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Academic Collaborations: Do’s and Don’ts
(Springernature , Campus, 4 Crinan St, London, England, N1 9xw, 2017) Kyamanywa, Patrick; Mukara, Kaitesi B; Sewankambo, Nelson K
Collaborations happen when individuals or organizations work together towards a common outcome. Academic collaborations date back to the colonial times but the advent of global health especially in the twenty-first century has led to an upsurge in north-south collaborations. In health, collaborations date back before 1978 when medical diplomacy was described as a way to transcend conflicts and improve international relations. Today, academic collaboration is not only an institutional initiative but also trainees continue to show interest in involvement and active participation. One of the major drivers is the desire by the north to bridge the unmet needs in the south through mutually beneficial capacity building efforts. The success of collaboration is a result of careful consideration of the many facets of the puzzle. In this paper, we review the literature and outline the dos and don’ts to be considered for fruitful and mutually beneficial academic collaborations in global health.
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.
Anaesthesia for Elective Inguinal Hernia Repair in Rural Ghana - Appeal for Local Anaesthesia in Resource-poor Countries
(SAGE PUBLICATIONS INC , 2455 TELLER RD, THOUSAND OAKS, USA, CA, 91320, 2006-07-01) Wilhelm, T.J.; Anemana, S.; Kyamanywa, Patrick; Rennie, J.; Post, S.; Freudenberg, S.
Local anaesthesia has been identified as the most favourable anaesthesia for elective inguinal hernia repair with respect to complication rate, cost-effectiveness, and overall patient satisfaction. Operation theatre notes in all seven hospitals in the Northern Region in Ghana over the period of 1 year were reviewed. Only 22.4% out of 1038 repairs were performed under local anaesthesia while predominantly spinal and general anaesthesia were used (48.0 and 29.6%, respectively). African surgeons chose local anaesthesia far less frequently than visiting overseas surgeons (15.6 versus 27.7%, respectively). All surgeons in resource-poor countries should be encouraged to use local anaesthesia more frequently for elective inguinal hernia repair. Valuable resources in sub-Saharan African hospitals could be saved, especially if used in combination with outpatient surgery. The technique should be taught in teaching institutions. A simple step-by-step technique is described.
An Approach for Setting Evidence-based and Stakeholder-informed Research Priorities in Low-and Middle-income Countries
(World Health Organization, Marketing And Dissemination, Geneva 27, Switzerland, Ch-1211, 2016) Rehfuess, Evan A; Durão, Solange; Kyamanywa, Patrick; Meerpohl, Joerg J; Young, Taryn; Rohwer, Anke
To derive evidence-based and stakeholder-informed research priorities for implementation in African settings, the international research consortium Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) developed and applied a pragmatic approach. First, an online survey and face-to-face consultation between CEBHA+ partners and policy-makers generated priority research areas. Second, evidence maps for these priority research areas identified gaps and related priority research questions. Finally, study protocols were developed for inclusion within a grant proposal. Policy and practice representatives were involved throughout the process. Tuberculosis, diabetes, hypertension and road traffic injuries were selected as priority research areas. Evidence maps covered screening and models of care for diabetes and hypertension, population-level prevention of diabetes and hypertension and their risk factors, and prevention and management of road traffic injuries. Analysis of these maps yielded three priority research questions on hypertension and diabetes and one on road traffic injuries. The four resulting study protocols employ a broad range of primary and secondary research methods; a fifth promotes an integrated methodological approach across all research activities. The CEBHA+ approach, in particular evidence mapping, helped to formulate research questions and study protocols that would be owned by African partners, fill gaps in the evidence base, address policy and practice needs and be feasible given the existing research infrastructure and expertise. The consortium believes that the continuous involvement of decision-makers throughout the research process is an important means of ensuring that studies are relevant to the African context and that findings are rapidly implemented.
