BackgroundThe care of high-risk neonates in intensive care units is a relatively new field in resource-limited countries. Consequently, pain management of neonates has not been included or considered as part of neonatal care. Neonatal pain is more difficult to assess than adult pain, as they are unable to self-report. Nurses and midwives caring for neonates have a professional responsibility to recognise and manage neonatal pain. ObjectivesTo assess the knowledge, attitude, and practice of nurses and midwives providing neonatal pain management at two hospitals in Kigali. Methodology A descriptive cross-sectional design was used. Data were collected from a convenience sample of 66 nurses and midwives providing neonatal care. Data analysis was achieved through descriptive and inferential statistics. ResultsThe majority (74.2%) demonstrated a low level of knowledge of neonatal pain and its management. Over half (51.5%) had a positive attitude toward neonatal pain management, though over three quarters (84.8%) reported a low level of integrating pain management into practice. ConclusionsThere is a knowledge deficit among the nurses and midwives providing neonatal pain management. A gap lies between their attitude and practice. More educational opportunities are needed to better assess and manage pain in the neonatal patient.Rwanda J Med Health Sci 2019;2(2):138-146.

_________________________________________________________ AbstractBackground Prematurity, birth asphyxia (BA), and sepsis are the leading causes of neonatal mortality. The BA prevalence rate is 23% worldwide and affects up to 39% in Rwanda. Birth asphyxia is an insult with significant consequences to the neonate's brain and other vital organs due to decreased oxygen before, during or immediately after birth. Objective To assess the BA prevalence, associated factors, and outcomes at a district hospital in Kigali. Methods A retrospective, cross-sectional study of 340 neonates admitted to the NICU in 2016. ResultsBirth asphyxia was identified in 135 out of 340 newborns (39.7%). Associated factors included gravida, meconium-stained amniotic fluid, normal duration of labor, normal duration of ROM, vaginal delivery, Apgar score of ≤5 at 5 minutes, respiratory ventilation and cardiac massage and normal birth weight (2500-3999gr). Two-thirds were born via vaginal birth (66.5%), and nearly half (47.3%) had BA. One-third was born via cesarean (33.5%), and a quarter (24.6%) had BA. Other BA outcomes included prolonged hospitalization beyond the neonatal period at 75% compared to non asphyxiated babies (25%). The mean days of NICU stay was 7.6 (SD: 6.1) for BA while it was 5.3 (SD: 4.16) for non-asphyxiated babies; early seizures (52.6%) and high specific mortality (87%). DiscussionFindings revealed a 6% BA prevalence increase, and a BA-specific mortality rate 13 times higher than previously recorded. Trained healthcare professionals need to reverse this significant trend in both vaginal and cesarean births that likely has a profound effect on the neonate, family, and community.Rwanda J Med Health Sci 2019;2(2):96-104. ________________________________________________________________________

Background Students returning to school who are breastfeeding face unique challenges. There is limited literature on breastfeeding university students. Several researchers have studied breastfeeding employees in the workplace. Institutions of higher education closely mimic the employment environment. Breastfeeding college students who express their milk while at school share similar challenges to employed mothers. A baccalaureate nursing program is rigorous and little is known about the challenges facing breastfeeding student nurses returning to classes. Research aim To explore the breastfeeding experience of baccalaureate nursing students. Methods Our study was a cross-sectional descriptive qualitative design. Purposive sampling was used to enroll participants ( N = 12). In depth, semi-structured interviews were conducted. Qualitative thematic analysis was used to analyze the data both manually and using Dedoose QDA software. Results An overarching theme of pervasive conflict between the role of the breastfeeding mother and the role of the student nurse surfaced. Three interrelated organizing themes also emerged; challenging, vulnerability, and resilience. Time constraints, self-care versus role demands, and structural accommodations contributed to the challenges. Only one participant indicated a knowledge of her breastfeeding rights. All of the participants expressed gratitude for faculty and community support, regardless of conflicts. Conclusion Breastfeeding participants were both vulnerable and resilient. Faculty may improve experiences through providing specific areas of support. A breastfeeding support policy outlining student rights and faculty responsibilities is needed to educate, guide, and enforce protections. Health care providers may enhance breastfeeding students’ experiences through anticipatory guidance, education, and continued support.

BackgroundA preterm neonate usually requires specialised care in the neonatal intensive care unit (NICU). Nurses in the NICU are the primary source of parental education particularly for preterm neonates. ObjectiveTo assess the effectiveness of a preterm infant care educational program on parental knowledge acquisition in the NICU. Methods A quasi-experimental pre-test post-test design was used. A convenience sample of 53 parents with preterm infants was recruited at a district hospital NICU in 2017 in Kigali. The twohour evidenced-based intervention in the local language of Kinyarwanda included five Global Health Media Project videos and a power-point presentation on the knowledge and skills to improve maternal and neonatal health. Data analysis included descriptive and inferential statistics. ResultsThe mean correct pre-test knowledge score was 54%, and the mean correct post-test score was 92%, indicating a significant increase (38%) of correct responses after the intervention. ConclusionAn educational intervention was found to be effective in improving parental knowledge in caring for preterm infants in a district hospital NICU in Kigali. This evidenced-based intervention could become routine for neonatal nurses in NICUs throughout Rwanda.Rwanda J Med Health Sci 2019;2(2):105-111.

No abstract