In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

Background: The hydatidiform moles remain prevalent in spectrum of gesta-tional trophoblastic diseases (GTDs). In resource-limited settings like Rwanda, the definitive diagnosis relies upon single of histomophological diagnosis. The histomorphology alone suffers from high interobserver and intra-observer vari-ability with poor diagnostic reproducibility. The present study aimed at deter-mining the role of p57 immunophenotyping in the validation of histomorpholog-ical diagnosis of hydatidiform moles. Methods: A retrospective cross-sectional study embarked for histological cases collected between January 2017 and June 2020. A review of Hematoxylin &Eosin(H&E) stained slides was performed with subsequent p57 immunohisto-chemical staining. Results: Recorded were 211 retrospective cases of hydatidiform moles and 96 (45.9%) cases were all subjected to p57 immunohistochemical staining consid-ered as gold standard diagnostic modality in the present study. As result, the sensitivity and specificity of the histomophological diagnosis of complete hyda-tidiform mole were estimated at 62.5% and 57.1% respectively with positive and negative likelihood ratio of 0.145 and of 0.54 respectively. PPV and NPV were 81.8% and 29.3%, respectively. Whereas of 57.1% and 79.2% with PPV and NPV of 42.9% and 83.8% respectively for partial hydatidiform moles. Per the Youden J statistics method, the accuracy estimation of histomophological diagnosis of hydatidiform mole (HM) was 0.196 (CHM) and 0.336(PHM). Conclusions: This study highlighted a need to integrate p57 immunostaining in routine histopathological diagnosis of hydatidiform moles refining the defini-tive diagnosis.

Several factors enhance the possibility of vertical HIV transmission in the pediatric population. Unfortunately, the data of the prevalence of HIV and associated risk factors in these populations remain limited in Rwanda. The study aimed to assess HIV prevalence and risk factors for infants born to mothers on ARV treatment at CHUB/Rwanda. MethodsA cross-sectional study was carried out on infants who were born to mothers under ARV treatment at CHUB. The associated risk factors were retrospectively assessed using prevention vertical HIV transmission records, and Dried Blood spots (DBS) were prospectively tested using Polymerase Chain Reaction (PCR). Data were analyzed by logistic regression. Ethical clearance (Ref: CMHS/IRB/198/2017) was issued by University of Rwanda to fulfill research ethical consideration.ResultsAmong 185(100%) infants born to HIV-positive mothers under ARV treatment, 5(2.7%) were HIV positive. The most associated risk factors were increased to over 1log copies/ml mother’s viral load (OR 9.3, 95% CI 1.01-85.45, P= 0.04) and mother’s CD4 count lower than 350 cells/µl (OR 6.4, 95% CI 1.03-40.06, P=0.04). The factors found to reduce the rate of vertical transmission of HIV were health facility as a delivery place (P=0.03), exclusive breastfeeding for 6 months (P= 0.006), and attending the antenatal care (P=0.01) while feeding children and vaginal delivery were associated risks but not statistically significant.ConclusionThe current study supports that the more mothers’ viral load and CD4 count decrease, so does the risk of HIV to their infants. A fact which indicates that both prevalence and risk factors remain an alarming issue. Much effort and multi-disciplinary approach are highly recommended.

We assessed the prevalence and correlates of stunting among children aged 6-23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother-child dyads living in poor households from five districts with a high prevalence of stunting. We used descriptive statistics to determine the prevalence of stunting, bivariate analysis, and a multivariate logistic re-gression model to measure the strength of the Association between childhood stunting and exposure variables. Stunting was at 34.1%. Children aged 19-23 months (AOR = 4.410, 95% CI: [1.911-10.173], p-value=0.01), children aged 13-18 months (AOR=2.788, 95% CI: [1.302-5.968], p-value=0.08), children from households that do not have a vegetable garden (AOR=2.165, 95% CI: [1.201-3.905], p-value<0.01) were more likely to be stunted. On the other hand, children whose mothers were not exposed to physical violence (AOR= 0.145, 95% CI: [0.074-0.287], p-value<0.001), children whose fathers were working (AOR=0.036, 95% CI: [0.005-0.242], p-value=0.001), children whose both parents were working (AOR=0.208, 95% CI: [0.051-0.851], p-value=0.029) and children whose mothers had good hand-washing practice (AOR=0.181, 95% CI: [0.091-0.362], p-value<0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of hand-washing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight stunting.

COVID-19, the fear it engendered, and the policy measures to manage its spread have disproportionately impacted the wellbeing of children and adolescents (CAs). We present an intensive critical realist case study of the impact of COVID-19 on the health and wellbeing of CAs in Rwanda, seeing it as much a social and political crisis as a medical and public health one. To do this, we carried out interviews with a purposive sample of 25 leaders with a working knowledge of children and young people; they were more likely than the CAs themselves to observe changes across the CA population within their remit and more likely to be looking for general explanations rather than individual experiences. The findings show that CAs' responses to the changes wrought on their lives by Covid-19 were conditioned by their age, gender, social class and if they lived in urban or rural areas. However, Covid19 has not just revealed the structural weakness of the Rwandan health system but of education, social protection, child protection, employment, family, and financial systems. The pathway to (adverse) impacts of COVID-19 on CAs is conditioned by these institutions and their interactions together with structural socioeconomic inequalities both within Rwanda and globally.

