Background Whilst injuries are a major cause of disability and death worldwide, a large proportion of people in low- and middle-income countries lack timely access to injury care. Barriers to accessing care from the point of injury to return to function have not been delineated. Methods A two-day workshop was held in Kigali, Rwanda in May 2019 with representation from health providers, academia, and government. A four delays model (delays to seeking, reaching, receiving, and remaining in care) was applied to injury care. Participants identified barriers at each delay and graded, through consensus, their relative importance. Following an iterative voting process, the four highest priority barriers were identified. Based on workshop findings and a scoping review, a map was created to visually represent injury care access as a complex health-system problem. Results Initially, 42 barriers were identified by the 34 participants. 19 barriers across all four delays were assigned high priority; highest-priority barriers were “ Training and retention of specialist staff ”, “ Health education/awareness of injury severity ”, “ Geographical coverage of referral trauma centres ”, and “ Lack of protocol for bypass to referral centres ”. The literature review identified evidence relating to 14 of 19 high-priority barriers. Most barriers were mapped to more than one of the four delays, visually represented in a complex health-system map. Conclusion Overcoming barriers to ensure access to quality injury care requires a multifaceted approach which considers the whole patient journey from injury to rehabilitation. Our results can guide researchers and policymakers planning future interventions.

IntroductionDelay in seeking healthcare contributes significantly to under-five mortality. Multiple socioeconomic and demographic factors have been reported as predictors of such delay. There is no published research in this area in Rwanda. Our aim was to describe the caregivers' delay in seeking healthcare during the acute phase of a childhood illness among under-five children admitted in a tertiary hospital, Rwanda.MethodsThis was an analytical, descriptive cross-sectional study conducted at University Teaching Hospital of Kigali. Bivariate analysis and logistic multivariate regression were used to analyze factors associated with delayed care-seeking behavior, defined as seeking care after the first 48 hours of illness onset.ResultsAmong 275 admitted children under age five, care-seeking delay occurred in 35% (97/275) of cases. The most significant predictors of delay in seeking care were use of traditional healers (AOR = 14.87, 95% CI: 3.94-56.12), the recognition of illness as mild (AOR = 8.20, 95% CI: 4.08-16.47), use of un-prescribed medicine at home (AOR = 2.00, 95% CI: 1.01-3.91), use of special prayers provided by ministers of God before seeking healthcare (AOR = 6.42, 95% CI: 2.50, 16.48), and first consultation at public institutions (AOR = 4.00, 95% CI:1.54-10.39).ConclusionEven though Rwanda has made tremendous achievements in strengthening the community-based health systems, delayed care-seeking is a reality. Health education and behavior change communication interventions are needed at the community level to address the factors that lead to delay in seeking healthcare.

Background We sought to develop a low-fidelity simulation-based curriculum for pediatric residents in Rwanda utilizing either rapid cycle deliberate practice (RCDP) or traditional debriefing, and to determine whether RCDP leads to greater improvement in simulation-based performance and in resident confidence compared with traditional debriefing. Methods Pediatric residents at the Centre Hospitalier Universitaire de Kigali (CHUK) were randomly assigned to RCDP or traditional simulation and completed a 6 month-long simulation-based curriculum designed to improve pediatric resuscitation skills. Pre- and post- performance was assessed using a modified version of the Simulation Team Assessment Tool (STAT). Each video-taped simulation was reviewed by two investigators and inter-rater reliability was assessed. Self-confidence in resuscitation, pre- and post-simulation, was assessed by Likert scale survey. Analyses were conducted using parametric and non-parametric testing, ANCOVA and intra-class correlation coefficients (ICC). Results There was a 21% increase in pre- to post-test performance in both groups ( p < 0.001), but no difference between groups (mean difference − 0.003%; p 0.94). Inter-rater reliability was exceptional with both pre and post ICCs ≥0.95 (p < 0.001). Overall, self-confidence scores improved from pre to post (24.0 vs. 30.0 respectively, p < 0.001), however, the there was no difference between the RCDP and traditional groups. Conclusions Completion of a six-month low-fidelity simulation-based curriculum for pediatric residents in Rwanda led to statistically significant improvement in performance on a simulated resuscitation. RCDP and traditional low-fidelity simulation-based instruction may both be valuable tools to improve resuscitation skills in pediatric residents in resource-limited settings. Electronic supplementary material The online version of this article (10.1186/s12909-019-1742-4) contains supplementary material, which is available to authorized users.

BackgroundGlobally, interns and residents face significant challenges with respect to research activity. Despite this, they are motivated and have an interest in undertaking research. To date, there has been no research regarding the perceived attitudes towards research activities amongst Rwandan residents and interns.ObjectivesThe primary objective of this study was to describe the perceived attitudes regarding the educational benefits and barriers surrounding research activity amongst interns and residents, and to identify any differences between these groups. The secondary objective was to describe the research methods used by interns and residents in Rwanda.MethodsA cross-sectional descriptive study of interns and pediatric trainees at the University of Rwanda. An online questionnaire using Likert scale questions was sent electronically to eligible participants.ResultsA total of sixty participants (38 interns and 22 pediatric residents) responded to the survey. Both groups acknowledged the educational importance of undertaking research, with interns reporting this more than residents. Both groups identified the following as barriers to research: faculty lacking time to mentor, lack of funding, lack of statistical support, and lack of faculty experienced in conducting research. Interns (87%) were much more likely to have undertaken retrospective research than pediatric residents (14%). Few interns or residents submitted their research for publication (27%).ConclusionsBoth interns and residents understood the importance of research, but many barriers exist. Increasing the time available for experienced faculty members to supervise research is challenging due to low faculty numbers. Novel solutions will need to be found as well as expanding the time for trainees to perform research.