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
Awareness of Breast Disease Among Female Undergraduate Students in Kampala, Uganda: A Descriptive, Cross-sectional Study
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2020) Okedi, X Francis; Lule, Herman; Wachaya, David; Kyamanywa, Patrick
Introduction: Uganda has recognized the importance of breast disease as a public health issue and has implemented efforts to increase awareness, early detection, and improved treatment. However, there are few published reports on awareness and screening of breast disease among women in Uganda. Methods: This descriptive cross-sectional study was conducted between July 2016 and May 2017 to evaluate breast disease awareness among female undergraduate students attending Kampala International University, Western Campus, in Uganda. A stratified random sample was drawn to proportionately represent students from each academic faculty. Participants completed a self-administered questionnaire assessing awareness of breast disease and self-breast examination (SBE). A 3-level scale for overall breast disease awareness was constructed to categorize students as “not aware”, “moderately aware”, or “very aware”, based on their responses to a 3-item assessment. Data were analysed to determine the proportion of students with awareness of various breast disease-related topics and to evaluate associations between demographic factors and awareness. Results: In total, 209 participants were enrolled, among whom 108 (51.7%) were 21 to 25 years old, and 192 (92.3%) were single. Most participants (n=197, 92.8%) had heard about breast disease; the main sources of information were friends (n=59, 27.8%), television (n=33,15.8%), and health workers (n=33, 15.8%). Only 27 participants (12.9%) reported familial history of breast disease. Over half (n=117, 55%) had heard about SBE, among whom 71 (60.9%) could perform it; 23 students reported performing it monthly. Overall, breast disease awareness was low, with only 2 participants (0.96%) categorized as “very aware”, 76 (16.3%) as “moderately aware”, and 173 (82.8%) as “not aware”. Breast disease awareness was significantly associated with older age (P=0.023), enrolment in a health-related faculty (P<0.0001), and having children (P=0.016). Conclusions: Female undergraduate students at Kampala International University had little awareness about breast disease. Efforts should be undertaken to raise breast disease awareness among undergraduate students in Uganda.
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.
Building trauma and EMS systems capacity in Rwanda: lessons and recommendations
(Ubiquity Press Ltd , Unit 3.22, East London Works, 65-75 Whitechapel Road, London, England, E1 1du, 2021) Jayaraman, Sudha; Ntirenganya, Faustin; Nkeshimana, Menelas; Rosenberg, Ashley; Dushime, Theophile; Kabagema, Ignace; Uwitonze, Jean Marie; Uwitonize, Eric; Nyinawankusi, Jeanne d'Arc; Riviello, Robert; Bagahirwa, Irene; Williams, Kenneth L; Krebs, Elizabeth; Maine, Rebecca; Banguti, Paulin; Rulisa, Stephen; Kyamanywa, Patrick; Byiringiro, Jean Claude
Background: Surgical capacity building has gained substantial momentum. However, care at the hospital level depends on improved access to emergency services. There is no established model for facilitating trauma and EMS system capacity in LMIC settings. This manuscript describes our model for multi-disciplinary collaboration to advance trauma and EMS capacity in Rwanda, along with our lessons and recommendations. Methods: After high-level meetings at the Ministry of Health in Rwanda (MOH), in 2016, a capacity building plan focusing on improved clinical services, quality improvement/ research and leadership capacity across prehospital and emergency settings. The main themes for the collaborative model included for empowerment of staff, improving clinical service delivery, and investing in systems and infrastructure. Funding was sought and incorporated into the Sector Wide Approaches to Planning process at the Ministry of Health of Rwanda. Findings: A shared mental model was created through a fully funded immersion program for Rwandese leaders from emergency medicine, nursing, prehospital care, and injury policy. Prehospital care delivery was standardized within Kigali through a train-thetrainers program with four new context-appropriate short courses in trauma, medical, obstetric/neonatal, and pediatric emergencies and expanded across the country to reach >600 staff at district and provincial hospitals. Forty-two protocols and checklists were implemented to standardize prehospital care across specialties. The WHO Trauma Registry was instituted across four major referral centers in the country capturing over 5,000 injured patients. Long-term research capacity development included Masters’ Degree support for 11 staff. Conclusions and Recommendations: This collaboration was highly productive in empowering staff and leadership, standardizing clinical service delivery in EMS, and investing in systems and infrastructure. This can be a useful model for trauma and EMS system capacity development in other LMICs.
Can Focused Trauma Education Initiatives Reduce Mortality OR Improve Resource Utilization in A Low-Resource Setting?
