Browsing by Author "Ntakiyiruta, Georges"

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Acute Care Surgery in Rwanda: Operative Epidemiology and Geographic Variations in Access to Care
(Mosby-Elsevier, 360 Park Avenue South, New York, Usa, Ny, 10010-1710, 2015) Wong, Evan G; Ntakiyiruta, Georges; Rousseau, Mathieu C; Ruhungande, Landouald; Kushner, Adam L; Liberman, Alexander S; Khwaja, Kosar; Dakermandji, Marc; Wilson, Marnie; Razek, Tarek; Kyamanywa, Patrick; Deckelbaum, Dan L
Background Surgical management of emergent, life-threatening diseases is an important public health priority. The objectives of this study were to (1) describe acute care general surgery procedures performed at the largest referral hospital in Rwanda and (2) understand the geographic distribution of disease presentations and referral patterns. Methods We performed a retrospective review of prospectively collected acute care surgery cases performed at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda between June 1 and December 1, 2011. Using Pearson's χ2 test and the Fisher exact test, we compared cases originating from within Kigali and transfers from other provinces. Geospatial analyses also were used to further describe transfer patterns. Results During the study period, 2,758 surgical interventions were performed, of which 25.6% (707/2,758) were general surgery operations. Of these, 45.4% (321/707) met the definition of acute care surgery. Only about one-third—32.3% (92/285)—of patients resided within Kigali, whereas about two-thirds—67.7% (193/285)—were transferred from other provinces. Most patients transferred from other provinces were younger than 18 years of age (40.4%; 78/193), and 83.0% (39/47) of patients older than 50 years of age originated from outside of Kigali. Specific operative indications and surgical procedures varied substantially between patients from Kigali and patients transferred from other provinces. Conclusion Emergency surgical conditions remain important contributors to the global burden of disease, particularly in low- and middle-income countries. Geographic variations exist in terms of operative diagnoses and procedures, which implies a need for improved access to surgical care at the district level with defined transfer mechanisms to greater-level care facilities when needed.
Augmenting surgical capacity in resource-limited settings
(Elsevier Science Inc, 2012) Deckelbaum, L Dan; Ntakiyiruta, Georges; Liberman, S Alexander; Razek, Tarek; Kyamanywa, Patrick
Deficiencies in access to surgical care in low-income and middle-income countries are well recognised. Despite the awareness and benchmarks generated by the Millennium Development Goals, 1 most sub-Saharan African nations have a negative annual growth rate in the number of physicians compared with their population growth rate. 2 In several sub-Saharan African nations, there are only 0·9 physicians per 1000 population, compared with 21 physicians per 1000 population in the UK and 28 per 1000 population in the USA. 3 These trends raise concerns about the morbidity, mortality, and disability-adjusted life-years lost due to injury and diseases requiring surgical treatment (including obstetrics) in sub-Saharan Africa. 4 Policy makers and health-care leaders in Rwanda, a nation with only 0·1 general surgeons per 100 000 population (compared with 6·4 per 100 000 in the USA), have recognised the substantial negative socioeconomic effect caused by such deficiencies and have committed themselves to tackling these challenges. 5 , 6 , 7
Building Research Capacity in Africa: Equity and Global Health Collaborations
(Public Library Science, 1160 Battery Street, Ste 100, San Francisco, Usa, Ca, 94111, 2014) Chu, Kathryn M; Jayaraman, Sudha; Kyamanywa, Patrick; Ntakiyiruta, Georges
Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs). N Partnerships with local collaborators rather than extractive research are needed. N LMICs have to take an active role in leading or directing these research collaborations in order to maximize the benefits and minimize the harm of inherently inequitable relationships. N This essay explores lessons from effective and equitable relationships that exist between African countries and HICs.
