child observations. SETTING The study took place in Sagnarigu, Gushegu, Wa East and Mamprugu-Moagduri districts from April 2022 to March 2023. Study sites included seventy-nine child welfare clinics (CWC) at Ghana Health Service facilities and eighty village savings and loan association (VSLA) groups. PARTICIPANTS We enrolled 211 adult caregivers in the study sites who had children 0-23 months at baseline and were enrolled in a CWC or a VSLA. RESULTS We observed improvements in RCEL and infant and young child feeding practices, opportunities for early learning (e.g. access to books and playthings) in the home environment and reductions in parental stress. CONCLUSIONS This study demonstrates the effectiveness of integrating RCEL content into existing nutrition and health services. The findings can be used to develop, enhance and advocate for policies integrating RCEL into existing services and platforms in Ghana. Future research may explore the relationship between positive changes in caregiver behaviour and improvements in child development outcomes as well as strategies for enhancing paternal engagement in care practices, improving child supervision and ensuring an enabling environment.
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Affiliation(s)
- Enam Aidam
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
| | - Veronica Varela
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
| | - Fauzia Abukari
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- USAID Advancing Nutrition Ghana, Plot# 11, Jisonaayili-Gurugu, Tamale, Ghana
| | - Kelsey A Torres
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
| | - Marie Paul Nisingizwe
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC, Canada
| | - Jennifer Yourkavitch
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- Results for Development, 1111 19th Street NW, Washington, DC, USA
| | - Eliasu Yakubu
- Saha Consulting and Services Limited, P. O. Box 430, Tamale, Ghana
| | - Abdulai Abubakari
- Saha Consulting and Services Limited, P. O. Box 430, Tamale, Ghana
- University for Development Studies, School of Public Health, Department of Global and International Health, P.O. Box TL1350, Tamale, Ghana
| | - Rashida Ibrahim
- Saha Consulting and Services Limited, P. O. Box 430, Tamale, Ghana
| | - Lesley Oot
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
| | - Kathryn Beck
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
| | - Selorme Azumah
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- USAID Advancing Nutrition Ghana, Plot# 11, Jisonaayili-Gurugu, Tamale, Ghana
| | - Al-Hassan Issahaku
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- USAID Advancing Nutrition Ghana, Plot# 11, Jisonaayili-Gurugu, Tamale, Ghana
| | - Joyce Apoassan Jambeidu
- Feed the Future Resilience in Northern Ghana Systems Strengthening, BA184 Dohana Kpema Street Gumani, Tamale, Ghana
- Abt Associates, 10 Fawcett Street, Cambridge, MA, USA
| | - Lutuf Abdul-Rahman
- United States Agency for International Development Ghana, No. 24 Fourth Circular Road, Cantonments, P.O. Box 1630, Accra, Ghana
| | | | - Malia Uyehara
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- JSI Research & Training Institute, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
| | - Kristen Cashin
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- Save the Children US, 501 Kings Highway E, Fairfield, CT, USA
| | - Romilla Karnati
- USAID Advancing Nutrition, 2733 Crystal Drive, Fourth Floor, Arlington, VA22201, USA
- Save the Children US, 501 Kings Highway E, Fairfield, CT, USA
| | - Catherine M Kirk
- ZemiTek LLC, USAID's Global Solution Ventures, 1300 Pennsylvania Avenue NW, Washington, DC, USA
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Loucaides EM, Zuurmond M, Nemerimana M, Kirk CM, Lassman R, Ndayisaba A, Smythe T, Baganizi E, Tann CJ. Livelihood support for caregivers of children with developmental disabilities: findings from a scoping review and stakeholder survey. Disabil Rehabil 2024; 46:293-308. [PMID: 36571438 DOI: 10.1080/09638288.2022.2160018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Poverty amongst families with a child with disability adversely impacts child and family quality of life. We aimed to identify existing approaches to livelihood support for caregivers of children with developmental disabilities in low- and middle-income countries. METHODS This mixed-method study incorporated a scoping literature review and online stakeholder survey. We utilised the World Health Organization community-based rehabilitation (CBR) matrix as a guiding framework for knowledge synthesis and descriptively analysed the included articles and survey responses. RESULTS We included 11 peer-reviewed publications, 6 grey literature articles, and 49 survey responses from stakeholders working in 22 countries. Identified programmes reported direct and indirect strategies for livelihood support targeting multiple elements of the CBR matrix; particularly skills development, access to social protection measures, and self-employment; frequently in collaboration with specialist partners, and as one component of a wider intervention. Self-help groups were also common. No publications examined effectiveness of livelihood support approaches in mitigating poverty, with most describing observational studies at small scale. CONCLUSION Whilst stakeholders describe a variety of direct and indirect approaches to livelihood support for caregivers of children with disabilities, there is a lack of published literature on content, process, and impact to inform future programme development and delivery.
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Affiliation(s)
- Eva M Loucaides
- Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH Centre), London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Zuurmond
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Mathieu Nemerimana
- Maternal and Child Health Programme, Partners in Health/Inshuti Mu Buzima (PIH/IMB), Kigali, Rwanda
| | - Catherine M Kirk
- Maternal and Child Health Programme, Partners in Health/Inshuti Mu Buzima (PIH/IMB), Kigali, Rwanda
| | | | - Albert Ndayisaba
- Maternal and Child Health Programme, Partners in Health/Inshuti Mu Buzima (PIH/IMB), Kigali, Rwanda
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Erick Baganizi
- Maternal and Child Health Programme, Partners in Health/Inshuti Mu Buzima (PIH/IMB), Kigali, Rwanda
| | - Cally J Tann
- Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH Centre), London School of Hygiene & Tropical Medicine, London, UK
- Social Aspects of Care Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Neonatal Medicine, University College London Hospitals NHS Trust, London, UK
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Nemerimana M, Havugarurema S, Nshimyiryo A, Karambizi AC, Kirk CM, Beck K, Gégout C, Anderson T, Bigirumwami O, Ubarijoro JM, Ngamije PK, Miller AC. Factors associated with recovery from stunting at 24 months of age among infants and young children enrolled in the Pediatric Development Clinic (PDC): A retrospective cohort study in rural Rwanda. PLoS One 2023; 18:e0283504. [PMID: 37418456 PMCID: PMC10328318 DOI: 10.1371/journal.pone.0283504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/11/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Stunting (low height/length-for-age) in early life is associated with poor long-term health and developmental outcomes. Nutrition interventions provided during the first 1,000 days of life can result in improved catch-up growth and development outcomes. We assessed factors associated with stunting recovery at 24 months of age among infants and young Children enrolled in Pediatric Development Clinics (PDC) who were stunted at 11 months of age. METHODS This retrospective cohort study included infants and young children who enrolled in PDCs in two rural districts in Rwanda between April 2014 and December 2018. Children were included in the study if their PDC enrollment happened within 2 months after birth, were stunted at 11 months of age (considered as baseline) and had a stunting status measured and analyzed at 24 months of age. We defined moderate stunting as length-for-age z-score (LAZ) < -2 and ≥-3 and severe stunting as LAZ <-3 based on the 2006 WHO child growth standards. Stunting recovery at 24 months of age was defined as the child's LAZ changing from <-2 to > -2. We used logistic regression analysis to investigate factors associated with stunting recovery. The factors analyzed included child and mother's socio-demographic and clinical characteristics. RESULTS Of the 179 children who were eligible for this study, 100 (55.9%) were severely stunted at age 11 months. At 24 months of age, 37 (20.7%) children recovered from stunting, while 21 (21.0%) severely stunted children improved to moderate stunting and 20 (25.3%) moderately-stunted children worsened to severe stunting. Early stunting at 6 months of age was associated with lower odds of stunting recovery, with the odds of stunting recovery being reduced by 80% (aOR: 0.2; 95%CI: 0.07-0.81) for severely stunted children and by 60% (aOR: 0.4; 95% CI: 0.16-0.97) for moderately stunted children (p = 0.035). Lower odds of stunting recovery were also observed among children who were severely stunted at 11 months of age (aOR: 0.3; 95% CI: 0.1-0.6, p = 0.004). No other maternal or child factors were statistically significantly associated with recovery from stunting at 24 months in our final adjusted model. CONCLUSION A substantial proportion of children who were enrolled in PDC within 2 months after birth and were stunted at 11 months of age recovered from stunting at 24 months of age. Children who were severely stunted at 11 months of age (baseline) and those who were stunted at 6 months of age were less likely to recover from stunting at 24 months of age compared to those with moderate stunting at 11 months and no stunting at 6 months of age, respectively. More focus on prevention and early identification of stunting during pregnancy and early life is important to the healthy growth of a child.