(Academic Press Inc Elsevier Science , 525 B St, Ste 1900, San Diego, Usa, Ca, 92101-4495, 2013) Petroze, RT; Byiringiro, JC; Ntakiyiruta, G; Riviello, R; Briggs, SM; Razek, T; Deckelbaum, D; Sawyer, RG; Kyamanywa, Patrick; Calland, JF
Advanced Trauma Life Support (ATLS) teaches a systematic approach to the initial management of injured patients in over 60 countries. Limited data exists on the impact of ATLS or similar team-based courses on patient outcomes, particularly in low and middle-income countries (LMIC). We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization.
Capacity-building for Equitable Global Health Research From Africa: The Power of Two
(Springer, 2016) Cubaka, Vincent Kalumire; Schriver, Michael; Kyamanywa, Patrick; Cotton, Philip; Kallestrup, Per
The editorial ‘‘Productive global health research from Africa: it takes more’’ (Waiswa 2015) is an important awakening for global health professionals to the challenges for carrying out effective research in Africa. Our experience is from a twinning partnership for capacity-building for global health research through a Ph.D. at the University of Rwanda and Aarhus University in Denmark (Schriver et al. 2015). We adopted a twinning model based in Rwanda linking a Ph.D. student from each country.
Cervical Cancer in Rwanda: Why do Women Consult in Late Stages?
(Rwanda Health Communication Center-Rwanda Biomedical Center (RHCC-RBC), 2016) Manirakiza, A; Longombe, AN; Kyamanywa, Patrick; Rulisa, S
Introduction: Cervical cancer remains among the most common and a serious cause of cancer-related mortality across the world. Many patients consult in late stages and this account to numerous reasons. We report here the reasons as found in a teaching hospital in Kigali, Rwanda. Methods: Observational, cross sectional study consisting of a one-onone interview to patients in a follow up clinic for a time period of 8 months at the Kigali University Teaching Hospital. Results: Twenty fie (25) patients were interviewed between May and December 2012. Most women (68%) were found to be above 35 years of age, and a considerable number (n=9) came from the Eastern Province of the country. Over two-thirds of the patients (68%) reported to have had their fist sexual intercourse below the age 20 years, yet a few consented a positive cigarette smoking history. About a tenth (12%) of the patients confimed knowing the typical fist signs of cervical cancer, and nearly a half (52%) of patients gave an indolent/painless course of disease as the main reason of delay to seek treatment. Conclusion: Integrated methods of sensitization and screening campaigns are highly needed. Further studies measuring the impact of these methods are necessary to know the impact on early detection and better management.
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.
A Comparison of Kampala Trauma Score II with the New Injury Severity Score in Mbarara University Teaching Hospital in Uganda
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2010-03) Mutooro, S.M.; Mutakooha, E.; Kyamanywa, Patrick
Background: Road traffic injury is of growing public health importance because of its significant contribution to the global disease burden. The need to predict outcome of injuries has led to the development of injury scores. The Kampala Trauma Score II (KTSII) now recommended for use in resource-poor settings, has not been compared with, the New Injury Severity Score (NISS) preferred by many authors. We compared the performance, predictive power, sensitivity, and specificity in predicting mortality at two weeks of the KTSII and NISS in patients involved in road traffic accidents seen on the surgical ward at Mbarara Regional Referral Hospital (MRRH). Methods: This prospective study conducted between June 2005 and August 2006, examined clinical and radiological data of 173 consecutive patients admitted to the emergency surgical ward at Mbarara Regional Referral Hospital with road traffic injuries. Only patients presenting within 24 hours of injury and with 3 or more injuries were recruited in the study. The KTS II and NISS scores were computed for each patient on admission. The primary outcome measure was survival. Receiver Operating Characteristics (ROC) analysis, and logistic regression analysis were used for comparison. Results: The KTSII predicted mortality and discharge with AUC of 0.87 (NISS, AUC 0.89). The KTSII was less accurate (AUC 0.65) than the NISS (AUC 0.83) in predicting long stay in the hospital. At cut off point of 9 and below, the KTSII had sensitivity of 87% and specificity of 81% while the NISS had 96% and 78.4% respectively in predicting mortality. The KTS II predicted long hospital stay at cut off score of 9 and below, with sensitivity of 87.5% and specificity of 81%. Conclusions: The KTSII is as reliable a predictive score as is the NISS. This study demonstrated that the KTS II provides reliable objective criterion upon which injured patients can be triaged in emergency care conditions. The KTS II may enhance the use of ambulance services and timely transfer of the injured and its use in trauma management should be further encouraged in resource-poor settings. In addition, the KTS II will make the documentation of the epidemiology of trauma more feasible in resource-poor settings.
