Background Breastfeeding in the first hour post birth can decrease neonatal morbidity and mortality. Disease prevention and health outcomes differ immensely between newborns who receive human milk and those who do not. Rwanda has high breastfeeding rates, though factors associated with early initiation of breastfeeding (EIBF) are unknown. Objective To assess factors associated with EIBF among mothers in immediate postpartum units at two hospitals. Methods A cross-sectional study design and a convenience sample of 187 mothers were used. An interviewer-administered questionnaire was used for data collection. A Chi-square test showed the relationship between EIBF and sociodemographic factors. Results The findings showed less than one quarter (20.5%) breastfed within the first hour after birth. The majority was < 25 years (52.4%), had some primary education (27.7%) employed (66.7%), urban dweller (58.1%), attendance of one ANC visit or more (81.3%), vaginal birth (58.8%), and did not receive EIBF health education (92.0%). The majority (78.5%) was too tired to initiate breastfeeding, and many supplemented (41.9%) due to perceived insufficient breastmilk. Conclusion Most mothers did not initiate breastfeeding within the first hour after birth. Sociodemographic factors were associated with EIBF. A program to promote, protect, and support EIBF is urgently needed the community. Rwanda J Med Health Sci 2020;3(2):181-192

Background Globally, about 10% of neonates require extra respiratory support to initiate breathing at birth. Over a million neonatal deaths could be prevented with quality basic care during neonatal resuscitation. Objective To determine the quality of care (QoC) of basic NR at birth among health care providers (HCPs) at three district hospitals in Kigali. Methods A descriptive cross-sectional study was conducted. Thirty-six HCPs were observed 2-3 times using a structured checklist. Descriptive and inferential statistics were used to analyze the data.  Results The majority had ‘good’ QoC scores for drying and stimulation (74.7%), and fair scores for airway clearance (85.1%). Some had poor scores for advanced bag and mask ventilation (BMV) (13%). Maternity work experience (1-5 years) was significantly associated with good quality drying and stimulation (p = 0.03), initial BMV (p = 0.02), and advanced BMV (p = 0.03), than HCPs with less than one-year experience.  Conclusion Maternity work experience of more than one year significantly improved the QoC during neonatal resuscitation. More NR support during the first year of work and regular NR refresher training would improve neonatal outcomes.  Rwanda J Med Health Sci 2020;3(2):225-237

Background HIV continues to be an important public health concern among adolescents. To reduce the high rate of mortality and improve the quality of life among people with HIV, WHO guidelines emphasize the early initiation of ART drugs in HIV-infected persons regardless of their CD4 count and clinical status. However, adherence to ART remains low in adolescents between 10 to 19 years from low and middle-income countries (LMICs). Objective To determine the factors influencing adherence to ART among adolescents with HIV in Rwanda. Method A cross-sectional design using proportional stratified random sampling to select 166 adolescents was conducted. Data were analyzed using descriptive and inferential statistics with a p-value <0.05 and a CI of 95%. Results The overall adherence to ARTs was 38%. Assistance of clinical staff in taking medication (p<0.001) and the help of parents in taking medication (p<0.001) positively influenced adherence to ART. Insufficient health care providers, forgetfulness (p=0.009), and dosage too complex (p=0.044) negatively influenced adherence to ART. Conclusion Factors such as someone reminding adolescents to take medication, non-stigmatization, and absence of side effects were positively associated with ART adherence. On the other hand, forgetfulness, complex dosage, being isolated and inadequate education about medications negatively affect adherence to ARTs. There is a need to set strategies to increase adherence to ARTs, including expert clients and trustable guardians in care provision. All adolescents should receive adequate counselling and health education before the initiation of ARTs. Rwanda J Med Health Sci 2022;5(3):251-263