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Affiliation(s)
| | | | | | | | | | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Todd Anderson
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Klein A, Uyehara M, Cunningham A, Olomi M, Cashin K, Kirk CM. Nutritional care for children with feeding difficulties and disabilities: A scoping review. PLOS Glob Public Health 2023; 3:e0001130. [PMID: 36962945 PMCID: PMC10022789 DOI: 10.1371/journal.pgph.0001130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/11/2023] [Indexed: 03/19/2023]
Abstract
One billion people worldwide have a disability, and 80 percent of them live in low- and middle-income countries (LMICs). The prevalence of feeding difficulties globally ranges from 25-45 percent to 33-80 percent in children without and with disabilities, respectively. The U.S. Agency for International Development's (USAID) flagship multi-sectoral nutrition project, USAID Advancing Nutrition, conducted a scoping review of programs supporting nutritional care of children with disability and non-disability related feeding difficulties. The non-systematic scoping review included a desk review of peer-reviewed and non-peer-reviewed literature and key informant interviews. In all, 127 documents with publication dates ranging from 2003 to 2022 were identified through keyword searches and snowballing and met the inclusion criteria, and 42 experts in nutrition and disability were interviewed. Findings were organized using structured matrices of challenges and opportunities across the universal progressive model of care framework in the identification and management of feeding difficulties and disabilities and support for children with feeding difficulties and disabilities and their families. The review found insufficient policies, programs, and evidence to support children with feeding difficulties and disabilities and their families. While some resources and promising approaches exist, they are not standardized or universally used, staff are not trained to use them, and there is insufficient funding to implement them. The combination of challenges in identifying feeding difficulties and disabilities, a lack of understanding of the link between disabilities and feeding, and weak or nonexistent referral or specialized services puts these children at risk of malnutrition. Additionally, their families face challenges providing the care they need, including coping with high care demands, accessing support, obtaining appropriate foods, and managing stigma. Four areas of recommendations emerged to support children with feeding difficulties and disabilities: (1) Strengthen systems to improve identification and service provision; (2) Provide direct support to families to address determinants that affect nutrition outcomes; (3) Conduct advocacy to raise awareness of the needs and opportunities; and (4) Build the evidence base on effective interventions to identify and support these children and their families.
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Affiliation(s)
- Alyssa Klein
- USAID Advancing Nutrition, Arlington, Virginia, United States of America
- * E-mail:
| | - Malia Uyehara
- USAID Advancing Nutrition, Arlington, Virginia, United States of America
| | - Andrew Cunningham
- USAID Advancing Nutrition, Arlington, Virginia, United States of America
| | - Madina Olomi
- USAID Advancing Nutrition, Arlington, Virginia, United States of America
| | - Kristen Cashin
- USAID Advancing Nutrition, Arlington, Virginia, United States of America
| | - Catherine M. Kirk
- USAID Advancing Nutrition, Arlington, Virginia, United States of America
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Gato S, Biziyaremye F, Kirk CM, De Sousa CP, Mukuralinda A, Habineza H, Asir M, de Silva H, Manirakiza ML, Karangwa E, Nshimyiryo A, Tugume A, Beck K. Promotion of early and exclusive breastfeeding in neonatal care units in rural Rwanda: a pre- and post-intervention study. Int Breastfeed J 2022; 17:12. [PMID: 35193639 PMCID: PMC8864904 DOI: 10.1186/s13006-022-00458-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Early initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding. Methods This pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge. Results Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge. Conclusions Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness.
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Affiliation(s)
- Saidath Gato
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
| | | | | | - Chiquita Palha De Sousa
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Boston Children's Hospital, Boston, USA
| | | | | | | | | | | | | | | | - Alex Tugume
- Rwinkwavu District Hospital, Ministry of Health, Kigali, Rwanda
| | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
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Byiringiro S, Wong R, Logan J, Kaneza D, Gitera J, Umutesi S, Kirk CM. A qualitative study to explore the experience of parents of newborns admitted to neonatal care unit in rural Rwanda. PLoS One 2021; 16:e0252776. [PMID: 34388168 PMCID: PMC8362984 DOI: 10.1371/journal.pone.0252776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/21/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Neonatal Care Units (NCUs) provide special care to sick and small newborns and help reduce neonatal mortality. For parents, having a hospitalized newborn can be a traumatic experience. In sub-Saharan Africa, there is limited literature about the parents' experience in NCUs. OBJECTIVE Our study aimed to explore the experience of parents in the NCU of a rural district hospital in Rwanda. METHODS A qualitative study was conducted with parents whose newborns were hospitalized in the Ruli District Hospital NCU from September 2018 to January 2019. Interviews were conducted using a semi-structured guide in the participants' homes by trained data collectors. Data were transcribed, translated, and then coded using a structured code book. All data were organized using Dedoose software for analysis. RESULTS Twenty-one interviews were conducted primarily with mothers (90.5%, n = 19) among newborns who were most often discharged home alive (90.5%, n = 19). Four themes emerged from the interviews. These were the parental adaptation to having a sick neonate in NCU, adaptation to the NCU environment, interaction with people (healthcare providers and fellow parents) in the NCU, and financial stressors. CONCLUSION The admission of a newborn to the NCU is a source of stress for parents and caregivers in rural Rwanda, however, there were several positive aspects which helped mothers adapt to the NCU. The experience in the NCU can be improved when healthcare providers communicate and explain the newborn's status to the parents and actively involve them in the care of their newborn. Expanding the NCU access for families, encouraging peer support, and ensuring financial accessibility for neonatal care services could contribute to improved experiences for parents and families in general.