Coordinating Between Medical Professions’ Tasks to Optimize Sub-Saharan Health Systems: A Response to Recent Commentaries
(Kerman Univ Medical Sciences , Jahad Blvd, Kerman, Iran, 7619813159, 2017) Eyal, Nir; Cancedda, Corrado; Hurst, Samia A.; Kyamanywa, Patrick
We are grateful that our perspective received commentary from leading experts on African human resources for health. All endorse and several quote our central suggestion that the “development in [non-physician clinician] deployment should unfold in parallel with strategic rethinking of the role of physicians and with critical innovations in physicians’ education and inservice training.
A descriptive-multivariate analysis of community knowledge, confidence, and trust in COVID-19 clinical trials among healthcare workers in Uganda
(MDPI , St Alban-Anlage 66, Basel, Switzerland, Ch-4052, 2020) Kasozi, Keneth Iceland; Laudisoit, Anne; Osuwat, Lawrence Obado; Batiha, Gaber El-Saber; Al Omairi, Naif E; Aigbogun, Eric; Ninsiima, Herbert Izo; Usman, Ibe Michael; DeTora, Lisa M; MacLeod, Ewan Thomas; Nalugo, Halima; Crawley, Francis P; Bierer, Barbara E; Mwandah, Daniel Chans; Kato, Charles Drago; Kiyimba, Kenedy; Ayikobua, Emmanuel Tiyo; Lillian, Linda; Matama, Kevin; Mak, Shui Ching Nelly; Onanyang, David; Pius, Theophilus; Nalumenya, David Paul; Ssebuufu, Robinson; Rugambwa, Nina Olivia; Musoke, Grace Henry; Bardosh, Kevin; Ochieng, Juma John; Ssempijja, Fred; Kyamanywa, Patrick; Tumwine, Gabriel; Alzahrani, Khalid J; Welburn, Susan Christina
Background—misinformation and mistrust often undermines community vaccine uptake, yet information in rural communities, especially of developing countries, is scarce. This study aimed to identify major challenges associated with coronavirus disease 2019 (COVID-19) vaccine clinical trials among healthcare workers and staff in Uganda. Methods—a rapid exploratory survey was conducted over 5 weeks among 260 respondents (66% male) from healthcare centers across the country using an online questionnaire. Twenty-seven questions assessed knowledge, confidence, and trust scores on COVID-19 vaccine clinical trials from participants in 46 districts in Uganda. Results—we found low levels of knowledge (i.e., confusing COVID-19 with Ebola) with males being more informed than females (OR = 1.5, 95% CI: 0.7–3.0), and mistrust associated with policy decisions to promote herbal treatments in Uganda and the rushed international clinical trials, highlighting challenges for the upcoming Oxford–AstraZeneca vaccinations. Knowledge, confidence and trust scores were higher among the least educated (certificate vs. bachelor degree holders). We also found a high level of skepticism and possible community resistance to DNA recombinant vaccines, such as the Oxford–AstraZeneca vaccine. Preference for herbal treatments (38/260; 14.6%, 95% CI: 10.7–19.3) currently being promoted by the Ugandan government raises major policy concerns. High fear and mistrust for COVID-19 vaccine clinical trials was more common among wealthier participants and more affluent regions of the country. Conclusion—our study found that knowledge, confidence, and trust in COVID-19 vaccines was low among healthcare workers in Uganda, especially those with higher wealth and educational status. There is a need to increase transparency and inclusive participation to address these issues before new trials of COVID-19 vaccines are initiated.
