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.

Aim: This study aimed to determine the prevalence of gestational diabetes mellitus (GDM) among women attending public health centers in Rwanda using the World Health Organization (WHO) 2013 diagnostic criteria. Methods:A cross-sectional analysis was performed on 281 pregnant women attending antenatal care at urban and rural public health centers. Diagnostic testing was performed between 24 and 32 weeks gestation using a 75 g oral glucose tolerance test. Venous plasma glucose was centrifuged within one hour and measured at one of two laboratories. Descriptive statistics were used.Results: GDM prevalence was 3.2%, (4.28% urban and 2.13% rural). Women diagnosed with GDM were older, had higher BMI, hypertension, and glycosuria of ≥2+. None with HIV (14/281) had GDM. All women reported birth outcomes. All women with GDM (9/281) had normal glucose values postpartum and therefore it is unlikely that any women had overt diabetes. Conclusion:This study adds important information about the GDM prevalence in Rwanda, which is a resource-limited country. Although the prevalence of 3.2% was low, significant risk factors for GDM were identified. We anticipate that the risk factors for developing GDM will increase in the near future, similar to the global trend of obesity and diabetes, necessitating continued research and education in this important condition that carries a double burden of disease to both mothers and infants.

Background Despite a variety of mainly school-driven prevention strategies, the number of adolescent pregnancies in Rwanda is worryingly high and is even expected to increase. The aim of this study is to empower Kirehe secondary school students aged 15–19 years old in sexual and reproductive health (SRH) by developing a peer education program. Methods A combination of quantitative and qualitative research will be used. A pre- and post-survey will examine adolescents’ knowledge and attitudes regarding SRH. In addition, six focus group interviews will explore these knowledge, attitudes but also SRH needs more in depth. Based on the obtained information, and after retrieving experts’ input, a peer education program is being developed in which Midwifery students obtain training in SRH and educational skills (= first train-the-trainer module). In turn, these students will educate and train a selected group of secondary school students (= second train the trainer module). Finally, these trained in-school students can act as reliable peers for other in-school students in the context of SRH. Discussion The project will contribute to 1) more independent and thoughtful decisions in contraception and sexual behavior, and consequently less adolescent pregnancies, and 2) the reinforcement of the Rwandan Midwifery education. Trial registration University of Rwanda, College of Medicine and Health Sciences, Institutional Review Board, Approval No 158/CMHS IRB/2019.

Background: Blended learning (BL) is defined as the combination of both traditional face-to-face learning and synchronous or asynchronous e-learning approaches. The aim of this scoping review was to explore the literature to obtain a broad understanding of the use of BLin nursing and midwifery education in general, in Sub-Saharan Africa (SSA), and in particular Rwanda.Methods: The literature published between 2010 and 2019 were reviewed from six electronic databases using keywords including blended learning, nursing education, midwifery education, higher education, SSA, and Rwanda. Arksey and O'Malley's framework was used in this review.Results: The initial search identified 1,283 records. Eleven articles were selected for this review after the application of predetermined inclusion criteria. Almost all reviewed articles indicated that the integration of BLmethods improved the quality of nursing and midwifery education in general, and in SSAcountries including Rwanda.Conclusions: Initial research in this area highlights that moving from traditional classroom-delivered programs to the BLapproach is feasible and can promote the quality of nursing and midwifery standards of education. This scoping review highlights a paucity of research on BL in nursing and midwifery education, particularly in SSAcountries. Keywords: Blended learning, nursing and midwifery education, SSA, Rwanda

Background: For a large trial of the effect of group antenatal care on perinatal outcomes in Rwanda, a Technical Working Group customized the group care model for implementation in this context. This process analysis aimed to understand the degree of fidelity with which the group antenatal care model was implemented during the trial period. Methods: We used two discreet questionnaires to collect data from two groups about the fidelity with which the group antenatal care model was implemented during this trial period. Group care facilitators recorded descriptive data about each visit and self-assessed process fidelity with a series of yes/no checkboxes. Master Trainers assessed process fidelity with an 11-item tool using a 5-point scale of 0 (worst) to 4 (best). Results: We analyzed 2763 questionnaires completed by group care facilitators that documented discreet group visits among pregnant and postnatal women and 140 questionnaires completed by Master Trainers during supervision visits. Data recorded by both groups was available for 84 group care visits, and we compared these assessments by visit. Approximately 80% of all group visits were provided as intended, with respect to both objective measures (e.g. group size) and process fidelity. We did not find reliable correlations between conceptually-related items scored by Master Trainers and self-assessment data reported by group visit facilitators. Conclusions: We recommend both the continued participation of expert observers at new and existing group care sites and ongoing self-assessment by group care facilitators. Finally, we present two abbreviated assessment tools developed by a Rwanda-specific Technical Working Group that reviewed these research results.

Background Infections contribute to 30% of the 2.5 million neonatal deaths that occur globally every year. A newly cut umbilical cord can be a pathway for bacteria to enter the vulnerable neonate and cause neonatal sepsis. Most infections are preventable with evidenced-based cord care. Objective To assess postnatal mothers’ knowledge and practice of umbilical cord care in the Kibungo Hospital catchment area in Rwanda.  Methodology A descriptive cross-sectional study design and purposive sampling strategy was used to recruit 224 postnatal mothers. Data were collected using a structured questionnaire. Descriptive and inferential statistics were used to analyze data.   Results A third of mothers (33%) had adequate knowledge, and a half (54%) had good umbilical cord care practice. The majority (70%) reported dry cord care practice, though many applied substances including Vaseline (23%) and Movit ointment (15%). There was a negative correlation between knowledge of cord care and substance applied to cord (R2=0.224, p=0.001), and days applied (R2=0.167, p=0.012).  Conclusion The study population had low cord care knowledge. Health care providers need to educate mothers on the practice of allowing the cord to dry naturally, and discourage the use of harmful substances that delay cord separation and increase risk of sepsis and subsequent neonatal mortality. Rwanda J Med Health Sci 2020;3(2):167-180

BackgroundAlthough blended learning (BL) is being adopted in public and private higher learning institutions (HLIs) in Rwanda, little is known about students’ use of BL in their learning activities. This article describes a qualitative descriptive study of students’ perceptions and experiences of BL in Rwanda’s post-secondary nursing and midwifery programs in public and private HLIs.MethodsThirty-three nursing and midwifery students from all public and private HLIs in Rwanda exposed to BL were invited to participate in three online focus group discussions (FGDs) conducted using a developed FGD guide with open-ended questions. Inductive content analysis was used to analyze the transcripts.ResultsThree main themes emerged from the data analysis:(1) BL perceived as a new and effective teaching and learning approach, (2) Contextual challenges to the BL method, and (3) Recommendations to improve the BL method. From students’ experiences, the benefits included but were not limited to the flexibility of the approach, time, and cost-saving. However, several challenges were identified, including technological issues such as lack of ICT skills and poor internet connectivity.ConclusionThis study provides insights into the usefulness of BL in HLIs and offers recommendations on how BL teaching and learning can be improved to strengthen nursing and midwifery pre-service education quality.Rwanda J Med Health Sci 2022;5(2):203-215

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