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Affiliation(s)
- Samuel Byiringiro
- Maternal and Child Health Department, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
| | - Rex Wong
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Jenae Logan
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
| | | | - Joseph Gitera
- Clinical and Public Health Services Division, Ministry of Health, Kigali, Rwanda
| | - Sharon Umutesi
- Maternal, Child and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Catherine M. Kirk
- Maternal and Child Health Department, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
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Oryono A, Iraguha B, Musabende A, Habimana E, Nshimyiryo A, Beck K, Habinshuti P, Wilson K, Itangishaka C, Kirk CM. Father involvement in the care of children born small and sick in Rwanda: Association with children's nutrition and development. Child Care Health Dev 2021; 47:451-464. [PMID: 33608895 DOI: 10.1111/cch.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/25/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about father's involvement in the care of children born with perinatal risk factors. This study aimed to understand father's involvement in the care of children born preterm, low birth weight (LBW) and/or with hypoxic ischemic encephalopathy (HIE) in rural Rwanda and assess child and home environment factors associated with father involvement. METHODS A cross-sectional study of children born preterm, LBW or with HIE who were discharged from Kirehe District Hospital neonatal unit from May 2015 to April 2016 and those enrolled in a neonatal unit follow-up programme from May 2016 to November 2017. Interviews were conducted when the children were ages 24-47 months in the child's home. Primary caregivers reported on father involvement in parenting, home environment, child disability, and child development outcomes. Children's nutritional status were directly measured. Only children whose fathers were living in the home were included in the sample. Bivariate analyses were conducted using Fisher's exact test and Wilcoxon Rank Sum test. RESULTS A total of 236 children aged 24-47 months were included in this study, 66.4% were born preterm or LBW with a mean age of 33.3 months. 73.5% of children were at risk of disability and 77.7% had potential delay in overall child development. 15.5% of fathers reported engaging in four or more activities with their child in the last 3 days. Factors associated with father involvement included smaller household size (p = 0.004), mother engaged in decision-making (p = 0.027), being on-track in developmental milestones for problem solving (p = 0.042) and mother's involvement in learning activities (p = 0.043); the number of activities a father engaged in was significantly associated with the child's overall development (p = 0.032). CONCLUSION We found that father involvement in activities to support learning was low amongst children born preterm/LBW and/or with HIE. Programme interventions should encourage fathers to engage with their children given the benefits for children's development.
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Affiliation(s)
- Andrew Oryono
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | | | | | | | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | - Kim Wilson
- General Pediatrics, Boston Children's Hospital, Boston, MA, United States
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Nemerimana M, Karambizi AC, Umutoniwase S, Barnhart DA, Beck K, Bihibindi VK, Wilson K, Nshimyiryo A, Bradford J, Havugarurema S, Uwamahoro A, Nsabyamahoro E, Kirk CM. Evaluation of an mHealth tool to improve nutritional assessment among infants under 6 months in paediatric development clinics in rural Rwanda: Quasi-experimental study. Matern Child Nutr 2021; 17:e13201. [PMID: 33960693 PMCID: PMC8476404 DOI: 10.1111/mcn.13201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 03/09/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
Infants born preterm, low birthweight or with other perinatal complications require frequent and accurate growth monitoring for optimal nutrition and growth. We implemented an mHealth tool to improve growth monitoring and nutritional status assessment of high risk infants. We conducted a pre-post quasi-experimental study with a concurrent control group among infants enrolled in paediatric development clinics in two rural Rwandan districts. During the pre-intervention period (August 2017-January 2018), all clinics used standard paper-based World Health Organization (WHO) growth charts. During the intervention period (August 2018-January 2019), Kirehe district adopted an mHealth tool for child growth monitoring and nutritional status assessment. Data on length/height; weight; length/height-for-age (L/HFA), weight-for-length/height (WFL/H) and weight-for-age (WFA) z-scores; and interval growth were tracked at each visit. We conducted a 'difference-in-difference' analysis to assess whether the mHealth tool was associated with greater improvements in completion and accuracy of nutritional assessments and nutritional status at 2 and 6 months of age. We observed 3529 visits. mHealth intervention clinics showed significantly greater improvements on completeness for corrected age (endline: 65% vs. 55%; p = 0.036), L/HFA (endline: 82% vs. 57%; p ≤ 0.001), WFA (endline: 93% vs. 67%; p ≤ 0.001) and WFL/H (endline: 90% vs. 59%; p ≤ 0.001) z-scores compared with control sites. Accuracy of growth monitoring did not improve. Prevalence of stunting, underweight and inadequate interval growth at 6-months corrected age decreased significantly more in the intervention clinics than in control clinics. Results suggest that integrating mHealth nutrition interventions is feasible and can improve child nutrition outcomes. Improved tool design may better promote accuracy.
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Affiliation(s)
| | | | | | - Dale A Barnhart
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Kim Wilson
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Jessica Bradford
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Silas Havugarurema
- Kirehe District Hospital, Ministry of Health of Rwanda, Kirehe Town, Rwanda
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Tuyisenge D, Byiringiro S, Manirakiza ML, Mutsinzi RG, Nshimyiryo A, Nyishime M, Hirschhorn LR, Biziyaremye F, Gitera J, Beck K, Kirk CM. Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda. BMC Pediatr 2021; 21:89. [PMID: 33607961 PMCID: PMC7893907 DOI: 10.1186/s12887-021-02544-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes. METHODS A pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests. RESULTS NCUs were run by a median of 1 nurse [interquartile range (IQR):1-2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77-155] to 137 [IQR: 79-184]. Availability of advanced equipment improved (syringe pumps: 57-100 %, vital sign monitors: 51-100 % and CPAP machine: 14-100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001). CONCLUSIONS The ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.
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Affiliation(s)
- David Tuyisenge
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda.
| | | | | | | | | | - Merab Nyishime
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
| | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, 625 N Michigan Avenue, 60611, Chicago, IL, USA
| | | | | | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
| | - Catherine M Kirk
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
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Abimana MC, Karangwa E, Hakizimana I, Kirk CM, Beck K, Miller AC, Havugarurema S, Bahizi S, Uwamahoro A, Wilson K, Nemerimana M, Nshimyiryo A. Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24-47 months in rural Rwanda. BMC Pregnancy Childbirth 2020; 20:643. [PMID: 33087076 PMCID: PMC7579859 DOI: 10.1186/s12884-020-03301-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Global investments in neonatal survival have resulted in a growing number of children with morbidities surviving and requiring ongoing care. Little is known about the caregivers of these children in low- and middle-income countries, including maternal mental health which can further negatively impact child health and development outcomes. We aimed to assess the prevalence and factors associated with poor maternal mental health in mothers of children born preterm, low birthweight (LBW), and with hypoxic ischemic encephalopathy (HIE) at 24–47 months of age in rural Rwanda. Methods Cross-sectional study of children 24–47 months born preterm, LBW, or with HIE, and their mothers discharged from the Neonatal Care Unit (NCU) at Kirehe Hospital between May 2015–April 2016 or discharged and enrolled in a NCU follow-up program from May 2016–November 2017. Households were interviewed between October 2018 and June 2019. Mothers reported on their mental health and their child’s development; children’s anthropometrics were measured directly. Backwards stepwise procedures were used to assess factors associated with poor maternal mental health using logistic regression. Results Of 287 total children, 189 (65.9%) were born preterm/LBW and 34.1% had HIE and 213 (74.2%) screened positive for potential caregiver-reported disability. Half (n = 148, 51.6%) of mothers reported poor mental health. In the final model, poor maternal mental health was significantly associated with use of violent discipline (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.17,4.45) and having a child with caregiver-reported disability (OR 2.96, 95% CI 1.55, 5.67). Greater household food security (OR 0.80, 95% CI 0.70–0.92) and being married (OR = 0.12, 95% CI 0.04–0.36) or living together as if married (OR = 0.13, 95% CI 0.05, 0.37) reduced the odds of poor mental health. Conclusions Half of mothers of children born preterm, LBW and with HIE had poor mental health indicating a need for interventions to identify and address maternal mental health in this population. Mother’s poor mental health was also associated with negative parenting practices. Specific interventions targeting mothers of children with disabilities, single mothers, and food insecure households could be additionally beneficial given their strong association with poor maternal mental health.