Collaboration in Surgical Capacity Development: A Report of the Inaugural Meeting of the Strengthening Rwanda Surgery Initiative
(SPRINGER , ONE NEW YORK PLAZA, SUITE 4600 , NEW YORK, United States, NY, 10004, 2013) Petroze, T Robin; Mody, Gita N; Ntaganda, Edmond; Calland, J Forrest; Riviello, Robert; Rwamasirabo, Emile; Ntakiyiruta, Georges; Kyamanywa, Patrick; Kayibanda, Emmanuel
Background Increasing access to surgical care is among the prioritized healthcare initiatives in Rwanda and other low income countries, where only 3.5 % of surgical procedures worldwide are being performed. Partnerships among surgeons at academic medical centers, non-governmental organizations, and representatives of industry for building sustainable local surgical capacity in developing settings should be explored. Methods With the goal of improving collaboration and coordination among the many stakeholders in Rwandan surgery, the Rwanda Surgical Society (RSS) convened a participatory workshop of these groups in Kigali in March 2011. The meeting consisted of presentations from Rwandan surgical leaders and focused brainstorming sessions on collaborative methods for surgical capacity building. Results The outcome of the meeting was a set of recommendations to the Rwandan Ministry of Health (MOH) and the formation of an ad hoc team, the Strengthening Rwanda Surgery (SRS) Advising Group. The inaugural meeting of the advising group served to establish common goals, a framework for ongoing communication and collaboration, and commitment to a fully Rwandan agenda for surgical and anesthesia capacity development. The SRS Advising Group continues to meet and collaborate on training initiatives and has been integrated into the MOH plan to scale up human resources across disciplines. Conclusions The SRS Initiative serves as an example of the concept of early communication and international collaboration in global surgical and anesthesia capacity building partnerships.
Enhancing Medical Students’ Education and Careers in Global Surgery
(Cma-Canadian Medical Assoc, 1867 Alta Vista Dr, Ottawa, Canada, Ontario, K1g 5w8, 2014) Gosselin-Tardif, Alexandre; Butler-Laporte, Guillaume; Vassiliou, Melina; Khwaja, Kosar; Ntakiyiruta, Georges; Kyamanywa, Patrick; Razek, Tarek; Deckelbaum, Dan L
With surgical conditions being significant contributors to the global burden of disease, efforts aimed at increasing future practitioners’ understanding, interest and participation in global surgery must be expanded. Unfortunately, despite the increasing popularity of global health among medical students, possibilities for exposure and involvement during medical school remain limited. By evaluating student participation in the 2011 Bethune Round Table, we explored the role that global surgery conferences can play in enhancing this neglected component of undergraduate medical education. Study results indicate high rates of student dissatisfaction with current global health teaching and opportunities, along with high indices of conference satisfaction and knowledge gain, suggesting that global health conferences can serve as important adjuncts to undergraduate medical education.
Infectious Outcomes Assessment for Health System Strengthening in Low-resource Settings: The Novel Use of a Trauma Registry in Rwanda
(Mary Ann Liebert, Inc , 140 Huguenot Street, 3rd Fl, New Rochelle, Usa, Ny, 10801, 2014) Petroze, Robin T; Byiringiro, Jean Claude; Kyamanywa, Patrick; Ntakiyiruta, Georges; Calland, J Forrest; Sawyer, Robert G
Background: More than 90% of injury deaths occur in low-income countries where a shortage of personnel, infrastructure, and materials challenge health system strengthening efforts. Trauma registries developed regionally have been used previously for injury surveillance in resource-limited settings, but scant outcomes data exist. Methods: A 31-item, two-page registry form was developed for use in Rwanda, East Africa. Data were collected over a one-year period from April 2011 to April 2012 at two university referral hospitals. Inpatient 30-d follow up data were abstracted from patient charts, ward reports, and operating room logs. Complications tracked included surgical site infection (SSI), pneumonia, urinary tract infection (UTI), decubitus ulcers, transfusion, cardiac arrest, respiratory failure, and blood thromboses. Univariate analysis with chi-square and the Fisher exact test was performed to determine the association between complications and hospital stay and complications and mortality. Multivariable logistic regression was used to control for age, gender, hospital, mechanism of injury (penetrating versus blunt), and Glasgow Coma scale score (GCS). Results: A total of 2,227 patients were recorded prospectively. One thousand five hundred nineteen patients were admitted for inpatient care (69%) with a 4% (n = 67) 30-d mortality. One hundred thirteen patients developed a hospital-acquired infection (88 SSI, 15 UTI, 12 pneumonia). For admitted patients, 25% (n = 387) were still in-hospital at 30-d. Whereas the development of any complication was associated with an increased mortality (p < 0.0001, unadjusted OR 3.2, 95% CI 1.8–5.7), there was no association between the development of an infection and mortality (p = 0.6). Hospital-acquired infection was associated with an increased length of stay (p < 0.0001, adjusted odds ratio (OR) 7.3, 95% confidence interval (CI) 4.7–11.2). Surgical site infection and UTI were individually associated with an increased length of stay. Conclusions: The development of hospital-acquired infections is associated with an increased hospital stay in the trauma population in Rwanda. This has important implications in improving a health system already strained by limited infrastructure, personnel, and finances.