Design of a Novel Online, Modular, Flipped-classroom Surgical Curriculum for East, Central, and Southern Africa
(Wolters Kluwer Medknow Publications , Wolters Kluwer India Pvt Ltd , A-202, 2nd Flr, Qube, C T S No 1498a-2 Village Marol, Andheri East, Mumbai, India, Maharashtra, 400059, 2022) Parker, Andrea S; Hill, Katherine A; Steffes, Bruce C; Mangaoang, Deirdre; O’Flynn, Eric; Bachheta, Niraj; Bates, Maria F; Bitta, Caesar; Carter, Nicholas H; Davis, Richard E; Dressler, Jeremy A; Eisenhut, Deborah A; Fadipe, Akinniyi E; Kanyi, John K; Kauffmann, Rondi M; Kazal, Frances; Kyamanywa, Patrick; Lando, Justus O; Many, Heath R; Mbithi, Valentine C; McCoy, Amanda J; Meade, Peter C; Ndegwa, Wairimu YB; Nkusi, Emmy A; Ooko, Philip B; Osilli, Dixon JS; Parker, Madison ED; Rankeeti, Sinkeet; Smith, James D; Snyder, David; Kimutai, R Sylvester; Wakeley, Michelle E; Wekesa, Marvin K; Torbeck, Laura; White, Russell E; Bekele, Abebe; Parker, Robert K; Shafer, Katherine
Objective: We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA). Summary Background Data: Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary. Methods: We utilized Kern’s 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation. Results: Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination. Conclusions: We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region.
The Desired Rwandan Health Care Provider: Development and Delivery of Undergraduate Social and Community Medicine Training
(Taylor & Francis Inc , 530 Walnut Street, Ste 850, Philadelphia, USA, PA, 19106, 2015) Flinkenflögel, Maaike; Cubaka, Vincent Kalumire; Schriver, Michael; Kyamanywa, Patrick; Muhumuza, Ibra; Kallestrup, Per; Cotton, Phil
What works well in primary care education in your locality, region or country? • The new undergraduate social and community medicine training (iSOCO) in Rwanda focuses on crosscutting skills, knowledge and attitudes in primary health care delivery. What challenges have you faced? • Challenges faced include programme sustainability (PHC), large student group teaching, limited resources and students being unfamiliar with the new online teaching platform with unstable internet accessibility. How have you addressed them? • The iSOCO development and teaching team was motivated to work with the limited resources available and to develop an innovative training with available resources. Strong focus of the Ministry of Health on PHC, the need of the College of Medicine and Health Sciences to become more socially accountable and long-term commitment of external partners increased the programme sustainability. What is the generalisable learning? • When students are exposed to the principles of PHC and social and community medicine early in the medical education, it is more likely they will become patient-centred and community-oriented health care providers who are good communicators, collaborators, managers, scholars, health advocates and professionals, as described in the ‘desired Rwandan health care. provider
Developing research potential and building partnerships: a report of the fundamentals of surgical research course at the College of Surgeons of East, Central, and Southern Africa
(Academic Press Inc Elsevier Science , 525 B St, Ste 1900, San Diego, USA, CA, 92101-4495, 2021) Long, Kristin L; Galukande, Moses; Kyamanywa, Patrick; Tarpley, Margaret J; Dodgion, Christopher
Background Approximately a decade after the inaugural Fundamentals of Surgical Research Course (FSRC) at the West African College of Surgeons meeting (2008), the Association for Academic Surgery expanded the course offering to the annual meeting of the College of Surgeons of East, Central and Southern Africa (COSECSA). After the second annual offering of the course in 2019, participants were surveyed to assess the impact of the course. Methods A survey was distributed to the attendees of the 2019 second COSECSA FSRC course, held in December 2019 in Kampala, Uganda. Approximately 80 people attended at least a portion of the full-day course. Forty-nine participants completed the voluntary survey questionnaire distributed to assess each session of the course at course completion. Results Ten different countries were represented among the attendees. Of the 49 evaluations, 35 respondents were male and six were female. Eight respondents did not identify a gender. Surgical residents comprised 19 of the 49 attendees, and one of the 49 attendees was a medical student. Thirty-five respondents indicated that their views of surgical research had changed after attending the course. Conclusions The second annual FSRC at COSECSA confirmed significant interest in building research skills and partnerships in sub-Saharan Africa. A wide variety of learners attended the course, and a majority of the sessions received overwhelmingly positive feedback. Multiple conference attendees expressed interest in serving as faculty for the course moving forward, highlighting a viable path for sustainability as the Association for Academic Surgery develops an international research education platform.