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Affiliation(s)
| | - Egide Karangwa
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
| | | | | | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Ann C Miller
- Division of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | - Sadallah Bahizi
- Rwanda Ministry of Health, Kirehe District Hospital, Kirehe, Rwanda
| | | | - Kim Wilson
- Division of General Pediatrics, Boston Children's Hospital, Boston, USA
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11
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Nshimyiryo A, Kirk CM, Sauer SM, Ntawuyirusha E, Muhire A, Sayinzoga F, Hedt-Gauthier B. Health management information system (HMIS) data verification: A case study in four districts in Rwanda. PLoS One 2020; 15:e0235823. [PMID: 32678851 PMCID: PMC7367468 DOI: 10.1371/journal.pone.0235823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/24/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Reliable Health Management and Information System (HMIS) data can be used with minimal cost to identify areas for improvement and to measure impact of healthcare delivery. However, variable HMIS data quality in low- and middle-income countries limits its value in monitoring, evaluation and research. We aimed to review the quality of Rwandan HMIS data for maternal and newborn health (MNH) based on consistency of HMIS reports with facility source documents. METHODS We conducted a cross-sectional study in 76 health facilities (HFs) in four Rwandan districts. For 14 MNH data elements, we compared HMIS data to facility register data recounted by study staff for a three-month period in 2017. A HF was excluded from a specific comparison if the service was not offered, source documents were unavailable or at least one HMIS report was missing for the study period. World Health Organization guidelines on HMIS data verification were used: a verification factor (VF) was defined as the ratio of register over HMIS data. A VF<0.90 or VF>1.10 indicated over- and under-reporting in HMIS, respectively. RESULTS High proportions of HFs achieved acceptable VFs for data on the number of deliveries (98.7%;75/76), antenatal care (ANC1) new registrants (95.7%;66/69), live births (94.7%;72/76), and newborns who received first postnatal care within 24 hours (81.5%;53/65). This was slightly lower for the number of women who received iron/folic acid (78.3%;47/60) and tested for syphilis in ANC1 (67.6%;45/68) and was the lowest for the number of women with ANC1 standard visit (25.0%;17/68) and fourth standard visit (ANC4) (17.4%;12/69). The majority of HFs over-reported on ANC4 (76.8%;53/69) and ANC1 (64.7%;44/68) standard visits. CONCLUSION There was variable HMIS data quality by data element, with some indicators with high quality and also consistency in reporting trends across districts. Over-reporting was observed for ANC-related data requiring more complex calculations, i.e., knowledge of gestational age, scheduling to determine ANC standard visits, as well as quality indicators in ANC. Ongoing data quality assessments and training to address gaps could help improve HMIS data quality.
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Affiliation(s)
- Alphonse Nshimyiryo
- Maternal and Child Health Program, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Catherine M. Kirk
- Maternal and Child Health Program, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Sara M. Sauer
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Emmanuel Ntawuyirusha
- Planning, Health Financing and Information Systems, Ministry of Health, Kigali, Rwanda
| | - Andrew Muhire
- Planning, Health Financing and Information Systems, Ministry of Health, Kigali, Rwanda
| | - Felix Sayinzoga
- Maternal, Child and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Bethany Hedt-Gauthier
- Maternal and Child Health Program, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
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12
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Bradford J, Beck K, Nshimyiryo A, Wilson K, Mutaganzwa C, Havugarurema S, Ngamije P, Uwamahoro A, Kirk CM. Nutritional evaluation and growth of infants in a Rwandan neonatal follow-up clinic. Matern Child Nutr 2020; 16:e13026. [PMID: 32525271 PMCID: PMC7507011 DOI: 10.1111/mcn.13026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 01/30/2023]
Abstract
Children born preterm, low birth weight (LBW) or with other perinatal risk factors are at high‐risk of malnutrition. Regular growth monitoring and early intervention are essential to promote optimal feeding and growth; however, monitoring growth in preterm infants can be complex. This study evaluated growth monitoring of infants under 6 months enrolled in Paediatric Development Clinics (PDCs) in rural Rwanda. We reviewed electronic medical records (EMR) of infants enrolled in PDCs before age 2 months with their first visit between January 2015 and December 2016 and followed them until age 6 months. Nurse classification of anthropometric measures and nutritional status were extracted from the EMR. Interval growth and length‐for‐age, weight‐for‐length, and weight‐for‐age z‐scores were calculated using World Health Organization anthropometry software as a ‘gold standard’ comparison to nurse classifications. Two hundred and ninety‐four patients enrolled and had 2,033 visits during the study period. Referral reasons included prematurity/LBW (73.8%) and hypoxic ischemic encephalopathy (28.2%). Nurses assessed interval growth at 58.7% of visits, length‐for‐age at 66.4%, weight‐for‐length at 65.6% and weight‐for‐age at 66.4%. Nurses and gold standard assessment agreed on interval growth at 53.3% of visits and length‐for‐age at 63.7%, weight‐for‐length at 78.2% and weight‐for‐age at 66.3%. At 6 months, 46.5% were stunted, 19.9% were wasted and 44.2% were underweight. There were significant challenges to optimizing growth and growth monitoring among high‐risk infants served by PDCs, including incomplete and inaccurate assessments. Developing tools for clinician decision support in assessing growth and providing specialized nutritional counselling are essential to supporting optimal outcomes in this population.
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Affiliation(s)
- Jessica Bradford
- Faculty of Global Health Delivery, University of Global Health Equity, Kigali, Rwanda.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kathryn Beck
- Faculty of Global Health Delivery, University of Global Health Equity, Kigali, Rwanda
| | - Alphonse Nshimyiryo
- Faculty of Global Health Delivery, University of Global Health Equity, Kigali, Rwanda
| | - Kim Wilson
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christine Mutaganzwa
- Faculty of Global Health Delivery, University of Global Health Equity, Kigali, Rwanda
| | | | - Patient Ngamije
- Kirehe District Hospital, Ministry of Health of Rwanda, Kirehe, Rwanda
| | | | - Catherine M Kirk
- Faculty of Global Health Delivery, University of Global Health Equity, Kigali, Rwanda
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13
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Nshimyiryo A, Hedt-Gauthier B, Mutaganzwa C, Kirk CM, Beck K, Ndayisaba A, Mubiligi J, Kateera F, El-Khatib Z. Risk factors for stunting among children under five years: a cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health 2019; 19:175. [PMID: 30744614 PMCID: PMC6371425 DOI: 10.1186/s12889-019-6504-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/01/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Child growth stunting remains a challenge in sub-Saharan Africa, where 34% of children under 5 years are stunted, and causing detrimental impact at individual and societal levels. Identifying risk factors to stunting is key to developing proper interventions. This study aimed at identifying risk factors of stunting in Rwanda. METHODS We used data from the Rwanda Demographic and Health Survey (DHS) 2014-2015. Association between children's characteristics and stunting was assessed using logistic regression analysis. RESULTS A total of 3594 under 5 years were included; where 51% of them were boys. The prevalence of stunting was 38% (95% CI: 35.92-39.52) for all children. In adjusted analysis, the following factors were significant: boys (OR 1.51; 95% CI 1.25-1.82), children ages 6-23 months (OR 4.91; 95% CI 3.16-7.62) and children ages 24-59 months (OR 6.34; 95% CI 4.07-9.89) compared to ages 0-6 months, low birth weight (OR 2.12; 95% CI 1.39-3.23), low maternal height (OR 3.27; 95% CI 1.89-5.64), primary education for mothers (OR 1.71; 95% CI 1.25-2.34), illiterate mothers (OR 2.00; 95% CI 1.37-2.92), history of not taking deworming medicine during pregnancy (OR 1.29; 95%CI 1.09-1.53), poorest households (OR 1.45; 95% CI 1.12-1.86; and OR 1.82; 95%CI 1.45-2.29 respectively). CONCLUSION Family-level factors are major drivers of children's growth stunting in Rwanda. Interventions to improve the nutrition of pregnant and lactating women so as to prevent low birth weight babies, reduce poverty, promote girls' education and intervene early in cases of malnutrition are needed.