An Innovative Paradigm for Surgical Education Programs in Resource-limited Settings
(Cma-Canadian Medical Assoc, 1867 Alta Vista Dr, Ottawa, Canada, Ontario, K1g 5w8, 2014) Deckelbaum, Dan L; Gosselin-Tardif, Alexandre; Ntakiyiruta, Georges; Liberman, Sender; Vassiliou, Melina; Rwamasirabo, Emile; Gasakure, Emmanuel; Fata, Paola; Khwaja, Kosar; Razek, Tarek; Kyamanywa, Patrick
The burden of surgical disease in low-income countries remains significant, in part owing to continued surgical workforce shortages. We describe a successful paradigm to expand Rwandan surgical capacity through the implementation of a surgical education partnership between the National University of Rwanda and the Centre for Global Surgery at the McGill University Health Centre.
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.
Scaling up a Surgical Residency Program in Rwanda
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2016) Rickard, Jennifer; Ssebuufu, Robinson; Kyamanywa, Patrick; Ntakiyiruta, Georges;
Background: Beginning in 2012, the Government of Rwanda implemented the Human Resources for Health (HRH) program to enhance capacity building in the Rwandan health education sector. Through this program, surgical training at University of Rwanda (UR) has expanded. The aim of this presentation is to describe the scaling up of the UR surgical residency program Methods: We performed a descriptive analysis of the UR surgical residency program after initiation of the Rwanda HRH Program. Results: Through the HRH Program, faculty from US institutions supplements the existing Rwandan educational infrastructure to increase the teaching capacity in Rwanda. Intake of surgical trainees more than doubled within the first year of the program. Service-based surgical training has changed to competency-based training through curriculum development, dedicated academic days and surgical education within firms. Lectures remain a dominant feature of the educational program, but more focus is placed on bedside teaching and peer-education. Shortage of operative space and a tremendous number of emergency patients overwhelm public teaching hospitals posing a challenge towards providing residents with a broad spectrum of operative experiences, especially elective surgical cases. Conclusion: Through this program, the ursurgical residency program has greatly expanded. Over time, the quantity and quality of surgical residents is expected to increase.
Trauma Care and Referral Patterns in Rwanda: Implications for Trauma System Development
(Cma-Canadian Medical Assoc , 1867 Alta Vista Dr, Ottawa, Canada, Ontario, K1g 5w8, 2016) Ntakiyiruta, Georges; Wong, Evan G; Rousseau, Mathieu C; Ruhungande, Landouald; Kushner, Adam L; Liberman, Alexander S; Khwaja, Kosar; Dakermandji, Marc; Wilson, Marnie; Razek, Tarek; Kyamanywa, Patrick; Deckelbaum, Dan L
Background: Trauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care. Methods: We retrospectively reviewed all prospectively collected operative cases performed at the largest referral hospital in Rwanda, the Centre Hospitalier Universitaire de Kigali (CHUK), between June 1 and Dec. 1, 2011, for injury-related diagnoses. We used the Pearson χ2 and Fisher exact tests to compare cases arising from within Kigali to those transferred from other provinces. Geospatial analyses were also performed to further elucidate transfer patterns. Results: Over the 6-month study period, 2758 surgical interventions were performed at the CHUK. Of these, 653 (23.7%) were for trauma. Most patients resided outside of Kigali city, with 337 (58.0%) patients transferred from other provinces and 244 (42.0%) from within Kigali. Most trauma procedures were orthopedic (489 [84.2%]), although general surgery procedures represented a higher proportion of trauma surgeries in patients from other provinces than in patients from within Kigali (28 of 337 [8.3%] v. 10 of 244 [4.1%]). Conclusion: To our knowledge, this is the first study to highlight geographical variations in access to trauma care in a low-income country and the first description of trauma procedures at a referral centre in Rwanda. Future efforts should focus on maturing prehospital and interfacility transport systems, strengthening district hospitals and further supporting referral institutions.
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.