Browsing by Author "Mutabazi, Zeta"

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    Laparoscopy in Rwanda: A National Assessment of Utilization, Demands, and Perceived Challenges
    (Springer , One New York Plaza, Suite 4600 , New York, United States, Ny, 10004, 2019) Robertson, Faith; Mutabazi, Zeta; Kyamanywa, Patrick; Ntakiyiruta, Georges; Musafiri, Sanctus; Walker, Tim; Kayibanda, Emmanuel; Mukabatsinda, Constance; Scott, John; Costas-Chavarri, Ainhoa
    Background: Laparoscopy has proven to be feasible and effective at reducing surgical morbidity and mortality in low resource settings. In Rwanda, the demand for and perceived challenges to laparoscopy use remain unclear. Methods: A mixed-methods study was performed at the four Rwandan national referral teaching hospitals. Retrospective logbook reviews (July 2014-June 2015) assessed procedure volume and staff involvement. Web-based surveys and semi-structured interviews investigated barriers to laparoscopy expansion. Results: During the study period, 209 laparoscopic procedures were completed: 57 (27.3%) general surgery cases; 152 (72.7%) ob/gyn cases. The majority (58.9%, 125/209) occurred at the private hospital, which performed 82.6% of cholecystectomies laparoscopically (38/46). The three public hospitals, respectively, performed 25% (7/28), 15% (12/80), and 0% (denominator indeterminate) of cholecystectomies laparoscopically. Notably, the two hospitals with the highest laparoscopy volume relied on a single surgeon for more than 85% of cases. The four ob/gyn departments performed between 4 and 87 laparoscopic cases (mostly diagnostic). Survey respondents at all sites listed a dearth of trainers as the most significant barrier to performing laparoscopy (65.7%; 23/35). Other obstacles included limited access to training equipment and courses. Equipment and material costs, equipment functionality, and material supply were perceived as lesser barriers. Twenty-two interviews revealed widespread interest in laparoscopy, insufficient laparoscopy exposure, and a need for trainers. Conclusion: While many studies identify cost as the most prohibitive barrier to laparoscopy utilization in low resource settings, logbook review and workforce perception indicate that a paucity of trainers is currently the greatest obstacle in Rwanda.
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    Vital Statistics: Estimating Injury Mortality in Kigali, Rwanda
    (Springer, One New York Plaza, Suite 4600 , New York, United States, Ny, 10004, 2016) Kim, Woon Cho; Byiringiro, Jean Claude; Ntakiyiruta, Georges; Kyamanywa, Patrick; Irakiza, Jean Jacques; Mvukiyehe, Jean Paul; Mutabazi, Zeta; Vizir, Jean Paul; Ingabire, Jean de la Croix Allen; Nshuti, Steven; Riviello, Robert; Rogers, Selwyn O; Jayaraman, Sudha P
    Background Globally, injury deaths largely occur in low- and middle-income countries. No estimates of injuryassociated mortality exist in Rwanda. This study aimed to describe the patterns of injury-related deaths in Kigali, Rwanda using existing data sources. Methods We created a database of all deaths reported by the main institutions providing emergency care in Kigali—four major hospitals, two divisions of the Rwanda National Police, and the National Emergency Medical Service—during 12 months (Jan–Dec 2012) and analyzed it for demographics, diagnoses, mechanism and type of injury, causes of death, and all-cause and cause-specific mortality rates. Results There were 2682 deaths, 57 % in men, 67 % in adults[18 year, and 16 % in children\5 year. All-cause mortality rate was 236/100,000; 35 % (927) were due to probable surgical causes. Injury-related deaths occurred in 22 % (593/2682). The most common injury mechanism was road traffic crash (cause-specific mortality rate of 20/100,000). Nearly half of all injury deaths occurred in the prehospital setting (47 %, n = 276) and 49 % of injury deaths at the university hospital occurred within 24 h of arrival. Being injured increased the odds of dying in the prehospital setting by 2.7 times (p\0.0001). Conclusions Injuries account for 22 % of deaths in Kigali with road traffic crashes being the most common cause. Injury deaths occurred largely in the prehospital setting and within the first 24 h of hospital arrival suggesting the need for investment in emergency infrastructure. Accurate documentation of the cause of death would help policymakers make data-driven resource allocation decisions.