Background By the end of 2015, epidemiological studies approximated 37 million people living with HIV (PLHIV) and 46.3% of them were initiated to antiretroviral therapies. From the 90-90-90 strategy, by 2020 at global level, 90% of all people living with HIV were expected to suppress viral load (VL). Although VL suppression is an important indicator of treatment success in PLHIV, studies on this indicator remain scarce in Rwanda where the prevalence of HIV is 3% with 9% for non-suppression. This work, thus, determined the prevalence of VL non-suppression and its associated predictors among PLHIV. Methods A cross-sectional study was conducted among 637 PLHIV enrolled in healthcare services between 2016 and 2017 in Nyaruguru district. Socio-demographic, treatment, clinical, immunological and VL data were extracted from medical records. Bivariate and multivariate logistic regression analyses were performed to determine associated factors with VL suppression considering 95% confidence intervals and statistical significance of p<0.005. Results More than half of participants were female (57.77%). The prevalence of unsuppressed HIV VL was 8.9% and 88.7% of respondents were satisfied with the service provided. Males were more likely to be unsuppressed HIV VL [aOR = 3.02; 95% CI (1.19–7.64), p = 0.02] than females. Higher likelihoods of VL non-suppression were among those with history of clinical failure [aOR = 3.14; 95% CI (1.70–14.03), p = 0.034] or history of treatment interruption [aOR = 8.29; 95% CI (2.60–26.42) p = 0.002]. Those with a bad perception toward the whole life treatment were more likely to be unsuppressed [aOR = 4.32; 95% CI (1.98–18.99), p = 0.049] than their counterparts. Conclusion Sex, treatment interruption, bad perception toward the whole life treatment, clinical failure and lack of confidentiality were the major predictors of being unsuppressed. More efforts on counseling HIV patients to improve their knowledge would drop levels of VL non-suppression, so improving the quality of service should be prioritized to increase suppression.
IntroductionMalaria is a major public health burden in developing countries despite efforts made by several countries. This disease leads to high morbidity and mortality among Rwandans, particularly in the Southern Province where it was the sixth national cause of morality; at Munini hospital it is the first cause of mortality, but the associated factors remain unknown. In this study, we determined the factors associated with deaths among patients with severe malaria to come up with evidence-based interventions to prevent malaria and its factors.MethodsA retrospective cross-sectional study was conducted on malaria patients who were treated at the Munini District Hospital from 2016 to 2017. Data were collected from the hospital records or registers relating to patients who were admitted with severe malaria. The odds ratio was estimated by bivariate logistic regression and multivariate hierarchical regression models for determining the associated factors of deaths. Data were analyzed using STATA/MP Version 14.1 and Epi-info with proportions.ResultsThe study population were mostly women (n = 237, 59.1%), farmers (n = 313, 78.05%), aged 16–30 years (n = 107, 26.68%). Our results indicated that the majority of deaths were women (56.25%). Socio-economic and clinical determinants are important predictors of death among patients with severe malaria. Patients with coma had higher odds of dying (AOR = 7.31, 95% CI :3.33–16.1, p < 0.001) than those who were not. The possibility of mortality increased by almost four times in patients who delayed consultation by a day (AOR = 3.7, 95%CI:1.8–4.1; p < 0.001) compared to those who came in very early. Patients who had severe malaria in the dry season were at a lower risk of mortality (AOR = 0.23, 95%CI:0.08–0.64, p = 0.005) compared to those with severe malaria during the rainy season.ConclusionLack of health insurance, age of the patient, delayed diagnosis, coma, proximity and access to healthcare services, and weather conditions were the major factors associated with mortality among patients with severe malaria. Comprehensive, long-term, equity-based healthcare interventions and immediate care strategies are recommended.
BackgroundRabies is an incurable zoonotic disease of public health concern. After exposure the only effective intervention is Post-Exposure Prophylaxis (PEP). Surveillance data in Rwanda shows that a high number of dog bites do not get PEP in time.ObjectivesDetermine factors associated with delays in post-exposure prophylaxis among victims of dog bites.MethodsThe retrospective cross-sectional study was conducted in Nyagatare District. It targeted people bitten by dogs and who attended Nyagatare district from January 2017 to December 2019. Review of registers and interview with victims were used to collected data using excel and analyze them using STATA version 15. Odds ratio (OR) and confidence interval (CI) were reported.ResultsAmong 412 dog bite victims, 161 (39%) delayed getting PEP. The more likely to delay in getting PEP, were people living in rural areas, AOR = 3.54, 95%CI [2.12, 5.90], and those without medical insurance, AOR = 4.40, 95%CI [1.82-10.62].ConclusionSeeking PEP among dog bites victims is subject to delay in Nyagatare district. Local leaders should establish initiatives to support people to get medical insurance while public health officers need to prioritize sensitization for PEP for people living in rural areas.Rwanda J Med Health Sci 2023;6(1):61-70
BackgroundMalaria remains a public health challenge among people aged five years and above. Despite the efforts made by the government of Rwanda in malaria control, the burden of malaria continues to be a health threat among humans aged five years and aboveObjectivesTo assess the prevalence and factors associated with malaria among febrile patients aged five and older in Ngoma District, Rwanda.MethodA facility based cross-sectional study was conducted among 420 participants using a systematic sampling technique. Blood smears were tested for malaria parasites and questionnaire used for other data collection. Analysis was done using STATA version 13.0. Multivariable logistic regression analyses were computed to determine factors associated with malaria infection at 95% confidence intervals and statistical significance at p< 0.05.ResultsAmong participants, 60.7% were females, 35.9% were of 35 years and older, Malaria parasites were identified in 257 cases (61.2%). Malaria positivity associated with age ≥35 years (AOR=3.6; CI=1.3-10.02; P=0.012) and living in Mutenderi Sector (AOR=3.15; CI: 1.2, 3.9; P=0.038).ConclusionMalaria prevalence was considerable and people living in Mutenderi Sector were more likely to suffer from it. Need of strengthening Malaria prevention in older people and in Muteneri Sector in particular.Rwanda J Med Health Sci 2023;6(1):27-35
BackgroundOptimal viral load suppression results from good adherence to treatment. The viral load suppression advantages include the reduction of virus transmission. In Rwanda, however, viral load suppression among adolescents and young adults has been proven relatively low than in other age groups.ObjectivesTo assess the factors associated with viral load suppression among adolescent and young adults in Ngororero district, Rwanda.MethodsA cross sectional study that included 151 adolescents and young adults aged from 15 to 24 years was conducted in Ngororero district. Data were entered in Epi-Info version 7 software and analyzed using STATA15.ResultsFemales and males were 68% and 32% respectively. Sixty percent of the participants were aged 20-24 years. Multivariable analysis revealed the factors associated with viral load suppression: Ubudehe category 2, P= 0.016, AOR = 6.6, CI [1.4, 31.1]; ubudehe category 3, P= 0.004, AOR = 8.9, CI [2.01,39.8]; spending between 5 to 9 years on ART, P= 0.022, AOR = 0.16 [CI0.03, 0.89;) and often forget to take medication, P= 0.011, AOR = 0.35, CI [0.13, 0.97.]ConclusionViral load suppression among adolescents and young adults was low. Improving socio-economic conditions of adolescents and young adults, as well as provision of continuous counselling to them during their whole treatment life can improve significantly their adherence.Rwanda J Med Health Sci 2023;6(1):43-52
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