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Affiliation(s)
| | - Bethany Hedt-Gauthier
- Partners In Health / Inshuti Mu Buzima, Kigali, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | | | - Kathryn Beck
- Partners In Health / Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Joel Mubiligi
- Partners In Health / Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Ziad El-Khatib
- Partners In Health / Inshuti Mu Buzima, Kigali, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada
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14
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Bayitondere S, Biziyaremye F, Kirk CM, Magge H, Hann K, Wilson K, Mutaganzwa C, Ngabireyimana E, Nkikabahizi F, Shema E, Tugizimana DB, Miller AC. Assessing retention in care after 12 months of the Pediatric Development Clinic implementation in rural Rwanda: a retrospective cohort study. BMC Pediatr 2018; 18:65. [PMID: 29452576 PMCID: PMC5815233 DOI: 10.1186/s12887-018-1007-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Africa, a high proportion of children are at risk for developmental delay. Early interventions are known to improve outcomes, but they are not routinely available. The Rwandan Ministry of Health with Partners In Health/Inshuti Mu Buzima created the Pediatric Development Clinic (PDC) model for providing interdisciplinary developmental care for high-risk infants in rural settings. As retention for chronic care has proven challenging in many settings, this study assesses factors related to retention to care after 12 months of clinic enrollment. Methods This study describes a retrospective cohort of children enrolled for 12 months in the PDC program in Southern Kayonza district between April 2014–March 2015. We reviewed routinely collected data from electronic medical records and patient charts. We described patient characteristics and the proportion of patients retained, died, transferred out or lost to follow up (LTFU) at 12 months. We used Fisher’s exact test and multivariable logistic regression to identify factors associated with retention in care. Results 228 children enrolled in PDC from 1 April 2014–31 March 2015, with prematurity/low birth weight (62.2%) and hypoxic ischemic encephalopathy (34.5%) as the most frequent referral diagnoses. 64.5% of children were retained in care and 32.5% were LTFU after 12 months. In the unadjusted analysis, we found male sex (p = 0.189), having more children at home (p = 0.027), health facility of first visit (p = 0.006), having a PDC in the nearest health facility (p = 0.136), referral in second six months of PDC operation (p = 0.006), and social support to be associated (100%, p < 0.001) with retention after 12 months. In adjusted analysis, referral in second six months of PDC operation (Odds Ratio (OR) 2.56, 95% CI 1.36, 4.80) was associated with increased retention, and being diagnosed with more complex conditions (trisomy 21, cleft lip/palate, hydrocephalus, other developmental delay) was associated with LTFU (OR 0.34, 95% CI 0.15, 0.76). As 100% of those receiving social support were retained in care, this was not able to be assessed in adjusted analysis. Conclusions PDC retention in care is encouraging. Provision of social assistance and decentralization of the program are major components of the delivery of services related to retention in care.
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Affiliation(s)
| | | | | | - Hema Magge
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Boston Children's Hospital, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Katrina Hann
- Partners In Health Sierra Leone, Freetown, Sierra Leone
| | - Kim Wilson
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Evelyne Shema
- Ministry of Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda
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15
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Abimpaye M, Kirk CM, Iyer HS, Gupta N, Remera E, Mugwaneza P, Law MR. The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis. PLoS One 2018; 13:e0192910. [PMID: 29451925 PMCID: PMC5815596 DOI: 10.1371/journal.pone.0192910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nearly a quarter of a million children have acquired HIV, prompting the implementation of new protocols-Option B and B+-for treating HIV+ pregnant women. While efficacy has been demonstrated in randomized trials, there is limited real-world evidence on the impact of these changes. Using longitudinal, routinely collected data we assessed the impact of the adoption of WHO Option B in Rwanda on mother to infant transmission. METHODS We used interrupted time series analysis to evaluate the impact of Option B on mother-to-child HIV transmission in Rwanda. Our primary outcome was the proportion of HIV tests in infants with positive results at six weeks of age. We included data for 20 months before and 22 months after the 2010 policy change. RESULTS Of the 15,830 HIV tests conducted during our study period, 392 tested positive. We found a significant decrease in both the level (-2.08 positive tests per 100 tests conducted, 95% CI: -2.71 to -1.45, p < 0.001) and trend (-0.11 positive tests per 100 tests conducted per month, 95% CI: -0.16 to -0.07, p < 0.001) of test positivity. This represents an estimated 297 fewer children born without HIV in the post-policy period or a 46% reduction in HIV transmission from mother to child. CONCLUSIONS The adoption of Option B in Rwanda contributed to an immediate decrease in the rate of HIV transmission from mother to child. This suggests other countries may benefit from adopting these WHO guidelines.
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Affiliation(s)
| | | | - Hari S. Iyer
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
- Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Neil Gupta
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
- Brigham and Women’s Hospital, Boston, MA, United States of America
| | | | | | - Michael R. Law
- The University of British Columbia, Vancouver, British Columbia, Canada
- University of Rwanda, Kigali, Rwanda
- Harvard Medical School, Boston, MA, United States of America
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16
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Kagabo DM, Kirk CM, Bakundukize B, Hedt-Gauthier BL, Gupta N, Hirschhorn LR, Ingabire WC, Rouleau D, Nkikabahizi F, Mugeni C, Sayinzoga F, Amoroso CL. Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda. PLoS One 2018; 13:e0190739. [PMID: 29320556 PMCID: PMC5761861 DOI: 10.1371/journal.pone.0190739] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/11/2017] [Indexed: 02/03/2023] Open
Abstract
Background Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children’s lives. This study describes the context surrounding children’s deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the child’s death, and identifies factors associated with care-seeking for these children in rural Rwanda. Methods Secondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the child’s birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisher’s exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level. Results Among the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking. Conclusion Interventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further understand remaining barriers to accessing appropriate, quality care.