Given the recent emergence of Rift Valley Fever (RVF) in Rwanda and its profound impact on livelihoods and health, improving RVF prevention and control strategies is crucial. Vaccinating livestock is one of the most sustainable strategies to mitigate the impact of RVF on health and livelihoods, yet vaccine supply chain constraints severely limit the effectiveness of vaccination programs. In the human health sector, unmanned aerial vehicles, i.e., drones, are increasingly being used to improve supply chains and last-mile vaccine delivery. We investigated perceptions on whether delivering RVF vaccines by drone in Rwanda might help to overcome logistical constraints in the vaccine supply chain. We conducted semi-structured interviews with stakeholders in the animal health sector and Zipline employees in Nyagatare District in the Eastern Province of Rwanda and used content analysis to identify key themes. We found that stakeholders in the animal health sector and Zipline employees believe that drones could improve RVF vaccination in Nyagatare. The main benefits study participants identified included decreased transportation time, improved cold chain maintenance, and cost savings.

Sustainable development goals (SDGs) are a global agenda consisting of 17 goals which are to be achieved in 2030 by all member states. SDGs are more holistic goals i.e. these goals are closely interrelated and they affect the progress of one another. Sub-Saharan Africa countries are, once more lagging behind in the implementations of SDGs despite the efforts by governments, non-government organisations and international agencies. Rwanda, South Africa and Zambia where the three Sub-Saharan Africa countries on which the study focused. The three countries in this study were chosen on the basis that they cater to the general overview of African countries performance on SDGs. To conduct this study, a desk research method was adopted and secondary data was utilised. An in-depth analysis was done on the on three subs Saharan African countries i.e. Rwanda, South Africa, Zambia. Those goals where serious attention is needed are goals 1-9, 16 and 17. Most Sub-Saharan African countries performed better on goals 11, 12 and 15. It was concluded that the achievement of Sustainable development goals remains a mere dream for Sub Saharan Africa unless serious interventions are made.

Water is an indispensable natural resource that is often prodigiously threatened by anthropomorphic activities. This study evaluated the physicochemical properties of water and selected heavy metals in edible muscles of a piscivorous fish (Protopterus annectens) from Nyabarongo and Nyabugogo rivers of Rwanda. Edibility health risk was evaluated using the target hazard quotient method. Water samples were taken in triplicate from Ruliba station and Kirinda bridge on Nyabarongo river and Giticyinyoni on Nyabugogo river. Fish samples were obtained from the sampling stations on Nyabarongo river. All samples were analyzed following standard methods and analytical results indicated that the average temperature, pH, total dissolved solids and electrolytic conductivity of water from the rivers were within WHO acceptable limits. The statistical mean concentrations of the ionic components of the water samples were 1.61 ± 0.03, 0.53 ± 0.002, 0.24 ± 0.02 and 0.051 ± 0.01 mg/L for Fe, Mn, Cu and Pb respectively at Ruliba station and 0.63 ± 0.02, 0.02 ± 0.002, 0.09 ± 0.01, 0.06 ± 0.002 and 0.75 ± 0.02 mg/L for Fe, Mn, Zn, Cr and Pb respectively at Kirinda bridge. Water from Giticyinyoni had 1.57 ± 0.02, 0.49 ± 0.03, 0.29 ± 0.058, 0.43 ± 0.058, 0.15 ± 0.00 and 0.59 ± 0.058 mg/L of Fe, Mn, Cu, Zn, Cr and Pb respectively. Zinc, Cu, Cr and Cd were below detection limits in samples from Ruliba station and Kirinda bridge (Nyabarongo river). Edible muscles of P. annectens from Nyabarongo river contained 272.8 ± 0.36, 292.2 ± 0.25, 8.8 ± 0.36, 135.2 ± 0.15, 148.0 ± 0.21 and 432. 0 ± 0.50 mgkg^-1 for Fe, Mn, Cu, Zn, Cr and Pb at Ruliba station and 336.0 ± 0.70, 302.6 ± 1.22, 6.4 ± 0.26, 44.7 ± 0.20, 138.2 ± 0.17 and 302.4 ± 1.50 mgkg^-1 for Fe, Mn, Cu, Zn, Cr and Pb respectively at Kirinda bridge. Health risk assessment indicated that consumption of the edible muscles of P. annectens may lead to deleterious health effects as reflected by values of target hazard quotients being greater than one. Therefore, the Rwandese government should lay strategies to reduce pollution of the rivers. Further research should evaluate the heavy metal content of metabolically active organs of P. annectens from Nyabarongo river as well as the microbiological profile of water from the rivers.

Background: Globally, women’s responsibility for unpaid care work (UCW) remains a barrier to gender equality and women’s empowerment. Rwanda, a low-income country, has a legal and policy framework for promoting gender equality but remains a patriarchal society with women responsible for UCW. Reseaux des Femmes, a local NGO, has been delivering a programme targeted at reducing and redistributing the UCW of women with the objective of gender transformational change. However, there has been no impact evaluation of their intervention to date. Methods/Design: The impact evaluation will be a proof-of-concept critical realist cluster control trial (CRcCT) to evaluate for which women, how and under what circumstances the intervention reduces and redistributes women’s UCW, promote gender equality and women’s empowerment, and improves women’s quality of life. Four clusters of villages in each of five districts in Rwanda will be randomly allocated to the intervention or control arms, and all eligible households, those headed by a couple with at least one child under 12 years, will be recruited. This will yield a sample of around 550 intervention households and 550 control. Discussion: This protocol describes the design of mixed-methods research to evaluate an intervention in Rwanda aimed at reducing and redistributing the time women spend on UCW, thereby promoting gender equality and women’s empowerment. This paper will contribute to our understanding of interventions for transforming gender relations from a scholarly perspective. From a policy perspective, it will act as a proof of concept of Reseaux des Femmes’ Programme.