The double burden of Ebola and COVID-19 viral infections and the readiness for safe surgical care provision in Uganda and the Eastern Democratic Republic of the Congo: an online cross-sectional survey
(Research Square, 2021) Sikakulya, Franck K; Ssebuufu, Robinson; Longombe, Albert Ahuka Ona; Okedi, Francis; Kalongo, Michel; Valimungighe, Moise Muhindo; Furaha, Nzanzu Blaise Pascal; Vahwere, Bienfait Mumbere; Mambo, Simon Binezero; Mulumba, Yusuf; Muyisa, Muhindo Muhasa; Sonia, Fatuma Djuma; Sekabira, John; Fualal, Jane; Kyamanywa, Patrick
Objective: This study aimed at highlighting the extent to which Uganda and the Eastern DR Congo are ready for safe surgical care provision during the double burden of Ebola and COVID-19. Methods: An online cross-sectional study was conducted in selected National, Regional Referral and General Hospital facilities of Uganda and in the Eastern part of D.R. Congo from 1st August 2020 to 30 October 2020. Data was analysed using Stata version 14.2. Results: A participation rate of 37.5% for both countries (72/192). The mean bed capacity of participating health facilities (HF) was 184 in Eastern DR. Congo and 274 in Uganda with an average surgical ward bed capacity of 22.3% (41/184) of the beds in the DR. Congo and 20.4% (56/274) in Uganda. The mean number of operating rooms was 2 and 3 in Eastern DR. Congo and Uganda respectively. Nine hospitals (12.5%) reported being able to test for Ebola and 25 (34.7%) being able to test for COVID-19. Only 7 (9.7%) hospitals reported having a specific operating room for suspect or confirmed cases of Ebola or COVID-19. Provision of appropriate Personal Protection Equipment to personnel were reported to be available in 60 (83.3%) hospitals. The mean of readiness score for provision of surgical care was 7.8/16 (SD: 2.3) or 60% in both countries with no statistical significance in multiple linear regression analysis (p>0.05). Conclusion: The majority of participating hospitals in both countries had a low level of readiness to provide safe surgical care due to lack of supplies to limit the exposure of Healthcare workers (HCW) to Ebola and Covid-19 viral infections, and poor funding. Governments and non-governmental organizations should work together to enhance health facility supplies and readiness for safe surgical provision in resourcelimited settings.
Dyspepsia Prevalence and Impact on Quality of Life Among Rwandan Healthcare Workers: A Cross-sectional Survey
(Sa Medical Assoc , Block F Castle Walk Corporate Park, Nossob Street, Erasmuskloof Ext3, Pretoria, South Africa, 0002, 2015) Bitwayiki, Remy; Orikiiriza, Judy T; Kateera, Fredrick; Bihizimana, Pascal; Karenzi, Ben; Kyamanywa, Patrick; Walker, Tim D
Background. Dyspepsia has been demonstrated worldwide to have major personal and societal impacts, but data on the burden of this disease in Africa are lacking. Objective. To document the prevalence of dyspepsia and its quality-of-life impact among healthcare workers (HCWs) at Butare University Teaching Hospital (BUTH), Rwanda. Methods. A cross-sectional survey among consenting HCWs at BUTH was conducted. Multilingual interviewers guided participants through validated questionnaires, including the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), to detect the presence and frequency of dyspeptic symptoms, and the Short-Form Nepean Dyspepsia Index (SF-NDI), to examine the impact of dyspepsia on quality of life. Results. The study included 378 enrolled HCWs, all of whom provided responses to the SF-LDQ and 356 of whom responded to the SF-NDI. The prevalence of dyspepsia in the study population was 38.9% (147/378). Of these 147 HCWs, 79 (53.7%) had very mild dyspepsia, 33 (22.4%) had mild dyspepsia, 20 (13.6%) had moderate dyspepsia and 15 (10.2%) had severe dyspepsia. Females were more likely to complain of dyspepsia than males (98/206 v. 49/172; odds ratio (OR) 2.3; 95% confidence interval (CI) 1.5 - 3.5; p<0.001). Participants with dyspepsia of at least mild severity had SF-NDI scores reflecting reduced quality of life when compared with non-dyspeptic participants (OR 17.0; 95% CI 5.0 - 57.1; p<0.001), with most marked effects on the ‘tension’ and ‘eating and drinking’ subdomains of the SF-NDI. Conclusion. The prevalence of dyspepsia among HCWs in Rwanda is high and is associated with lowered quality of life

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