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Affiliation(s)
- Daniel M. Kagabo
- Partners in Health/Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
- * E-mail:
| | | | | | - Bethany L. Hedt-Gauthier
- Partners in Health/Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Neil Gupta
- Partners in Health/Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Lisa R. Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | | | | | | | | | - Felix Sayinzoga
- Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
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Kirk CM, Uwamungu JC, Wilson K, Hedt-Gauthier BL, Tapela N, Niyigena P, Rusangwa C, Nyishime M, Nahimana E, Nkikabahizi F, Mutaganzwa C, Ngabireyimana E, Mutabazi F, Magge H. Health, nutrition, and development of children born preterm and low birth weight in rural Rwanda: a cross-sectional study. BMC Pediatr 2017; 17:191. [PMID: 29141590 PMCID: PMC5688768 DOI: 10.1186/s12887-017-0946-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/09/2017] [Indexed: 12/11/2022] Open
Abstract
Background As care for preterm and low birth weight (LBW) infants improves in resource-limited settings, more infants are surviving the neonatal period. Preterm and (LBW) infants are at high-risk of nutritional and medical comorbidities, yet little is known about their developmental outcomes in low-income countries. This study evaluated the health, nutritional, and developmental status of preterm/LBW children at ages 1–3 years in Rwanda. Methods Cross-sectional study of preterm/LBW infants discharged between October 2011 and October 2013 from a hospital neonatal unit in rural Rwanda. Gestational age and birth weight were gathered from hospital records to classify small for gestational age (SGA) at birth and prematurity. Children were located in the community for household assessments in November–December 2014. Caregivers reported demographics, health status, and child development using locally-adapted Ages and Stages Questionnaires (ASQ-3). Anthropometrics were measured. Bivariate associations with continuous ASQ-3 scores were conducted using Wilcoxon Rank Sum and Kruskal Wallis tests. Results Of 158 eligible preterm/LBW children discharged from the neonatal unit, 86 (54.4%) were alive and located for follow-up. Median birth weight was 1650 grams, median gestational age was 33 weeks, and 50.5% were SGA at birth. At the time of household interviews, median age was 22.5 months, 46.5% of children had feeding difficulties and 39.5% reported signs of anemia. 78.3% of children were stunted and 8.8% wasted. 67.4% had abnormal developmental screening. Feeding difficulties (p = 0.008), anemia symptoms (p = 0.040), microcephaly (p = 0.004), stunting (p = 0.034), SGA (p = 0.023), very LBW (p = 0.043), lower caregiver education (p = 0.001), and more children in the household (p = 0.016) were associated with lower ASQ-3 scores. Conclusions High levels of health, growth, and developmental abnormalities were seen in preterm/LBW children at age 1–3 years. As we achieve necessary gains in newborn survival in resource-limited settings, follow-up and early intervention services are critical for ensuring high-risk children reach their developmental potential. Electronic supplementary material The online version of this article doi: (10.1186/s12887-017-0946-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Kim Wilson
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Bethany L Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Neo Tapela
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | - Francis Mutabazi
- Rwinkwavu District Hospital, Ministry of Health, Rwinkwavu, Rwanda
| | - Hema Magge
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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18
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Chaudhury S, Brown FL, Kirk CM, Mukunzi S, Nyirandagijimana B, Mukandanga J, Ukundineza C, Godfrey K, Ng LC, Brennan RT, Betancourt TS. Exploring the potential of a family-based prevention intervention to reduce alcohol use and violence within HIV-affected families in Rwanda. AIDS Care 2017; 28 Suppl 2:118-29. [PMID: 27392007 PMCID: PMC4964967 DOI: 10.1080/09540121.2016.1176686] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
HIV-affected families report higher rates of harmful alcohol use, intimate partner violence (IPV) and family conflict, which can have detrimental effects on children. Few evidence-based interventions exist to address these complex issues in Sub-Saharan Africa. This mixed methods study explores the potential of a family-based intervention to reduce IPV, family conflict and problems related to alcohol use to promote child mental health and family functioning within HIV-affected families in post-genocide Rwanda. A family home-visiting, evidence-based intervention designed to identify and enhance resilience and communication in families to promote mental health in children was adapted and developed for use in this context for families affected by caregiver HIV in Rwanda. The intervention was adapted and developed through a series of pilot study phases prior to being tested in open and randomized controlled trials (RCTs) in Rwanda for families affected by caregiver HIV. Quantitative and qualitative data from the RCT are explored here using a mixed methods approach to integrate findings. Reductions in alcohol use and IPV among caregivers are supported by qualitative reports of improved family functioning, lower levels of violence and problem drinking as well as improved child mental health, among the intervention group. This mixed methods analysis supports the potential of family-based interventions to reduce adverse caregiver behaviors as a major mechanism for improving child well-being. Further studies to examine these mechanisms in well-powered trials are needed to extend the evidence-base on the promise of family-based intervention for use in low- and middle-income countries.
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Affiliation(s)
- Sumona Chaudhury
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Felicity L Brown
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Catherine M Kirk
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | | | | | | | | | | | - Lauren C Ng
- e ScD, Division of Global Psychiatry, Massachusetts General Hospital , Boston , MA , USA
| | - Robert T Brennan
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Theresa S Betancourt
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
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19
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Betancourt TS, Ng LC, Kirk CM, Brennan RT, Beardslee WR, Stulac S, Mushashi C, Nduwimana E, Mukunzi S, Nyirandagijimana B, Kalisa G, Rwabukwisi CF, Sezibera V. Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial. J Child Psychol Psychiatry 2017; 58:922-930. [PMID: 28504307 PMCID: PMC5730278 DOI: 10.1111/jcpp.12729] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children affected by HIV are at risk for poor mental health. We conducted a pilot randomized controlled trial (RCT) of the Family Strengthening Intervention (FSI-HIV), a family home-visiting intervention to promote mental health and improve parent-child relationships in families with caregivers living with HIV, hypothesizing that child and family outcomes would be superior to usual care social work services. METHODS Eighty two families (N = 170 children, 48.24% female; N = 123 caregivers, 68.29% female) with at least one HIV-positive caregiver (n = 103, 83.74%) and school-aged child (ages 7-17) (HIV+ n = 21, 12.35%) were randomized to receive FSI-HIV or treatment-as-usual (TAU). Local research assistants blind to treatment conducted assessments of child mental health, parenting practices, and family functioning at baseline, post-intervention, and 3-month follow-up. Multilevel modeling assessed effects of FSI-HIV on outcomes across three time points. TRIAL REGISTRATION NCT01509573, 'Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-HIV-R).' https://clinicaltrials.gov/ct2/show/;NCT01509573?term=Pilot+Feasibility+Trial+of+the+Family+Strengthening+Intervention+in+Rwanda+%28FSI-HIV-R%29&rank=1. RESULTS At 3-month follow-up, children in FSI-HIV showed fewer symptoms of depression compared to TAU by both self-report (β = -.246; p = .009) and parent report (β = -.174; p = .035) but there were no significant differences by group on conduct problems, functional impairment, family connectedness, or parenting. CONCLUSIONS Family-based prevention has promise for reducing depression symptoms in children affected by HIV. Future trials should examine the effects of FSI-HIV over time in trials powered to examine treatment mediators.
