Background Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of childbearing women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Methods A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed methods study. Semi‐structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women’s partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides describing factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. Results We generated four interrelated themes: (1) Meaning of PPH: beliefs, knowledge and understanding of PPH: (2) Organizational factors; (3) Caring and family involvement and (4) Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. Conclusions Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. Involvement of all levels of the health system was recommended for a proactive prevention of PPH. Further quantitative research, using case control design is warranted to develop a screening tool for early detection of PPH risk factors for a proactive prevention.

Background and objectives: Postpartum hemorrhage is an important cause of maternal mortality worldwide. A host of literature highlights the difficulty in predicting which women will experience Postpartum hemorrhage. The present study aims at describing the research output on factors affecting the prevention of Postpartum hemorrhage in Low- and Middle- Income Countries.Methods: A total of 24 published research articles and 2 papers from grey literature published between 2010 and 2019 were retrieved from PubMed, Scopus, CINAHL and Nursing and Allied Health Database (ProQuest). Data were extracted based on main study features and the findings were described narratively. Arksey and O’Malley’s framework for scoping studies was used in this review.Results: Findings from the literature from Low- and Middle- Income Countries are grouped into three themes: Knowledge and understanding about the prevention of Postpartum hemorrhage; Postpartum hemorrhage risk factors among childbearing women; and use of prophylactic uterotonic drugs for PPH prevention and related policies. The majority of studies investigate pharmacological interventions for PPH prevention, while few address the early assessment of risk factors associated with Postpartum hemorrhage for proactive prevention.Conclusions: The present study suggests that assessing risk factors associated with PPH would be a practical method for early identification of clients at high-risk for developing Postpartum hemorrhage. The present scoping review highlights the paucity of research considering Postpartum hemorrhage risk factors in low- and middle- income countries, particularly in Rwanda. Further qualitative research on the perceptions of health care workers and beneficiaries about Postpartum hemorrhage risk factors is warranted, to enable the development of a tool to assess risk factors associated to Postpartum hemorrhage among childbearing women in Low- and Middle- Income Countries.

Background: Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of childbearing women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Methods: A qualitative descriptive exploratory study was drawn from a larger sequential exploratory‐mixed methods study. Semi‐structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women’s partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides to describe factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. Results: We generated four interrelated themes: (1) Meaning of PPH: beliefs, knowledge and understanding of PPH: (2) Organizational factors; (3) Caring and family involvement and (4) Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. Conclusions: Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. Involvement of all levels of the health system was recommended for a proactive prevention of PPH. Further quantitative research, using case control design is warranted to develop a screening tool for early detection of PPH risk factors for a proactive prevention.

The aim of the study was to explore the factors contributing to nurses' stress and related coping strategies used by nurses in the University Teaching Hospital of Butare (UTHB), Rwanda. The objectives were to: Explore the stressors faced by nurses at UTHB; identify the coping strategies of nurses for stress management among nurses at UTHB, and identify the consequences of stress among nurses at UTHB. Conclusion Drawing from these findings, it can be inferred that nurses' stressors need to be addressed in order to create a working environment conducive to high quality of care and also to enhance nursing staff morale, satisfaction, motivation and retention.

Background: Postpartum hemorrhage remains the main cause of maternal mortality in Low and Middle Income Countries. There is a need to advocate for extra vigilance to recognize women at a greater risk and implement early intervention for Postpartum hemorrhage prevention. The purpose of the present study is to develop a content validated risk assessment tool for the prediction and prevention of Postpartum hemorrhage among childbearing women.Methods: This study is drawn from a larger mixed method sequential exploratory study. Factors influencing the prevention of Postpartum hemorrhage were identified from a scoping review and qualitative descriptive studies previously conducted. To establish content validity Index of the instrument, content experts assessed each item of the tool for comprehensiveness, relevance, and face validity. The tool was pilot tested to assess its clinical utility by fifteen (15) health care providers purposively selected from one district hospital based on a minimum of one-year experience in maternity. Ethical considerations were observed.Results: The Risk Assessment Tool went through three rounds of assessment for its content validity. The final round of quantification of the content validity demonstrates that 4 items out of 46 had an Item Content Validity Index (I-CVI) of 0.85 while 42 had the maximum I-CVI of 1. The overall Scale Content Validity Index/ Average (S-CVI/Ave) was 0.98, and the universal approach of Scale Content Validity Index/Universal Agreement (S-CVI/UA) was 0.91. The assessment of clinical utility of Risk Assessment Tool for the Prediction and Prevention of Postpartum hemorrhage among Childbearing women (RATP) demonstrates that its format allows easy recording of findings and using the tool can be an added value for prevention of PPH.Conclusions: The risk assessment tool for the prediction and prevention of Postpartum hemorrhage is intended to be used by health care providers in Rwanda to identify mothers at risk of developing PPH and implement timely prevention strategies. The clinical use of the tool can be vital in the development of accurate preventive approaches by key policy makers in Rwanda in particular and in other developing countries.

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BackgroundAdolescent pregnancy is a global public health concern. In Rwanda, adolescent pregnancy has increased from 4.1% in 2005 to 7.3% in 2015 and continues to rise. ObjectiveTo determine adolescents' perceptions of how their lives would change if they experienced an adolescent birth. Method A cross-sectional quantitative study. A proportionate stratified random sampling technique was used to select 245 adolescents 15-19 years of age who attended two secondary schools in Rwanda. Data analysis used descriptive and inferential statistics. ResultsThe majority of participants had positive perceptions of adolescent parenting. The bivariate analysis showed significant relationships between adolescents' perceptions and three sociodemographic variables (female, pregnancy status, and monthly attendance at the religious group) and one sexual behaviour variable (history of sexual intercourse). The multivariate analysis revealed one significant relationship, females' negative perceptions of adolescent parenting (p<0.001). ConclusionThere is a need to strengthen sexual health education programs in secondary schools to raise adolescents' awareness of sexual and reproductive health. Health facilities should provide easy access and affordable contraceptive methods to adolescents, which will help the individual, families, communities and Rwanda.Rwanda J Med Health Sci 2019;2(2):86-95. ________________________________________________________________________

Background: Reduction of maternal mortality and morbidity is a major global health priority.However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for early detection and prevention of PPH as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Methods: A qualitative descriptive exploratory study was drawn from a larger sequential exploratory‐mixed methods study. Semi‐structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women’s partners or close relatives, community health workers (CHWs) in charge of maternal health and health care providers . A socio ecological model was used to develop interview guides to describe factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. Results: We generated four interrelated themes:Meaning of PPH: beliefs, knowledge and understanding of PPH:Organizational factors; Caring and family involvement and Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. Conclusions: Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. A further case control study is warranted to develop a screening tool for early detection predictors to PPH.