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Affiliation(s)
- Theresa S Betancourt
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lauren C Ng
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Catherine M Kirk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Robert T Brennan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Sara Stulac
- Brigham and Women's Hospital, Boston, MA, USA
- Partners in Health, Boston, MA, USA
| | | | | | | | | | | | | | - Vincent Sezibera
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
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20
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Ngabireyimana E, Mutaganzwa C, Kirk CM, Miller AC, Wilson K, Dushimimana E, Bigirumwami O, Mukakabano ES, Nkikabahizi F, Magge H. A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda. Matern Health Neonatol Perinatol 2017; 3:13. [PMID: 28706729 PMCID: PMC5506624 DOI: 10.1186/s40748-017-0052-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implemented to provide comprehensive follow-up to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda. Methods At each PDC visit, children undergo clinical/nutritional assessment and caregivers participate in counseling sessions. Social assessments identify families needing additional social support. Developmental assessment is completed using Ages and Stages Questionnaires. A retrospective medical record review was conducted to evaluate the first 24 months of PDC implementation for patients enrolled between April 2014–December 2015 in rural Rwanda. Demographic and clinical characteristics of patients and their caregivers were described using frequencies and proportions. Completion of different core components of PDC visits were compared overtime using Fisher’s Exact test and p-values calculated using trend analysis. Results 426 patients enrolled at 5 PDC sites. 54% were female, 44% were neonates and 35% were under 6 months at enrollment. Most frequent referral reasons were prematurity/low birth weight (63%) and hypoxic-ischemic encephalopathy (34%). In 24 months, 2787 PDC visits were conducted. Nurses consistently completed anthropometric measurements (age, weight, height) at all visits. Some visit components were inconsistently recorded, including adjusted age (p = 0.003), interval growth, danger sign assessment, and feeding difficulties (p < 0.001). Completion of other visit components, such as child development counseling and play/stimulation activities, were low but improved with time (p < 0.001). Conclusions It is feasible to implement PDCs with non-specialized providers in rural settings as we were able to enroll a diverse group of high-risk infants. We are seeing an improvement in services offered at PDCs over time and continuous quality improvement efforts are underway to strengthen current gaps. Future studies looking at the outcomes of the children benefiting from the PDC program are underway.
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Affiliation(s)
| | - Christine Mutaganzwa
- Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,P.O. Box 3432, Kigali, Rwanda
| | - Catherine M Kirk
- Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Ann C Miller
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, USA
| | - Kim Wilson
- Division of General Pediatrics, Boston Children's Hospital, Boston, USA.,Harvard Medical School, Department of Global Health and Social Medicine, Boston, USA
| | | | | | | | | | - Hema Magge
- Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, USA
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21
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Nduwimana E, Mukunzi S, Ng LC, Kirk CM, Bizimana JI, Betancourt TS. Mental Health of Children Living in Foster Families in Rural Rwanda: The Role of HIV and the Family Environment. AIDS Behav 2017; 21:1518-1529. [PMID: 27578000 DOI: 10.1007/s10461-016-1482-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fostering children is common in sub-Saharan Africa, but few studies examine these children's mental health needs. This study investigated the impact of living in a foster family on the mental health of HIV-positive, HIV-affected and HIV-unaffected children (n = 681 aged 10-17) in rural Rwanda. Regression analyses assessed the impact of living in a foster family on mental health, parenting, and daily hardships; multiple mediation analyses assessed whether family factors mediated the association between foster status and mental health. HIV-positive children were eight times more likely to live in foster families than HIV-unaffected children. Being HIV-affected was predictive of depression and irritability symptoms after controlling for family factors. Controlling for HIV-status, foster children had more symptoms of depression, anxiety, and irritability than non-fostered children. Positive parenting fully mediated the association between foster status and mental health. Mental health and parenting interventions for foster children and HIV-affected children may improve child outcomes.
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Affiliation(s)
| | | | - Lauren C Ng
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Catherine M Kirk
- Department Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, 12th Floor, Boston, MA, 02115, USA
| | | | - Theresa S Betancourt
- Department Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, 12th Floor, Boston, MA, 02115, USA.
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22
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Ndayisaba A, Harerimana E, Borg R, Miller AC, Kirk CM, Hann K, Hirschhorn LR, Manzi A, Ngoga G, Dusabeyezu S, Mutumbira C, Mpunga T, Ngamije P, Nkikabahizi F, Mubiligi J, Niyonsenga SP, Bavuma C, Park PH. A Clinical Mentorship and Quality Improvement Program to Support Health Center Nurses Manage Type 2 Diabetes in Rural Rwanda. J Diabetes Res 2017; 2017:2657820. [PMID: 29362719 PMCID: PMC5738565 DOI: 10.1155/2017/2657820] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/08/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The prevalence of diabetes mellitus is rapidly rising in SSA. Interventions are needed to support the decentralization of services to improve and expand access to care. We describe a clinical mentorship and quality improvement program that connected nurse mentors with nurse mentees to support the decentralization of type 2 diabetes care in rural Rwanda. METHODS This is a descriptive study. Routinely collected data from patients with type 2 diabetes cared for at rural health center NCD clinics between January 1, 2013 and December 31, 2015, were extracted from EMR system. Data collected as part of the clinical mentorship program were extracted from an electronic database. Summary statistics are reported. RESULTS The patient population reflects the rural settings, with low rates of traditional NCD risk factors: 5.6% of patients were current smokers, 11.0% were current consumers of alcohol, and 11.9% were obese. Of 263 observed nurse mentee-patient encounters, mentor and mentee agreed on diagnosis 94.4% of the time. Similarly, agreement levels were high for medication, laboratory exam, and follow-up plans, at 86.3%, 87.1%, and 92.4%, respectively. CONCLUSION Nurses that receive mentorship can adhere to a type 2 diabetes treatment protocol in rural Rwanda primary health care settings.
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Affiliation(s)
| | | | - Ryan Borg
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | | | | | - Gedeon Ngoga
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | | | | | - Joel Mubiligi
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Charlotte Bavuma
- Ministry of Health, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Paul H. Park
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
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23
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Chaudhury S, Kirk CM, Ingabire C, Mukunzi S, Nyirandagijimana B, Godfrey K, Brennan RT, Betancourt TS. HIV Status Disclosure through Family-Based Intervention Supports Parenting and Child Mental Health in Rwanda. Front Public Health 2016; 4:138. [PMID: 27446902 PMCID: PMC4925695 DOI: 10.3389/fpubh.2016.00138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/15/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Few evidence-based interventions exist to support parenting and child mental health during the process of caregiver HIV status disclosure in sub-Saharan Africa. A secondary analysis of a randomized-controlled trial was conducted to examine the role of family-based intervention versus usual social work care (care as usual) in supporting HIV status disclosure within families in Rwanda. METHOD Approximately 40 households were randomized to family-based intervention and 40 households to care as usual. Parenting, family unity, and child mental health during the process of disclosure were studied using quantitative and qualitative research methods. RESULTS Many of the families had at least one caregiver who had not disclosed their HIV status at baseline. Immediately post-intervention, children reported lower parenting and family unity scores compared with those in the usual-care group. These changes resolved at 3-month follow-up. Qualitative reports from clinical counselor intervention sessions described supported parenting during disclosure. Overall findings suggest adjustments in parenting, family unity, and trust surrounding the disclosure process. CONCLUSION Family-based intervention may support parenting and promote child mental health during adjustment to caregiver HIV status disclosure. Further investigation is required to examine the role of family-based intervention in supporting parenting and promoting child mental health in HIV status disclosure.
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Affiliation(s)
- Sumona Chaudhury
- Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Catherine M Kirk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | | | | | | | | | - Robert T Brennan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Theresa S Betancourt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, MA , USA
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24
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Ingabire W, Reine PM, Hedt-Gauthier BL, Hirschhorn LR, Kirk CM, Nahimana E, Nepomscene Uwiringiyemungu J, Ndayisaba A, Manzi A. Roadmap to an effective quality improvement and patient safety program implementation in a rural hospital setting. Healthc (Amst) 2015; 3:277-82. [PMID: 26699357 DOI: 10.1016/j.hjdsi.2015.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
Implementation lessons: (1) implementation of an effective quality improvement and patient safety program in a rural hospital setting requires collaboration between hospital leadership, Ministry of Health and other stakeholders. (2) Building Quality Improvement (QI) capacity to develop engaged QI teams supported by mentoring can improve quality and patient safety.
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Affiliation(s)
| | | | - Bethany L Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, USA
| | - Lisa R Hirschhorn
- Department of Global Health and Social Medicine, Harvard Medical School, USA; Ariadne Labs, Boston, MA, USA
| | | | | | | | | | - Anatole Manzi
- Partners In Health/Inshuti Mu Buzima, Rwanda; Partners In Health, USA.
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25
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Ng LC, Kirk CM, Kanyanganzi F, Fawzi MCS, Sezibera V, Shema E, Bizimana JI, Cyamatare FR, Betancourt TS. Risk and protective factors for suicidal ideation and behaviour in Rwandan children. Br J Psychiatry 2015; 207:262-8. [PMID: 26045350 PMCID: PMC4555444 DOI: 10.1192/bjp.bp.114.154591] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/17/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for young people. Children living in sub-Saharan Africa, where HIV rates are disproportionately high, may be at increased risk. AIMS To identify predictors, including HIV status, of suicidal ideation and behaviour in Rwandan children aged 10-17. METHOD Matched case-control study of 683 HIV-positive, HIV-affected (seronegative children with an HIV-positive caregiver), and unaffected children and their caregivers. RESULTS Over 20% of HIV-positive and affected children engaged in suicidal behaviour in the previous 6 months, compared with 13% of unaffected children. Children were at increased risk if they met criteria for depression, were at high-risk for conduct disorder, reported poor parenting or had caregivers with mental health problems. CONCLUSIONS Policies and programmes that address mental health concerns and support positive parenting may prevent suicidal ideation and behaviour in children at increased risk related to HIV.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Theresa S. Betancourt
- Correspondence: Theresa S. Betancourt, Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA.
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27
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Abstract
Primary lymphomas of the female genital tract are rare. Most involve the cervix rather than the uterine corpus. All of those previously reported have been B-cell lymphomas, with the exception of 1 case report of an endometrial T-cell lymphoma in a Japanese woman. We report the case of a white woman from the United States with a diffuse large cell lymphoma of the endometrium, characterized as a peripheral T-cell type on the basis of immunophenotypic and molecular probe studies. Staging evaluation revealed tumor limited to the endometrium (stage IE). The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection and received 6 cycles of combination chemotherapy, after which she remained free of disease at last follow-up of 36 months. Unusual features of this lymphoma case are discussed, with emphasis on differential diagnosis and speculation on histogenesis. This case illustrates that, while most peripheral T-cell lymphomas are widely disseminated at presentation, those limited to a single extranodal site may have a favorable outcome akin to that associated with high-grade extranodal B-cell lymphomas of early stage.
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Affiliation(s)
- C M Kirk
- Dept of Pathology, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA
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28
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Kirk CM, Papadea CN, Lazarchick J. Laboratory recognition of a rare hemoglobinopathy: hemoglobins SS and SG(Philadelphia) associated with alpha-thalassemia-2. Arch Pathol Lab Med 1999; 123:963-6. [PMID: 10506456 DOI: 10.5858/1999-123-0963-lroarh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article describes the laboratory investigation of an unusual hemoglobinopathy involving hemoglobin (Hb) S, HbSG(Philadelphia), and alpha-thalassemia-2 in a patient whose phenotype was HbSC by alkaline electrophoresis. Findings of a mean corpuscular volume of 62 fL and microcytes on the blood smear were inconsistent with HbSC disease. The patient's clinical course over several years had been mildly symptomatic. Testing in our hospital laboratory using isoelectric focusing and cation-exchange high-performance liquid chromatography to separate hemoglobins showed an unknown variant. Additional studies, including globin chain electrophoresis, reverse-phase high-performance liquid chromatography, and polymerase chain reaction-based DNA analysis were performed at reference laboratories, which reported the following findings: HbG(Philadelphia) associated with alpha-thalassemia-2, HbS and HbG(Philadelphia), and the alpha-globin deletions defining the -alpha3.7/-alpha3.7 genotype. The hemoglobin molecular defects, alpha-thalassemia-2, and the pattern of inheritance are discussed.
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Affiliation(s)
- C M Kirk
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
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Abstract
Mucosa-associated lymphoid tissue (MALT) lymphomas are low-grade B-cell lymphomas that occur in a variety of extranodal sites but rarely as a primary hepatic lymphoma. We describe the histological findings, immunophenotype, and immunohistochemistry of one such lymphoma found incidentally in a 69-year-old woman. The lymphoid infiltrate invaded the liver in a serpiginous configuration with entrapment of nodules of normal liver. Reactive follicles were surrounded by intermediate-sized lymphoid cells with slightly irregular nuclei and pale cytoplasm. Only a few scattered lymphoepithelial lesions were identified since most of the bile ducts were destroyed. The immunophenotype determined by flow cytometry identified the lymphoid cells as being CD19, CD20 positive and exhibiting lambda light chain restriction. CD5, CD10, and CD23 were negative. Immunohistochemistry showed the neoplastic cells to be positive for CD20 (L-26) and bcl-2. The reactive follicles were negative for bcl-2. CD3 showed only a few scattered T cells. Cyclin D1 did not stain the neoplastic cells. Cytokeratin (AE1/AE3) highlighted the lymphoepithelial lesions and residual bile ducts. MALT lymphomas need to be recognized and distinguished from other B-cell lymphomas, particularly mantle cell lymphomas, because of the difference in behavior and treatment.
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Affiliation(s)
- C M Kirk
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston 29414, USA
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30
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Howard-Martin J, Kirk CM. Westchester County Medical Center case sends powerful warning to hospitals. Healthspan 1992; 9:8-11. [PMID: 10183819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Kirk CM, Peake BM, Robinson BH, Simpson J. Paramagnetic organometallic molecules. XIV. Ion-pair and steric effects in dissociative electron transfer reactions of metal cluster carbonyl radical anions. Aust J Chem 1983. [DOI: 10.1071/ch9830441] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An investigation of
electron attachment reactions of cluster metal carbonyls is presented. In
general, alkyl and organometallic halides react rapidly with metal carbonyl
cluster radical anions at ambient temperatures to give the neutral cluster
molecule. Halide ion and alkyl or organometallic radicals are also produced,
which indicate that these are dissociative electron attachment reactions
analogous to those of organic radical anions. The rate of dissociative electron
attachment in reactions of PhCCo3(CO)9- was found to
depend on the R-X bond energy, the size of the alkyl group and the nature of
the counter-ion. In particular, (Ph3P)2N+ retarded
some electron transfer reactions to the extent that the bimolecular decay of
PhCCo3(CO)9- effectively competed with the
electron transfer process in determining the reaction path.
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Abstract
Examination of the e.s.r,
spectrum of pyrene anion in tetrahydrofuran under conditions of high resolution
has yielded the 13C hyperfine coupling parameters for five of the
six carbon positions. The parameters agree well with those calculated by molecular
orbital methods. No evidence of ion pair formation was found under the
conditions used in these experiments.
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Wright HP, Kirk CM. SOLANUM TUBEROSUM. Can Med Assoc J 1933; 28:398-400. [PMID: 20319072 PMCID: PMC402798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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